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Marcia Sasano
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Study the influence of psychological and
behavioral factor on illness course
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Evaluate prevention and intervention programs
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Practical Application of theory
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Therapeutic intervention
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Advocacy
"Ogres are like onions"
"They stink?"
"Yes. No."
"Oh, they make you cry."
"No."
"Oh, you leave’em out in the sun, they get all
brown, start sproutin' little white hairs."
"NO. Layers. Onions have layers. Ogres have
layers. Onions have layers. You get it? We both
have layers."
"Oh, you both have layers. Oh. You know, not
everybody likes onions. What about cake?
Everybody loves cake!"
- Shrek and Donkey in Shrek
Acromegaly is a hormonal disorder that results when the
pituitary gland produces excess growth hormone (GH).
Researches estimate that about 3 out of every 1 million people
develop acromegaly each year.
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Initial Impact
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Shock
Denial
Loss and grief
Anxiety and depression
 20-25% experience psychological symptoms
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If these reactions last too long, they can have an negative effect
on the illness
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Must adjust to:
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Symptoms of the disease
Stress of Treatment
Feelings of vulnerability
Loss of Control
Threat to self-esteem
Financial Concerns
Changes in family structure
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Denial
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Fear &Anxiety
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Depression
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Anger
◦ Defense mechanism by which people avoid implication of illness
◦ Double edge sword
◦ Fear of treatment, death, loss of partner
◦ Uncertainties contributes to anxiety
◦ Loss is central to most expression of depression
◦ Factors associated with depression include lack of social support
and stress
◦ Why me?
◦ Directed at health care providers, partners, family, friends, and
the illness itself
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Must adjust to:
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Increased stress
Change in the nature of the relationship
Change in family structure/roles
Lost income all have impact
Different issues for different relationships
◦ Adult children of ill parents
◦ Spouse of ill person
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Illness is a crisis because it is a turning point in an
individual’s life
Disrupts to established patterns of personal and
social functioning produces a state of
psychological, social, and physical disequilibrium
Adaptation = finding new ways of coping with
drastically altered circumstances. Restore
equilibrium.
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Coping process (3 stages) is influenced by
3 factors
◦ Illness-Related Factors
◦ Background and personal Factors
◦ Physical and Social Environment Factors
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Coping process influences outcome
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Illness-Related Factors
◦ Degree of illness acceptance
◦ Degree of lifestyle/functional impairment
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Background and Personal Factors
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Physical and Social Environment Factors
◦ Demographic - Age, Gender, SES
◦ Personality - Negative affectivity vs. Hardiness
◦ Social support – Instrumental & Emotional
 In the long run emotional is better
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Some of the complications can be medically
managed – pain, cardiovascular problems,
sleep disturbances, weight gain, diabetes,
etc.
Treatment can be stressful due to complexity
of endocrine system
Psychosocial adjustment difficulties are
oftentimes neglected
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Adjust to symptoms
Threatened self-image
Interruption to life role
Loss of independence
Learning new techniques for symptom control
Facing stressors of modern medicine
Facing complex, conflicting emotions
Uncertain future
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Major Depression
Anxiety Disorders
Adjustment Disorder
Stress
Brain Executive functioning
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Planning
Memory
Attention
Problem solving
Reasoning etc
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What does the Pituitary
have to do it?
◦ Endocrine glands –
specialised for growth,
development, metabolism
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Response to stress (natural alarm system)
Interact with all systems in the body
Control growth and development
Maintain homeostasis
Production, storage and utilization of energy
Birth
Lactation
Peak
Loss of Control
Start
Fail
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What
◦ Reaction to stressor
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When
◦ Threatens ability to cope (subjective)
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Where
◦ Body & Mind
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How
◦ Physiological changes
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Who
◦ Children, Adolescents, and Adults
During stressful situations some physiological
adjustment are made via the Autonomic Nervous
System to overcome stress
◦ Hormones – Adrenaline, Cortisol, etc
◦ Blood Pressure
◦ Heart Rate
◦ Blood Distribution
◦ Energy Management
◦ Immune System
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Pituitary Gland = stress circuit
Stress
Cortisol
Mood
Difficulties
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What is the relationship between stress and
acromegaly?
◦ Stress changes physiology
◦ Stress changes behaviour
◦ Moderating factors: e.g., coping, social support,
personality and control
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Stress takes away the ‘focus’ from growth,
reproduction, metabolism and immunity
Cognitive Symptoms
Physical Symptoms
Memory problems
Inability to concentrate
Poor judgment
Seeing only the negative
Anxious or racing thoughts
Constant worrying
Aches and pains
Diarrhea/constipation
Nausea
Dizziness
Chest pain
Rapid heartbeat
Loss of sex drive
Frequent colds
Emotional symptoms
Behavioral Symptoms
Moodiness
Irritability/short temper
Agitation
Feeling Overwhelmed
Sense of loneliness
Depression
General unhappiness
Eating more or less
Sleeping (too much/little)
Isolating from others
Procrastinating
Neglecting responsibilities
Alcohol, cigarettes, or drugs
Nervous habits
Numbness/
Emotionally
unresponsive
Absence of
Motivation
Relationships
Non-participation/
social isolation
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Humor
Friends and Family
Relax Time
Faith
Attitude
Knowledge/Preparation
Problem Solving
“I have to monitor my energy levels, no multitasking anymore, or running around. My serenity is
my priority to stay alive. My control needs to stay
balanced, so less stress in my life is most urgent”
...
“... I know it can be “good excitement” or bad
stress. No difference, my body reacts the same ...”
“... If I can’t control my environment, at least I can
learn about my inner workings and free myself
from my behaviour or thoughts that can bring
unnecessary worry ...”
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Problem Focused
◦ Direct action: doing something to cope directly with the
stressor
◦ Seeking information: finding what help in available
◦ Seeking advice: asking others for advice or help
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Emotion Focused
◦ Resigned acceptance: the individual comes to terms with
the problem and accepts it
◦ Emotional discharge: expressing feelings to others as a way
of release
◦ Intrapsychic processes: cognitive redefinition, denial,
avoidance
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Adaptation and Adjustment
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Quality of Life
◦ Physical, vocational, self-concept, social,
emotional, compliance
◦ Degree of quality people appraise their lives to
contain
 Quality = fulfillment or purpose
◦ Health-related quality of life (physical status and
functioning, psychological status, social
functioning, disease or treatment-related
symptomatology)
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Physical
Emotional
Social
Daily functioning
Symptoms
Cognitive ability
Health perception
Sexual functioning
Vitality
Pain
Body image
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Be your advocate
Sympathise with your cause
Deal with sleep deprivation
Have appropriate treatment
System must be balanced
Talking therapy must be considered
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Increase social support
Manage Time
Pace
4 Basics
Reducing the impact of the stress
“Maybe it’s hard to believe what’s with my obvious
charm and good looks but people used to think that I
was a monster.
And for a long time… I believe them.
But after a while, you learn to ignore the names people
calling you. You just trust who you are.”
– Shrek