Posts Tagged ‘illness’

Stress Illness Haiku

Tuesday, April 20th, 2010

Haiku are three line poems of 5, 7 and 5 syllables first composed in 17th century Japan.  A friend and colleague who writes haiku urged me to give it a try.  I laughed and said the analytic (left) part of my brain is so overused compared to the creative (right) part of my brain that I probably tilt slightly to the left when I walk.  She persisted, though, so I went on to suggest that writing bad haiku is probably one of the easiest tasks in literature and writing good haiku one of the most difficult.


Kroenke & Mangelsdorff (2)

Friday, January 8th, 2010

To continue discussion of the Kroenke & Mangelsdorff research*, let’s begin by looking at what  became of all 567 symptoms (in 380 patients).  For 2/3 of the symptoms, doctors did diagnostic testing or referred to a specialist.  In the other 1/3, no evaluation was done beyond the initial visit.  Treatment was recommended for only 55% of symptoms, and this took the form of a prescription in over ¾ of cases.  There was nothing to suggest that anyone searched for hidden stresses linked to the symptoms (posts tagged with “Stress History” explain how this is done).


Kroenke & Mangelsdorff (1)

Thursday, January 7th, 2010

Last year marked the 20th anniversary of one of the most frequently quoted studies in the stress illness literature.  The paper reports a discovery that would have shocked me if I had read it during my training years.  Their finding has profound implications for primary care practice.


The Physiology of Stress Illness (3)

Friday, December 11th, 2009

Evidence of abnormalities in the brain in stress-related illness continues to accumulate.  A recent paper * compared MRI scans in 14 Fibromyalgia (FM) patients and 14 healthy people and found reduced gray matter in pain-processing areas in the brain in the FM group.  The authors wondered whether this reduction in gray matter caused the chronic pain or whether it was a result of chronic pain.


Mental Health Professionals and Physicians (Letter)

Friday, December 4th, 2009

Building referral pathways from medical to mental health professionals will be a key part of relieving stress illness.  Here is an example of a letter written by a mental health professional  to a medical clinician offering ideas that could help.  (The references below will be discussed in more detail in a future post.)


Mental Health Professionals and Physicians (Intro)

Thursday, December 3rd, 2009

Millions of people who could benefit significantly from a few visits with a mental health professional never get the chance.  This is because the psychosocial stresses they are coping with manifest primarily as physical symptoms.  When they go to a medical office, diagnostic tests are normal because the stress causes no visible damage to the body.  Most of the time, neither the physician nor the patient knows what to do next.


Adults who had Stress in Childhood (4)

Tuesday, December 1st, 2009

The long-term effects of childhood stress impact relationships and mood in adults.  The study* described in the last post surveyed 380 women who came to a general medical clinic.  In addition to questions about abuse in childhood, patients were surveyed about whether they had ever experienced intimate-partner violence (IPV) and also about depression.  (The vast majority of those who had experienced IPV were no longer in an abusive relationship.)


Adults who had Stress in Childhood (3)

Monday, November 30th, 2009

Adult patients seen by primary care medical clinicians often are affected by stress in childhood.  Recent evidence of this is a study of 380 women at a medical clinic at Oregon Health & Science University in Portland *.  Their survey asked about physical or sexual childhood abuse and assessed the impact of these on physical symptoms.


Adults who had Stress in Childhood (2)

Wednesday, November 25th, 2009

Researchers have been shocked at the profound impact childhood stress can have on health in adults.  The ACE (Adverse Childhood Experience) Study *, led by my friend Vincent Felitti, MD in San Diego, is one of the best examples.  They studied 18,000 people who were having routine check-ups.  You can read a summary here .


Adults who had Stress in Childhood (1)

Tuesday, November 24th, 2009

Childhood stress can cast a long shadow.  Thanksgiving week is an appropriate time to look at the issue since this holiday is often a challenge for my patients who are still in touch with their families of origin.