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