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Now generic ketoconazole 200mg overnight delivery antifungal journal, at age fifty-five 200mg ketoconazole with mastercard antifungal for thrush, Ella had become increasingly con- cerned about her phobia order ketoconazole 200mg line do fungus gnats jump. She was at an age when it seemed more important than ever to have regular medical checkups. Also, her parents were older, and she worried that they might soon need to spend time in a hospital and thatshewouldn’tbeabletovisitthem. Shefinally decided to seek treatment when her husband was sched- uled to have his hip replaced. Ella’s treatment began with developing two hierar- chies—one for doctor visits and the other for hospitals. The hierarchy took into account the variables confronting your fear 95 that contributed to her fear, including the sex of the doc- tor (female doctors were easier than males), the age of the doctor (doctors younger than forty and older than sixty made her more anxious), the type of procedure being done (she was most nervous about procedures used to detect cancer, such as a mammogram), and the type of doctor (family doctors were easier than specialists). The hospital hierarchy included items ranging in difficulty from relatively easy (for example, spending time in the lobby or cafeteria of a hospital) to more difficult (for example, walking through the halls in the emergency room or visiting someone in a hospital room). She made appointments for physical exams three times per week over a two-week period. The next four exams were with other doctors (recommended by her family doctor), starting with female physicians and working up to male physicians. Ella also arranged to have a number of tests done, including blood work, a mammogram, and a colonoscopy. Over the course of these two weeks, her fear of doctors decreased to a mod- erate level. Ella decided to continue her exposure prac- tices with doctors about once per week over the next month while also starting to confront her fear of hospitals. During the next few weeks, Ella made a point of vis- iting hospitals about four times per week for an hour or two, usually on her way home from work. She visited the hospital where her husband was scheduled to have his 96 overcoming medical phobias surgery, as well as several others. She began with the eas- ier items on her hierarchy (for example, visiting her fam- ily doctor, who was a woman in her early fifties) and worked her way up to the more difficult items (for exam- ple, seeing a young male dermatology resident for a spe- cialist appointment). Eventually, she had practiced all of the items on her hierarchy except for visiting a loved one in the hospital; at the time, she had no friends or rela- tives who were hospital patients. However, when her hus- band had his surgery, she was able to visit him daily with only minimal anxiety. It requires time and patience, as well as a willingness to feel uncomfortable, at least temporarily. Unlike some of the other exercises in this book, this is not an exercise you can complete in a few minutes. Instead, you’ll need to practice for several hours over the course of a few days or a few weeks to complete this exercise. If you have a history of fainting upon encountering blood, needles, or related situations, don’t complete this exercise until you have read chapter 6. For those who faint or even just feel faint, we recommend only confronting your fear 97 completing this exercise in conjunction with the applied tension techniques described in chapter 6. Essentially, this exercise involves exposing yourself to the situations on your hierarchy, using the strategies described in this chapter along with those in chapters 3 and 4. Remember, your exposures should be planned, structured, predictable, frequent (at least several times per week), and prolonged (ideally lasting until your fear has decreased to a mild or moderate level). The case examples in this chapter illustrate how you might orga- nize your own exposure practices. Each time you complete an exposure practice, record in your journal how anxious you were before beginning the practice, your anxiety level every five or ten minutes during the practice, and your anxiety level at the end. In addition, record what practice you completed (for example, “watching a cardiac surgery video for thirty minutes”), how long it took for your dis- comfort to decrease, and any other relevant details (for example, whether you fainted during the practice). Here are 98 overcoming medical phobias some strategies for dealing with four of the most common obstacles. You may be busy with work, school, raising children, or any number of other activities, making it difficult to find an hour or two to devote to exposure on a given day. If so, we recommend that you schedule your exposure practices just as you would any other activity or appoint- ment in your day. If it’s too difficult to prac- tice during the week, increase the amount of practice you do on the weekend. Fortunately, exposure-based treatments tend to work quickly for phobias of blood, needles, doctors, and dentists. Following a few hours of exposure, you will likely notice a reduction in your fear. If you can’t complete a specific exercise, ask yourself, “How can I change this exercise to make it more manageable? Specifically, some people have small veins that are hard to find, making it difficult to take blood. As a result, nurses, doctors, and others often try unsuccessfully to take blood from various locations and may end up causing considerable pain and bruising with each attempt. If you have small veins, you should take steps to minimize the “trauma” that normally occurs when you have blood taken. First, make sure that the person drawing your blood is experienced in drawing blood from people with small veins. Second, let the person know that it’s generally very difficult to draw your blood from the usual places. If there’s another location that tends to work better (for example, your hand), suggest that the person drawing your blood try that location first. If your fear is staying high, make sure you have given it an adequate opportunity to come down. Another factor that may pre- vent your fear from decreasing is significant life stress (for example, a hectic work schedule, frequent marital con- flict, or parenting pressures). If you’ve had a stressful day 100 overcoming medical phobias and your fear doesn’t decrease during practice, try again another day. Finally, it’s best not to engage in safety behaviors or subtle avoidance behaviors, such as distrac- tion, during your exposures. These behaviors may keep your anxiety higher over the course of your exposure practice. For people who faint, exposure should be combined with applied muscle tension exercises, which are described in chapter 6.

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This may help to reinforce the unacceptability of violence to a person who still retains some insight discount ketoconazole 200mg without prescription antifungal undercoat, or may permit a judge to compel treatment in someone who has previously been resisting it buy ketoconazole 200mg where do fungus gnats come from. Delirious individuals may have waxing and waning of consciousness 200 mg ketoconazole antifungal medication side effects, may be agitated or lethargic, and frequently have disturbed sleep. Clinicians usually expect delirious individuals to exhibit agitation or hyper-arousal, and may overlook the delirious person who is somnolent or obtunded. Subdural hematoma, due to a recognized or unrecognized fall, should also be considered if the person suffers a sudden change in mental status. Delirium may come about gradually as the result of an undiagnosed underlying problem. For example, a dehydrated individual may no longer be able to tolerate his usual medication regimen. Identifcation and correction of the underlying cause is the defnitive treatment for delirium. Low doses of neuroleptics may be helpful in managing the agitation of a delirious individual temporarily. The husband says that his wife falls a lot and could have hit her head in an unwitnessed accident. Anxiety Anxiety is not a single syndrome, but serves as the fnal common pathway for many different psychiatric disorders. For example, some may develop social anxiety in response to their visible symptoms. They may worry for days in advance about what to wear when going to an appointment or what to order at a restaurant. Stopping a job that has become too 78 diffcult may result in a remarkable improvement. Some caregivers fnd it useful to refrain from discussing any anxiety provoking events until the day before they are to occur. Some individuals will not improve with counseling and environmental interventions and will require pharmacotherapy. The clinician should frst assess whether the anxiety is a symptom of some other psychiatric condition, such as a major depression. People with obsessive compulsive disorder may be made anxious by obsessions or if their rituals are interrupted. It is characterized by the acute onset of overwhelming anxiety and dread, accompanied by physiological symptoms such as rapid heartbeat, sweating, hyperventilation, light-headedness, or paraesthesias. Panic attacks usually last only ffteen or twenty minutes, may begin during sleep, and may even result in synocope (tingling or creeping feeling in the skin). Suspected panic attacks require medical evaluation, because some of the other possible explanations for the symptoms are dangerous conditions. This may occur fairly early in the course of the disease, when the individual is still functional in most other ways and can be very frustrating for the spouse or partner. Frank discussion with each person, individually and together, may help to improve understanding and generate compromises. The 79 spouse, usually the wife, may be distressed and apprehensive that the person will become aggressive if sexual demands are not met. Open communication about sex between the doctor and the family can help to de-stigmatize this sensitive topic, and distressing sexual behaviors can sometimes be adapted into more acceptable acts. Interventions can be diffcult in circumstances where impaired judgment is an issue. Keeping the individual awake and active, for example through a day program, may be all that is needed to counteract under-stimulation and achieve restful sleep. Depressed individuals commonly complain of early morning awakening or may appear to sleep most of the night but not feel rested in the morning. There are no ideal hypnotic medications, but agents such as sedating antidepressants (such as trazodone) or neuroleptics (such as quetiapine) may be used judiciously. Benzodiazepine and other prescription sedative-hypnotics are potentially delirogenic and habit forming and should be used cautiously, if at all. This may be acceptable to the person and family if it is understood as a feature of the disease. In situations where harm could result from apathy, for example if the person is not getting out of bed for meals, judicious use of amphetamines may be appropriate. The person experiences the failure of his hopes for the future and the loss of his sense of self worth and begins to experience despair. Demoralization should be considered when the person lacks the full depressive syndrome, and when the feelings of hopelessness have arisen in clear proximity to signifcant losses. Treatment for demoralization requires a combination of psychotherapy and social work to help the individual, and his or her family, solve real world problems, reduce stressors, build a support system, and emphasize the positive factors in life. His disability pension is fairly generous and his wife picks up extra hours at her job to make ends meet. Now that he is home, however, he is not helping with the household chores, is irritable with his wife and children and is beginning to drink excessively in the evenings. He tells his wife that he feels worthless and “half a man” and she is worried because he still owns a revolver. He seems surprised at the question and replies that he would never do such a thing to hurt his family. He discusses his feelings of guilt and worthlessness over not being able to provide for his family. The doctor reminds him that his condition is very mild and that he has many good years ahead of him. He agrees to abstain from alcohol for the time being and, with encouragement, obtains a part time job providing security at a large retail store. With the money he is making, his wife is able to reduce her hours and now that he is feeling less resentful, he begins to pitch in at home, going grocery shopping or doing the laundry. Six months later, at a follow- up visit, he is in excellent spirits and has made a successful transition to his new situation. This may be due to the onset of symptoms in the child before the parent’s onset, the early death of a parent (before the parent’s symptoms were evident), misdiagnosis or lack of diagnosis in a parent who was affected, non-paternity (a biological father who is not the same as the apparent father), or adoption.

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Despite the number of published studies on (1996d) were used to derive country-specific estimates for hearing loss generic ketoconazole 200 mg on-line fungus monsters inc, many of them use different criteria and relate incidence from the estimated country-specific mortality rates generic 200 mg ketoconazole anti fungal die off. Migraine has been ing threshold level in the better ear is 41 decibels or greater treated as a chronic disease lasting from 15 years to around averaged over 0 generic ketoconazole 200 mg antifungal pill otc. The case definition was or greater hearing loss (hearing threshold level in the better taken from the International Headache Society’s definition ear is 61 decibels or greater averaged over 0. Regional tion provided prevalence estimates that were quite similar estimates of the prevalence of hearing aid use were used in across most regions. For details of methods and data sources see Fewtrell and others (2004) and Pruss- Angina Pectoris. Both regional and subregional the prevalence and case fatality rates for angina pectoris prevalences for blindness and low vision were updated using (Mathers, Truelson, and others 2004). Observed correlations all available data gathered since 1980 (Resnikoff and others between the prevalence of acute myocardial infarction sur- 2004; Thylefors and others 1995). Subregional prevalences vivors and the prevalence of angina pectoris (whether inci- were estimated from more than 50 cross-sectional, dent before or after acute myocardial infarction) were used The Burden of Disease and Mortality by Condition: Data, Methods, and Results for 2001 | 83 to estimate the prevalence of angina pectoris from the mod- populations based on spirometry were available, both direct eled prevalences of acute myocardial infarction survivors. Asthma prevalence estimates were based on a case rates for acute myocardial infarction. Because accurate prevalence A total of 149 population-based studies were used to data based on spirometry are not available in many regions, derive estimates of asthma prevalence for a wide range of an alternative approach was used to infer disease occurrence countries for children, teenagers, and adults. The relative risk of mortality due to chron- European Community Respiratory Health Survey of adults ic obstructive pulmonary disease across subregions was esti- ages 20 to 44 using self-reported symptoms and bronchial mated as a function of its two leading risk factors—tobacco hyper-responsiveness (Chinn and others 1997; Pearce and smoking and indoor air pollution from solid fuel used for others 2000). Estimates from the population-based studies cooking—along with regional fixed effects (Lopez and oth- were then used to derive subregional average prevalence ers forthcoming). Data on risk factors were derived from the rates, which were assumed to apply in countries without comparative risk assessment carried out for the World specific population studies. Subregional prevalence rates for estimated regional prevalence with data from available pop- rheumatoid arthritis were derived from available published ulation studies. For regions where surveys of representative population studies using case definitions for definite or 84 | Global Burden of Disease and Risk Factors | Colin D. Subregional prevalence rates for in determining the overall health status of populations in all osteoarthritis were derived from available published popu- regions of the world. Prevalence numbers were based on regional causes dominates the overall burden of nonfatal disabling prevalence rates for edentulism estimated by Murray and conditions. The disabling burden of neuropsychiatric condi- tions is almost the same for males and females, but the major contributing causes are different. While depression is Injuries the leading cause for both males and females, the burden of An incident episode of a nonfatal injury is defined as an depression is 50 percent higher for females than for males, episode that is severe enough for the person to be hospital- and females also have a higher burden from anxiety disor- ized or that requires emergency room care (if such care is ders, migraine, and senile dementias. In higher than that for females and accounts for one-quarter of brief, the incidence of nonfatal injuries by external cause the male neuropsychiatric burden. Adult-onset hearing loss is extremely prevalent, with of health facility data provided by 18 countries in five World more than 27 percent of men and 24 percent of women aged Bank regions. For most cause categories, extrapolations 45 and over experiencing mild hearing loss or greater. The total attributable burden of disability due to alcohol use is much larger (see chapter 4). Although healthy life lost through time spent in states of less than full the prevalences of disabling conditions such as dementia health. From 1991 to 1994, average, poor health resulted in a loss of nearly eight years of the risk of premature death increased by 50 percent for healthy life globally. This once again illustrates the importance of Latin America and the Caribbean taking nonfatal conditions into account, as well as deaths, Middle East and North Africa when assessing the causes of loss of health in populations. East Asia and Pacific In 2001, the leading causes of the burden of disease in low- and middle-income countries were broadly similar to South Asia those for the world as a whole (table 3. Between ed for 36 percent of the world’s total burden of disease and 1994 and 1998, life expectancy for males improved, but injury in 2001 and adults ages 15 to 59 accounted for almost declined again significantly between 1998 and 2001 (Men 50 percent. While the proportion of the total burden of disease stantially higher burden of noncommunicable disease than borne by adults ages 15 to 59 was the same in both groups of high-income countries (figure 3. Other uninten- top four causes of the burden of disease, four nonfatal condi- tional injuries and violence were the third and fourth Table 3. Low- and middle-income countries High-income countries around 85 percent in adults ages 15 and older,the proportion 0–4 in middle-income countries has already exceeded 70 percent. Population aging and changes in the distribution of risk factors have accelerated the epidemic of noncommunicable disease in many developing countries. Injuries were also important older attributable to cancer was 6 percent in low- and mid- for women ages 15 to 44, although road traffic accidents dle income countries and 14 percent in high-income coun- were the 10th leading cause, preceded by other unintentional tries in 2001. The number of cases of lung cancer increased nearly 30 percent since 1990, largely reflecting the emergence of the tobacco epidemic in low- and middle- The Growing Burden of Noncommunicable Diseases income countries. The burden of noncommunicable diseases is increasing, Stomach cancer, which until recently was the leading site accounting for nearly half the global burden of disease for all of cancer mortality worldwide, has been declining in all parts ages, a 10 percent increase from estimated levels in 1990. Liver cancer was the third leading site, with The Burden of Disease and Mortality by Condition: Data, Methods, and Results for 2001 | 89 607,000 deaths in 2001, more than 60 percent of them in the compared with other regions. Among women, the leading cause of burden in Latin America and Caribbean countries, cause of cancer deaths was breast cancer. Globally, neuropsychiatric Group I causes also appear in the top 10 causes for this conditions accounted for 19 percent of the disease burden region, with road traffic accidents being the only non- among adults, primarily from nonfatal health outcomes. Of particular note, road traffic accidents were Injuries, both unintentional and intentional, primarily the third leading cause and congenital anomalies were the affect young adults, and often result in severe, disabling seventh leading cause. In 2001, injuries accounted for 16 percent of the Group I causes of the disease burden remained dominant adult burden of ill-health and premature death worldwide. In developed countries, suicides accounted hensive assessment of global population health, and has also for the largest share of the intentional injury burden, where- confirmed the growing importance of noncommunicable as in developing regions, violence and war were the major diseases in low- and middle-income countries. The former Soviet Union and other high-mortality has also documented dramatic changes in population health countries of Eastern Europe have rates of death and disabil- in some regions since 1990. The key findings include the ity resulting from injury among males that are similar to following: those in Sub-Saharan Africa.

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It ging the disease condition by surgical buy 200 mg ketoconazole visa antifungal medication, radiological purchase 200 mg ketoconazole with amex antifungal oils, phar- was not before the 13th century that new ideas about macological and similar methods trusted 200mg ketoconazole fungus gnats indoors, which is almost a me- body-mind relations appear. Saint Thomas Aquinas, a fa- chanical approach to disease where human body is viewed mous philosopher of the Dominican order, rejected in his as a complex organic mechanism that the physicians will writings the idea of soul and body as separate entities. The assumption The new position within the Church itself, actualised by here is that there is strict division between the non-ma- the only recognised philosopher and scientist at that terial spirit, i. Every the perennial problem of body-mind relations, the inter- change in bodily function thus occurs separately from ests that by the beginning the Renaissance led to wide the changes in mental functions, and vice versa. Yet ginning of the 15 century was for a long time strongly the efficacy of biomedical model became highly question- influenced by French philosopher Rene Descartes and able when massive new non-infectious chronic diseases his categorical opinion about body and mind being com- occurred, in the development of which there participated pletely separated. Although Descartes was of opinion numerous risk factors, among which a great number of that mind and body could communicate through certain 4 psychological and social factors. The new diseases could not nisms of digestive and other body systems, the discovery be efficiently controlled by extensive vaccination of the of a microscope; for all of these medicine turned toward population nor merely organ-oriented therapeutic meth- looking for physiological causes and means of treatment ods. The model became too narrow and the need to over- of most common bodily illnesses. Diagnostic efficacy and come it was substantiated by ever increasing scientific treatment of diseases are significantly improved, espe- evidence about psychological and social effects on health cially when microorganisms as causative agents of many and disease. The introduction of hy- In his paper »The need for a new medical model«, gienic measures, e. Prevention of diseases by vaccination fur- new bio biopsychosocial model by which he supports the ther increases the efficacy of treatment and strengthens integration of biological, psychological and social factors the biomedical concept of disease. However, despite the evident efficacy, more and more According to Engel the biomedical model is a reduc- criticism is addressed to the biomedical concept, the most tionistic one since it is based on the philosophical princi- common one being that it reduces the disease to the low- ple that complex problems are derived from simple pri- est level, i. Furthermore, it is a sin- also, that it is dualistic in terms of separating the mental gle-factorial model describing diseases only as a disorder from somatic processes. Engel further states that the in biological functioning of the body; it is based on dual biomedical model has almost become a medical dogma re- concept of body and mind; it considers body and mind to quiring that all diseases, including the mental ones, be be two separate entities in spite of ample scientific evi- conceptualised on primarily physical, chemical and other dence of complex interactions between body and mind; it biological mechanisms. He also claims that the border- over-emphasises disease, ignoring health and important line between disease and health has never been clear and 305 M. Relations between biological, psychological and social aspects in biosociopsychological model of health and disease (according to Serafino3). Engel provides concrete reasons for which he is of The Role of Biopsychosocial Model opinion that new approach is needed in modern medi- cine, like for instance, that patients with the same diag- The role of biopsychosocial model is particularly im- nosis and laboratory tests can present with completely portant in the studies of how psychological stress affects different course of disease for different psychosocial cha- the development of somatic diseases, since they have racteristics; that for proper diagnosis it is necessary to identified numerous facts about the interactions between extensively interview the patient during which impor- the nervous, endocrine, immune and other organic sys- tant, not only biomedical, information can be obtained tems in stressful situations. Many mechanisms of direct for correct diagnosis and treatment method; that psy- influence of stress on single organ and system functions chosocial factors often determine whether the patients have been established together with the indirect ones, considers her/himself sick or in need for medical assis- like for instance increase in stress induced risk beha- tance; that psychosocial factors are interrelated with the viour6. Wide evidence of the accuracy of Melzack and biological ones to the extent that they may influence the Wall’s holistic pain theory, i. Such an in- physicians and not psychologists or sociologists, the bio- teraction takes place within one unique system specific psychosocial model has contributed more to structural for each individual, a system within which all three ma- changes in psychology and sociology. In medicine the jor subsystems communicate by exchanging information, model provided the greatest contribution in the develop- energy and other substances. The centre of interest in ment of preventive programs in public health and the biopsychosocial model is not the disease but a sick indi- smallest in clinical medical practice. In the diagnosis and treatment, beside medical ence is significant in education of medical professionals procedures, the model employs all other methods related in terms of introducing many behavioural sciences topics to psychological and social aspect, i. Specific influ- tive participation of psychological, social, economic, an- ence may be noticed in psychiatric education and extend- thropological and other professionals whose expertise ing of psychiatric approaches to somatic and not only will only contribute to the increase in health care effi- psychic disorders, like for example in liaison psychiatry. The model The Engel model significantly influenced the develop- stimulates team work and interdisciplinary approach in ment of interdisciplinary studies of biological-psychologi- both medical research and practice, contributing also to cal-social relations, resulting in the development of new more rapid and successful development of medicine it- disciplines, namely the psychoneuroendocrinology and self. Great contribution of psychological procedures and techniques in the field of biopsychosocial model may be seen in the development of health preservation and treatment of somatic, and not new fields of psychological science. There is no doubt that the biopsy- chosocial model shows its greatest influence on the devel- entific ideas concerning the influence of psychosocial fac- opment of health psychology9,10. Accord- Behavioural Medicine and Health ing to the logic of the biopsychosocial model, the previ- Psychology ously used dichotomy of »psychosomatic« and »non-psy- chosomatic« diseases became obsolete. A new term is Although the basic concepts of psychological theory introduced about 1970, namely the »behavioural medi- explaining the mental-physical relation have always been cine«, relating to the field within which the activities of present (stress and body health, emotions and body im- psychologists working in health care system would be ex- munity, coping with disease, social support and disease, tended. The term describes and defines the »interdisci- health behaviour, personality and disease, life styles and plinary field concerned with the development and inte- health, patients’ life quality, etc), and although the use of gration of the behavioural and biomedical science and psychological techniques in preservation of health and techniques relevant to health and illness and the applica- treatment of diseases has been practiced for a long time, th tion of this knowledge and these techniques to prevention, it is only about the beginning of 80-is of the 20 century diagnosis, treatment and rehabilitation. The terms and lems of health preservation and treatment of somatic dis- 4 the wide area it covers were subject to significant criti- eases has begun. Too much of »behaviourism«, which is only one of Clinical psychology and occupational psychology to a many psychological theories, and particularly the use of certain extent have long been the only branches of ap- »medicine« as a term, caused its rather short duration. However, clinical psychology was primar- a pioneering effort in the field, discuss in detail many ily focused on diagnosis and therapy of mental diseases, topics and contents of the new field of psychology, the which psychological processes acting upon the onset and field defined as part of psychological science instead of me- course of somatic diseases were somewhat detached from dical one, the field in which the use of the term »health« the usual activities and wider interest of clinical psychol- 11 instead of »medicine« widens the approach no only the is- ogists within a health care system. Matarazzo, the first president be understood for the 50-is of the 20th century, the time of American Psychological Society Division of Health when clinical psychology begins to develop as an alterna- Psychology, established in 1978, defines health psychol- tive to a rather obsolete psychoanalytical approach. At ogy as »…the aggregate of specific, educational, scientific that time the infectious and parasitic diseases prevailed, and professional contributions of the discipline of psycho- and in their development and treatment the psychologi- logy to the promotion and maintenance of health, the pre- cal processes did not have any specific role. Hence, as a vention and treatment of illnesses, the identification of priority task, clinical psychologists focused themselves etiological and diagnostic correlates of health and illness on finding alternative methods of diagnosis and therapy and related dysfunctions, and the analysis and improve- of mental diseases based on new ideas of behavioural and ment of the health care system and health policy«13. Because of the dominant psycho- analytical approach in explaining the causes and treat- Rapid development of health psychology following its ment of mental diseases, the clinical psychologists were initial conceptual definitions, is instigated by numerous directed toward proving the importance and efficacy of factors, among which mostly by increasing knowledge clinical psychological procedures and techniques in the about insufficient efficacy of traditional medical appro- diagnosis and therapy of mental diseases. Many studies of the influence of social, the development of new diseases of modern society, na- cultural, psychological and other »non-medical« factors mely the massive non-infectious chronic diseases, started in the onset and development of massive, especially chro- to occur, about the end of the 70-is of the 20th century nic cardiovascular and cerebrovascular diseases contrib- grows the interest of psychologists in how mental states ute to the development not only of health psychology, but affect the onset and course of somatic diseases. Grad- of other allied disciplines as well, the medical sociology in ually the knowledge about the effects of mental states on particular14. However, during The critics of biopsychosocial model state that it is the past 20 years great number of general textbooks of mostly a biomedical model, that biological factors are health psychology have been published and they discuss still superimposed to the psychological and social ones, the basic fields of health psychology, like for instance; that the theoretical basis of the model is not clear enough, psychological factors of health risks, prevention tech- that the disadvantage of the model is the lack of a com- niques of risk factors, psychological aspects of individual mon language/system of concepts (i. An- cal health conditions, psychological mechanisms of pain, other opinion is that by proposing a model so conceived, and other. Engel, as a physician, wanted to incorporate the so-called »external enemy« into the medical model and thus pro- Several magazines were initiate in the field of health tect the official medicine from severe criticism for not ta- psychology, among which the British Journal of Health king into account mental and social factors, and also from Psychology, Psychology and Health, and Health Psychol- significant resentment and antagonism of medical care ogy, in which there are published many theoretical and users toward complementary and alternative medicine. For example, Smith17 investigated the thesis about the benefits of a vigorous development resulted in significantly greater participation of psychologists in health care practice.


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