Emotional dimensions of chronic disease

Abstract

Emotional dimensions of chronic diseaseAdvances in research and the delivery of health care have reduced mortality from disease and extended life expectancy in developed countries.We are living longer, but are we necessarily living better?Those who would have died from their condition may now survive but there is the emotional cost of long-term treatment and medical surveillance to consider (for example, the patient who has had a liver transplant must then continue immunosuppression treatment).Such patients must cope with a chronic condition and yet the emotional dimensions of these conditions are frequently overlooked when medical care is considered.Concepts such as the "sick role" and "illness behavior" have helped us understand the impact of disease and are familiar to most clinicians.Yet challenges still exist in the recognition and management of the psychological and social dimensions of chronic illness. CHRONIC MEDICAL ILLNESS Mental illness developing from chronic diseasePatients with chronic conditions often have to adjust their aspirations, lifestyle, and employment.Many grieve about their predicament before adjusting to it.But others have protracted distress and may develop psychiatric disorders, most commonly depression or anxiety.A prospective study of general medical admissions found that 13% of men and 17% of women had an affective disorder. 1The proportion of patients with conditions such as diabetes or rheumatoid arthritis who have an affective disorder is between 20% and 25%. 2 Among patients admitted to the hospital for acute care and among patients with cancer, rates can exceed 30% 3 compared with a prevalence of depression in the community of about 4%-8%. 4t can be difficult to diagnose depression in the medically ill.Physical symptoms such as disturbed sleep, impaired appetite, and lack of energy may already exist as a result of the disease.Sometimes treatment for a medical condition (for example, the use of steroids) may affect the patient's mood, as may the disease process itself (for example hypoxia and infection in a patient with chronic respiratory disease may have a direct cerebral impact on mood).The functional limitations imposed by the disease may result in "understandable" distress, and some clinicians find it difficult to conceptualize such distress as a depressive disorder. 5Indeed, the distinction between an adjustment reaction and a depressive illness is often not clear.Clarification of the diagnosis may be aided by examining the patient's risk factors for depression-that is, whether they have a history of depression, a major functional disability, or pain.Other risk factors include adverse social circumstances, such as unemployment or financial strain, and a lack of emotional support. 6In elderly people