FFP1 Health Illness and Disease Bahrain 24-25 LB (2) PDF

RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn Health, Illness and Disease Class Direct Entry Medicine Course Foundations for Practice 1 Lecturer Ms. Luma Bashm...

RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn Health, Illness and Disease Class Direct Entry Medicine Course Foundations for Practice 1 Lecturer Ms. Luma Bashmi Date 2024-25 Learning outcomes 1. Define health and illness 2. Distinguish health, illness and disease 3. Explain the biopsychosocial model of health 4. Outline the perception of symptoms and illness 5. Describe the common sense model of illness 6. Critically comment on the relationship between aspects and types of personality and health and illness outcomes LO1&2. Define and distinguish health and illness Definition of health?? ‘State of complete physical, mental and social well- being and...not merely the absence of disease or infirmity’. WHO (1947) Definition of health?? ‘State of complete physical, mental and social well- being and...not merely the absence of disease or infirmity’. WHO (1947) Requirement of complete health would exclude most of the population as unhealthy (Huber 2011) – Screening for abnormalities – Primary preventive therapeutic treatments, e.g lipid lowering treatment? – Subjective perception of illness – Do we have to feel sick to feel healthy? Stable conditions/disability Health and illness are concepts that relate to social and moral values as much as they relate to disease  Health, Illness and Disease Disease: Pathological changes diagnosed by signs & symptoms; abnormality in structure or function of body organs or systems; considered to be objective. Illness: Subjective experience of negative changes in states of well-being and in social function; defined and responded to differently by different people. Differentiate disease and illness: e.g. Hypertension = Disease in absence of illness Phantom limb pain = Illness in absence of disease Alder B et al. Psychology and Sociology Applied to Medicine. 3 nd ed. Churchill Livingstone: London; 2009. pp38- 39 Disease and illness: interactions DISEASE ILLNESS e.g. Renal Failure e.g. Hypertension e.g. Skin Conditions e.g. Hypochondriasis LO3: Describe the biopsychosocial model of illness  Simple/Historical Perspective Traditional model: biomedical model Exposure Treatment to pathogen Recovery Physiologica Disease Chronic state l& state biochemical mechanism Death s Engel G. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129-136. On Moodle Importance of Determinants: Modern perspective Biopsychosocial model – Interaction of determinants contributes significantly to patient health seeking behaviour Sociocultural Exposure to environment pathogen Treatment Recovery Physiological & Psychosocial Disease state Chronic state biochemical processes mechanisms Death Personal history Genetic Learned Developmental The biopsychosocial model of illness Disease and illness are affected by multiple levels of organization, from the societal to the molecular. At the practical level, it is a way of understanding the patient’s illness experience as an essential contributor to accurate diagnosis of disease and health outcomes – Include the patient’s subjective experience alongside objective biomedical data MODELS: BIOMEDICAL BIOPSYCHOSOCIAL What causes illnesses? Viruses, bacteria, Multifactorial genes Who is responsible for Not patient (victim); Sometimes illness? external patient/context How should illness be Medical only Medical + health treated? promotion Who is responsible for Medical profession Medical + patient treatment? What is the relationship Either healthy or ill - Continuum between health & illness? no continuum What is the relationship None - function Interrelated (holistic between mind and body? independently view) What is the role of Illness has Psychological factors psychology in health & psychological can contribute to illness? consequences only, aetiology no role in aetiology Problems with biomedical model: ignores psycho/social causes; promotes passive patient awaiting care LO4: Outline the perception of symptoms and illness  Individual reactions to symptoms of illness. An example of stroke onset RCSI research 1010 participants completed the Stroke Awareness Questionnaire Almost 9 out of 10 respondents (87%) had heard a radio or TV stroke advertisement Over two-thirds (67%) of respondents were able to correctly identify two or more warning signs Yet…. Only 57% would call an ambulance if stroke symptoms occurred. Why? https://www.youtube.com/watch?v=_PW4rhZokS8 Attentional states and symptom perception Individual differences exist in the amount of attention people give to their internal and external states. Personal and social influences: Well-publicised illness increase symptom perception – ‘mass psychogenic illness’, e.g. COVID-19 The increased knowledge of symptoms can increase the perception of them, e.g. ‘medical student’s disease’. Other relevant distractions reduce symptom perception, e.g. athlete winning a race despite injury. Factors that increase likelihood of Symptom Perception Painful or disruptive: If a bodily sign has consequences for the person, e.g. they cannot sit comfortably, vision is impaired, or they can no longer perform a routine activity, then the person is more motivated to perceive this as a symptom. Novel: Experiencing a ‘novel’ symptom is more likely to be considered indicative of something rare and serious. Persistent: A bodily sign is more likely to be perceived as a symptom if it persists for longer than is considered usual or if it persists in spite of self-medication. Pre-existing chronic disease: Having a chronic disease increases the number of other symptoms perceived and reported. Past or current illness experience has a strong influence upon somatisation (i.e. attention to bodily states). Morrison and Bennett, An Introduction to Health Psychology, 3rd edition © Pearson Education Limited 2012 LO5: Describe the common sense model of illness Common-sense model of illness Figure 1 The self-regulation model: the common-sense model of illness representations ). Self-regulatory model of illness representations/perceptions themes developed… Identity: The label given to an illness and the symptoms associated with it Causality: The factors contributing to the development of the illness (heredity, diet, behaviour, etc.) Timeline: Beliefs about how long the illness will last (acute, chronic, cyclical) Consequences: Beliefs about the possible effects of the illness on their life - immediate and long-term Curability/Controllability: Is there a cure? Can this be controlled by self/others? Also Emotional: Whether the illness makes the patient scared, distressed BEHAVIO UR Illness Representations – MI example Factor Positive Negative representation representation 1) Identity Chest pain=MI? Chest pain=exertion “I better call an ambulance” “I’ll just rest for a while” 2) Causality Smoking - can change Heredity - can’t change “I can give up smoking” “My father died of a heart attack too” 3) Time-line Chronic problem Acute problem “I can stop this happening “It’s over now - the damage is again” done” 4) Consequences Long-term good Long-term poor “I can get over this and be “That’s me gone in a couple of healthier” years” 5) Control/Cure Yes - lifestyle change No “I can start exercising more “When your time is up, your often” time is up”  ILLNESS REPRESENTATIONS AND CLINICAL PRACTICE CLINICAL PRACTICE [ask about illness representation factors]: “what do you think it is?’ [identity] ‘what do you think the symptoms might be?’ ‘what does [cancer] mean to you?’ ‘what do you think caused your health problem?’ [causality] ‘what do you think about returning back to work? [consequences] ‘what do you think about managing the condition in the long- term?’ [timeline] ‘how would you feel about trying to reduce your risk by changing your lifestyle?’[cure /control] Illness representations and outcomes Illness representations have been shown to have direct effects on a wide range of outcomes: Seeking, using and adhering to medical treatment; Engagement in self-care behaviours or behaviour change; Attitudes towards use of medicines and treatment choices; Illness-related disability and return to work; Quality of life. Leventhal 2016. J Behav Med. 39:935-946 - On Moodle LO6: Critically comment on the relationship between aspects and types of personality and health and illness outcomes  Biological Perspective: Big Five Theory of Personality Trait approach to personality that considers a person’s personality profile in terms of stable and enduring dimensions Eysenck - ‘Personality is determined to a large extent by a Personality: person’s genes’ – differences in physiological functioning personal influences amount of conditioning experienced by an characteristics that determine individual e.g. introverted person the different ways we act & Introverts tend to have high levels of physiological arousal, which makes then more react in a variety easily conditioned – therefore acquire more inhibitions which make them more bashful, of situations tentative and uneasy in social situations – this social discomfort leads them to turn inward and become introverted 3 bipolar factors/dimensions originally – extraversion (introversion), neuroticism (emotional stability) and psychoticism (self-control)  Big Five Theory of Personality Low score High score Key Theorists: Eysenck (1970) followed by Costa & McCrae (1992)  What's the evidence? Meta-synthesis of 30 meta-analyses The Big 5 Traits were moderately associated with overall health (Multiple R=.35) Personality-health relations were largest for mental health, intermediate for health behaviors, and smallest for physical health.  Personality may have a more direct effect on mental health  Mechanisms such as perceived stress are a key mechanism underlying the effect of personality on health behaviors and physical health  The effect of personality on physical health is less robust because it is mediated by its effect on heath behaviors. Strickhouser, 2017. Does personality predict health and well-being? A metasynthesis. Health Psychology, 36(8), 797–810. https://doi.org/10.1037/hea0000475 Relevancy for Medical Practice Helps you develop an appreciation of individual differences Different individuals respond best to different approaches – good clinicians recognise this implicitly and act accordingly Explicit understanding of personality traits may facilitate tailoring medical practice to the individual  Conclusions Health and illness are not simple concepts The biopsychosocial model recognises that individuals do not have a uniform response to the same disease. – Disease = Individual + Environment Symptom perception and response, and seeking healthcare influenced by a range of factors – Not everyone who needs treatment presents for treatment – May be significant delay even in those who present The Common Sense model of illness is used to understand peoples response to illness – Illness perceptions may influence coping, and in turn influence outcome.  Reading Recommended – Alder B, Abraham C, van Teijlingen E, Porter M. Psychology and Sociology Applied to Medicine. 3rd ed. Churchill Livingstone: London; 2011. pp. 38-9, 88-9, 100-1. – Morrison V, Bennett P. An Introduction to Health Psychology. Pearson Education Limited, Harrow. 2012, 3rd edition. Ch 1, pp 4-14; Ch 9 pp 230-260 – If interested in reading more: – The Body Keeps the Score, by Bessel van Der Kolk Hemingway H & Marmot M. Evidence based cardiology: Psychosocial factors in the aetiology and prognosis of coronary heart disease: systematic review of prospective cohort studies. BMJ 1999;318;1460-1467.