Psychobiological Aspects of Asthma and the Consequent Research Implications: THE INTERACTION OF MEDICAL part 5

It can be seen how many of these factors may interact, as shown in Figure 1. This demonstrates how even a patient with a disastrous developmental back­ground, major medical problems, and a strong biologic propensity to develop both asthma and psychiatric disorders may still adapt well if he has good insight into his problems and complies appropriately with an effective therapeutic regimen organized by a physician with whom he has a good and trusting relationship. Conversely a patient with a reasonable upbringing, a relatively mild degree of asthma, and a very dependent personality with few family and social supports, being treated by a physician who does not appreciate the patients psychological needs, and who consequently gets angry and frustrated, may spend inordinate amounts of time in the hospital and be placed on a regimen of excessive dosages of corticosteroids leading to a markedly increased level of disability.

Research Implications

The presentation of this model of asthma suggests several potentially fruitful lines of future research. In particular, the biologic overlap between asthma and anxiety disorders merits careful scientific study. These studies include the following:

(1)  Genetic, developmental, and social investiga­tions should identify whether a predisposition toward psychiatric disorder causes increased vulnerability to death from asthma. These studies should confirm that knowledge of the personal and family psychiatric history of a patient is likely to be helpful to the physician in assisting him predict, and understand, the type of adaptation his asthmatic patient is making to his illness. silagra tablets

(2)   Further investigations should attempt, using psychobiologic methods as have been discussed above, to learn how to precipitate attacks of asthma, presumably via hyperventilation, in anxious asthmat­ics. These studies might, for instance, also employ lactate acid infusions that could be set up in a similar manner to the infusion regimens that have been successfully developed for the study of biologic aspects of panic disorders. This “lactate challenge test” would in most medical and ethical respects be similar to the histamine challenges presently commonly given to asthmatics and might well clarify the role of “emo­tional” factors in asthma as well as demystifying these.

(3)  Another way of investigating the psychobiologic diathesis would be to mount a therapeutic trial of, for instance imipramine, in asthmatics with panic disor­ders. We would hypothesize that this medication would lead to both a functional and an objective improvement in the medical status of these patients, as well as to an improvement in their mood, as compared with a matched equally anxious control group. A properly controlled therapeutic trial of the various forms of psychiatric treatment of anxiety in asthmatic patients is clearly indicated anyway.

(4)  There is a need for further detailed examination of the issue of denial in both asthmatics and in their medical, familial, and social systems. In particular, the interaction of denial, psychiatric disorder, and physical illness merits attention.

(5)  The relationship between an individual patient s perceived level of breathlessness and his physiologic lung function parameters measured simultaneously needs further elucidation. This type of study may well have significant therapeutic importance if as a result patients can be taught to perceive dyspnea more accurately. It is also likely to shed more light on the reasons why some individuals differ so greatly in their levels of functional and social disability yet have similar measures of physiologic impairment. viagra soft tabs online

(6)       A final study of great interest would center on transference and counter-transference phenomena and study both patient outcome, as well as patient and physician satisfaction, in a group of chronically ill asthmatics where these issues were addressed as compared with a matched group of patients receiving conventional medical treatment.