Transcript Document

Health Psychology
Chapter 12:
The Role of Health Psychology
in Heath Care Settings
Nov 26-28, 2007
Classes #38-39
Patient Symptoms
 Attentional Focus
– Internal vs. External
– Awareness vs. Unawareness
 Athletes
–Playing with pain – some can
–Probably externally focused
Attentional Focus
 Sensitizers
– Actively monitor an aversive event and react to it
– Scan themselves and environment
– Seek out information and think about stress
– Likely to seek help early
 Repressors
– Ignore then deny health related issues
– Look through life with rose-colored glasses
– “Don’t worry be happy”
– Not likely to seek help early
Illness Representations
 Our personal views on health and illness
– Includes:
 Identity of the illness
 Causes
 Timeline
 Consequences
 Controllability
Illness Identity:
Patient’s Label and Symptoms
Pain
Nausea
Breathlessness
Weight Loss
Fatigue
Stiff joints
Sore Eyes
Headaches
Upset Stomach
Sleep difficulties
Dizziness
Loss of Strength
Cause: Internal or External Reasons
How would you classify the following?
– A germ or virus caused my illness
– Diet played a major role in causing my illness
– Pollution of the environment caused my illness
– My illness is hereditary - it runs in my family
– It was just by chance that I became ill
– Stress was a major factor in causing my illness
Timeline: Course of the illness
 My illness will last a short time
 My illness is likely to be permanent rather than
temporary
 My illness will last a long time
Consequences
My illness is a serious condition
My illness has had major consequences on
my life
My illness has become easier to live with
My illness has not had much effect on my life.
My illness has strongly affected the way
others see me.
Control/Cure
My illness will improve in time
There is a lot which I can do to control my symptoms.
There is very little that can be done to improve my illness.
My treatment will be effective in curing my illness.
Recovery from my illness is largely dependant on chance
or fate.
What I do can determine whether my illness gets better or
worse.
Some influences on illness perceptions
and seeking treatment
 Personal experience
– A patient’s prior experience with the illness is big factor
on perception and sometimes symptoms
– See Ruble (1972) study on PMS (page 365)
 Age
– Child: yes
– Elderly: yes
– Everyone else: no
 Gender differences
– Women: yes
– Men: no
 See page 367 for some clear gender difference
examples
Some influences on illness perceptions
and seeking treatment
 Socioeconomic Status
– If you’re sick do you get help?
 High SES – yes
 Low SES – no
– Why is this the case?
 Cultural Factors
– Lay Referral System
 Likely to be used by those not trusting
traditional Western medicine
Delay Behavior
 Safer (1979)
– Appraisal delay
– Illness delay
– Behavioral delay
– Scheduling delay
– Treatment delay
Misusing Health Services
 Lets look at two “abnormal psych” illnesses
– Somatization Disorder
– Hypochondrasis
 Both of these are in DSM-IV
Somatization Disorder
 Diagnostic Criteria
– To be diagnosed a person must have reported
at least the following:
 Gastrointestinal symptoms (2)
 Sexual symptoms (1)
 Neurological symptoms (1)
 Pain (4 locations)
 These symptoms cannot be explained by a
physical disorder
Somatization Disorder
 Key point:
– It’s a chronic, recurrent, multi-symptom syndrome…
here are some…
– Vomiting, abdominal pain, nausea, bloating, diarrhea or
constipation, pain in arms or legs, back pain, joint pain,
pain during urination, headaches, shortness of breath,
fainting, fatigue, palpitations, chest pain, dizziness,
amnesia, difficulty swallowing, vision changes, paralysis
or muscle weakness, sexual apathy, pain during
intercourse, etc. etc. etc.
Somatization Disorder
 Sex difference
–F>M
– Primarily a female disorder with about 1%
suffering from this disorder
 Onset
– Usually by age 30 but its seen from childhood
on up
A typical scenario…
 Typically, patients are dramatic and emotional when
recounting their symptoms, often referring to them as
"unbearable," "beyond description," or "the worst
imaginable"
 Patients become extremely dependent in their personal
relationships
 They increasingly demand help and emotional support and
may become enraged when they feel their needs are not
being met
 They are often described as exhibitionistic and seductive
and self-centered
 In an attempt to manipulate others, they may threaten or
attempt suicide
These patients “doctor-shop”…
 Often dissatisfied with their medical care,
they go from one physician to another…
– What would be a recommended route for
these patients to choose insofar a
medical/mental health care is concerned???
They usually don’t go and further than
their General Practitioner…
 Bottom line:
– Psychologists and psychiatrists rarely manage
the majority of patients with somatoform
disorders -- this difficult undertaking falls
predominantly on general practitioners
Hypochondrasis
 Unrealistic belief that a minor symptom reflects a
serious disease
 Excessive anxiety about one or two symptoms
 Examination and reassurance by a physician does
not relieve the concerns of the patient
 They believe the doctor has missed the
real reason
Hypochondrasis
 Symptoms adversely affect social and
occupational functioning
 Diagnosis is suggested by the history and
examination and confirmed if symptoms
persist for at least 6 months and cannot be
attributed to another psychiatric disorder
(such as depression)
Hypochondrasis
 Gender difference
– More common in women than men (I couldn’t
find any stats though)
 Onset
– Usually in 30’s
– But seen in all age groups
Other Misuses of Health System
 Malingering
– Secondary benefits of playing the sick role
– They are faking it
– Its hard to separate those telling the truth (for
example chronic fatigue syndrome) from those
that are not
– Unless of course you see someone whose
receiving workman’s comp playing tackle
football at the park
But will they follow doctor’s orders?
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Factors Predicting Adherence
Good Mood
Perceived Control
Preference for Treatments
Provider Variables
Degree of Difficulty
Communication
Patient-Provider Communication
 Problems include:
– Initial consultation too vague
– Lack of info
– Felt rushed
– Patients listening
– Prejudicial Patient Stereotypes
– Might also have to do with attachment styles
 Secure individuals show the highest amount of
confidence and trust in their doctors
Health Care System
 Defined as all activities whose primary purpose is to promote,
restore, or maintain health
 The U.S. is the only major industrialized nation in the world
lacking government-run or subsidized universal health care
 In the United States, around 84% of citizens have health
insurance, either through their employer (60%), purchased
individually (9%), or provided by government programs (27%)
 Certain publicly-funded health care programs help to provide
for the elderly, disabled, children, veterans, and the poor, and
federal law ensures public access to emergency services
regardless of ability to pay.
 Americans without health insurance coverage at some
time during 2006 totalled about 16% of the population, or
47 million people
Some recent changes…
 Managed Care
– HMOs
– PPOs
 Higher Costs
Hospitalization
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Patient dissatisfaction
Medical errors
Loss of control
Depersonalization
Control is key…
 Preparing for Hospitalization
– Need to increase:
 Informational Control
 Cognitive Control
 Behavioral Control
Credits
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http://www.leeds.ac.uk/lihs/documents/presentations/chronic%20illness%20ma
nchester2.ppt#1