discussion #2
Biopsychosocial Aspects of Chronic Medical Conditions
Psychological Aspects of Chronic Illness ¡ Psychological aspects of chronic illness are
commonly overlooked ¡ Most patients adjust well to the psychological
aspects of chronic illness
¡ However, adjustment can decrease when when patients experience a decline in physical health status and when patients experience stigma as a result of:
¡ Limited independence ¡ Negative impact on daily routine ¡ Increase self-care demands ¡ Dynamic nature of life changes
Locus of Control & Psychological Vulnerabilities ¡ Patients with chronic illness have to balance their
need to be in control of their lives with the need to have significant others “take over” certain aspects of their life/care at times
¡ Psychological difficulties may complicate the management of a chronic medical condition ¡ Can make assessment and formulations complex ¡ Do psychological problems make us vulnerable to
chronic illness? Does chronic illness make us vulnerable to experiencing psychological distress that results in a psychological disorder?
Factors Impacting Chronic Illness Management ¡ Information/Knowledge
¡ A patient’s access to information influences their help-seeking behaviors and is highly related to a patient’s contact with health-service providers
¡ Psychophysiology ¡ Patients can experience deleterious effects as a result of the impact that illness-related stress
can have on their illness-related symptomatology (i.e., stress aggravates arthritic pain)
¡ Behavior Change ¡ A patient’s ability to modify their behavior can have significant consequences on the
management of their disease (e.g., quit smoking in cancer treatment or increased exercise in Type 2 Diabetes)
¡ Social Support ¡ Social support can mediate a patient’s interaction with the health care system
¡ Somatization ¡ Physical symptoms that arise as a result of undiagnosed psychological problems or emotional
distress can make a illness presentation more complex
Factors Impacting Chronic Illness Management
Illness Management
& Patient Help-Seeking
Behaviors
Information/ Knowledge
Psychophysiology
Behavior Change Social Support
Undiagnosed Psychological
Disorder
Somatization
Psychological Adjustment ¡ There is a HUGE variation in the SUBJECTIVE impact of chronic
medical conditions that are similar in severity
¡ Illness representation ¡ The subjective experience of the illness determines a patients ability
to cope and manage the chronic medical condition. This affects:
¡ A patient’s reactions to their symptoms ¡ Self-care behaviors ¡ Changes in mood states
¡ Our job as providers is to help patients find the appropriate framework for ascribing MEANING to their illness/symptoms
¡ We need to help patients understand and cope with their illness in light of pre-existing beliefs and assumptions about their world
Illness Representation Themes Identity
• Diagnostic label and the symptoms viewed as part of the chronic illness
Cause
• Personal ideas about causality
• Explanatory models (can be single or multiple causality model)
Timeline
• How long the individual expects the illness will last
Consequences
• Expected impact or effects and outcome of the illness
Cure/Control
• How the individual anticipates recovery from and control of the illness
§ These themes reflect and individual’s perceptions and beliefs about the illness. They provide patients a framework to make sense of their symptoms, assess their health status, predict treatment adherence, and help patients cope with their medical condition.
§ Assessing and modifying illness perceptions is a key component of biopsychosocial interventions
§ What factors influence a patient’s illness perception?
Stress & Illness ¡ Stress is a universal phenomenon
¡ Stress is particularly present and significant in individuals with chronic illnesses
¡ Stress has been linked to higher morbidity and mortality
¡ Stress has been identified as a significant predictor of symptomalotogy in chronic illness
¡ Stress is one of the most compelling constructs in the biopsychosocial model of illness
¡ Please watch the following video in preparation for this week’s discussion-NIH Vcast Stress and Health: From Molecules to Societies by Robert Sapolsky, Ph.D, Stanford University: ¡ http://youtu.be/XvMQQsyPirM
Conclusions ¡ As providers working with chronically ill patients
we need to have a clear understanding of:
¡ 1). The role of a chronic stress response in illness-
related symptomatology and management
¡ 2)A patient’s illness presentation across domains and how that impacts or could potentially impact their adherence to treatment and their ability to cope with the multiple challenges of living with a chronic medical condition