PSYCHOSOCIAL EVALUATION AND TREATMENT IN CHRONIC RESPIRATORY DISEASES

1. PSYCHOSOCIAL EVALUATION AND TREATMENT IN CHRONIC RESPIRATORY DISEASES Prof Behcet Coşar M.D. Gazi Uni. School of Med. Psychiatry Dep Consultation Liaison Psychiatry Unit

2. HUMAN • Bio • Psycho • Social

3. COPD is a severe andtreatmentresistantpulmonarydiseasewithvaryingimpact on thepatients’ • general physicalcondition, • functioning • quality of life.

4. Theassociationbetweenchronicrespiratorydisordersandpsychiatricdisorders, in particulargeneralizedanxiety, panicanxietyanddepression, has beenacknowledgedformanyyears. • Theprevalence of psychiatriccomorbidity in thesepatients as well as theeffect of treatmentandtheprognosis ???????

5. There is evidence that psychiatric comorbidity contributes significantly to the functional impairment of COPD patients • Psychiatric treatment may improve not only psychiatric status but also pulmonary function

6. Patients react emotionally to the discomfort of dyspnea, the loss of functional capacity and the threat of suffocation and death.

7. Dyspnea, likepain is subjective, clearlyinfluencedbyemotionalandpsychiatricfactors • Dyspneamay be felt as a sensation of suffocationand is overwhelminglyfrightening.

8. MAIN PSYCHIATRIC FINDINGS • Depression • Anxietyandpanic • Sexualdysfunction • Cognitiveimpairment

9. Depression • Depression can rangefrom a • Milddysthymia • Adjustmentdisorderwithdepressedmood • to a majordepressiveepisode.

10. Anxiety and Panic • Panicdisorder, subsyndromalpanicandexpectationanxietyoftenaccompaniestherespiratorysymptoms

11. Sexual Dysfunction and Cognitive Impairment • Inhibitedsexualexcitement • Inhibitedorgasm • Prematureejeculation • Cognitiveimpairmentgenerally in geriatricpatients

12. Sexual dysfunction Cognitive impairment Depression Anxiety Muscle tension Shortness of breath Chronic worry Palpitations Nausea Numbness Fear of loosing control Fatigue Weight loos/gain Sleep disturb. Agitation Irritability Difficulty concentrating Thoughts of death Depressed mood Loss of interest Motor retardation Hopelessness Low self-esteem

13. Importance of Psychiatric Symptomatology (I) • Patientswithstablechronicobstructivepulmonarydisease (COPD) whoshowsignificantsigns of depressionmayalsohave an increased risk of mortality • COPD patientswithdepressivesymptomshave a significantlyhigher risk forexacerbations. • Neuropsychologicaldysfunction is generallyevident in problem-solvingdeficits

14. Importance of Psychiatric Symptomatology (II) • Impairedquality of life andrestrictedactivities of dailyliving • Cognitivedeficits; a) difficulty in monitoringtheintensity of theirsymptoms b) reducedadherencetotheirmedications c) poorquality of life

15. Early secreening and diagnosis!!!!!!!! • How???????? • Mini MentalStatusExamination • HospitalAnxietyandDepressionScale • Clinicalinterviewaccordingto DSM IV-TR

16. PSYCHOSOCIAL EVALUATION • A thoroughassessment of boththepatientsandthefamilytodeterminewhetherteherarespecificpsychodynamicconflicts, behavioraltriggers, orenvironmentalissuesthatcontributetoexacerbation of therespiratoryillness

17. PSYCHOSOCIAL EVALUATION I • Asthmahavebeenproposedtohave a significantpsychosomaticcomponent • Somesomaticcomplaintsmayresultfrombehavioralconditioning • Clasicallyitsknownthatseparationanxietytriggerstheasthmaticattacks.

18. PSYCHOSOCIAL EVALUATION II • Developmental life stageduringwhichthepatientdevelopsrespiratorydisease is important • Childrenwith severe respiratorydisease • percievedandtreateddifferentlybyfamilyandfriends • significantalterations in therelationshipwithmother • latersusceptibilitytothetrauma of seperationorotherpsychologicalimpairments

19. PSYCHOSOCIAL EVALUATION III • Experience of fear of drowning + • Frequenttripstotheemergencyroom • Pervasiveanxiety

20. PSYCHOSOCIAL EVALUATION IV • Middleagedoroldagedpatients • Long-standingplansdisturbs • May resultswithdepression • High risk of suicideandanxiety

21. PSYCHOSOCIAL EVALUATION V • COPD patientsrestrictsbothactivating (anger / anxiety)andnonactivating (depression / withdrawal) affectstoavoidtheexperience of dyspnea. • A “personalitytrait” mayresultfrombehavioralreactionstotheillness, ratherthan be a cause of illness

22. SOCIAL COGNITIVE THEORY • Perceived self-efficacy is a persons’ appraisal of his or her abilitytoperformeffectivelyorcompletely in a designatedsituation • A strong sense of self-efficacy is necessaryfor a sense of personalwell-being • Allowsforpersevering in effortstowardsuccess

23. SOCIAL COGNITIVE THEORY I • Self-efficacyexpectationsvary on 3 dimensionsthathave an importanteffect on performance • 1) Magnitude:Level of difficulty of thetask. Someindividualsmayfeelcapable of performingonlysimpletasks (i.e., low-magnitudeexpectations), whereasothershavefeelingsorcompetencyaboutperformingcomplextasks (i.e., high-magnitudeexpectation). • 2) Generality:Theextentthat a domain of behaviour can be generalizedtoothersituations. Forexample, ifpatientswith COPD aresuccessfully in performing an activity (such as stairclimbing) whensupervised, theymayanticipatebeingsuccessfulwhenperformingtheactivityunsupervised. • 3) Strength:Theconfidenceindividualshave in theaccomplishment of a specifictask

24. SOCIAL COGNITIVE THEORY II • Theobjectives of structurededucationcan be formedtoincreaseexpectations of self-efficacytherebyassistingpatients in theireffortstomanage, oravoid, breathingdifficultywhileengaging in certainactivities.

25. SOCIAL COGNITIVE THEORY III • Self-efficacy is enhancedorinfluencedbyfourdifferentmechanisms. • 1) Masteryexperience • 2) Modelling • 3) Socialpersuasion • 4) Judgement of bodilystates.

26. EDUCATION • Illness • Drugs • Apparatus • .......

27. THE TRANSTHEORETICAL MODEL (TTM) • Usedtodescribethedynamicprocessbywhichindividualscometoadoptandmaintainchanges in healthbehaviors. • This model assertsthatindividualsmovethroughfivestages of motivationalreadinessforexerciseadoption

28. TTM-I

29. TTM-II

30. TTM-III

31. TTM-IV

32. TTM-V

33. Thankyou