Psychiatry I 5.

BEHAVIORAL & PSYCHOLOGICAL REACTIONS TO ILLNESS

Dr. Sundiang January 23, 2013

OUTLINE I. Concepts Regarding Illness V. Reactions to Illness Behavior VI. Clinical Behaviors II. Determinants of Illness VII. Predictors of Reaction to Illness Behavior VIII. Common Clinical Problems III. Components of Illness Behavior IX. Coping with Illness IV. Steps in an Illness X. Dealing with Pain CONCEPTS REGARDING ILLNESS BEHAVIOR Disease Precipitant o Anatomical or physiological change which arises from several possible causes/disease agents. o It is not always with certainty that we are able to identify these precipitants, and it is important to acknowledge this uncertainty. o Particularly in Psychiatry, there are many theories with regards to the possible causation of different behavioral or psychological conditions, but very few definite pathophysiologic mechanisms can be brought forth to explain these conditions. Host Defenses o When the defenses are able to react properly and able to manage, there is no disease o When defenses are overwhelmed or over react, disease begins Disease Process o Features of host defense & disease agent interaction which remains purely anatomical, physiological, or behavioral o In many patients, this will probably take a long period of time before we actually see obvious signs of the changes happening in their body. Illness o Refers to when the individual has a realization that there are changes happening and that these changes are not the usual things he would experience o Personal features of a disease o Patients perceive illnesses o Subjective in nature Illness Behavior o Complex of patient behaviors in reaction to the development or continuation of an illness o Patients reaction (cognitive, behavioral, and psychological) to being sick o Behaviors of person who feels ill to relieve the experience or to better define the meaning of the illness experience o There will be different reactions at different levels in that we will not only see in terms of actual behavioral reactions (e.g. seeking consult), but also psychological responses. o In some patients, there is a need to explore more extensively how they may be reacting psychologically and cognitively to the condition they are experiencing. DETERMINANTS OF ILLNESS BEHAVIOR May give you a better insight on how your patient is reacting to their particular condition Involves getting to know the patient, beyond just interviewing them Example: in Physical Diagnosis, you also get the psychosocial history of the patient (important in understanding the illness behaviour of patients) These are: 1. Biological predispositions 2. Nature of symptomatology 3. Learned patterns of responses 4. Assumed cause of illness 5. Situational influences 6. Characteristics of the health care systems

These involve reviewing things in the past but this prevents many physicians from having a better understanding of their patients (may be missed out due to TIME CONSTRAINTS or TOO MUCH FOCUS on the particular disease processes) Some of these areas can be used to see if patients have misconceptions in their conditions (inaccurate information of their disease and how its treated) and it is important to CORRECT THEM. COMPONENTS OF ILLNESS BEHAVIOR Psychological and behavioural reactions to the illness Social context o social or external changes with the care providing system o socioeconomic factors and social network/support system STEPS IN AN ILLNESS 1. Initial perception that something is wrong o Actual process of disease may be already happening before patient can perceive that there is something wrong o Patients may not know if something is pathologic already especially if the disease is not causing major disturbance in the patients usual functioning 2. Patient decides something is wrong and labels himself as SICK o Happens when the condition is already causing a disturbance in their functioning 3. Decision to seek professional care o May be immediate or delayed (due to external factors such as financial reasons) REACTIONS TO ILLNESS Loss and Grief o Reactions to lowered self-image, because the patient is unable to perform usual responsibilities and tasks Fear o Due to changes in bodily functions or threat to homeostasis o Disease may progress and may not respond to treatment Shame and Guilt o Patient is not able to perform daily activities and not able to take care of himself (Failure of self care) o Lowered self-image + failure to self care = dependency on others Helplessness and Hopelessness o Due to sense of loss of control o Can be a big source of psychological defeat o Not knowing enough facts about their illness and treatment increases sense of helplessness CLINICAL BEHAVIORS These are important to recognize and address immediately. If the behaviours become extreme, they may interfere with management/treatment. Look at these behaviors as external manifestations of the patients reaction to his/her condition, so as NOT to personalize and feel that you are ineffective in addressing their concerns. If you are able to address these and help the patient overcome the negative behaviors, then you may facilitate better compliance and management. These are: o Anxiety o Isolation o Denial o Dependency o Depression o Anger o Bargaining and blaming o Acceptance o Regression

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PSYCHIATRY I 5.1
PREDICTORS OF REACTION TO ILLNESS Past reaction to loss Prior illness experiences o As part of the history taking, particularly of new patients, it should be noted how the patient has reacted previously to certain illnesses which he/she has confronted, or others who are close to him/her may have experienced. Cultural attitudes and belief COMMON CLINICAL PROBLEMS Depression and Mania Cognitive and Neurobehavioral changes (may be due to illness or treatment being given) Adjustment and Coping difficulties Changes in Body Image Non-adherence to Treatment Loss (of loved one or of functioning) and Bereavement Anxiety Substance related problems Sleep difficulties Sexual dysfunction Behavior issues Pain COPING WITH ILLNESS Coping may be defined as the totality of cognitive and behavioural strategies employed by the sick person to deal with the demands imposed by the illness. Acceptance o facilitates mature strategies for coping with illness Taking control o finding new ways to regain control and increase self-esteem o performing daily activities and making long-term plans Benefitting from others o utilizing their social network to have greater ease in confronting their illness o cooperating caregivers, deepening personal relationships and expanding support networks STRATEGIES TO COPE WITH ILLNESS Gain knowledge o In order to get a better perspective, patients need information about their illness and their treatment options. o Not only the positive, but all aspects, in order to establish trust. Plan ahead Exercise positive thinking Look for solutions to problems Widen and utilize social support system o Support groups provide an environment where you can learn new ways of dealing with illness o Patients will also gain strength in knowing that they are not facing hardships alone Acceptance of physical changes o Patients may reject the idea of acceptance, feeling that it suggests they are "giving in" and giving up, but ultimately acceptance allows for progress in a direction away from the anger. o Patients should also be encouraged to move from 'Why me?' to 'What now? Understand self and needs Express feeling o Patients may express sensitive or private feelings that they have about their illness, and its impact on their lifestyle and relationships 9. Reasonable degree of assertiveness 10. Humor 11. Spirituality DEALING WITH PAIN 1. Explain nature of pain signal o involves describing to patients how pain works o teaching patients about the gate control theory on pain 2. Explain degrees and causes of pain 3. Explain expected effects of medications including side effects o May be a countermeasure against patients abuse of medication 4. Maximize effects of medications with higher initial doses and reinforcing positive effects 5. Relieve concomitant anxiety if any DEALING WITH CHRONIC PAIN 1. Eliminate doubts about availability of medications 2. Do not make medications contingent on proof of need 3. Focus also on healthy materials and other issues, not only in pain 4. Do not make contact with care system contingent on pain Mind and Body No argument is needed to show what transforming power the mind can exert. The energy set free by the magic agencies of hope, courage, desperation, fanaticism, or by the enthusiasm for a great cause, may reveal the possession of a force undreamed of, or so husband the resources of the body as to keep the flame of life burning for a time when the oil seems exhausted. - James J. Putnam (1846-1918)

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