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BEHAVIORAL AND PSYCHOLOGICAL RESPONSE TO

ILLNESS

Disease precipitant
- Anatomical or physiological change which arises from
several possible causes (disease agents)
- + Management plans follow the etiologic agent.

Host defenses
- Properly react and manage, no disease
- Overwhelmed or overreact, disease begins [to set in]

Disease Process
- Features of host defense & disease agent interaction,
which remains purely anatomical, physiological or
behavioral
- + can occure with patient not knowing ( late admission)

Illness
- Personal features of a disease
- Patients perceive illnesses
- Subjective in nature

Illness Behavior
- Complex of patient behaviors in reaction to the
development or continuation of an illness
- Patients reaction to being sick
- Behaviors of person who feels ill to relieve the experience
or to better define the meaning of the illness experience
- + Aspects of illness behavior have sometimes been termed
the sick role, or the role that society ascribes to people who
are sick

Determinants of Illness Behavior:
1. Biological predispositions
2. Nature of symptomatology
3. Learned patterns of responses
4. Assumed cause of illness
5. Situational influences
6. Characteristics of the health care system

+ The following is not in ppt, just nice to know.

These factors can greatly influence the attitude of the patient in
seeking medical care.

Assessment of Individual Illness Behavior (From Kaplan and old
trans)

Prior illness episodes, especially illnesses of standard severity
(childbirth, renal stones, surgery)
Cultural Degree of stoicism
Cultural beliefs concerning the specific problem
Personal meaning or beliefs about the specific problem

Particular Questions to ask to elicit the patients explanatory
model:
What do you call your problem? What name does it have?
What do you think caused your problem?
Why do you think it started when it did?
What does your sickness do to you?
What do you fear most about your sickness?
What are your chief problems that your sickness has caused
you?
What are the most important results you hope to receive from
treatment?
What have you done so far to treat your illness?

Components of Illness Behavior
1. Psychological and behavioral reactions to the illness
[+ We will focus on this component]
2. Social or external changes with the care providing
system (+ support networks)

Steps in an Illness
1. Initial perception that something is wrong
2. Patient decides something is wrong and labels himself
sick
3. Decision to seek professional care (socioeconomic
decisions)

Reactions to Illness
1. Lowered self image loss, grief
2. Threat to homeostasis fear
3. Failure of self care shame, guilt
4. Sense of loss of control- help/hopelessness

Clinical Behaviors
1. Anxiety
+ Worry about side effects, fear, ask many questions
2. Denial
+ May be adaptive
3. Depression
+ Loss, grief, helplessness, hopelessness, patient may
be giving up
4. Bargaining and blaming
5. Regression
6. Isolation
7. Dependency
8. Anger
+ May affect management of patient
9. Acceptance
+ Ideal, realistic expectation




Predictors of Reaction to Illness
1. Past reaction to loss
2. Prior illness experiences
3. Cultural attitudes and beliefs



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Common Clinical Problems
1. Depression and Mania
2. Cognitive and Neurobehavioral changes
3. Adjustment and coping difficulties
4. Changes in Body Image
5. Non Adherence to Treatment
6. Loss and Bereavement
7. Anxiety
8. Substance Related Problems
9. Sleep Difficulties
10. Sexual Dysfunction
11. Behavior Issues
12. Pain
+ Note: Important to also get feedback from other people who
interact more often with the patient

Coping with Illness
1. Acceptance facilitates mature strategies for coping
with illness
2. Taking control finding new ways to regain control and
increase self esteem
3. Benefitting from others cooperating care givers,
deepening personal relationships and expanding
support networks

Strategies to Cope with Illness
1. Gain knowledge
+ Accurate and up-to-date information
2. Plan ahead
+ Chronically ill patients: Prepare and tell them and
their families what to expect; help them settle their
affairs
3. Exercise positive thinking (most especially for
pessimistic patients)
+should be tempered with realistic information and
expectations pt. should be realisic and compatible to
otheir situation and expectation.
4. Look for solutions to problems
+ Encourage patients to share problems in order to help
them find solutions
5. Widen and utilize social support system
+ Physicians, family, friends and other sources of
comfort
6. Acceptance of physical changes
7. Understand self and needs
8. Express feeling
9. Reasonable degree of assertiveness
+ Help patients to have more sense of control of their
own condition
10. Humor
11. Spirituality


Dealing with Pain
1. Explain nature of pain signal
2. Explain degrees and causes of pain
3. Explain expected effects of medications including side
effects
4. Maximize effects of medications with higher initial
doses and reinforcing positive effects
5. Relieve concomitant anxiety if any
+ avoid drug dependence , make pt understand that
there are other ways of managing pain aside from
medications.


Dealing with Chronic Pain
1. Eliminate doubts about availability of medications
2. Do not make medications contingent on proof of need
3. Focus also on healthy materials and other issues, not
only on pain
4. Do not make contact with care system contingent on
pain
+ Make contact even if not in pain