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Integrative Medicine Mind – Body Connections

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  1. Integrative MedicineMind – Body Connections PLC OR RN November 26, 2010 Jeffrey P Schaefer MSc MD FRCPC FACP

  2. websitedr.schaeferville.com

  3. Conflicts of Interest • none

  4. Objectives • Session participants will learn that: • the current paradigm is insufficient • a psychobiological framework is useful • there is more to stress than stress • we can reduce the effects of stress

  5. And above all... Relax Responsibly

  6. Case • 46 year old educator total body pain and fatigue x 5 years assessed by GIM, Neurology, Gastroenterology investigations  normal

  7. Problem List • daily occipitofrontal headache • chest pain, episodic, at work • abdominal pain • fatigue • poor concentration & dizziness • work issues

  8. What’s your diagnosis? Diagnosis: ______________________

  9. Hopefully, uptodate.com has something…

  10. Diagnosis Menu • What’s your diagnosis / diagnoses? • Chronic Fatigue Syndrome / Idiopathic Chronic Fatigue • Fibromyalgia • Tension Headache • Irritable Bowel Syndrome • Multiple Chemical Sensitivity Syndrome • Interstitial Cystitis • Hematuria Loin-pain Syndrome • Depression and Anxiety • Conversion Disorder • Somatization

  11. This is a problem!

  12. One condition or many?

  13. Chronic Fatigue Syndrome Fibromyalgia Irritable Bowel Syndrome Multiple Chem Sensitivity Syndrome Sick Building Syndrome Hypoglycemia Gulf War Syndrome Undocumented Labels Headache Syndromes Asthma Painful Conditions Various Bodily Distress Disorder

  14. Do functional symptoms cluster in a way that support multiple conditions? • Cross sectional survey of patients with functional symptoms • Screened 2,300 patients  978 were judged functional

  15. Median Number of Symptoms Men & Women  5

  16. Chest Pain Group GI Symptoms Group Musculoskeletal Group < 3% of patients had symptoms confined to their predominant group 3 group model explained 36% of the variance “Bodily Distress Disorder” Fink et al. Psychosom Med 2007

  17. associated with anxiety • preoccupied with symptoms • preoccupied with illness • low threshold to request consultation • difficult / impossible to reassure Multiplicity of diagnostic labels is an artifact of medical specialization.

  18. Psychobiology‘the mind-body connection’

  19. Psychobiological Framework NO MATTER WHAT ELSE IS GOING ON!

  20. Talk about Stress...

  21. Acute Stress Response Fight, Fright, Flight, Frolic Response

  22. Hans Selye (1907-1982) General Adaptation Response • Alarm • Failure to adapt • Exhaustion

  23. Recipe for Stress • Novelty • Unpredictability • Threat to ego • Loss of control

  24. Absolute Stress

  25. Relative Stress Interpretation of the world

  26. stress4 parts

  27. Stress Stimuli

  28. Experience the stimuli

  29. Physiological Response(Body Chemistry Response) • Hormones • Neurochemistry • Immunochemistry • Energy Metabolism

  30. Experience of thePhysiological Response

  31. Stress Hormones • Corticosteroids • Cortisol • Catecholamines • Adrenaline (Epinephrine) • Nor-adrenaline (Nor-epinephrine)

  32. Cortisol

  33. Cortisol Regulation • Brain • emotion, pain, memory • Hypothalamus • autonomic function • Pituitary • stimulating hormone • Adrenal Gland • cortex

  34. Mind Body Connection: neural and hormonal Left: Areas of the brain that ‘light-up’ during strong emotion. (happy, sad, disgust) These correlate to Vagus Nerve mediated Heart Rate Variability.

  35. Immediate Effects of Cortisol • Response to Absolute Stress • increase vigilance • respond to emotion  don’t think • raise blood sugar • increase psychomotor activity • obtain food

  36. Prolonged Effects of Cortisol • bone calcium loss • muscle wasting • insomnia • irritability • depressed mood • memory loss* • immune dysfunction • increase appetite • increase blood sugar • increase fat stores • redistribute fat • salt retention  BP + • reduce acid barrier • menstrual cycle problems • male impotence

  37. Pituitary Tumor & Cushing’s Disease

  38. Disease States • Moon facies

  39. Catecholamines • Adrenaline (Epinephrine) • Nor-adrenaline (Nor-epinephrine)

  40. Effects of Catecholamines • increase heart rate • increase cardiac force of contraction • narrows blood vessels • increase blood pressure • dilates pupils • dilates airways • reduces flow of blood to GI tract • reduces saliva production • increases platelet adherence ‘stickiness’ • increases sweat production

  41. Acute Stress and MI • Mortality in Widowers • 40% increase within 6 mo of spouses death • Myocardial Infarction Onset Study • incidence of AMI 14X among recent widows / widowers

  42. Self-report AMI Trigger412 reports from 849 AMI

  43. Chronic Stress & Immune Dysfunction • Influenza Vaccination • Difference between stressed and non-stressed group. • Lancet 1999