Psychiatric aspects of general medicinePsychiatric aspects of chronic physical disease
Section snippets
The biopsychosocial model
The philosophical dualistic separation of mind and body was a feature of the biomedical models which dominated medical thinking for much of the 20th century. However, in 1977 George Engel proposed that to understand and respond to a patient’s suffering clinicians must simultaneously consider the biological, psychological and social dimensions of an illness.4 This model came to be known as the biopsychosocial model and is now central to the understanding and management of chronic medical
The role of ‘patient’
When a person is diagnosed with an illness they become a patient. This idea was famously conceptualized by Parsons’ notion of a ‘sick role’, in which an ill individual was exempt from normal social roles provided they undertook certain obligations, such as to seek professional advice and try to return to good health.6
Patients with a chronic illness are experts in their own illness and have a major role in the monitoring and treatment of any relapses. Some patients experience this increased
Treatment adherence
It has been estimated that as many as 60% of patients with a chronic illness are poorly adherent to treatment.8 There are multiple factors which may contribute to low levels of treatment adherence. Patients may not have received understandable instructions or may forget when they are meant to take medication. Many chronic illnesses do not have obvious physical symptoms, leading many patients to assume they do not need to continue to take medication. Sometimes patients may have difficulties
Stigma and the recovery model
In 1963, the sociologist Erving Goffman described how some individuals were disqualified from full social acceptance, or stigmatized, due to their ill health, behaviour or appearance, ‘their spoilt identity’.10 Individuals suffering with chronic diseases continue to suffer the consequences of stigma in a number of different ways. Some conditions are viewed differently from others; for instance, there is a societal widespread sympathy for people with breast cancer whereas diabetes is sometimes
Some specific chronic diseases
Psychiatric problems are relevant in all types of chronic disease. We have chosen four examples of chronic illnesses to demonstrate the way in which psychiatric and chronic physical health problems can interact.
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Cited by (22)
Old age depression: worse clinical course, brighter treatment prospects?
2018, The Lancet PsychiatryTranscranial Direct Current Stimulation as a Treatment for Depression in the Hemodialysis Setting
2016, PsychosomaticsCitation Excerpt :It is well established that depression is more common among those with chronic physical health problems and that these patients are often challenging to diagnose and treat.1,2
Depression and the older medical patient - When and how to intervene
2014, MaturitasCitation Excerpt :In addition to antidepressants and ECT, psychological treatments have also been shown to be effective in older depressed subjects, either as a stand-alone treatment or as a component of a stepped-care programme [7]. Developing physical illness in old age has long been recognised as a major risk for depression [8,9]. For example, Pfaff et al. [10] demonstrated that depression was 3–4 times more likely to occur amongst older adults with the highest number of medical comorbidities and the greatest level of functional impairments.
Associations between physical activity and mental health among bariatric surgical candidates
2013, Journal of Psychosomatic ResearchCitation Excerpt :After controlling for bodily pain and role limitations due to physical problems, associations between PA parameters and depressive symptoms were no longer significant. It is possible that they confounded the relationship (i.e., pain and physical health factors may have limited PA), while also independently increasing depressive symptoms [55]. However, it is also possible that pain and physical role limitations mediated the relationship between PA and depressive symptoms, given that PA participation can decrease pain and improve physical health, thereby lessening role limitations due to physical problems [56].
Common mental disorders and disability pension award: Seven year follow-up of the HUSK study
2010, Journal of Psychosomatic ResearchOvercoming barriers to diabetes care: Perceived communication issues of healthcare professionals attending a pilot Diabetes UK training programme
2010, Diabetes Research and Clinical PracticeCitation Excerpt :People with diabetes have to undertake many life-long self-care tasks, lifestyle modifications, and often make adjustments to aspirations, self-image, relationships, employment, and social activities [1], which can result in significant psychological distress [1,2].