Transcript Document

Interdisciplinary View
Cases of ill-health
Dr. Craig Jackson
Senior Lecturer in Health Psychology
Faculty of Health
BCU
www.hcc.bcu.ac.uk/craigjackson
Traditional model of Disease Development
Pathogen
Modifiers
Lifestyle
Individual susceptibility
Disease (pathology)
Biopsychosocial model of Illness
Hazard
Illness (well-being)
Psychosocial Factors
Attitudes
Behaviour
Quality of Life
Recap Sociology of ill health
Recap Psychology of ill health
Recap Physiology of ill health
Case #1 – Mrs Burroughs
•30-year-old married woman
•married 6 years
•secretary in company
•hospitalized about one month ago for pneumonia
•responded well to erythromycin
•discharged after 5 days
•completed a 14-day course of antibiotics
•within 2 weeks of discharge, she noted:
increasing shortness of breath & low-grade fever
similar to what she had before she was hospitalized
Case #1 – Mrs Burroughs
•
•
•
•
•
•
history of asthma as a child (not had problems since)
no history of heart disease, diabetes, allergies, lung disease in her
family, or other ill family members who are currently ill
denies any history of blood transfusions or sex outside of marriage
has a 4-year-old son
not taking any medications except for paracetamol prn
On interview with attending physician;
possible recurrent pneumonia
shortness of breath
chest pain
fever
slight hypertension
some skin rash
Case #1 – Mrs Burroughs
AVENUES OF INVESTIAGTION – COMMUNITY EXPOSURES
•
•
•
•
•
•
•
Home exposures
General
Consumer products
smoking
pesticides
air fresheners
soft furnishings
Hobbies
Building materials
Heating system
Take-home toxins
Case #1 – Mrs Burroughs
AVENUES OF INVESTIAGTION – OCCUPATIONAL EXPOSURES
•
Other workers ill?
•
Hazardous substances
Chemical
Biological
•
Other Hazards
Psychosocial
Physical
Ergonomic
Case #1 – Mrs Burroughs
PSYCHOLOGICAL ISSUES?
PHYSIOLOGICAL ISSUES?
SOCIOLOGICAL ISSUES?
Symptoms
Case Summary of a Chronic Patient #2
Date
Symptoms
Referral
1985 (16)
Anorexia
Secure unit teenagers
1986 (17)
Suicide attempt
Secure unit teenagers
1986 (17)
Self-harm
(A levels)
Secure unit CAMHS
Psychiatry
1987-9
(18-20)
Self-harm. Anorexia
(university)
UMC
1990
(21)
Working as au pair
(left university)
GP monitoring & anti-depressants
1993
(24)
Self-harm
(joined commune)
Secure unit admission
ECT
Female. Abused by father from 6 to 15. Moved to boarding school, then to
grandparents
Insomnia - Feeling worthless – Guilt - Recurrent morbid thought - Bleak views - Self
harm – Suicide Ideation
Scholastically bright. University. Dropped out. Tried own business. Business failed.
Case Summary of a Chronic Patient #3
Date
Symptoms
Referral
1985 (17)
Pervasive low mood
GP monitors
1986 (18)
Suicide attempt
Child Psychiatry
1986 (18)
Self-harm
Psychiatry
1987 (19)
Anorexia. Self-harm
Psychiatry – CPN
1988 (20)
Suicide attempt
(failed romance)
Psychiatry – CPN
1989 (21)
Suicide attempt
(failed romance)
Psychiatry – CPN
1990 (22)
Fertility worries
Psychiatry – CPN – fertility counselling
1990 (22)
Working in office
GP monitoring & anti-depressants
1992 (24)
Self-harm
MH unit (open door policy) CPN
1996 (26)
Chronic Fatigue
MH unit (open door policy) CPN
1998 (28)
Fibromyalgia
MH unit (open door policy) CPN
Potential Health Risks
Multivariate Symptoms and Effects
3x
Cardiovascular problems
“High Demand
Low Control”
3x Back pain
2x Substance abuse
2-3x Injuries
5x Certain cancers
2-3x Conflicts
2-3x Infections
2-3x
Mental health problems
Shain & Kramer 2004
“High Effort
Low Reward”
Summary of ill-health processes