PSYCH 441 - Chronic Illnesses

Chronic illness

A chronic health condition is a persistent health problem that typically lasts for a year or longer, often requires continuous medical care, and usually cannot be completely cured but can be managed.

Examples:

• Diabetes

• Heart disease

• Asthma

Chronic illness does not always been it is severe, but it means it is persistent and ongoing.

Risk factors of chronic illness

• smoking

• poor nutrition

• physical inactivity

• excessive alcohol use

Social determinants of chronic illness

• poverty

• unsafe or unhealthy environments

• food insecurity, lack of access to enough food

• lack of access to quality education and jobs that pay livable wages

chronic illness and quality of life

• has several components such as physical functions, psychological status, social functions, and disease of treatment related symptoms

• focus is on how the disease or treatment interfere with activities in daily living

• understanding the impact of chronic heath diseases on quality of life is important because

  • it can pinpoint which problems are likely to emerge for patients with which disease

  • it can measure the impact of treatments

  • it can be more cost effective than other physical functioning measures

  • high quality of life can reduce the rate of illness progression

what are the emotional responses to coronary heart disease?

denial, anxiety, depression

denial

coping mechanism by which people avoid the implications of a disorder.

interferes with absorption of treatment information and compromises health.

anxiety

patients become overwhelmed by potential changes in their lives and the prospect to dying

can interfere with treatment

depression

complicates treatment adherence and medical decision making

experience pain more intensely

lack of social support might exacerbate the chronic condition

self-concept

a composite of self-evaulations regarding many aspects of life, which include body image, achievement, social functions and private self

physical self

body image: perception and evaluation of one’s physical functioning and appearance

body image can negatively affected in the presence of chronic illness

It has downstreamed psychological and physical consequences

achieving self

• chronic illness might impair vocational and avocational activities which might have negative impact on achieving self

  • achieving self is an important source of self-esteem and self-concept

social self

• social support is needed to deal with the demands of chronic illness

• increased worry about being abandoned among people with chronic illness

private self

• identity can be damaged

• a person may not feel like themselves after a chronic illness

• dreams, ambitions, plans for future might need to change

what are the three coping with chronic illness methods?

problem-focused coping, emotion-focused coping, maladaptive coping

problem-focused coping includes…

taking medication, diet, and exercise

emotion-focused coping includes…

seeking support, relaxation, mindfulness

maladaptive coping includes…

avoidance and substance abuse

patients’ beliefs about chronic health disorders

people with chronic health disorders often develop theories about how it arose:

cause:

• patients may blame stress, physical injury, disease-causing bacteria, and God’s will for their disorders

• self-blame can lead to guilt, self-recrimination, or depression

• blaming another person has negative consequences

controllability:

• patients who have a sense of control or self-efficacy with respect to the disorder are more adaptive

• experience of control or self-efficacy may prolong life

common challenges of chronic illness

physical

• fatigue

• pain

• functional limitations

psychological

• depression and anxiety

• loss of identity (I can’t do what I used to")

• uncertainty about the future

social

• work limitations

• financial stress

• strain on relationships

coronary heart disease

• number one killer in the United States

• illness cause by narrowing of coronary arteries

• temporary shortages of oxygen and nutrients cause pain, called angina pectoris, that radiates across the chest and arm

• severe shortages can result in heart attack

• may cause heart failure, where the heart does not pump blood as it should

CHD risk factors

• high cholesterol

• high blood pressure

• elevated levels of inflammation

• diabetes

• cigarette smoking

• obesity

• lack of exercise

metabolic syndrome

• helps predict heart attacks

• if individuals are diagnosed with three or more problems:

  • excess body fat centered around the waist

  • high blood pressure

  • low levels of HDL (why?)

  • difficulty metabolizing sugar (an indicator of risk for diabetes)

  • high levels of triglycerides (related to bad cholesterol)

What is the role of stress in CHD?

• cumulative effects lead to damage of the endothelial cells which enables lipids to deposit plaques, increasing inflammation

• not only initial reponses to stress but also reflected in a prolonged recover period

What is the role of gender in CHD?

one of the leading causes of death in women in developed nations

estrogen prevents early onset of CHD

• diminishes sympathetic nervous system arousal

• lowers incidence of high blood pressure and neuroendocrine and metabolic reponses

risk increases after menopause. There is an ongoing debate in the scientific field about estrogen replacement therapy and CHD

What is the role of negative emotions in CHD?

negative emotions increase risk for metabolic syndrome and CHD

depression: it affects the development, progression, and mortality from CHD

extreme excitement?

CHD Other personality and psychosocial factors

vigilant coping: chronically searching the environment for potential threat

social isolation: independently increases the risk of heart disease ranging from 16% to 31%

hypertension

• occurs when the supply of blood through the vessels is excessive

• it is a risk factor for other disorders like heart disease and kidney failure

• systole blood pressure lower than 120 is ideal

• mild hypertension: between 140 and 159

• moderate hypertension: between 160 and 179

• severe hypertension: high than 180

hypertension risk factors

• gender

• genetic factors

• emotional factors

• family environment that fosters chronic anger

• stress

hypertension treatment

• drugs

• low-sodium diet

• reduction of alcohol

• weight reduction in overweight patients

• exercise

• caffeine restriction

• cognitive behavioral treatments

cognitive behavioral treatments

• biofeedback

• progressive muscle relaxation

• meditation

• deep breathing and imagery

• anger management

stroke

results from a disturbance in blood flow to the brain

stroke warning signs

• sudden numbness or weakness of the face, arm, or leg, especially on one side of the body

• sudden confusion, trouble speaking or understanding

• sudden trouble seeing in one or both eyes

• sudden trouble walking, dizziness, loss of balance or coordination

• sudden, severe headache with no known cause

consequences of stroke

• motor problems

  • stroke almost always leads to increased dependence on others, at lease for a while

• cognitive problems

  • patients with left brain damage may have communication disorders, while people with right brain damage may be unable to process certain kinds of visual feedback

• emotional problems

  • patients with left-brain damage react to the disorder with anxiety and depression, while people with right-brain damage may seem indifferent to their situation, a condition know as alexithymia

stroke interventions

• medication

• psychotherapy

• cognitive remedial training

• movement therapies

• the use of structured, stimulating environments

type 2 diabetes

a chronic disease where the body makes too little insulin or cannot use it properly, causing blood sugar levels to remain high

characterized by:

• insulin resistance (cells don’t respond well to insulin

• relative insulin deficiency over time

• leads to chronically elevated blood glucose

potential health complications in type 2 diabetes

heart disease, blindness, damage to the blood vessel, kidney failure, diabetic neuropathy

symptoms of type 2

• frequent urination

• fatigue and dryness of the mouth

• irregular menstruation

• loss of sensation

• frequent infection of the skin, gums, or urinary system

• pain or cramps in legs, feet, or fingers

• slow healing of cuts and bruises

• intense itching and drowsiness

type 2 risk factors

• being overweight

• get little exercise

• have high blood pressure

• have a sibling or parent with diabetes (genetics)

• had a baby weighing over nine pounds at birth

• are a member of a high risk ethnic group which includes African Americans, Latinos, Native Americans, Asian Americans, and Pacific Islanders

type 2 management

lifestyle

• physical activity

• dietary changes

• weight management

• stress reduction

medical

• oral medications

• injectable therapies

• insulin

insulin patches

wearable technology that makes managing diabetes easier by automatically or as-need delivering insult, eliminating the need for daily injections