1. Health Psychology Health Psychology Chapter 12: The Role of Health Psychology in Heath Care Settings Nov 26-28, 2007 Classes #38-39

2. Patient Symptoms  Attentional Focus –Internal vs. External –Awareness vs. Unawareness  Athletes –Playing with pain – some can –Probably externally focused

3. Attentional Focus  Sensitizers –Actively monitor an aversive event and react to it –Scan themselves and environment –Seek out information and think about stress –Likely to seek help early  Repressors –Ignore then deny health related issues –Look through life with rose-colored glasses –“Don’t worry be happy” –Not likely to seek help early

4. Illness Representations  Our personal views on health and illness –Includes:  Identity of the illness  Causes  Timeline  Consequences  Controllability

5. Illness Identity: Patient’s Label and Symptoms PainNauseaBreathlessness Weight Loss Fatigue Stiff joints Sore Eyes Headaches Upset Stomach Sleep difficulties Dizziness Loss of Strength

6. Cause: Internal or External Reasons  How would you classify the following? –A germ or virus caused my illness –Diet played a major role in causing my illness –Pollution of the environment caused my illness –My illness is hereditary - it runs in my family –It was just by chance that I became ill –Stress was a major factor in causing my illness

7. Timeline: Course of the illness  My illness will last a short time  My illness is likely to be permanent rather than temporary  My illness will last a long time

8. Consequences My illness is a serious condition My illness is a serious condition My illness has had major consequences on my life My illness has had major consequences on my life My illness has become easier to live with My illness has become easier to live with My illness has not had much effect on my life. My illness has not had much effect on my life. My illness has strongly affected the way others see me. My illness has strongly affected the way others see me.

9. Control/Cure My illness will improve in time There is a lot which I can do to control my symptoms. There is a lot which I can do to control my symptoms. There is very little that can be done to improve my illness. There is very little that can be done to improve my illness. My treatment will be effective in curing my illness. My treatment will be effective in curing my illness. Recovery from my illness is largely dependant on chance or fate. Recovery from my illness is largely dependant on chance or fate. What I do can determine whether my illness gets better or worse. What I do can determine whether my illness gets better or worse.

10. Some influences on illness perceptions and seeking treatment  Personal experience –A patient’s prior experience with the illness is big factor on perception and sometimes symptoms –See Ruble (1972) study on PMS (page 365)  Age –Child: yes –Elderly: yes –Everyone else: no  Gender differences –Women: yes –Men: no  See page 367 for some clear gender difference examples

11. Some influences on illness perceptions and seeking treatment  Socioeconomic Status –If you’re sick do you get help?  High SES – yes  Low SES – no –Why is this the case?  Cultural Factors –Lay Referral System  Likely to be used by those not trusting traditional Western medicine

12. Delay Behavior  Safer (1979) –Appraisal delay –Illness delay –Behavioral delay –Scheduling delay –Treatment delay

13. Misusing Health Services  Lets look at two “abnormal psych” illnesses –Somatization Disorder –Hypochondrasis  Both of these are in DSM-IV

14. Somatization Disorder  Diagnostic Criteria –To be diagnosed a person must have reported at least the following:  Gastrointestinal symptoms (2)  Sexual symptoms (1)  Neurological symptoms (1)  Pain (4 locations)  These symptoms cannot be explained by a physical disorder

15. Somatization Disorder  Key point: –It’s a chronic, recurrent, multi-symptom syndrome… here are some… –Vomiting, abdominal pain, nausea, bloating, diarrhea or constipation, pain in arms or legs, back pain, joint pain, pain during urination, headaches, shortness of breath, fainting, fatigue, palpitations, chest pain, dizziness, amnesia, difficulty swallowing, vision changes, paralysis or muscle weakness, sexual apathy, pain during intercourse, etc. etc. etc.

16. Somatization Disorder  Sex difference –F > M –Primarily a female disorder with about 1% suffering from this disorder  Onset –Usually by age 30 but its seen from childhood on up

17. A typical scenario…  Typically, patients are dramatic and emotional when recounting their symptoms, often referring to them as "unbearable," "beyond description," or "the worst imaginable"  Patients become extremely dependent in their personal relationships  They increasingly demand help and emotional support and may become enraged when they feel their needs are not being met  They are often described as exhibitionistic and seductive and self-centered  In an attempt to manipulate others, they may threaten or attempt suicide

18. These patients “doctor-shop”…  Often dissatisfied with their medical care, they go from one physician to another… –What would be a recommended route for these patients to choose insofar a medical/mental health care is concerned???

19. They usually don’t go and further than their General Practitioner…  Bottom line: –Psychologists and psychiatrists rarely manage the majority of patients with somatoform disorders -- this difficult undertaking falls predominantly on general practitioners

20. Hypochondrasis  Unrealistic belief that a minor symptom reflects a serious disease  Excessive anxiety about one or two symptoms  Examination and reassurance by a physician does not relieve the concerns of the patient  They believe the doctor has missed the real reason

21. Hypochondrasis  Symptoms adversely affect social and occupational functioning  Diagnosis is suggested by the history and examination and confirmed if symptoms persist for at least 6 months and cannot be attributed to another psychiatric disorder (such as depression)

22. Hypochondrasis  Gender difference –More common in women than men (I couldn’t find any stats though)  Onset –Usually in 30’s –But seen in all age groups

23. Other Misuses of Health System  Malingering –Secondary benefits of playing the sick role –They are faking it –Its hard to separate those telling the truth (for example chronic fatigue syndrome) from those that are not –Unless of course you see someone whose receiving workman’s comp playing tackle football at the park

24. But will they follow doctor’s orders?  Factors Predicting Adherence  Good Mood  Perceived Control  Preference for Treatments  Provider Variables  Degree of Difficulty  Communication

25. Patient-Provider Communication  Problems include: –Initial consultation too vague –Lack of info –Felt rushed –Patients listening –Prejudicial Patient Stereotypes –Might also have to do with attachment styles  Secure individuals show the highest amount of confidence and trust in their doctors

26. Health Care System  Defined as all activities whose primary purpose is to promote, restore, or maintain health  The U.S. is the only major industrialized nation in the world lacking government-run or subsidized universal health care  In the United States, around 84% of citizens have health insurance, either through their employer (60%), purchased individually (9%), or provided by government programs (27%)  Certain publicly-funded health care programs help to provide for the elderly, disabled, children, veterans, and the poor, and federal law ensures public access to emergency services regardless of ability to pay.  Americans without health insurance coverage at some time during 2006 totalled about 16% of the population, or 47 million people

27. Some recent changes…  Managed Care –HMOs –PPOs  Higher Costs

28. Hospitalization  Patient dissatisfaction  Medical errors  Loss of control  Depersonalization

29. Control is key…  Preparing for Hospitalization –Need to increase:  Informational Control  Cognitive Control  Behavioral Control

30. Credits  http://www.leeds.ac.uk/lihs/documents/presentations/chronic%20illness%20ma nchester2.ppt#1 http://www.leeds.ac.uk/lihs/documents/presentations/chronic%20illness%20ma nchester2.ppt#1 http://www.leeds.ac.uk/lihs/documents/presentations/chronic%20illness%20ma nchester2.ppt#1