1. 1 Health Psychology Chapter 11: Other Chronic Illnesses Spring 2000 Mansfield University Dr. Craig, Instructor

2. Living with Chronic Illness §At any given time 1/2 population has a CI l a some point everyone will have a CI §Effects are far reaching l not just a personal problem, global effects Finance, person perception, re l difficult to conceptualize as long-term. Tendency to think in terms of disease and cure a la acute illness §Crisis Theory- a psychosocial “homeostasis theory” l Psychosocial effects are proportional to amount of disruption in personal/social functioning--- l crisis occurs when traditional coping methods are inadequate l a turning point for better or worse.

3. Patient Impact §Areas of impact: Social functioning physical function & pain mental functioning/processing §Revisiting Crisis Theory- What CI might produce the greatest and least impact? ( Degree of intrusiveness of symptoms more important than severity of disease in affecting patient lives!) §Hypertenstion (Low) HD and GI disorder (High) §Coping Skills- avoidance, social support seeking, deny/distance from illness, avoidance by substance abuse §Hopelessness and negative emotion common in CI but not so much in acutely ill

4. Family Impact of Chronic Illness §Often “dependent” relationships are required §Structural changes in relationship with CI parent l mother-daughter, father-son etc. (authority issues) l other family dynamics fear, loss of closeness §Treatment is not the major source of problem, rather it is differences in perceptions of the problem between patient and caregiver (family). §Sick children- emotional support often by mother l husband relationship may suffer anger, attentional issues, financial burden support groups often very helpful

5. Cardiac Rehab §Health psychologists implement supplemental programs to tradition rehab- l shown to lower mortality after coronary event §Ornish- a program that “reverses heart disease l diet: 10% of cals from fat l smoking cessation l communication/group work l relaxation techniques l physical activity §Psychosocial reactions l fear of death (50/50), depression/anxiety, sex fears, golf (?) l emotional support (particulary in first 6 months)

6. Cancer Impact §Personal: Isolation, change in appearance, time consuming; anger/dysthymia; helplessness/control §Social: change in relationship with friends and family (awkwardness, distance) §Long term l returning to normal functions l specter of cancer looms after treatment l marital difficulties and divorce rate higher §Psychology’s role: pain mgmt, relaxation techniques, active coping skills, social support groups.

7. Diabetes- Two types §Type I: Insulin-dependent l early onset l non SES correlates l 5% of diabetics l requires lifestyle changes such as diet, exercise etc, but not caused by lifestyle l requires insulin injection §Type II: Non- Insulin Dep l usually l usually after 30 years l overweight/sedentary l middle class/lower mid l 95% of diabetics l can be handled without insulin with lifestyle changes and diet Inadequate Insulin Supply from Islet cells of the pancreas

8. Medical Risks of Diabetes & Health Psych §Damage to blood vessels l more prone to CVD and hypertension §Damage to retina (17x more likely to go blind) §Kidney disease (renal failure, dialysis) §Cancer of the pancreas (2x the risk) §ROLE OF HEALTH PSYCH l handle the emotional reaction fear (esp with children) stress & metabolic control denial of problem l help with adjustments in lifestyle/compliance education, symptom recognition, optimistic bias

9. Health Psychology and AIDS §AIDS-- gradual loss of immune system effectiveness  comes from 2 strains of the HIV virus §death rates declining sharply, but still killed 70K in 1996 l on reason: awareness of transmission and lifestyle relationships §Health Psychology l encouraging protective measures (condoms, gloves) l educating about patterns of high risk conditions/behaviors (clustering effects) l coping with AIDS l medicinal regimens

10. AIDS Transmission §Direct contact with semen or blood of infected individuals §1.Male-Male Sexual Contact l still leading source of AIDS transmission in US l intercourse or oral §2. IV drug use (dirty needles) §3. Heterosexual Contact (leading source in Africa) l male to female 8x more likely than vice-versa §4. Birth process (15-30%) of children born to HIV positive mothers

11. Alzheimer's Disease §Degenerative cognitive, emotional and behavioral impairment “plaques & tangles” of neural fibers in the hippocampus and cerebral cortex early and late onset “forms” of AD 10% of people over 65 show some symptoms 47% over 85 show some symptoms depression common (as you might expect) §Progressively Lowered Stress Threshold l minimize stress and fatigue §Caregiver support