other chronic illnesses Flashcards
• Degenerative disease of the brain
• Major source of cognitive disability around the
world
• Can only be diagnosed definitively by autopsy
– Plaques and tangles of nerve fibers in cerebral cortex and hippocampus
• Symptoms:
– Behavioral symptoms & memory loss
– Brain imaging can detect deterioration
alzheimer’s disease
– Early onset (
2 types of alzheimer’s
• Agitation and irritability, sleep difficulties, delusions, paranoia and suspiciousness, aggression, incontinence, inappropriate
sexual behavior, hallucinations
• Source of stress for patient and caregivers
behavioral problems of alzheimer’s
• Goal: slow progression
• Pharmaceuticals:
– Donepezil Slows loss of neurons from the hippocampus
– Mematine Improves cognitive measures
– Statins
– Neuroleptic drugsReduce agitation and aggression
• Behavioral interventions
– Sensory stimulation and reality orientation
– Identification and analysis of problem situations
– Environmental modification
alzheimer’s treatment
Even after patient has died caregivers still are
more distressed and immunocompromised than
non-caregivers
• Caregivers are more likely to be women,
especially daughters
• Help for caregivers
– Programs for caregivers provide knowledge and skills
– Support groups for caregivers
– Relief services
alzheimer’s effect of family
• Syndromes that are marked by the symptoms and disability they cause • but have no demonstrable tissue abnormality – Chronic fatigue syndrome – Fibromyalgia – Irritable bowel syndrome – Gulf War syndrome – Silicone breast implant syndromes – Chronic whiplash – Chemical sensitivity – Sick building
Functional Somatic Disorders
• At any given time, 50% of the population has a
____condition
• Can range from mild to severe
• Medical management of these conditions
accounts for ¾ of the nation’s health spending
• Most of us will develop at least one chronic
disability or disease, which may ultimately be
the cause of our death
chronic illness
– Involvement of the patient in all aspects of a chronic illness and its implications,
– Includes medical management, changes in social and vocational roles, and coping
self management of chronically ill
- Chronic illness is a stressor
- primary appraisal :It is appraised as a harm, threat, or challenge
- secondary appraisal: Are the coping abilities and resources sufficient?
emotional responses of chronic illness
• Defense mechanism by which people avoid the
implications of an illness
• common early reaction to the
diagnosis of a chronic illness
– This illness is not severe
– This illness will go away soon
– There will be few long term implications
denial
• Immediately after the diagnosis, denial can
serve a protective function
– Keeps patient from dealing with full range of problems posed by illness
– can reduce days in intensive care& side effects of treatment
• During the rehabilitative phase, denial may have adverse effects
– High deniers at this time show less adherence to treatment regimen
denial
common after diagnosis &increases when people:
– Are waiting for test results
– Are anticipating adverse side effects
– Are awaiting invasive medical procedures
• ____ high when
– Substantial lifestyle changes are expected
– People feel dependent on health care professionals
anxiety
• Assessment and treatment of ___may be
needed
• may increase over time
– Concern about possible complications
– Concern about implications for the future
– Concern about the impact of the disease on work and
leisure-time activities
anxiety
• When the acute phase of chronic illness has
ended
– Then full implications begin to sink in
– is common
– Often is debilitating
• Impacts symptoms experienced and the overall
prospects for rehabilitation or recovery
– Longer hospital stays or discharge to nursing homes
– Less like to maintain gains made in rehabilitation or to restore quality of life
– Exacerbates symptoms and complicate treatment
– Linked to suicide
• Treatment may reduce symptoms and improve functioning
depression
– Greater severity of illness – Pain and disability – Other negative life events, social stress, or lack of social support – Physical limitations early in illness – Psychological factors later in illness
what predicts depression
• Disabled individuals elicit ambivalence from
acquaintances
– Verbal signs may be of warmth, affection
– Gestures, body posture may convey rejection
• Distant relationships are more adversely
affected than are intimate relations with close
friends and family
chronic illness social interaction problems
Substantial strain on primary caregiver
– Typical ___r: Women in her 60s caring for an elderly spouse
– Also common: Care for parents and disabled children
• Role commonly falls to women
• at risk for
– Distress, depression, declining health
caregiving, caregiver role
• Chronically ill people may
– Perceive a narrow escape from death
– Reorder their priorities
– Find meaning in smaller activities of life
– Cancer samples had greater quality of life than nonill samples
positive changes
• Differs from therapy with patients who have
primarily psychological complaints
• Therapy is more likely to be episodic rather than continuous
– Chronic illness raises crises and issues intermittently
• Psychological defenses should be respected
rather than challenged
• Therapist should have a comprehensive
understanding of the illness and treatment
individual therapy for chronic illness
– Telling what to expect during treatment
• Forestalls anxiety
– Group coping skills training successful
• Enhances perceptions of control
– Therapy conducted over the telephone or internet
• Benefits patients by enhancing personal control
– Music, art, and dance therapies
• Improve patients’ responses to chronic illness
Brief Psychotherapeutic interventions
– To inform patients about the disorder and its
treatment
– To train them in methods for coping with the disorder and its corresponding limitations
patient education programs
