1. Dr. YASER ALHUTHAIL Associate Professor & Consultant Consultation Liaison Psychiatry

2. The concept of stress Stress is unavoidable component of life Psychosomatic framework Stressful life events are correlated with increased risk of becoming medically ill Hetreogenecity of stress and response to it Multifactorial process

3. Development of concepts Biopsychosocial model Schedule of recent life events: Linear relationship between score and illnesses experienced, highest in the following 6 months The more life events, the more illnesses in the next 2 years Consistent findings across all cultures What makes an individual vulnerable?

4. Cognitive appraisal Stressful events for a person may not be so for another!! Interpretation of a harmful or threatening stress Positive Vs. negative life events !

5. Coping The behavior involving special physical and emotional energy and attention that is required to deal with some difficult circumstances Different ways of coping Could have an impact on the individual

6. Social support Protective effect Facilitates coping and adaptation Longer life!!, less physical illnesses, and more positive mental health Lower mortality rates in married people Long-term influence of childhood stressors

7. Biological Predisposition Peptic ulcer & H pylori Acute stress & sudden cardiac death

8. Psychophysiological Pathways The Hypothalamus: Autonomic nervous system, immune system, neuroendocrine system Extensive dynamic feedback system Sympathetic and parasympathetic Homeostasis

9. Major depression & prolonged periods of stress Associated with increased morbidity & mortality specially cardiac Effects on platelets

10. DSM-IV Diagnostic Criteria for Psychological Factors Affecting Medical Condition A. A general medical condition (coded on Axis III) is present. B. Psychological factors adversely affect the general medical condition in one of the following ways: (1) the factors have influenced the course of the general medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the general medical condition. (2) the factors interfere with the treatment of the general medical condition. (3) the factors constitute additional health risks for the individual. (4) stress-related physiological responses precipitate or exacerbate symptoms of a general medical condition.

11. Mental disorder affecting medical condition (e.g., an Axis I disorder such as major depressive disorder delaying recovery from a myocardial infarction) Psychological symptoms affecting medical condition (e.g., depressive symptoms delaying recovery from surgery; anxiety exacerbating asthma) Personality traits or coping style affecting medical condition (e.g., pathological denial of the need for surgery in a patient with cancer, hostile, pressured behavior contributing to cardiovascular disease) Maladaptive health behaviors affecting medical condition (e.g., lack of exercise, unsafe sex, overeating) Stress-related physiological response affecting general medical condition (e.g., stress-related exacerbations of ulcer, hypertension, arrhythmia, or tension headache) Other unspecified psychological factors affecting medical condition (e.g., interpersonal, cultural, or religious factors)