Psychological Consequences of Chronic Disability Diseases PDF

Psychological consequences of chronic Disability diseases Dr Eman Elsheshtawy Prof of Psychiatry  Stress In Chronic Illness And Disability Potential threats of chronic illness or disability include: threats to body integr...

Psychological consequences of chronic Disability diseases Dr Eman Elsheshtawy Prof of Psychiatry  Stress In Chronic Illness And Disability Potential threats of chronic illness or disability include: threats to body integrity and comfort as a threats to threats to self- threats to threats to the result of the independence, concept and threats to life relationships ability to threats to threats to life illness or privacy, fulfillment of goals and with family, remain in economic well- and physical disability itself, autonomy, and customary future plans. friends, and familiar being well-being the diagnostic control roles colleagues surroundings procedures, or treatment EMOTIONAL REACTIONS TO CHRONIC ILLNESS OR DISABILITY Grief Fear and anxiety Anger Depression Guilt The extent of impact is dependent on: the nature of the condition individuals’ pre-illness/disability personality the meaning of the illness or disability to individuals individuals’ current life circumstances the degree of family and social support  Cognitive Appraisal  Primary appraisal  Eustress optimal performance  Stressful: higher arousal, distress, deterioration of functioning  Secondary appraisal  Sufficient: successful coping  Insufficient: Vulnerability Reaction to stressful event (chronic illness)  Emotional response with somatic complaint in the form of anxiety or depression  A coping strategy  A defense mechanism  Healthy Coping  Problem solving coping to decrease the problem through:  Obtain information  Solve problems  Confrontation  Emotion focused coping to decrease emotional reaction through: Ventilation of emotion Evaluation of problem  Maladaptive (pathological) coping  Use of alcohol, drugs  Self harm  Aggressive behavior  Unrestrained display of feeling  Defense mechanism  Some patients adopt some defense mechanisms that are unconscious (patient is unaware of it) as:  Denial : where the patient deny the presence of any illness Leads to refusal of treatment and investigations  Repression: exclusion of the problem from consciousness (never think about)  Reaction to chronic illness  Can lead to development of psychiatric diseases as:  Post traumatic stress disorder  Adjustment disorder with anxiety, depression Or disturbed conduct(behavior)  Impact of Depression in Chronic Medical Illness Increased prevalence of major depression in the medically ill Depression amplifies ( increased both number and severity of) physical symptoms associated with medical illness Comorbidity increases impairment in functioning Depression decreases adherence to prescribed regimens  Depression is associated with increased heath care utilization and cost Depression is associated with adverse health behaviors (diet, exercise, smoking) Depression increases mortality associated with certain medical illness (e.g., heart disease) (a  Personality change  Permanent hostile attitude  Social withdrawal  Feeling of emptiness  Being changed Relation between physical illness and psychiatric problems  Physical illness can be a cause of psychiatric illness as in cases of hepatic encephalopathy, delirium, hypothyroidism.  Psychiatric illness due to treatment of chronic illness as cases managed with high dose of steroids, antihypertensive, oral contraceptive  Psychiatric disorder due to general medical condition as depression , psychosis, sleep disorder Psychiatric manifestation of medical illness Amnestic Delirium Dementia disorder Personality Psychosis Depression changes Sleep Sexual Anxiety disorder disorder Examples of medical conditions causing psychiatric disorders Degenerative disorders Parkinson Wilson Huntington infectious ds. herpes simplex encephalitis T.B meningitis Immune disorders AIDS SLE Metabolic encephalopathy Nutritional Endocrine disorders toxins demyelinating Head trauma Brain tumors ds Predictors of poor adjustment Personality disorders Dependency traits Depression Emotional immaturity  Absence of social support from significant others Anger or resentment Fear of failure Loss of self-efficacy/self-esteem External locus of control Fear of pain Risk factors for suicide Depression Anger aggression Alcohol other drug abuse throughout hospitalization Pre-morbid psychiatric illness Past suicide attempts Male Chronic pain Multiple medical problems Isolation Schizophrenia Expressions of hopelessness Family disintegration  Aim of treatment  Manage the symptoms  Relieve the burden  Strength relation ship  Help patient to adjust  Sense of control  Role of Psychiatrist  Manage depressed patient  Manage the problem of un-communicativeness, uncooperativeness  Manage symptoms of anxiety or psychosis  Help in managing long standing conflicts  Anxiety management (e.g. coping with worry strategies catastrophe scale, stimulus control techniques, problem-solving/ de-catastrophising etc.)  Increasing either mastery or pleasure activities to at least one per day to counter self-esteem mood problems