1. BS 22

2. Psychosomatic medicine  Stress & health  Psychological factors affecting health – psychosomatic disorders – involve any system – Poor health behavior – smoking & no exercise Chronic / acute life stress – depression (emotional), divorce (social), loss of job (economic)  Stress & health  Psychological factors affecting health – psychosomatic disorders – involve any system – Poor health behavior – smoking & no exercise Chronic / acute life stress – depression (emotional), divorce (social), loss of job (economic)

3.  Physiologic effects of stress:  Acute / chronic life stress lead to activation of ANS, which in turn affect CVS / RS  Stress may lead to altered level of neurotransmitter (like serotonin / nor epinephrine) which result in mood / behavior changes  Stress may increase release of adreno corticotropic hormones (ACTH), which may lead to decreased immune response  Physiologic effects of stress:  Acute / chronic life stress lead to activation of ANS, which in turn affect CVS / RS  Stress may lead to altered level of neurotransmitter (like serotonin / nor epinephrine) which result in mood / behavior changes  Stress may increase release of adreno corticotropic hormones (ACTH), which may lead to decreased immune response

4.  Stressful life events – Holmes & Raphe scale  80% of persons with > 300 points become ill next year  Stressful life events – Holmes & Raphe scale  80% of persons with > 300 points become ill next year

5. Magnitude of stress (Holmes & Rahe Scale) stress event Very highDeath of spouse (100%) Divorce (73%) Marital separation (65%) Death of close family member (63%)

6.   HighMajor personal loss of health / injury (53%) Marriage (50%) Job loss (47%) Retirement (45%) Major loss of health of a close family member (44%) Birth / adoption of child (39%) ModerateTaking a major debt (31%) Promotion / demotion in work (29%) Child leaving home (29%)

7. LowChanging residence (20%) Vacation (15%) Major holiday (12%)

8.  Hospitalised pts, surgical pts, ICU, CCU pts – depressions  Pts with chronic pain –trtmt with opiates – fear of addiction – not correct  Hospitalised pts, surgical pts, ICU, CCU pts – depressions  Pts with chronic pain –trtmt with opiates – fear of addiction – not correct