ILLNESS AS A STRESS AND COPING WITH ILLNESS

AAM. AMJATHMEDICINE4TH BATCH

FHCS.

Stress• A state of mental or emotional strain or tension resulting from adverse or

demanding circumstances.

• Not always harmful.

• A particular amount of stress is beneficial and healthy also.

• Positive stress:

• Improve performance

• Motivation

• Adaptation

• Excess stress: lead to many harmful effects

Distress: Stress due to an excess of adaptive demands placed upon a person.

Eustress: The optimal amount of stress, which helps to promote health and growth

Components of psychological response to stressful circumstances

• Emotional response

• To threat: fear

• To loss: depression

• Somatic response

• Autonomic arousal (HR , BP , Muscle tone , dry mouth)

• Reduced physical activity

• Difficulty in recall and numbing (absence of feeling about events)

• Coping strategies

• Adaptive

• Maladaptive

• Culturally determined

Strategies for coping with stressful experiences• Adaptive

• Avoidance

• Working through problems

• Coming to terms with situation

Effective in short and long term

• Maladaptive

• Excess use of alcohol and drugs

• Histrionic or aggressive behaviour

• Deliberate self-harm

Short term but may lead to difficulties in longer term.

Associated disorders• Acute stress disorders: symptoms last 2 days – 4 weeks.

• Post-traumatic stress disorder: last 4 weeks or longer

Some illnesses which cause stress• Cancers

• Stroke

• CVS illnesses (MI etc..)

• Some skin conditions (Acne, psoriasis…)

• STD (HIV, Genital herpes…)

• Headaches (Migraine, cluster…)

• Insomnia

Physical illness as a stressor• Physical illness may lead to

Anxiety

Depression

Anger

• Short lived

• Subsides when pt adjusts to new situation

• Stressful effect of illness can’t be judged solely by objective severity, because it also depends on patient’s appraisal. (may lead to false assumption)

Determinants of stress/psychological impact of physical illness

• Illness factors

1. Pain

2. Threat to life

3. Duration

4. Disability

5. Conspicuousness of others

Determinants of stress/psychological impact of physical illness

• Treatment factors

1. Side effects of medication

2. Uncertainty of outcome

3. Self care demands

4. Some unpleasant Tx such Major surgery, chemotherapy and radio therapy

Determinants of stress/psychological impact of physical illness

• Patient factors

1. Psychological vulnerability

2. Social circumstances

3. Beliefs about illness and Tx

• Reaction of others

1. Family

2. Employers

3. Doctors and others involved in care

Coping to physical illness• Illness behaviour: the manner in which individuals monitor the structure and

functions of their own bodies, interpret symptoms, take remedial action, and make use of health care facilities.

• It includes:

• Seeking medical advice

• Taking medications

• Accepting help

• Giving up activities

• At 1st illness behaviours are adaptive but if they persist too long, they may become maladaptive.

Coping to physical illness

• The sick role: The protective role given an individual who is physically or mentally ill or injured; it may be assumed by the individual or it may be imposed as a part of social custom.

• Society allow sick people to adopt a special role.

• Two privileges and two duties.

• Exemption(freedom) from some responsibilities

• The right to help and care

• The obligation to seek and cooperate in Tx

• The expectation of a wish to recover and efforts to achieve this

• Usually adaptive

Treatment….• When adjustment to physical illness is slow and incomplete, Tx is given

• By primary care or hospital team

• Clinicians:

• Explain nature of illness and its Tx

• Discuss about pt’s anxiety Effect of illness in family

Threat of job loss

• Treat the maladaptive behaviours (overdependence/poor adherence) Counselling is effective

Take more time to achieve good relationship

But trusting relationship must not be allowed to become one of dependence

COPING TO TERMINAL ILLNESS• After Dx patients get some emotional symptoms

• Anxiety

• Depression (disease, Tx, separation from loved one)

• Confusion (due to delirium: by dehydration, drug S.E, 2ry to infection)

• Guilt

• Anger

• Some adopt to maladaptive way of coping

• About half in hospital who are dying due to terminal illness have emotional symptoms.

• Young > Old

• Less common in religious

Response of pt to terminal illness1. Denial

• 1st reaction to news

• It diminishes gradually when pt get to know about situation

2. Displacement

• Anger about the situation may displaced to doctors, nurses and relatives

3. Dependency

• Common

• Adaptive

• Excessive: make Tx more difficult

4. Acceptance

• Final stage of adjustment in terminal illness

TREATMENT..• Control of the pain and confusion

• Explain the illness and treatment

• Sharing information

• Help for relatives

• Special nursing: Given by terminal care nurses who are skilled in psychological as well as physical care of the dying.

• Referral to psychiatrist:

• Indications:

1. Doubt about the psychiatric Dx

2. Previous psychiatric disorders

3. Refuse to discus the illness

4. Refuse to cooperate with treatment

THANK YOU