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Dr. Amal Yassien HaikalLecturer of psychiatryFaculty of medicine-Mansoura University

Psychological impact of

chronic illness

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The cognitive appraisal of external events in relation to one’s coping resources & its physiological responses in

the individual.

Definition of stress:

Chronic illness is considered as a stressful event.

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• eustress optimal arousal for task performance

• stressful higher arousal, distress & deterioration of performance

Primary appraisal: “event”

• sufficient successful coping• insufficient vulnerability

Secondary appraisal:

“coping resources”

Cognitive appraisal

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factors that increase or

decrease the effects of

stress.

mediators that protect from

unhealthy effects of

stress

Stress

mediators

Stress Buffers

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Emotional reaction to

chronic illness

Personality ”type A/B”

Social support

Spiritual support “Belief in afterlife”

Cognitive appraisal

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Anxiety

Depression

guilt, anger

Psychiatric

disorders

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• Fear of death , surgery , disfigurement, dependency, incontinence, severe pain

• more in young patients

Anxiety

• Fear of loss, separation from family• Loss of physical activity• Changes in physical appearance• The effect of surgery• Debilitating effect of radiotherapyDepression

(5-15%)

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• Guilt from dependency, excessive demand

• Illness represented to the patient as a punishment for previous wrong doings

• Anger displaced to medical staffGuilt

& anger

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Denial• Adaptive (calms patient)• maladaptive (refuse medical care)

Dependency• adaptive (comply with ttt)• maladaptive (burden on caregiver)

Displacement anger towards medical staff

Acceptance• role of staff through good

communication

Defense mechanisms

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Stages of emotional reaction to chronic

illness

Denial & isolation “Something is wrong, shock”

Anger “Why me? displaced….

Bargaining (partial acceptance)

Depression “hopelessness, isolation, sleep problems

Acceptance

not necessa

rily occur

in same se

quence;

nor take sa

me

duration

Indications for referral to

psychiatrist

Depression

AnxietyPersonality changes

Treatment By Physic

ians &

psychiatri

sts

13pain management stress management coping skills increasing family communication

Multimodal interventions using a variety of techniques but with same general goal

help patients adjust to their illness and take a more active approach

Psychological

Interventions

Chronic illness involves more than physical symptoms. There are the psychological and emotional symptoms as well.

The psychological effects of chronic illness can be profound.

Chronic illness can strongly disrupt social life and put strains on social support networks.

Individuals with chronic illness are more likely to be depressed, especially those who experience greater levels of pain and disability.

Take home

message

Emotional disturbance “e.g., depression” interferes with compliance to ttt and worsen prognosis

Patients who become unmotivated to improve their illness-related coping tend to have greater numbers of hospital admissions and poorer health.

There is substantial diversity in individuals’ adjustment to chronic disease magority: positive adjustment minority: significant distress or life disruption.

Take home

message