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Psychological Aspects of Illness

Psychological Aspects of Illness. Emotions Behaviors Cognitive States Psychiatric Disorders. Relevance for Physicians. Diagnosis Treatment Screening for Psychiatric Disorders. Role of Psychological Factors in Diagnosis and Treatment. History - Symptom Reporting Physical Exam

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Psychological Aspects of Illness

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  1. Psychological Aspects of Illness • Emotions • Behaviors • Cognitive States • Psychiatric Disorders

  2. Relevance for Physicians • Diagnosis • Treatment • Screening for Psychiatric Disorders

  3. Role of Psychological Factors in Diagnosis and Treatment • History - Symptom Reporting • Physical Exam • Blood Drawing • Other Diagnostic Procedures • Treatment • Compliance vs. Non-Compliance

  4. Emotional Responses to Illness • Anxiety - Fear - Panic • Sadness - Despair - Hopelessness • Irritability - Anger - Rage • Passivity - Helplessness • Relief - Happiness - Mania

  5. Problematic Behaviors in Response to Illness • Withdrawal - Social Isolation - School Refusal • Oppositional Behavior - Tantrums - Aggression • Head-banging - Self-Mutilation - Suicide • Attention-Seeking Behaviors

  6. Potential Cognitive Changes in Physical Illness • Impairments in Intellectual Functioning • Attentional and Learning Problems • Slowed or Racing Thoughts • Hallucinations and Delusions

  7. Potential Responses toChronic Illness • Denial • Why Me? or Why My Child? • Guilt • Feeling of Being “Different” • Fears of Disfigurement, Disability, Death

  8. Physical Illness as Risk Factor for Psychiatric Disorder • Psychiatric Disorders found in 20% or more of medically ill children • High Rates of psychiatric disorders in children with CNS impairments (ie., epilepsy, AIDS, Brain Tumors, Head Injuries)

  9. Approaches to Understanding Psychological Responses • Need for Conceptual Framework • Awareness of Risk and Protective Factors • Applications to Patient Care

  10. Conceptual Frameworks • Biopsychosocial Model • Developmental Models • Applications of Developmental Concepts

  11. Biopsychosocial Model: A Systems Approach to Disease • Biological Component - anatomical, biochemical and molecular substrates • Psychological Component - emotions, motivations, cognition • Social Component - Family, School, Community, including Medical System

  12. Developmental Approach: Basic Tenets • Development occurs as a continuous series of interactions between the child’s biological endowment and the environment • The child’s understanding of and psychological response to medical illness is contingent on his or her developmental level and environmental experiences

  13. Potential Effects of Illnesson Development • Regression from previous levels of mastery • Delay in Achievement of Developmental Landmarks - Emotional, Social, Motoric, Linguistic, Academic • Acceleration of Cognitive Understanding of Illness and Death • Neglect or Excessive Attention to Somatic Concerns

  14. Cognitive Development: Piaget • Sensorimotor Stage (Birth to 2 Years) • Pre-operational Stage (2 to 7 years) • Concrete Operations (7 to 11 years) • Formal Operations (11 years through adolescence)

  15. Applications of Developmental Concepts • Regression • Children’s Understanding of Illness and Death • Adolescents’ Sense of Invincibility

  16. Regression • Return to developmentally earlier mode of functioning - emotional, behavioral, cognitive, linguistic or motoric • Example: a 12 year old boy insists that his mother feed him and sleep in his room after he returns home from a hospitalization for a broken leg sustained in a bicycle accident

  17. Cognitive Understanding of Illness • Pre-operational Stage: “Immanent Justice” - illness as punishment • Concrete Operations (Early): “Contagion” • Concrete Operations (Late) and Formal Operations: Growing Understanding of Disease Mechanisms and Etiological Complexity

  18. Understanding of Illness: Examples • A 3 year old boy states that he has asthma attacks because he is “bad” • (concept of “immanent justice”) • A 6 year old girl states that she “caught” diabetes from her sister (contagion) • A 12 year old boy with diabetes describes the role of the pancreas and insulin in regulating blood levels of glucose

  19. Concepts of Death and Dying • Below Age 5: Fears of Abandonment, Lack of Awareness of Irreversibility • Ages 5 to 10: Confusion, Focus on body parts • Ages 10 to 15: Reality, Despair

  20. Concepts of Death and Dying: Examples • A 3 year old girl asks who will “take care” of her if she dies • A 6 year old boy wonders who he will be able to “eat ice cream” with in his grave • A 13 year old boy with osteosarcoma asks why he has to go to school since he is “going to die anyway”

  21. Mediating Factors in Emotional Response to Illness • Child Characteristics • Illness Characteristics • Family • School • Community • Health Care System

  22. Mediating Factors: Child Characteristics • Age • Sex • Developmental Level • Temperament • Previous Experiences

  23. Acute vs. Chronic Systemic vs. Local Disability Disfigurement Pain Restrictions on Activity Etiology Age at Onset Diagnosis Prognosis Mediating Factors: Illness Characteristics

  24. Mediating Factors: Family • Family Structure: Intact vs. Fragmented • Socio-economic Status • Family Members’ Previous Experiences • Supportive • Capacity for Collaboration with Treating Staff

  25. Mediating Factors: Other Environmental Variables • School • Peers • Health Care System

  26. Mediating Factors: Treatment Variables • Short vs. Long-Term • Invasive vs. Non-invasive • Frequency • Need for Hospitalization - Single vs. Multiple • CNS Effects • Other Side Effects

  27. Insulin-Dependent Diabetes Mellitus (Juvenile Diabetes) • Affects about 1 in 600 children below age 12 in North America • 11,000 - 12,000 new cases per year • 7 million people with Diabetes Mellitus in U.S.; 5 - 10% have IDDM

  28. IDDM: Management Issues • Need for Daily Monitoring and Treatment • Effects on Broad Range of Activities (Diet, Exercise, School, Social Situations) • Risk of Acute Crises (Seizures, DKA) • Uncertainty about long-term outcome

  29. IDDM: Cognitive Factors • Risk of Neurocognitive Impairments from Hypo- and Hyper-Glycemia and Seizures • Age of Onset and Duration • Role of Cognitive Understanding by Parents and Child to Disease Management and Control

  30. IDDM: Emotional & Behavioral Problems • Symptoms of Depression and Anxiety at time of diagnosis • Impairment in Self Esteem • Non-compliance with daily management regimen • Involvement in High-Risk Activities in Adolescence

  31. IDDM: Management Approach • Parent Education regarding the disorder • Child Education appropriate to age and developmental level • Involvement of School Staff • Psychotherapy and family counseling when indicated • Peer Support Groups - Local and National • American Diabetic Association • Juvenile Diabetes Foundation

  32. Emotional Aspects of Physical Disease: Management Summary • Assess child, family, environment • Know Illness Characteristics - onset, course, treatment side effects, prognosis • Identify Risk and Protective Factors • Formulate Developmentally Appropriate Plan for Child and Family

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