心身疾病psychosomatic-disease.ppt

1Psychosomatic Disease心身疾病心身疾病2Tomato diet kills six-stone modelA YOUNG model who lived on a diet of apples and tomatoes has died of anorexia（神经性厌食症）.Ana Carolina Reston,21,a Brazilian who had worked for Giorgio Armani,was 5ft 7in tall but weighed only six stone when she died on Tuesday.(174cm,40kgBMI:13.4)3objectives1.To master the concept of psychosomatic diseases,etiology（病因学）,pathogenesis,diagnosis,and treatment principles.2.To be familiar with a variety of common psychosomatic diseases.4introductionPsychosomatic medicine has its roots in the earliest writings of the history of medicine,awareness of body-mind linkages was recorded by ancient philosophers and physicians many centuries ago.Body and mind were always inseparably connected.Current understanding of psychosomatic takes into account the interaction between physical and psychic（精神的、心灵的）in all disorders and diseases.5The principle features include1.2.3.p716uHistory and definition of psychosomaticuPathogenic mechanism and process of psychosomatic diseasesuClinic work in psychosomatic diseasesuTypical psychosomatic diseases.content7uHistory and definition of psychosomatic1.History of psychosomatic medicine2.Definition of psychosomatic medicine3.Concept of psychosomatic diseases.4.Morbidity rate（患病率）and population characteristic of psychosomatic diseases.8psychosomatic disease refers to physical symptoms or illnesses that result from the interplay of psychosocial and physiological processes.9Classification according system1.Cardiovascular system coronary heart disease(CHD)essential hypertension Cardiac arrhythmias2.Respiratory system bronchial asthma hyperventilation syndrome 10Classification according system3.Gastrointestinal system peptic ulcer ulcerative colitis4.Endocrine system diabetes mellitus hyperthyroidism 11Classification according system5.Musculoskeletal system rheumatoid arthritis low back pain6.Neurological system migraine headache tension headache12Why do some people who are under stress get sick whereas others do not?13Type A and Type B behavior patternsThe discovery of“type A”Meyer Friedman and Ray Rosenman were studying dietary differences in cholesterol（胆固醇）intake between male heat disease victims and their wives.“If you really want to know what is giving our husbands heart attacks,I will tell you.It is stress,the stress they receive in their work.”Focusing on the subjects stress and behavioral characteristics.14Type A behavior pattern It consists of three characteristics Competitive achievement orientationTime urgencyAnger/hostility15Competitive achievement orientationType A individuals tend to be very self-critical and to strive toward goals without feeling a sense of joy in their effortsHard workers16Time urgencyType A people seem to be in a constant struggle against the clock.They quickly become impatient with delays,schedule commitments too tightly,and try to do more than one thing at a time,such as reading while eating or watching TV.17Anger/hostilityType A individuals tend to be easily aroused to anger or hostility,which they may or may not express overtly.18Type B behavior patternlow levels of competitiveness,time urgency and hostility.Tending to be more easygoing and philosophical about life they are more like to“stop and smell the roses”.19Measuring Type A and Type BDo you want to know what patterns you belong to?20Answerthesesquestionswithyesorno1.你你说说话话时时会会刻刻意意加加重重关关键键字字的的语语气气吗吗？Do you deliberately accentuate the key words?2.你你吃吃饭饭和和走走路路时时都都很很急急促促吗吗？Do you eat and walk quickly?3.你你认认为为孩孩子子自自幼幼就就该该养养成成与与人人竞竞争争的的习习惯惯吗吗？Do you think that children should develop the habit of competition when they are young?4.当当别别人人慢慢条条斯斯理理做做事事时时你你会会感感到到不不耐耐烦烦吗吗？Do you get impatient when others are slow?21Answerthesesquestionswithyesorno5.当当别别人人向向你你解解说说事事情情时时你你会会催催他他赶赶快快说说完完吗吗？Do you rush him out when someone explains things to you?6.在在路路上上挤挤车车或或餐餐馆馆排排队队时时你你会会感感到到激激怒怒吗吗？Do you get annoyed when youre in a crowded car or restaurant?7.聆聆听听别别人人谈谈话话时时你你会会一一直直想想你你自自己己的的问问题题吗吗？Do you always think about your problems while listening to others?8.你你会会一一边边吃吃饭饭一一边边写写笔笔记记或或做做其其他他事事吗吗？Do you write notes or do other things while you eat?229你你会会在在休休假假之之前前先先赶赶完完预预定定的的一一切切工工作作吗吗？Do you have to finish everything before you leave?10与与别别人人闲闲谈谈事事你你总总是是提提到到自自己己关关心心的的事事吗吗？Do you always talk about things you care about?11让你停下工作（或学习）休息一会时你会觉得浪费了让你停下工作（或学习）休息一会时你会觉得浪费了时时间间了了吗吗？You will feel wasted when you stop working(or study)for a while.12你你是是否否会会全全心心投投入入工工作作（或或学学习习）而而无无暇暇欣欣赏赏周周围围的的美美景景Are you willing to work(or learn)and have No time to appreciate the beauty around you.13你你是是否否觉觉得得宁宁可可务务实实而而不不愿愿从从事事创创新新或或改改革革的的事事？Do you feel youd rather be practical than innovate or reform?2314你你是是否否尝尝试试在在时时间间限限制制内内做做出出更更多多的的事事？Are you trying to do more in the time limit?15与与别别人人有有约约时时你你是是否否绝绝对对遵遵守守时时间间？Are you absolutely punctual when you have an appointment?16表表达达意意见见时时你你是是否否握握紧紧拳拳头头以以加加强强语语气气？Do you clench your fist to strengthen your voice?17你你是是否否有有信信心心再再提提升升你你的的工工作作（学学习习）绩绩效效？Do you have the confidence to improve your performance?18你你是是否否觉觉得得有有些些事事等等着着你你立立刻刻去去完完成成？Do you feel like there are things you can do right away?2419你你是是否否觉觉得得与与人人竞竞争争时时非非赢赢不不可可？Do you feel like you have to win the competition?20你你是是否否对对自自己己的的工工作作（学学习习）效效率率一一直直不不满满意意？Are you dissatisfied with your work efficiency?21你你是是否否经经常常打打断断别别人人的的话话？Do you often interrupt others?22看看见见别别人人迟迟到到你你是是否否会会生生气气？Are you angry at seeing others late?2523用用餐餐时时你你是是否否一一吃吃完完就就立立刻刻离离席席？Do you leave immediately when you finish eating?24你你是是否否经经常常有有匆匆匆匆忙忙忙忙的的感感觉觉？Do you often feel rushed?25你你是是否否对对自自己己近近来来的的表表现现不不满满意意？Are you dissatisfied with your recent performance?26This is the questionnaire of type A.If the answers“yes”are more than half,you should change your habits,and slow down.27How does Type A influence the health?Type A individuals react differently to stressor than do those with the Type B pattern.Responding more quickly and strongly to stress,often interpreting stressors as threats.Increasing the persons likelihood of encountering stressful events.(tend to have more accidents)28Western cooperative group study(WCGS,19601969)基线：基线：35243524名名36593659岁男性，岁男性，113113人有人有CHDCHD，TABPTABP占占71%71%剔除患者，剔除患者，8 8年半系统追踪，期间年半系统追踪，期间257257人患人患CHDCHD，TABPTABP是是TBBPTBBP的的2.372.37倍（倍（2.7%2.7%和和1.1%1.1%）控制年龄、血脂、血压、吸烟等因素，控制年龄、血脂、血压、吸烟等因素，TABPTABP患患CHDCHD的危险性是的危险性是TBBPTBBP的的2 2倍。倍。结论：结论：TABPTABP是是CHDCHD的危险因素。的危险因素。19781978年，世界心肺和血液研究学会确认年，世界心肺和血液研究学会确认TABPTABP与与CHDCHD有关。有关。29Stress and Cardiovascular disordersCHD(coronary heart disease)（冠心病）Hypertension（高血压）30CHDA disease of modernized societiesRate of CHD is higher in technologically advanced countries than in other nationsLive longer,being less likely to die of infectious diseasesHaving certain risk factors for CHD,obesity and low levels of physical activity31CHDType AStress High workloadsJob responsibilityJob dissatisfactionMajor life stressors32uTypical psychosomatic diseases.uEssential hypertension（高血压）uCoronary heart disease（冠心病）uDiabetes mellitus（糖尿病）uPeptic uicer（消化性溃疡）uCancer（癌症）（癌症）uAsthma（哮踹）uCerebral infarction（脑梗阻）uHepatic encephalopathy（肝脑病变）uAnorexia（神经性厌食症）33HypertensionEssential hypertensionObesityDietary elements,such as salt,fatsExcessive alcohol usePhysical inactivityFamily history of hypertensionPsychosocial factors:anger,hostility34Occupational and Environmental stressors Rate of hypertension were higher for traffic controllers working at high stress location than those at low stress sites.Crowding and aggression