Biopsychosocial Model Of Health and Disease Alma L.

Jimenez, MD Biomedical Model of Disease The traditional model Disease are caused by one or a chain of biochemical and physiological changes that can ultimately be identified and measured. Diseases = biological causes Therefore, no biological cause, not a disease. And if no physical cause can be found, it is not an illness. Examples MD of diabetic patient is more interested in the patients blood sugar and insulin dosage but not his emotional state or living conditions The doctor treating a schizophrenic patient solely with medicines. We do not ascribe to this model. What model do we ascribe to? - The Biopsychosocial Model The Biopsychosocial Model of Disease The concept that states of health and illness are produced by the interaction between biological, psychological, and social factors. Basic Underpinning of the BPS model Systems Theory BPS has been applied to three levels of structure:  Nature  Health and disease in general  Mental health and illness.

relationships, and criteria for explanation.  At the same time, each level is also a component of a higher level Engel wrote that: Every unit is at the very same time both a whole and a part An individual represents at the same time the highest level of organismic hierarchy and the lowest level of the social hierarchy Every system is influenced by the configuration of the system of which it is a part, that is, by its environment. Application of BPS to Health and Disease BPS in Health and Disease Illness is a dynamic process rather than a steady state. The process of illness changes continuously as biological, psychological and social factors interact. A person is best understood in terms of indivisibility and wholeness rather than as separate entities of body and mind. A person is a unified living system composed of subsystems that exchange inputs and outputs of information among the internal subsystems and other external systems. The interaction of subsystems creates the vulnerability or predisposition of the whole system, the living organism, to a disease process. Examples Psychological distress precedes the onset of a variety of physical illnesses  Leukaemia, lymphoma, uterine CA, lung CA are preceded by history of loss, hopelessness and depression  Depressed patients had lower rates of heart surgery survival  Mortality from heart disease increases within six months after the loss of as spouse Certain personality styles may predispose a patient to characteristic responses to stress

Application of BPS to Nature Nature as a hierarchical continuum from less complex, smaller units such as cells through intermediate units such as individuals and up to more complex, larger units such as societies  Each level in this hierarchy has its own identity, possesses distinct qualities,

or may be associated with a lifestyle which leads to illness  Type A Personality: anxious, pressured, impatient individual who is intensely ambitious and competitive, who is unable to relax, who has a chronic sense of urgency, and who is quick to feel anger and hostility because of a low tolerance for frustration is closely associated with coronary artery disease Psychiatric illness may represent a psychological reaction to the significance of a physical illness  e.g. depression BPS Model of Mental Health and Disease Human personality and behaviour are..  the sum of the interaction of biological subsystems  with environmental and relationship components (family, school, community and so on) Thus, psychopathology originates not only from the psychological aspects of a persons behaviour but also from a persons total system of relationships. Clinical Implications A systems approach to the understanding of human personality and behaviour clarifies the dynamics of change and change management.  Change at multiple levels within the system might have either a positive or a negative effect on the individual  Sources of stress do not always come directly from within or even close to an individual Thus, the most effective interventions in any clinical situation might not necessarily entail direct involvement of the identified patient. Similarly, a full appreciation of the impact of stressful situation on an individual requires an understanding of the total context within which the stressor occurs. BPS Factors in Mental Health and Illness Biological  Genetic  Neurochemical, neuroendocrine, and psychopharmacological  Biological rhythms

Psychological     Social

Conflicts Defense mechanisms Object relations Self-esteem

Theoretical Premises of the BPS Model in Mental Health and Illness A patients problems are best understood in terms of multicausation involving biological, psychological and social factors rather than a single aetiology. A patients problems are best understood in terms of multicausation involving biological, psychological and social vulnerabilities. A patients problems are best understood as manifestations of the patients attempt to cope with stressors given his or her vulnerabilities and resources. A patients condition is best treated with a multimodal approach that is flexible and tailored to the patients needs and expectations rather than a single modality. Illustration of the BPS Model in Mental Health and Illness Patterns of Reaction to Stress - Fight-flight The psychophysiologic mobilization which is a reaction to stress, real or imaginary The natural reaction to a dangerous situation is to feel frightened or angry or both The body prepares to either run away (flee) or to attack (flight) through a number of physiological changes:  Activation of the sympathetic nervous system  Suppression of the parasympathetic nervous system  Pituitary-adrenal-cortical activation leading to an increase in the secretion of catecholamines (epinephrine and norepinephrine) from the adrenal medulla  Mobilization of the reticular activating system The end result:  Increase energy mobilization (through an increase in blood glucose and free fatty acids)

 Increased heart rate and cardiac output (through an increase in circulating catecholamines  Increase in the capacity for physical activity (through an increase in blood flow to the skeletal musculature) In the healthy individual, the flight-fight activation has few consequences. In the vulnerable person or who is exposed to chronic or unrelieved activation, there may be adverse consequences  Hypertension  Coronary artery disease Conservation-withdrawal Definition:  A psychophysiologic state characterized by decreased interaction with the environment, decreased energy mobilization, and decreased activation of bodily systems. Through:  Activation of the parasympathetic nervous system  Suppression of the sympathetic nervous system End-result:  Decreased heart rate, blood pressure and body temperature  Decreased muscle tone and general lack of motor activity Examples:  Institutionalised babies  Monkeys separated from their mothers Summary The BPS is the prevailing orientation in psychiatry. All forthcoming lectures shall apply the biopsychosocial model to its analytic framework. What did you learn about the biopsychosocial model? Post-test Post-test Q 1 1. All diseases have strictly biological causes. So, if a condition has no biological cause, it is mot a disease. Post-test Q 2

2. A persons state of health is all in the mind. Post-test Q 3 3. A person is a system composed of subsystems that interact with other internal and external systems. Post-test Q4 4. Psychopathology has solely psychological causes. Post-test Q5 5. A patients condition is best treated with a combination of biological. Psychological and social causes. Life. Its a mind-brain game.