Does mood influence the development of diseases

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Yes, mood influences the development of pathologies. Although doctors do not dare to ensure that there are diseases caused exclusively by psychological discomfort, “it is true”, according to psychiatrist Antonio Lobo, that some appear for various reasons, including psychological. Stress can be a trigger, but this is just a theory. In practice, “psychic influence is real in all diseases.” And in 10% of cases, the discomfort is so obvious that a mental health specialist has to intervene.

There is already medical evidence of the axiom “I am myself and my circumstances”. “All diseases have biopsychosocial factors that affect their development,” confirms Tirso Ventura, from the Psychosomatic and Liaison Psychiatry Group that Lobo launched at the Spanish Psychiatric Society. The state of mind makes a pathology evolve in one way or another. “Even diabetes is worse with depression .” this reality is called psychosomatic illness, a concept that comes from the verb somatise, which means to turn mental disorders, for example, anxiety, into physical symptoms involuntarily.

Exist, exist. Although the large health entities, such as the World Health Organization (WHO), do not agree on how to define psychosomatic illnesses and, therefore, do not contemplate them, “doctors talk a lot about them,” says Antonio Lobo, former head of the Psychiatry Service at the Clinical Hospital of Zaragoza. And it is that, in that 10% of patients who, whatever their pathology, require attention from a mental health specialist, their deteriorated mood “complicates the course of the disease and its treatment and worsens the prognosis,” says Lobo. So it happens with cancer patients, coronavirus patients and all diseases.  

Two types of psychosomatic disorders: with and without physical injury

Although it does not appear in the current International Classification of Diseases, doctors, especially primary care doctors, use the term psychosomatic disorder with their patients. And they contemplate these two types:

  1. No lesion is found in the organism, and the doctor suspects a psychological causality. The patient is in pain and experiences a body malfunction, but medical tests reveal no physical disease. “Approximately 9% of primary school patients have this disorder, which is often called psychosomatic.” Panic disorder involves bodily symptoms to which the individual directs excessive attention. Hypochondria belongs to this category, defined as “persistent worry or fear of having one or more serious, progressive or life-threatening diseases”. And the worry is associated with erroneous and catastrophic interpretations of bodily signs.
  2.  Yes, bodily injuries are verified, in whose origin psychological factors are contemplated. It happens, for example, with duodenal ulcers, asthma or rheumatoid arthritis. In the strict sense, these are so-called psychosomatic illnesses, although the belief that the cause is purely psychic is highly discredited in the medical environment. Therefore, it is thought that many factors influence the appearance of any pathology. And specialists are aware that psychological factors represent an additional risk to health since they often precipitate or exacerbate the symptoms of the evidenced pathology. For example, they can cause hypertension, arrhythmias, and headache. Its real incidence is not well known precisely because of the diversity of criteria. Still, Antonio Lobo assures that “in practically all illnesses, and not only in the so-called psychosomatic ones, the psychic influence is also frequent. For example, 30% of patients admitted to general hospitals present psychological discomfort, such as low mood; in 10%, the Psychosomatic and Liaison Psychiatry Unit should intervene. These data are little known, even by the doctors themselves.”
In health centres and hospitals   

They are the greatest experts in psychosomatic illnesses. Family doctors are on the front line of care and very involved; their patients often do not go beyond that. Gema Garissa is a family doctor in Alagón (Zaragoza) and assures that the key to detecting a psychosomatic disorder in a patient is the close contact they maintain with them. “We know them very well, we know their families, we have been to their homes, we know if they have work problems; sometimes we have been seeing them for years, and we know their evolution”. So, when psychosomatic factors are involved, primary care doctors detect them immediately. If a patient presents muscular, cervical or lumbar pain, diarrhoea or insomnia, it may reflect problems at work, a separation or the loss of a loved one. “The first thing we do is rule out an organic pathology,” says Garcia. And if it is sensed that the disorder is psychological, “we listen and accompany above all, in addition to trying to stop the pain. But, of course -she adds- if there is a lot of suffering, mental health specialists intervene, with whom we maintain direct and permanent contact”.

According to the psychiatrist Antonio Lobo, family doctors face the following situation concerning psychosomatic disorders: “You have to support the patient, because that is indeed how he feels, sick, but they have to earn his trust because, if not a physical injury is found, the patient sometimes does not want to believe the doctor and begins to pass from hand to hand. If the patient does not receive any treatment, even though he has no physical injuries, his condition worsens.

In health centres, there are links with mental health support units. In hospitals, at least in half of the Spanish hospitals, in the largest ones, there are Psychosomatic Psychiatry and Liaison units. The latter work like this: psychiatrists join other specialists to treat hospitalised patients who are depressed or have anxiety, and, in addition, they join various medical teams to learn how to treat certain patients, for example, cancer patients and those affected by the new coronavirus.

Many doctors on the street are simultaneously investigating how to improve the condition of patients with psychosomatic disorders. Many studies have been done, especially about chronic diseases. And the Spanish Society of Psychiatry created a specific working group for this, currently led by Ignacio Gómez-Reino. His imminent objective is to generate consensus to develop action protocols and effective ways of treating these patients all at once.    

In any case, family doctors and psychiatrists already use standard means of diagnosis and therapy. However, depending on the intensity, patients are treated with psychopharmaceuticals in combination with specific psychotherapies and social interventions. 

Coronavirus assistance

Covid-19 does not affect all people equally, but doctors believe that mood influences its spread, treatment and subsequent complications, as with other diseases. “Based on data from other diseases, including infectious ones, Covid-19 infection is considered to be no exception to the general rule,” the psychiatrists suggest.

Along with the work to contain the coronavirus that family doctors are carrying out, Tirso Ventura, from the Clinical Hospital of Zaragoza, explains that, concerning patients admitted for Covid-19, “a service has been added to the interconsultations more: volunteer psychiatrists and psychologists who are acting as a link between patients and their families”. According to experts, the profile of these patients is very similar to that of cancer patients.

Even the Spanish Association Against Cancer offers, due to its long experience, support in cases of bereavement. According to Ventura, this is a time to learn more, considering all patients’ psychosocial aspects.

From primary care, doctors contact the patients they consider most vulnerable:
  • Older people develop anxiety due to loneliness.
  • Young people with psychosomatic ailments face the uncertainty of their future employment.
  • Patients in psychiatric treatment.

The family doctor Gema Garissa tells it. “We try to follow them closely despite the confinement.” And counteracting the psychosomatic disorder, she highlights the “solidarity”, the number of psychologists, social workers and neighbours who generally offer help altruistically.

Gracia Lasheras, head of the Psychiatry, Psychology and Psychosomatic Medicine Service at the Dexeus Hospital in Barcelona, ​​details the action with coronavirus patients:

On the one hand, support is given to health personnel who face the first line of care for affected patients, especially emergency and ICU professionals. “Our colleagues face highly stressful situations and can develop emotional reactions of anxiety, irritability, discouragement, insomnia and exhaustion.” For this reason, the Psychosomatic and Liaison units offer self-care guidelines to better cope with stress and assistance to evaluate and improve reactions to acute stress by telephone or telemedicine.

 And on the other hand, mental health care is given to the sick and their families due to:
  • Emotional anguish in the face of seriousness.
  • Separation during admission.
  • Having to face death with minimal parting contact.
  • Support for severely affected mothers who see limited contact with their newborn babies.
  • Adequacy of psychopharmacological treatments to avoid interactions with antivirals and other drugs to treat the disease.

The action is summarised with the three medical principles enunciated by the psychiatrist Tirso Ventura: “The first thing is to cure; if not possible, relieve; and, if not, to comfort”.

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