26.12 - Psychological Aspects of Medical Practice

Question 1

What is the difference between illness and disease?

[IMPORTANT]

Answer 1

• Illness is a subjective perception of change in the structure or function of the body that gives rise to concern.
• Disease is objective observable abnormality in bodily structure or function.

Question 2

Give some experimental evidence for disease not being able to explain all illness.

[EXTRA]

Answer 2

(Henningsen, 2007):

• Found that approximately 1/3rd of illness in a secondary care setting cannot be explained adequately by an underlying disease

Question 3

What are the different types of factor that can contribute to illness?

Answer 3

Question 4

Give some examples of how biological factors can influence illness.

Answer 4

• Physiological changes (e.g. cardiovascular and muscular effects of bed rest)
• Neurophysiological changes (e.g. sensitisation in chronic pain)

Question 5

Give some examples of how psychological factors can influence illness.

Answer 5

• Fears and beliefs (e.g. ‘my dad died when he got chest pain so maybe I will too’)
• Focussing of attention on symptoms (e.g. ‘I need to monitor my chest pain carefully’)
• Low or anxious mood (e.g. I feel really depressed and anxious about dying)

Question 6

Give some experimental evidence for how common depression is as a comorbidity in cancers.

[EXTRA]

Answer 6

(Walker, 2014)

Question 7

Give some experimental evidence for how comorbid depression affects people’s perception of illness.

[EXTRA]

Answer 7

(Moussavi, 2007):

• Found that for common conditions such as angina, the mean “health” rating that patients gave themselves was lower in patients with the condition and depression, compared to a patients with just the condition

Question 8

Give some examples of how social factors can influence illness.

Answer 8

• Common cultural beliefs (e.g. ‘Chest pain is dangerous’)
• What other people say (e.g. ‘My son had that and he died’)
• What doctors say (e.g. ‘It is probably nothing…………but take the medicine just in case.)

Question 9

What is iatrogenesis?

Answer 9

When medicine or treatment does harm.

Question 10

What are some examples of iatrogenesis?

Answer 10

• Physical iatrogenesis (e.g. adverse effects of medical treatment)
• Psychological iatrogenesis (e.g. illness worsened as a result of anxiety about what the doctor said)
• Social iatrogenesis (e.g. ‘medicalisation’ of common illness in our society)

Question 11

Describe the components of a biopsychosocial formulation of illness. Who came up with the idea?

[IMPORTANT]

Answer 11

For each of the biological, psychological and social realms in an illness, we must consider:

• Predisposing factors (those that predispose to the illness)
• Precipitating factors (those that trigger the illness)
• Perpetuating factors (those that cause the illness to continue)

(Engel, 1977)

Question 12

For a patient with unexplained chest pain, complete a biopsychosocial table of example factors.

Answer 12