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Psychological Assessment in Chronic Disease Lecture Notes
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Notes Lecture PAICDSuzanne Derksen Health and Medical Psychology
Lecture 1: Psychosocial and biomedical aspects of chronic
illness and disability
Topic 1: Introduction
Chronic disease: Introduction
➢ Chronic somatic diseases are for the most part noncontagious long-term
conditions which can often be controlled but generally not cured by medications
or prevented by vaccinations.
➢ Common chronic somatic diseases: heart disease, cancer, lung disease,(type 2)
diabetes.
➢ Globally >50% of all deaths are due to chronic diseases .
Risk factors for chronic disease
➢ Chronic diseases have both genetic and modifiable risk factors.
➢ Modifiable risk factors are even more important if genetic risk factors are already
present.
➢ Disease rates are accelerating globally.
➢ The rise of chronic diseases has been driven by a three major behavioral risk
factors (WHO):
○ Tobacco use
○ Sedentary lifestyles/ physical inactivity
○ Unhealthy diet/obesity
➢ And related preventable biological risk factors:
○ High blood pressure
○ High cholesterol
○ Overweight
Four pillars of primary prevention
➢ The following interventions significantly impact the course of common diseases:
1
, ○ Tobacco cessation (±21% in USA smoke)
○ Weight loss (±66% in US is overweight)
○ Healthy diets (±64% in US have too much saturated fat in diet)
○ Regular exercise (30-45 minutes 3-5 times weekly)
➢ General survey in US citizens shows that less than 3% adheres to all these pillars;
10% does not adhere to any of them.
At risk populations:
➢ Risky health behaviours
➢ Elderly
➢ Females
➢ Psychopathology
➢ Personality profiles
➢ Maladaptive coping styles
➢ Dysregulated neuroendocrine/immunological system function
➢ … many more
What does chronically ill mean?
➢ Level of disability is dependent on several factors related to the severity of the
disease and the course of the symptoms:
○ Acute versus chronic
○ Stable versus progressive
○ Episodic
○ Remissions
➢ Stress: Dependent on manageability of the (course of the) disease and the threat
it represents.
➢ If someone is chronically ill, then:
○ Change in body integrity and comfort
○ Change in mental and physical wellbeing
○ Change in concept of self, loss of control
○ Change in life goals, future plans
○ Status change, relationships, colleagues
○ Potential loss of independence, change in surroundings
○ Financial (in)stability
Emotional reactions to chronic illness and disability
➢ Grief: reaction to loss
2
, ➢ Fear and anxiety: facing threats with both rational and irrational aspects
➢ Anger: due to frustration, self-blame, others or circumstances
➢ Depression: helplessness, hopelessness, apathy (realization of reality)
➢ Guilt: self-criticism or blame
Psychosocial factors in chronic illness and disability
➢ (In)visible disability → Stigmatization vs denial/avoidance
➢ Sexuality → Physical limitations/barriers
➢ Family adaptations → Redefinitions of family relationships often necessary
Adjustment to chronic illness and disability
➢ Patients with chronic disease need to adjust to their changed lives. This will
either support or deteriorate their coping behavior.
➢ Factors influencing the success of adjustment:
○ Personal factors/resources (gender, age, coping)
○ Social and family relationship, social support
○ Socioeconomic status
○ Culture
○ Environment (physical, social, political)
○ Activities (daily living, recreation, school, work)
○ Goals of the individual
○ Developmental stage (childhood, adulthood, elderly)
➢ Individuals need to be considered in the context of their own capacity to function in
their environment.
QoL in chronic diseases
3
, ➢ Mean quality of life (QoL), adjusted for age, gender, and wealth for respondents
with no chronic condition and for all eight chronic conditions.
➢ Higher scores indicate better QoL.
H&M psychologist in chronic diseases:
○ Advisor/consultant
○ Preventing
○ Treating
➢ Address barriers for healthy behaviors → i.e. adherence to medication.
➢ Facilitate coping with chronic disease / help with adjustment problems to the
condition.
➢ Address and treat psychosocial problems associated with a chronic disease.
➢ Important for health care professional to:
○ Understand the biomedical aspects of the chronic illness or disability →
facilitate the ability to achieve optimal functional capacity.
○ Get insight in the individual’s and societal perception of their condition.
○ Understand the individual strengths, resources, and abilities.
○ Understand personal factors, activities, social and physical environment
→ assess how condition affects daily life.
Topic 2: Theory vs Practice
Biopsychosocial model
➢ Change of perspective → Roles of patient and therapist differ based on
treatment situation.
➢ Biomedical model: Physician is the e xpert and a
ctively treats an illness and its
symptoms, patient is more p
assive.
➢ Psychosocial model: Therapist is a coach, patient has to actively work on e.g.
coping strategies and lifestyle changes - both have to work actively.
➢ Often, a single factor is most likely an inadequate explanation.
➢ Change in one domain necessarily leads to a change in another domain.
➢ More knowledge of interaction of factors can lead to improved diagnosis.
➢ Interventions involving all elements will do better than treatments based on a
single domain.
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