Presentation on the Principles of Mind-Body Connections: A ...

Presentation on the Principles of Mind-Body Connections: A ...

Presentation on the Principles of Mind-Body Connections: A Case Example Gerald A. Solfanelli, M.S. Behavioral Medicine: Mind-Body Connection (c) 2011 - www.ThePsychologist.com

Case Example: John John is a 53-year-old separated veteran who has recently been diagnosed with diabetes. He is very concerned about his health. He has been in and out of the emergency room over the past six months with extreme heart palpitations. It is still not clear whether he

was experiencing panic or a mild heart attack (or both). He is very worried about his marital situation and desperately wants to reunite with his wife. In addition, his supervisor at work has informed him that if he continues to miss days at work, he will need to 'let him go.'

John claims that he does not sleep well, eats at fast-food restaurants, and 'drinks' alone on the weekends while watching television. He reports that he doesn't want to leave his apartment on the weekend because he 'doesn't have the energy' and fears having more heart palpitations. He notes that his 'whole life

has been a nightmare', noting that his father was physically and emotionally abusive to him throughout his entire childhood. Can John's diabetes and possible heart condition have anything to do with his emotional state?

Proposed Treatment Diagnosis Axis I: 300.22 Panic Disorder with agoraphobia 305.00 Alcohol Abuse R/O 309.0 Adjustment Disorder, Depressed Mood Axis II: V71.09 No Diagnosis Axis III: 249.0 Diabetes mellitus R/O 414.00 Coronary Heart Disease

Axis IV: Relational, Employment, and Medical problems Axis V: 53 (current) Source: American Psychiatric Association (2000). Human Nervous System Source: Copyright 2010 Adam.com. Image used with permission.

Sympathetic activity of the nervous system contributes to heart rate volatility, like atrial fibrillation. Ziegelstein found that acute stress can stimulate sympathetic activity and contribute to atrial fibrillation. Source: Ziegelstein, 2007. Abrupt chest pain and contracted breathing can be

experienced soon after an emotionally stressful event, due to the effect of stress in contributing to left ventricular disturbance within the heart. Source: Ziegelstein, 2007. "Asymmetric brain activity is particularly important in making the heart more vulnerable to developing ventricular arrhythmias."

Source: Ziegelstein, 2007, p. 327. "Lateralization of cerebral activity during emotional stress may stimulate the heart asymmetrically and produce areas of inhomogeneous repolarization that create electrical instability and facilitate cardiac arrhythmias." Source: Ziegelstein, 2007, p. 327.

There is likely a "strong relationship between asymmetric brain activity during mental stress and susceptibility to ventricular arrhythmias." Source: Ziegelstein, 2007, p. 327. "Asymmetry of brain activity during emotional or mental stress is exaggerated in patients with coronary

artery disease." Source: Ziegelstein, 2007, p. 327-328. According to Petrak and his colleagues, patients diagnosed with diabetes mellitus and concomitant depression have poorer metabolic control than patients who are diagnosed with diabetes without concomitant depression.

Source: Petrak, Herpertz, Albus, Hirsch, Kulzer & Kruse, 2005. Those diagnosed with diabetes mellitus often experience subsequent, corresponding negative emotions and difficulty coping which can adversely affect glycaemic control and sufferers' treatment cooperation. Source: Petrak, et al., 2005.

Depression is a separate risk factor for the onset of both diabetes mellitus and coronary heart disease. Source: Petrak, et al., 2005. Patients diagnosed with diabetes mellitus often experience anxiety over possible complications and worry about hypoglycemia.

Anxieties can contribute to insufficient metabolic control. Source: Petrak, et al., 2005. Alcohol abuse increases the risk of the develpment of type 2 diabetes, via pancreatitis corresponding to the alcohol abuse. Source: Petrak, et al., 2005.

"Metabolic control is negatively influenced by the direct effect of alcohol on glucose metabolism." Source: Petrak, et al., 2005. "Chronic stress can lead to an elevation in blood levels of triglycerides, free fatty acids, cholesterol, glucose, and insulin."

Source: Takett-Kendall & Marshall, 1999, p. 593. Consistently high insulin and glucose levels cause the body to decrease its acuity to insulin. A patient who presents as "insulin resistant" demonstrates a key symptom of diabetes. Source: Takett-Kendall & Marshall, 1999, p. 593.

People with a child abuse history (a chronic stress environment) are more likely to develop subsequent symptoms of diabetes. Source: Takett-Kendall & Marshall, 1999. Summary and Conclusions In light of the aforementioned information, the

client illustrated within this case example should be considered a candidate for a psychologically induced illness. John's heart palpitations and chest pain can be related to symptoms of a Panic Disorder which could be exacerbating his current psychosocial stressors. Additionally, his marital discord, employment stress, and John's fears about his

medical problems could be independently contributing to his heart palpitations and chest pain. John's poorly managed stress and current depressive symptoms are likely contributing factors to his symptoms of diabetes. His poor diet (eating fast food) and alcohol abuse, for example,

suggests that his current psychosocial stressors may be contributing to his treatment noncompliance, which is likely further aggravating his medical problems. John's history of childhood victimization is likely a contributing factor to his symptoms of diabetes. "Physical and mental health are inextricably linked to each other and to

the well-being of individuals." -- Dr Gro Harlem Brundtland Former WHO Director-General Source: Brundtland, 2001, as cited in World Health Organization, 2010. References American Psychiatric Association. (2000). Diagnostic and statistical

manual of mental disorders (Revised 4th ed.). Washington, DC. Animated Dissection of Anatomy for Medicine. (2010). Human nervous system. [Image]. Retrieved from http://pfizer.adam.com/graphics/images/en/8679.jpg Petrak, F., Herpertz, S., Albus, C., Hirsch, A., Kulzer, B., Kruse, J.

(2005). Psychosocial factors and diabetes mellitus: Evidencebased treatment guidelines, Current Diabetes Reviews, 1(3), 116. doi:10.2174/157339905774574329 Takett-Kendall, K. A., Marshall, R. (1999). Victimization and diabetes: An exploratory study, Child Abuse & Neglect, 23(6), 593-596. doi:10.1016/S0145-2134(99)00033-2 World Health Organization. (2010). Retrieved from http://www.who.int/whr/2001/media_centre/dg_speech/en/ind

ex.html Ziegelstein, R. C. (2007). Acute emotional stress and cardiac arrhythmias. Journal of the American Medical Association, 298(3), 324-329. doi:10.1001/jama.298.3.324

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