Health Psych: Chronic Illness

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PSYC 412
David Perrin

Chapter 11: Management of Chronic Illness 10/24/2013 9:23:00 AM Acute illness:short term,no symptomsonce healed Chronic illness:long term,>6months,doesnot goaway Prevalence of Chronic Conditions  50%of Americanshave a chroniccondition o 33%of young adults o Accountsfor 75%ofAmerican healthspending o 90% of home care visits, 83% ofRxdruguse o Most people will develop at least oneat somepoint  70%of people die from a chronicillness  Prevalence isincreasing Trendsin Prevalence ofAsthma by Age,US,1985-96 Wide Range and Prevalence of ChronicConditions intheUS  Hypertension—73.6million  Arthritis—46 million  Diabetes—23.6million  Heart attack survivor—16.8million  Cancer survivor—10.7 million  Stroke survivor—6million  Alzheimer’s—4.5 million  HIV—1.1 million  End-stage renaldisease—300,000 Chronic Illnessasa Good Thing?  Increasing prevalence ofchronicillnesscan alsobeasignofimprovements/success in health care o Better treatment ofacuteillnesses—can nowmanagediseasesthat were once fatal o Longer lifespans—developchronicasage  IraqandAfghanistan wars o Traumatic brain injury o Traumatic amputation  Much better carein battlefield,nolonger traumatic  People live longer with chronicconditions(withtreatment) o But what about their qualityoflife? o Health Psych seekstohelptreat and manage conditions Quality of Life  Degree to which a person isabletomaximizephysical,psychological,vocational and socialfunctioning o Indicator of recoveryfromoradjustment tochronicillness o Interference with activitiesofdailyliving(ADLs):  Sleeping,eating,working,bathing,toileting,dressing  Why study quality of life? o Providesbasisfor interventionstoimprove quality of life o Can helppinpoint which problemslikelytoemerge fromdifferent conditions o Assesses impact/quality oftreatments o Used to compare therapies o Can inform decisionsaboutcare  Treatment o The effectsof treatmentonqualityoflife influence patientbehavior  Treatmentnonadherence  Treatmentrefusal Emotional Responsesto Chronic Illness  Crisis:phase after diagnosis  Denial:defense mechanismbywhichpeopleignore/avoid implicationsof an illness (second opinion,misdiagnosis,etc) o Short term advantagesvs.longtermdisadvantages o Linked to lessadherenceand more hospitalizations  Anxiety:become overwhelmed bypotentialchangesintheir livesand/orthe possibility of death o Sobering,existentialcrisis o Highest anxiety whilewaitingfor testresults,duringdiagnosis,awaiting procedures o Hyper vigilant to physicalchangesor symptoms  Depression:mood disorder marked bysadness,inactivity,lethargy,difficulty concentrating,changesin appetiteand sleep,hopelessness,and suicidal thoughts or attempts o 1/3 inpatients with chronicillnessreport moderate depression o Often occurslater intheadjustment process(after crisis,denialand anxiety) o Linked to:  Increased symptoms  Lessmotivationfor rehabilitation  Nonadherence totreatment  Lower qualityoflife  EX:After someonehasaheart attack,depression predictsgreater physical impairmentslater on,thanphysicalimpairments predict depression  IOW:Depression causes moreseveresymptoms,severe symptomsdon’t causedepression  Higher risk for mortality,higher risk for suicide o Can be a long-termreaction o YouTube: “Depression inBreastCancer Patients”  Improvement indepression predictslongtermsurvivalofmetastatic cancer patients—survived more than2yearslonger thanthose whose depression didnotalleviate  Co-morbid risk factorformortality incancer o Assessing/DiagnosingDepression  Can be problematicinchronicillness  Some depressivesymptomsaresimilar tothose oftheillnessitself  Difficultysleeping,poorappetite,fatigue,impaired concentration,loss ofsexualdesire  Often goesuntreated  Beck Depression Inventory  Higher scoresindicatehigher levelsofdepression o Depression can lead patientstomake extreme decisionsabouttheir own care—EXterminatingtreatment  1 out of 6end-stagerenaldiseasepatientsstops treatment,quickly leading to death o Which patients aremorelikelytobecomedepressed?  Experiencingpain anddisability  Having physicallimitations  With social isolation  Women more likelytoreport mood disorders Personal Issuesin Chronic Illness  Self-concept:stable set of beliefsaboutone’squalitiesand attributes o Self-esteem:evaluation ofone’sself-concept o Can be affected dramaticallybychronicillness The Physical Self  Body image:perception and evaluation ofone’sphysicalappearance and functioning o Can plummet duringillness  Poor body image relatedtolower self-esteemand increased depression and anxiety o Lower treatment adherence  Can be improvedby stressingother aspectsofhealth,selfand life Other Aspects of Self  Achieving self:achievement isimportant toself-esteem and self-concept o Career,hobbies,leisureactivities  Social self:family and friendsareimportant for self-esteemandreadjustment after illness o Social support iscriticalin recovery  Private self:loss of independence,inabilitytoachievecertaingoals,dislikeimposing on others o Feel like a burden toloved ones o Importance of developingalternativepathstoachieving goals ordeveloping new goals Coping with Chronic Illness  Social support  Direct problem solving  Positive focus  Cognitive escape/avoidance  Behavioral escape/avoidance  Which work the best? o Active, flexiblecoping—problemsolving,seekingsupport, etc. o Passive coping associated withdistress,worsesymptoms,low sense of control Beliefs About Chronic Illness  Nature of the illness o Can adopt inappropriate/inaccurate modelfor the disorder  May act as thoughacute ratherthan aschronic  “I feel better soIcan stoptakingmymedication”  Cause of the illness o Patients blame stress,physicalinjury,disease-causingbacteria,or God’swill o Self-blame can leadtoguiltand depression ORit can lead to asense of control/mastery o Blaming others—maladaptive  Controllability of the illness o Belief in ability to prevent recurrence mayor maynot beaccurate  EXflare ups o Belief in controland self-efficacyaregenerallyadaptiveand mayprolonglife o When real controlislow, effortstocontrolmaybackfire  Engage in behaviorsthataren’t actuallye
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