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Chapter 24. Psychological Factors Affecting Medical Conditions

James L. Levenson, M.D.
DOI: 10.1176/appi.books.9781585623402.299099

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The fact that psychological factors and psychiatric disorders may affect the clinical course of medical illness is incontrovertible and is no longer the topic of serious debate. For example, psychiatric disorders may negatively affect outcome, increasing adverse events, length of stay in general hospital patients, and health care costs (Daumit et al. 2006; Walker et al. 2003). A striking example is the increased morbidity and mortality associated with major depression in patients with coronary artery disease (Frasure-Smith et al. 1993). Although most of the consultation-liaison literature has focused on interrelations between comorbid psychiatric and medical disorders, a wealth of epidemiological research has identified behavioral risk factors for the development of medical illness. Behavioral factors such as cigarette smoking, obesity, alcohol and substance dependence, and hazardous sexual practices are major causes of premature death and medical morbidity both in the United States and worldwide. A description of areas of investigation for classifying the psychological, behavioral, and social factors that may affect physical health is presented in Table 24–1.

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TABLE 24–1. Psychological and behavioral factors affecting medical conditions
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TABLE 24–2. DSM-IV-TR diagnostic criteria for specified psychological factor affecting general medical condition
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TABLE 24–3. Illustrative classic studies supporting the effects of psychological factors on cancer
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TABLE 24–4. Illustrative studies supporting the effects of psychological factors on diabetes mellitus
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TABLE 24–5. Illustrative studies supporting the effects of psychological factors on coronary artery disease
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TABLE 24–6. Illustrative studies supporting the effects of psychological factors on pulmonary disease
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TABLE 24–7. Factors affecting the development and progression of peptic ulcer disease
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TABLE 24–8. Illustrative studies supporting the effects of psychological factors on end-stage renal disease
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Psychological factors have profound adverse effects on many medical conditions, including

1. Decreasing functional capacity and quality of life

2. Increasing risk for developing the medical disorder

3. Increasing morbidity and mortality

4. Increasing health care costs

The mechanisms by which psychological factors affect medical conditions include

1. Promotion of other risk factors

2. Amplification of somatic symptoms

3. Interference with access to health care

4. Decreased motivation and compliance

5. Effects on the doctor–patient relationship

6. Effects on pathophysiology

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Sample questions:
1.
The relationship between psychiatric illness and cancer has been the subject of several research inquiries addressing correlation and possibly inferred causality. Which of the following statements is true?
2.
Temoshok et al. (1985) described a series of behavioral and emotional traits among cancer patients. Which of the following is not characteristic of Temoshok's description?
3.
Diabetes mellitus is an endocrinological disorder that is well known to have significant psychiatric comorbidity. Which of the following statements regarding psychiatric and behavioral factors in diabetes mellitus is true?
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