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Clinical models of stress

Published online by Cambridge University Press:  24 June 2014

Mjajm Hoes
Mjajm Hoes*
Affiliation:
Department of Psychiatry, Ziekenhuis Rivierenland, Tiel, the Netherlands
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Abstract

Background:

Here we propose a stress model with disease-specific aspects and aspecific factors. The latter are subdivided into load (perception, psychic defence mechanisms), strain (psychophysiological responses) and stress sensu strictu (biological and behavioural compensation). Insufficiently compensated strain will result in being sick and precipitation of a specific disease according to one's predisposition. In the clinical practice, multiconditionality requires a multidimensional analysis, the the five-axial DSM-system being designed especially for this purpose. Multidisciplinary treatment is then organized accordingly, i.e. Axis I: case management, medication; Axis II, (focal) psychotherapy; Axis III, somatic specialists; Axis IV, social worker; Axis V, psychotherapy for coping deficits.

Objective:

To test the efficacy of this multimethodical approach.

Method:

In a 1-year prospective study of 257 admissions in a department of psychiatry in a general hospital, the General Health Questionnaire (30 items) was filled out at admission, discharge and first polyclinical visit post-discharge.

Results:

The 213 evaluable questionnaires at admission did not show differences (17–18.9) between the four groups, mood disorders (62%), alcoholism (17%), psychoses (15%) and anxiety disorders (6%). At discharge all four groups had reached the cut-off value for ‘not-sick’ (< 6), this remaining so at follow-up; the three measurements differed significantly throughout the patient groups. Hospitalization was definitely 28.2 days shorter than the Dutch mean of 42 days.

Conclusions:

Working to the proposed clinical model for multiconditionalty is effective on intensity and duration of disorders, sustained improvement is attained.

Keywords

clinical modelgeneral health questionnairemulticonditionalitypsychosomaticsstrain
Type
Original Article
Information
Acta Neuropsychiatrica , Volume 14 , Issue 4 , August 2002 , pp. 196 - 201
Copyright
Copyright © Blackwell Munksgaard 2002

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References

Weiner, H.Psychobiology and human disease. Amsterdam: Elsevier, 1977. Google Scholar
Selye, H.Stress in health and disease. London: Butterworth, 1976, 15. Google Scholar
Wulff, HR, Andur Pedersen, S, Rosenberg, R.Filosofie van de Geneeskunde. Een verkenning. Utrecht: Bunge, 1988. Google Scholar
Hoes, MJAJM.l-tryptophaan. In: Depressie en strain. Academic thesis, Nijmegen, 1981. Google Scholar
Hoes, MJAJM.Depression, anxiety, load, strain, stress and the metabolism of l-tryptophan. Stress 1982;3: 109–124. Google Scholar
Hoes, MJAJM.Xanthurenic acid as a measure of strain. In: Selye, H, ed. Selye's guide to stress research, vol. III. Toronto: Van Nostrand Reinhold, 1983, 86–99. Google Scholar
Hoes, MJAJM.Strain and stress. In: Vinken, PJ, Bruyn, GW, Klawans, HL, eds. Handbook of clinical neurology, vol. 45. Amsterdam: Elsevier, 1985, 245–254. Google Scholar
Hoes, MJAJM, Nijdam, SJ.Psychosomatische Aspecten in de Dagelijkse Praktijk. Leiden: De Medicus, 1986. Google Scholar
Hoes, MJAJM.Liaisonpsychiatrie. Verwaarloosde Aspecten in de Opvang en Begeleiding van Patienten in de Dagelijkse Praktijk. Utrecht: Bohn, Scheltema & Holkema, 1989. Google Scholar
Hoes, MJAJM.Biologische psychiatrie en psychotherapie. Nieuws Voor Psychotherapeuten 1992;24: 5–16. Google Scholar
Ven, LLM, Mouthaan, BJ, Hoes, MJAJM.Treatment of the hyperventilation syndrome with bisoprolol: a placebo-controlled clinical trial. J Psychosom Res 1995;39: 1007–1015.Google ScholarPubMed
Hoes, MJAJM.Adverse life events and psychosomatic disease. Curr Opin Psychiatry 1997;10: 462–465. CrossRefGoogle Scholar
Hoes, MJAJM.Psychosomatische geneeskunde in de dagelijkse praktijk. Med J Kennemer Gasthuis 1998;6: 23–28. Google Scholar
Hoes, MJAJM.Geneeskunde en maatschappelijk werk. Maatschappelijk Werk Magazine 1998;5: 18–22. Google Scholar
Hoes, MJAJM, Zeijpveld, JHB, Ruijgrok, M.Improvements in alcoholics measured using the General Health Questionnaire. Alcohol Alcohol 1998;33: 421–423.Google Scholar
American Psychiatric Assiciation (APA) DSM-III. Diagnostic and statistical manual of mental disorders, 3rd edn. Washington, DC: APA Press, 1980. Google Scholar
Janca, A, Kastrup, MC, Katschnig, H, López-Ibor, JJ, Mezzich, JE, Sartorius, N.The ICD-10 multiaxial system for use in adult psychiatry: structure and applications. J Nerv Ment Dis 1996;184: 191–192.CrossRefGoogle ScholarPubMed
Rahe, RH.Anxiety and physical illness. J Clin Psychiatry 1988;49 (Suppl. 10):26–29.Google Scholar
Vaillant, G.The Wisdom of the Ego. Cambridge, MA): Harvard University Press, 1993. Google Scholar
Paris, J, Zweig-Frank, H, Bond, M, Guzder, J.Defense styles, hostility, and psychosocial risk factors in male patients with personality disorders. J Nerv Ment Disord 1996;184: 153–158. Google Scholar
Vingerhoets, AIJM, Ratcliff-Crain, J, Jabaaij, L, Tilders, FJH, Moleman, P, Menges, LJ.Self-reported stressors, symptom complaints and psychobiological functioning II. Psychoneuroendocrine variables. J Psychosom Res 1996;40: 191–203.Google Scholar
Young, RR.The acute effects of exercise on mood states. J Psychosom Res 1996;40: 129–141. Google Scholar
Romanov, K, Appelberg, K, Honkasaio, M-L, Koskevuo, M.Recent interpersonal conflict at work and psychiatric comorbidity: a prospectivbe study of 15,530 employees aged 24–64. J Psychosom Res 1996;40: 169–175.Google Scholar
Viner, R, McGrath, M, Trudinger, PH.Family stress and metabolic control in diabetes. Arch Dis Child 1996;74: 418–421.CrossRefGoogle ScholarPubMed
Stenn, PG.Depression in the medically ill. Can J Psychiatry 1996;41: 65–66.Google Scholar
Lahgrise-Tohde, F, Pollock, BG, Szanto, K, Reynolds, CHF.Depression and suicide in the medically ill patients. Curr Opin Psychiatry 1996;9: 137–140. Google Scholar
Segal, ZV, Williams, JM, Teasdale, JD, Gemar, M.A cognitive science perspective on kindling and episodic sensitisation in recurrent affective disorder. Psychol Med 1996;26: 371–380.CrossRefGoogle ScholarPubMed
Hodiamont, P.Zoeken naar Zieke Zielen. Thesis, Nijmegen, 1986. Google Scholar
Goldberg, DP, Gater, R, Sartorius, N, et al. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 1997;27: 191–197.Google Scholar
Hoes, MJAJM, Banki, P, Hermes, BM. Workshop Samenwerking bij alcoholisme in het ziekenhuis. Lunteren, Voorjaarscongres Nederlandse Vereniging vooor Psychiatrie, sectie ziekenhuispsychiatrie, 1993. Google Scholar
Bloch, S.Moses Maimonides'contribution to the biopsychosocial approach in clinical medicine. Lancet 2001;358: 829–832.Google Scholar
Malterud, K.The art and science of clinical knowledge: evidence beyond measures and numbers. Lancet 2001;358: 397–400.Google Scholar