1. Describe the relationship between assessment and diagnosis.
Clinicians, in hope to find the correct treatment to help their clients experiencing dysfunctional symptoms and signs, use both the processes of assessment and diagnosis. The clinician will first take a psychological assessment in order to summarize the individual’s symptoms. This is done through a variety of ways, including objective and subjective tests, structured and unstructured interviews and observation. After completing an assessment, the clinician has an understanding of the individual’s symptoms, circumstances surrounding those symptoms as well as decides if and how to treat the individual. During an assessment, the clinician makes sure to highlight the abilities of the individual so that they can be compared to his abilities during and after treatment. This helps the clinician later on see the effects of the treatment and be able to change it if necessary. Only after an assessment, can the clinician make a clinical diagnosis. Clinical diagnosis is the way the person’s symptoms and signs learned in the assessment are organized and classified based on the Diagnostic Statistical Manual of Mental Disorders (DSM). The DSM is a standard guide to diagnose abnormal behaviors by providing criteria for each abnormal behavior listed. A clinician will gather all the information gained during an assessment and will organize it and see if it fits the criteria of any of the abnormal behaviors listed in the DSM. After a clinician diagnoses, the patient’s insurance will then cover their treatment (Butcher, Mineka & Hooley, 2013 p. 104). If a person experiencing low appetite and fatigue seeks help from a clinician, the clinician will first conduct and assessment to find out all the symptoms of the client. If the clinician finds that the person is depressed with no major depressive event as well as has low appetite, inability to sleep and low self esteem all lasting for longer than two years, he may diagnose the individual with Dysthymic disorder, based on the criteria in the DSM (Butcher ‘et al,’ 2013 p. 127). An assessment is necessary in order for a clinician to diagnose a person seeking help, precedes the diagnosis as well as helps the clinician diagnose.
2. What is stress and what is the stress response?
Stress is the reaction of the body when one faces challenges or difficulties, interfering with their daily lives and are beyond their means of dealing with. Stress can either be positive, like the stress experienced when one gets married or negative, like the stress experienced when missing the bus to work. (Negative stress is called distress.) There are many stressors throughout life, some cause extreme stress that interfere with daily living and others are minor and manageable. The extremity of the stressor depends on the following: how long the stressor lasts, when it occurs, if it is expected and if one can control it. When a stressor lasts long, and occurs at the same time as other stressors, it is more likely to be more stressful. A stressful event like a natural disaster causes a lot of stress as it is not expected or controllable (Butcher ‘et al,’ 2013 p. 135-137).
The human body’s response to stress is to enter what is called the ‘fight or flight’ response. During this automatic reaction, the body focuses all its energy on dealing with the stress, either by escaping or fighting it. Someone with an extreme fear of dogs, when faced with a dog, is focused solely on escaping from the dog. When faced with a stressful situation, the human body reacts with two different systems, the SAM and HPA systems that both respond with the ‘fight or flight’ response. The SAM, adrenomedullary system, starts to prepare the body for the fight or flight response by increasing the person’s heart rate, as well as starts to save up the body’s energy for when needed, increasing glucose in the body. It does this by triggering the hypothalamus to stimulate the somatic nervous system which causes the adrenal glands to secrete adrenaline and noradrenaline which flow throughout the blood. This results in an increase of heart rate and more glucose to be created, which helps the body deal with the stress (Butcher ‘et al,’ p. 139). Someone who meets up with a band of robbers, their SAM system will respond, causing an increase of energy and heart rate, so the person can try to either fight the bandits or escape them. The HPA, hypothalamus pituitary adrenal system, also creates a fight or flight response. The hypothalamus releases corticotrophin-releasing hormones which flow throughout the blood, stimulating the pituitary gland which secretes ACTH, triggering the adrenal glands to produce glucocorticoids (cortisol). Cortisol suppresses the immune system, allowing the body to use all its energy to escape the stressor (Butcher ‘et al,’ p. 139-140). When one faces a stressor, the body responds with the fight or flight response via the SAM and the HPA systems.
3. What is psychoneuroimmunology?
Psychoneuroimmunology is the study of the communication and connection between the nervous system and the immune system, which keeps the body healthy by fighting diseases and other foreign objects. Psychologists have found that the two systems are very much related. This is seen in relation to the stress response. When faced with a stressor, the nervous system reacts by triggering the HPA stress response. This results in the release of cortisol, which leads to immunosuppression, which reduces the efficiency of the immune system. This helps in the fight or flight response but if the stressor is long term, this will cause the immune system to have decreased strength long term. If the immune system is suppressed, the body is more vulnerable to disease. The nervous system’s response to stress influences the strength of the immune system in one’s body (Butcher ‘et al,’ p. 140).
4. Describe the relationship between psychological factors and cardiovascular disease.
There are a few types of cardiovascular diseases, diseases of the heart. Coronary heart disease (CHD) occurs when the arteries bringing the blood to the heart become clogged, causing the heart to receive a decreased amount of oxygenated blood. This can cause a type of heart failure called angina pectoris with symptoms such as chest pain. Silent CHD, sudden cardiac death can occur when plaque tears off from the walls of the passageways near the heart and blocks a hole. Myocardial infarction is a very severe cardiovascular disease and occurs when there is an obstruction in the arteries of the heart. This can also result in cardiac death. Hypertension is when an individual’s blood pressure is abnormally high, with a constant systolic blood pressure over one hundred and eighty and constant diastolic blood pressure over ninety; this can lead to heart diseases. Psychological factors such as stress, depression and personality types are closely related to such cardiovascular diseases (Butcher ‘et al,’ p. 144, 145).
Stress is directly related to ones psychical health, especially cardiovascular diseases. Stress increases ones heart rate and blood pressure (as part of the fight or flight response) causing the blood vessels carrying blood to the body to become narrower, causing the heart to pump the blood faster and work harder. When the stressor leaves, the blood pressure and heart rate return back to normal. It there is a long term stressor, this results in a constant increase of the blood pressure and heart rate, resulting in hypertension. Hypertension can cause blockage of the arteries which can result in heart failure. Stress increases the chances of one developing a cardiovascular disease as seen in two research experiments. Researchers found that deaths caused by CHD significantly increased shortly after strong earthquakes, which leads to say that the stress caused by the natural disaster led more people to die of cardiac diseases. The second research found that working people have had more heart attacks on Monday’s than on any other day of the week; this led them to say that the stress of going back to work after a weekend can cause cardiovascular disease. People with anxiety, specifically those with a phobic anxiety, are more at risk to CHD.
Types of personality can also affect cardiovascular disease. There are three types of personalities, Type A, Type D and Type B. A person with Type A personality is aggressive, competing, hard worker, hostile and ambitious. An individual with this type of personality is most likely to develop a cardiovascular disease. A person with Type D personality is someone who looks at life in a negative way, is anxious, hesitant and unsure; they are also at high risk of developing these diseases. Type B personality includes someone who is calm, works steadily, does not easily get stressed and is less likely to develop any of the above diseases.
Depression can also lead to cardiovascular problems. This can be caused by the proinflamatory cytokines that are released into the body of a depressed person. When in the body for long term, these cytokines can cause plaques to grow on the walls of the blood vessel, making it more likely for the person to have CHD (Butcher ‘et al,’ p. 146-149).
If an individual has either long term stress, type A or D personality or depression as well as does not have adequate social support, he is at an even higher risk to develop cardiovascular diseases.
5. Describe posttraumatic stress disorder.
Posttraumatic stress disorder, also called PTSD, is classified as an anxiety disorder according to the DSM and has a main symptom of stress. PTSD was discovered when veterans of the Vietnam War came home traumatized and unable to function properly within society. PTSD can occur after an unordinary, terrifying, traumatizing, stressful and life threatening event occurs to the individual. Any of the following types of situations may result in PTSD: surviving the holocaust, torture, prisoners of war and any other extremely traumatizing event. People with PTSD may: experience flashbacks, nightmares and memories of the traumatic event, try to avoid anything associated with the event, are unable to enjoy the pleasures in life and have an increase of arousal which can lead to the inability to sleep, irritability and difficulty concentrating. While many people recover quickly from PTSD, for others it may become chronic, long lasting. Someone displaying the above symptoms could be diagnosed with PTSD if it lasts for at least one month; one can be diagnosed with acute stress disorder for any of these symptoms lasting from two days to a month. This is useful because they need to be diagnosed in order to receive insurance compensation for their treatment (Butcher ‘et al,’ p. 153- 158).
