Principles and Methods of Psychosomatic Approach to Asthmatic Patients

1. Ψ Principles and Methods of Psychosomatic Approachto Asthmatic Patients Prof. I. B. Iamandescu MD, PhD, BA Psychol, Chairman of Health Psychology (Behavioral Medicine) and Psychosomatics Department “Carol Davila” University of Medicine and Pharmacy, Bucharest

2. Bronchial Asthma - psychosomatic disease • 1. Multifactorial etiology organ specific psychological (distress and conditional reflexes) • 2. Double vulnerability - organic - bronchial - psychological - anxiety, irritability, depression (frequently illness-induced) • 3. Fluctuating evolution (attacks and relapses) - among triggering factors: psychological stress QOL • 4. Somatopsychic kickback psychological disorders psychotherapy • 5. Favourable influence of psychotropic drugs

3. Algorhythm of psychosomatic approach to asthmatic patients • 1. Identification of all triggers of asthma symptoms; • 2. Isolation of psychological trigger; • 3. Biography and personality traits of the asthmatic patient; • 4. Quality of life (QOL) assessment; • 5. Supportive or “special” psychotherapy applied by different specialists; pharmaceutical agents • 6. Therapeutic Compliance (Adherence) versus new life style • 7. Patient’s education – ensures a good therapeutic compliance (adherence)

4. The psychological factor’s participation in asthma • 1. The triggers of clinical manifestations are (according to patient’s opinion): - allergic exclusively among them psychic factors - unspecific (some) without psychic factor’s participation • 2. The influence of psychological factors on the disease is: - continnous (possible “psychogenic life context”) - discontinnous (possible intermittent psychic trigger); • 3. Life stressing context (biography, inclusively): - events quantified by Holmes-Rahe Scale or Lindemann Scale - the possible link (parallelism) between disease course and “life changes” (Kourilsky method)

5. The impact of asthmaon the psyché and QOL of the patient • 1. Somato-psychic recoil troubles to specific dyscomfort; • somato-psychic troubles; • behavioral changes; • 2. Quality of life indicators (of psychological nature) + social insertion of the asthmatic patients, both affected by the illness; • energy / fatigue SF - 36 • physical function AIR - index • mental health Juniper questionnaire (for asthma) • emotional role • social function • allergen avoidance • Psychological reactions to the possible repetition of “asthma attacks”

6. Psychotherapy in asthmatic patients • 1. Psychic stress prevention or mitigation; • 2. Social integration improvement; • 3. Effective influencing of symptoms of asthma

7. Biography of an asthmatic patient • 1. Mechanisms of Ego-edification • 2. Relation between aspirations / possibilities levels (K.Lewin) familial supportive • 3. His insertion profesional adversive problems • 4. His mechanism of copying to stress - centered on emotion - reanalyse of situation • 5. The quality of prior physician – patient relations

8. Personality type of asthmatic patients • 1. Classical specific personality type of asthmatic ( Fl. Dunbar ) type is not valid - MMPI and Rorschach results evidentiated polymorphous traits - many asthmatics have also Hypertension, Ulcer, Urticaria and other psychosomatic diseases; • 2. Varied personality traits converted into general stress vulnerability - these personality traits are dominated by anxiety and depression (often secondarily induced ); - the same traits are present also in other psychosomatic diseases (type A behavior inclusively) • 3. THE AMPLITUDE OF STRESS VULNERABILITY OF ASTHMATIC PATIENT IS INTERMEDIATE BETWEEN NEUROTICS’ ONES AND HEALTHY SUBJECTS’ ONES. (Iamandescu, 1980)

9. Patient’s education • OBJECTIVES PSYCHOLOGICAL FACTORS AntiGINA 1. Asthma attacks treating by himself anxiety/ hopelessness/ depression 2. Daily PEF monitorizing motivation(lazy/ chaotic life style/ type A behavior) 3. Prevention of triggers allergic (visits, pets, etc.)/non specific (physical and chemical iritants, exercise, tC, etc.) 4. Therapeutic planning - cognitive factors: QI, memory - affective factors: depression - volitional factors: determination

10. Supportive psychotherapy • Applied by Objectives - Physician Distress’ prevention and (allergologist, GP) mitigation - Nurses, Students Attacks’ control (Ascona Modell) • PeculiaritiesTherapeutic compliance (partenership relation) • -“Dum spiro, spero”- type • - realistic and competent information; Asthmatic patient’s behavior - accessible to each allergologist; (risk factors) • - improves therapeutical compliance and QOL; • - increases pharmacological action of asthma drugs; • - partnership with the patient for healing and Socio - familial integrationimproving the disease’s course.

11. Ensurance of optimaltherapeutic compliance (a) Principles and methods of inducing optimal therapeutic compliance (adherence) • Partnership between physician and patient; • Insistence on psychological factors implied in patient monitoring and his effective participation in the therapy strategy; • Vigilance to the QOL by therapy and interdictions (pets e.g.) in children asthma; • Clear and simple explanations about illness and treatment; • Written indications; • Involvement of patient family and of therapeutical team.

12. Ensurance of optimaltherapeutic compliance (b) • The attitude of an asthmatic patient Psycho - social factors versus pharmaceutical agents abuse a) - high compliance Psychological influence dependence - physician’s prestige - patient himself - other’s people - social factors refuse b) - low compliance withdrawal Life style / hobbies

13. 4. Neuro – Psychiatric Disturbances • Somato – psychic troubles / behavioral modifications • - phobias / compulsive reactions; • - cognitive troubles (attention, e.g.); • - anxiety / depression; • - sleep disturbances; • - anger; • - AD/HD; • - irritability (itching e.g.); • - behavioral changes.