With Transplant Psychologist, Dr. Christine Machado-Denis, listeners will be able to identify situations where consulting health psychologists may be helpful, describe the benefits of integrating a biopsychosocial approach in patient care to improve patient outcomes, and summarize the training needed and current specialty areas in the field of health psychology.
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Target Audience: all physicians
Release Date: 10/25/2022
Expiration Date: 10/25/2023
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Mending the Mind-Body Gap with Health Psychology
Featuring:
Dr. Machado-Denis earned her Psy.D in Clinical Psychology with a specialization in Behavioral Medicine at Albizu University in Miami. She completed her medical/health psychology residency at the University of Maryland School of Medicine/VA Maryland Healthcare System in Baltimore, Maryland. She later completed a postdoctoral fellowship specializing in solid organ transplant and bariatric surgery at the University of Florida. She also holds a post-doctoral master’s degree in clinical psychopharmacology.
In her work with the Department of Veterans Affairs, Dr. Machado-Denis focused on health promotion and disease prevention in primary care and cardiology clinics. In addition, she completed pre-transplant evaluations for patients with liver disease, developed mental health programming for liver transplant candidates and conducted psychological assessments of and provided treatment for veterans with chronic pain.
She later completed a postdoctoral fellowship specializing in solid organ transplant and bariatric surgery at the University of Florida. Her research has focused on alcohol use disorders in liver transplant populations, reducing hospital readmission rates in heart failure populations, and psychological aspects of cardiovascular disease and solid organ transplantation.
Christine Machado-Denis, Psy.D, MSCP
Dr. Machado-Denis is the attending transplant psychologist on the Transplant Hepatology team at the TGH Transplant Institute. She is a co-leader of the Alcohol Use Disorder Clinic specially designed for post-liver transplant patients at TGH. She is an Assistant Professor in the Dept of Psychiatry and Behavioral Neurosciences at USF Morsani College of Medicine.Dr. Machado-Denis earned her Psy.D in Clinical Psychology with a specialization in Behavioral Medicine at Albizu University in Miami. She completed her medical/health psychology residency at the University of Maryland School of Medicine/VA Maryland Healthcare System in Baltimore, Maryland. She later completed a postdoctoral fellowship specializing in solid organ transplant and bariatric surgery at the University of Florida. She also holds a post-doctoral master’s degree in clinical psychopharmacology.
In her work with the Department of Veterans Affairs, Dr. Machado-Denis focused on health promotion and disease prevention in primary care and cardiology clinics. In addition, she completed pre-transplant evaluations for patients with liver disease, developed mental health programming for liver transplant candidates and conducted psychological assessments of and provided treatment for veterans with chronic pain.
She later completed a postdoctoral fellowship specializing in solid organ transplant and bariatric surgery at the University of Florida. Her research has focused on alcohol use disorders in liver transplant populations, reducing hospital readmission rates in heart failure populations, and psychological aspects of cardiovascular disease and solid organ transplantation.
Transcription:
Scott Webb: With transplant psychologist, Dr. Christine Machado-Denis, listeners will be able to identify situations where consulting health psychologists may be helpful, describe the benefits of integrating a biopsychosocial approach in patient care to improve patient outcomes and summarize the training needed in current specialty areas in the field of health psychology.
Welcome to MD Cast by Tampa General Hospital, a go-to listing location for specialized physician-to-physician content and a valuable learning tool for world-class healthcare. I'm Scott Webb. And doctor, thanks for your time today. I've been looking forward to this one. I tried to do some research to make sure I could keep up with you. I'm really going to rely on your expertise though. What is health psychology?
Dr. Christine Machado-Denis: Health psychology, sometimes known as behavioral medicine, explores individual's motivation in the pursuit of embracing health promotion and illness prevention. So the specialty area of psychology examines how biological, social, and psychological factors influence the choices we make about our health. And the focus is really on the intersection of health and behavior, the psychological manifestations of disease and contributors to disease and suffering.
Scott Webb: It's very interesting. And I'm glad you sort of laid the foundation or the groundwork for us. So when we think about what makes a health psychologist, so how do you become one and what specialty areas exist within the field?
Dr. Christine Machado-Denis: Health psychologists complete graduate course work and training through a doctoral program, typically accredited by the American Psychological Association. The training is comprised of about seven total years, which includes a one or two-year fellowship. This level of training makes them knowledgeable about medical problems and evidence-based non-pharmacologic ways to treat medical problems.
Some health psychologists like myself go on to complete post-doctoral coursework and training in clinical psycho-pharmacology to augment their practice. This allows them to prescribe psychotropic medications for patients they treat in states that recognize prescribing psychologists or consult with medical counterparts in states where psychologists are not yet able to prescribe. Some of the specialty areas of health psychology include transplant psychology, cardiac psychology, psycho-oncology, pain psychology, bariatric psychology, just to name a few.
Scott Webb: Yeah, I'm wondering, you know, in my intro there, I mentioned that you are a transplant psychologist. I sort of have a sense of what that means, but what does that mean? And what do you really do?
Dr. Christine Machado-Denis: My training has focused mainly on solid organ transplant patients. And as a transplant psychologist, what I do is I participate on a multidisciplinary team, transplant team. And my role is to assess patients prior to transplant and determine their risk profile for the post transplant phase, psychological risk profile that is. So I look at different factors, like I had mentioned before what health psychologists look at, those biological, social psychological factors that impact their current illness and how those will translate into their post-transplant phase. Will unmanaged depression impact their ability to take care of themselves post-transplant? And does that need intervention? Those are typical questions that I will answer. And I will give the rest of the medical review board team recommendations on how to mitigate risk factors to ensure that the patients have the best outcome after transplant and really maximize their outcome and extend their life. That's typically what a transplant psychologist does.
And then after, the post-transplant, once the patient has already been transplanted, many times. those patients can develop other psychological comorbidities or preexisting psychological comorbidities can become exacerbated after the stressor of the transplant and that can impact their ability to engage in self-care, to take their medications, to adhere to prescribe regimens, and just to adapt and adjust to everything that comes with transplant. It is a big life change and it requires a lot of lifestyle changes to sustain the transplant.
Scott Webb: Wondering what interventions do health psychologists employ to promote health behavior change?
Dr. Christine Machado-Denis: Well, psychologists have unique training and expertise to incorporate standardized assessments and have several health-related assessments at their disposal that are validated on medical populations to help draw conclusions about patient profile, guide treatment planning and measure outcomes. Specific evidence-based interventions used in the health psychology arena can include motivational interviewing, which is an effective intervention for helping people change and discover the why they want to change, which can be used in combination with cognitive behavioral therapy to help with the how to go about change.
There're also other specific cognitive behavioral intervention protocols for conditions such as insomnia, chronic pain management and substance use disorders that can also help treat medical patients.
Scott Webb: And what are some of the benefits of integrating health psychologists on the treatment teams? You mentioned being a part of this multidisciplinary team, the transplant team. So what are some of the benefits?
Dr. Christine Machado-Denis: So health psychologists study the factors that allow people to be healthy, recover from an illness or cope with a chronic condition. And we have come to understand that we cannot separate the mind from the body and we can see that connection. For instance, in the bidirectional relationship between chronic pain and mood disorders.
Another example of this mind, body connection can be seen in the transplant population. For example, studies have shown that about 30 to 40% of patients meet criteria for a major depressive disorder after a liver transplant, and about 60% of patients experience depression or anxiety after any solid organ transplant. Furthermore, data show that depression doubles the risk of death after transplant in lung, heart, and kidney recipients highlighting the interplay between the psychological and physical factors.
So because the health psychologist develops a unique relationship with the patient, they can notice mental status changes sooner, discover previously unreported medical symptoms or relevant history that they may not have shared with other providers; address factors underlying adherence and compliance issues, which studies have shown that about 50 to 60% of patients are nonadherent to medicines they're prescribed, especially in those patients who suffer from chronic illnesses. And health psychologists can also address the beliefs and attitudes about medicine and faulty thinking patterns that can interfere with their recovery from an illness and extend the duration of their hospital stay.
Another benefit includes getting to the root of hospital readmissions. Certain populations have high levels of hospital readmissions, and the science has shown us that behavioral factors and psychological comorbidity contribute to hospital readmission. In fact, about 21% of medical patients with comorbid mental health conditions are readmitted within 30 days compared to 15% of medical patients without comorbid psychological problems. And additional data show that more than 30% of medicine-related hospital admissions stem from medication non-adherence.
Scott Webb: Well, you know, doctor, I told you before we got started, that I wanted to learn from you today, that I was really excited about this topic, and I've definitely done that. I'm sure listeners have as well. As we finish up here, we've talked about the multidisciplinary team and you working with your physician counterparts, so maybe you can talk about that a little bit as we close up here. How do you work with them? How do you help them in addressing patient needs, concerns and so on?
Dr. Christine Machado-Denis: I always like to tell my colleagues, "When in doubt, health psych can help out." So health psychologists can help when treating medically complex individuals, those with medically unexplained symptoms and can assess for and identify complicated presentations, such as somatic symptom disorders or conversion disorders like those seen with non-epileptic psychogenic seizures.
Consultations are typically requested to help teams distinguish between things like delirium and other mood disorders, determine the presence of comorbid mental health conditions versus psychological symptoms secondary to medical problems; assess health literacy, adherence, and compliance problems; assess cognitive functioning to assist with decisional capacity evaluations and provide end-of-life crisis intervention. And the health psychologist, they can also help the physicians address patients who may be viewed as difficult or resistant to medical advice, which often frustrates physicians health psychologists can help patients engage in health behavior change, such as tobacco cessation, weight management and help patients manage chronic conditions and implement lifestyle changes needed to mitigate risks for conditions that are known to lead to high resource utilization and increased healthcare costs, such as diabetes, hypertension, and hypercholesterolemia.
Scott Webb: Well, doctor, it's been so great to have your expertise today and to learn from you. This is a fascinating topic. I wish we were, you know, doing like an old school radio talk show where we had more time and we could really flesh out some of this. But this serves as a nice appetizer, if you will, for me, for listeners. So thank you so much. You stay well.
Dr. Christine Machado-Denis: Thank you.
Scott Webb: And thank you for listening to MD Cast by Tampa General Hospital, which is available on all major streaming services for free. To collect your CME, please click on the link in the description. For other CME opportunities, including live webinars, on-demand videos and local events offered you by Tampa General Hospital, please visit cme.tgh.org.
Scott Webb: With transplant psychologist, Dr. Christine Machado-Denis, listeners will be able to identify situations where consulting health psychologists may be helpful, describe the benefits of integrating a biopsychosocial approach in patient care to improve patient outcomes and summarize the training needed in current specialty areas in the field of health psychology.
Welcome to MD Cast by Tampa General Hospital, a go-to listing location for specialized physician-to-physician content and a valuable learning tool for world-class healthcare. I'm Scott Webb. And doctor, thanks for your time today. I've been looking forward to this one. I tried to do some research to make sure I could keep up with you. I'm really going to rely on your expertise though. What is health psychology?
Dr. Christine Machado-Denis: Health psychology, sometimes known as behavioral medicine, explores individual's motivation in the pursuit of embracing health promotion and illness prevention. So the specialty area of psychology examines how biological, social, and psychological factors influence the choices we make about our health. And the focus is really on the intersection of health and behavior, the psychological manifestations of disease and contributors to disease and suffering.
Scott Webb: It's very interesting. And I'm glad you sort of laid the foundation or the groundwork for us. So when we think about what makes a health psychologist, so how do you become one and what specialty areas exist within the field?
Dr. Christine Machado-Denis: Health psychologists complete graduate course work and training through a doctoral program, typically accredited by the American Psychological Association. The training is comprised of about seven total years, which includes a one or two-year fellowship. This level of training makes them knowledgeable about medical problems and evidence-based non-pharmacologic ways to treat medical problems.
Some health psychologists like myself go on to complete post-doctoral coursework and training in clinical psycho-pharmacology to augment their practice. This allows them to prescribe psychotropic medications for patients they treat in states that recognize prescribing psychologists or consult with medical counterparts in states where psychologists are not yet able to prescribe. Some of the specialty areas of health psychology include transplant psychology, cardiac psychology, psycho-oncology, pain psychology, bariatric psychology, just to name a few.
Scott Webb: Yeah, I'm wondering, you know, in my intro there, I mentioned that you are a transplant psychologist. I sort of have a sense of what that means, but what does that mean? And what do you really do?
Dr. Christine Machado-Denis: My training has focused mainly on solid organ transplant patients. And as a transplant psychologist, what I do is I participate on a multidisciplinary team, transplant team. And my role is to assess patients prior to transplant and determine their risk profile for the post transplant phase, psychological risk profile that is. So I look at different factors, like I had mentioned before what health psychologists look at, those biological, social psychological factors that impact their current illness and how those will translate into their post-transplant phase. Will unmanaged depression impact their ability to take care of themselves post-transplant? And does that need intervention? Those are typical questions that I will answer. And I will give the rest of the medical review board team recommendations on how to mitigate risk factors to ensure that the patients have the best outcome after transplant and really maximize their outcome and extend their life. That's typically what a transplant psychologist does.
And then after, the post-transplant, once the patient has already been transplanted, many times. those patients can develop other psychological comorbidities or preexisting psychological comorbidities can become exacerbated after the stressor of the transplant and that can impact their ability to engage in self-care, to take their medications, to adhere to prescribe regimens, and just to adapt and adjust to everything that comes with transplant. It is a big life change and it requires a lot of lifestyle changes to sustain the transplant.
Scott Webb: Wondering what interventions do health psychologists employ to promote health behavior change?
Dr. Christine Machado-Denis: Well, psychologists have unique training and expertise to incorporate standardized assessments and have several health-related assessments at their disposal that are validated on medical populations to help draw conclusions about patient profile, guide treatment planning and measure outcomes. Specific evidence-based interventions used in the health psychology arena can include motivational interviewing, which is an effective intervention for helping people change and discover the why they want to change, which can be used in combination with cognitive behavioral therapy to help with the how to go about change.
There're also other specific cognitive behavioral intervention protocols for conditions such as insomnia, chronic pain management and substance use disorders that can also help treat medical patients.
Scott Webb: And what are some of the benefits of integrating health psychologists on the treatment teams? You mentioned being a part of this multidisciplinary team, the transplant team. So what are some of the benefits?
Dr. Christine Machado-Denis: So health psychologists study the factors that allow people to be healthy, recover from an illness or cope with a chronic condition. And we have come to understand that we cannot separate the mind from the body and we can see that connection. For instance, in the bidirectional relationship between chronic pain and mood disorders.
Another example of this mind, body connection can be seen in the transplant population. For example, studies have shown that about 30 to 40% of patients meet criteria for a major depressive disorder after a liver transplant, and about 60% of patients experience depression or anxiety after any solid organ transplant. Furthermore, data show that depression doubles the risk of death after transplant in lung, heart, and kidney recipients highlighting the interplay between the psychological and physical factors.
So because the health psychologist develops a unique relationship with the patient, they can notice mental status changes sooner, discover previously unreported medical symptoms or relevant history that they may not have shared with other providers; address factors underlying adherence and compliance issues, which studies have shown that about 50 to 60% of patients are nonadherent to medicines they're prescribed, especially in those patients who suffer from chronic illnesses. And health psychologists can also address the beliefs and attitudes about medicine and faulty thinking patterns that can interfere with their recovery from an illness and extend the duration of their hospital stay.
Another benefit includes getting to the root of hospital readmissions. Certain populations have high levels of hospital readmissions, and the science has shown us that behavioral factors and psychological comorbidity contribute to hospital readmission. In fact, about 21% of medical patients with comorbid mental health conditions are readmitted within 30 days compared to 15% of medical patients without comorbid psychological problems. And additional data show that more than 30% of medicine-related hospital admissions stem from medication non-adherence.
Scott Webb: Well, you know, doctor, I told you before we got started, that I wanted to learn from you today, that I was really excited about this topic, and I've definitely done that. I'm sure listeners have as well. As we finish up here, we've talked about the multidisciplinary team and you working with your physician counterparts, so maybe you can talk about that a little bit as we close up here. How do you work with them? How do you help them in addressing patient needs, concerns and so on?
Dr. Christine Machado-Denis: I always like to tell my colleagues, "When in doubt, health psych can help out." So health psychologists can help when treating medically complex individuals, those with medically unexplained symptoms and can assess for and identify complicated presentations, such as somatic symptom disorders or conversion disorders like those seen with non-epileptic psychogenic seizures.
Consultations are typically requested to help teams distinguish between things like delirium and other mood disorders, determine the presence of comorbid mental health conditions versus psychological symptoms secondary to medical problems; assess health literacy, adherence, and compliance problems; assess cognitive functioning to assist with decisional capacity evaluations and provide end-of-life crisis intervention. And the health psychologist, they can also help the physicians address patients who may be viewed as difficult or resistant to medical advice, which often frustrates physicians health psychologists can help patients engage in health behavior change, such as tobacco cessation, weight management and help patients manage chronic conditions and implement lifestyle changes needed to mitigate risks for conditions that are known to lead to high resource utilization and increased healthcare costs, such as diabetes, hypertension, and hypercholesterolemia.
Scott Webb: Well, doctor, it's been so great to have your expertise today and to learn from you. This is a fascinating topic. I wish we were, you know, doing like an old school radio talk show where we had more time and we could really flesh out some of this. But this serves as a nice appetizer, if you will, for me, for listeners. So thank you so much. You stay well.
Dr. Christine Machado-Denis: Thank you.
Scott Webb: And thank you for listening to MD Cast by Tampa General Hospital, which is available on all major streaming services for free. To collect your CME, please click on the link in the description. For other CME opportunities, including live webinars, on-demand videos and local events offered you by Tampa General Hospital, please visit cme.tgh.org.