This slideshow explores the way that stress leads to biological pathology. It attempts to connect the adverse childhood events study with Bruce McEwen's work on cortisol and stress. It explored the impact of PTSD, early childhood trauma and stress on health and longevity.
2. Goals for today
ï Understand current research on childhood adversity
and resilience in health.
ï Know the common
pathways that lead
from childhood
adversity to pathology.
ï Recognize some biological
markers that lead to
childhood adversity
transitioning disease and
early death.
ï Begin to develop clinical tools to address impacts of
childhood adversity in our patients.
4. Aces
Study
âWhen a house is
burning down you
do not see the
flames you see the
smoke. If you do
not know the
relationship
between smoke
and fire one might
think that smoke
was the problem
and bring a fan and
blow the smoke
away.â
- Dr. Felitti
https://www.youtube.com/watch?v=U3iKxjk-I-8
5. Public Health Crisis
Scope of the Childhood Adversity
ï More then 5.5 million children likely effected
by child abuse each year (child abuse
reports).
ï More then 16.6 million Children below the
poverty line (2010).
ï 1.5 milion Children have parents in jail.
ï Prenatal impacts of domestic assault,
maternal stress, socioeconomic stress are
endemic.
6. The Brain of a Severely Neglected Child Can Be 38%
smaller with an IQ = 50 half of typical IQ =100
10. Aces and Autoimmunity
ï Sixty-four percent reported at least one ACE.
ï 34.4 men and 31.4 women out of 10,000 (first
hospitalization from any autoimmune disease).
ï First hospitalizations for any autoimmune disease
increased with increasing number of ACEs.
ï People with 2+ ACEs:
⊠Th1 had 70% increased risk of hospitalization compared to
those with no ACEs
⊠Th 2 had 80% increased risk for hospitalizations
⊠100% increased risk for rheumatic diseases.
* All p values reported at .05
14. Developing Resiliency
ï Positive Family
Relationships
ï School attachment
ï Neighbor support
ï Peer support/Social support
ï Religiosity
ï Academic Achievement
ï Emotional support outside the family
ï Positive Self-regard
ï Spirituality
ï Inner-directed locus of control
ï Family closeness
ï Cognitive Coping Stratigies/Emotion Regulation
15. Pathways â Adversity to Pathology
Behavior, Social Functioning and Biochemical Changes
16. The Pathways to Pathology
3 Key Factors
1. Difficulty w/ Behavioral
Regulation Leading to Adverse
Health Behaviors.
2. Poor Social Support
3. Changes in Biological Systems
19. Social Support â Health Outcomes
ï Loneliness is highly related to all cause mortality
and is significant risk factor for health outcomes.
ï Lack of social support effects:
⊠Poor Self-Concept
⊠Emotional responses and ability to regulate emotions
⊠Problem solving â attempting to solve life's problems
with out the advice, support or mentorship of others
(e.g. you have to make all the mistakes yourself)
⊠Effects multiple biological systems from cortisol to insulin
30. Allostasis and Health
ï Higher allostatic load scores associated with:
⊠Poorer cognitive fxn.
⊠Physical functioning.
⊠Predicted larger decrements in cognitive and
physical functioning.
⊠Increased risk for the incidence of cardiovascular
disease
ï Allostatic Load predicted these outcomes
independent of sociodemographic and health
status risk factors.
Seeman, Teresa E., et al. "Price of adaptation: allostatic load and its health consequences:
MacArthur studies of successful aging." Archives of internal medicine 157.19 (1997): 2259-2268.
35. Importance of Treatment Teams
ï Increased continuety of care.
ï Defined roles can lead to effective
collaboration and improved patient outcomes.
ï Increased job satisfaction and reduced burn
out.
ï Address health complexity, patient defined
goals and support the patient to be an active
participant in health.
36. Building Health Teams
ï Five key factors: Trust, Communication,
Commitment, Accountability and Results.
ï Create role clarity, pathways for
communication, and point person for health
goals.
ï Culture of a profession can develop a culture
of interprofessionalism.
ï Clean house. Deal with challenges to team
care openly and quickly.
38. Patient Centered
Biopsychosocial Care Planning
ï Patient Driven Health Goals? â Developed in
collaboration w/ PCP and health team.
ï Creating Continuity of Care? â Identifying gaps in
treatment, adherence problems, follow through,
stressors (ABC â Antecedent, Behavior,
Consequence).
ï Building Care Team? â Who is on the team? Defined
by the best way to support PT to reach health goals.
Defining roles.
ï Incremental Implementation? â Do enough but not
too much. Support PT to develop new tx goals as
previous goals are accomplished.
39. Case Discussion
ï 32 yr-old Caucasian Woman
ï Homeless 1 yr
ï Substance abuse hx, Bipolar II dx
ï Insomnia
ï Current depression impacting tx adherence
and decision making.
ï Physical abuse by spouse and parents.
ï Hyperlypidemia
ï HTN
ï Migraines poorly controlled
ï Chronic pain LB and Legs
ï Poor Medication adherence due to life stress,
financial stress & relational chaos.