Illness Behavior In Patients Research Articles

Sex differences in illness beliefs and illness behaviour in patients with suspected coronary artery disease

The aim of this study was to explore sex differences in illness beliefs and behaviour in patients with suspected coronary artery disease (CAD). Twenty-eight patients, 16 women and 12 men, were interviewed. The results show that both men and women think of CAD as a `men's disease' and have equal knowledge of CAD risk factors. However, especially the men considered their own risk of developing CAD lower than their estimated probability of their own sex and as low as their estimated risk for women. Both men and women did not attribute their symptoms indicative of CAD to their heart. Women, especially those who did not attribute their symptoms to their heart, had a longer patient delay than men, although their symptoms were indicative of CAD. To conclude, men as well as women should be made more aware of their own risk of developing CAD and of the manifestation of CAD symptoms. Physicians could be encouraged to ask patients more explicitly and thoroughly about their illness beliefs, to check their knowledge and inform them about CAD.

Feminine Gender Role and Illness Behavior in Irritable Bowel Syndrome

The purpose of this study was to investigate the relationship between aspects of the feminine gender role and modes of illness behavior in patients with irritable bowel syndrome (IBS). Fifty IBS patients (34 women and 16 men) completed the Personal Attributes Questionnaire (PAQ), which assesses aspects of gender role, and the Illness Behavior Questionnaire (IBQ), which assesses components of illness behavior. The Communal Femininity subscale of the PAQ, which is characterized by traits of servility and subordination, showed a significant positive correlation with the Disease Conviction subscale of the IBQ, which is characterized by symptom preoccupation and rejection of physician reassurance (r = .55; p < .001). The Communal Femininity subscale of the PAQ also correlated positively with the General Hypochondriasis subscale of the IBQ, which is characterized by a high level of anxiety over one's state of health (r = .55; p < .001). These results suggest that characteristics of the feminine gender role, such as the nurturing of others before oneself, may influence the experience of physical symptoms by contributing to a heightened focus on physiological cues and by increasing levels of psychosocial stress.

The meaning of symptoms in 10 women with somatization disorder and a history of childhood abuse.

To understand the associated experiences and illness behavior in patients with somatization disorder and a history of childhood abuse. In-depth interviews were conducted with patients who had somatization disorder and a history of childhood abuse; qualitative content analysis was then performed. Patients were recruited from 2 primary care teaching practices. Physicians were asked to refer patients suspected of having both conditions, yielding 21 potential participants. Eight declined, and 3 did not meet standardized screening questionnaire criteria, yielding 10 women who participated in the study. Participants and nonparticipants had a similar range of socioeconomic variables. An analysis of the interviews yielded 22 themes. Seven themes relevant to understanding the link between illness behavior and abuse were the abuse experiences, emotional and behavioral reactions to the abuse, relationship of abuse to somatoform symptoms, relationship of abuse to health care use, attempts to tell about the abuse, relationships with physicians, and physician behavior. Childhood attempts to tell adults about the abuse resulted in threats of punishment, contributing to lifelong patterns of secrecy, even with physicians. Six women reported having childhood physicians who were family members, friends, or the abuser's physician, reinforcing their subsequent secrecy. The women reported that their current physicians denied their physical pain as adults, just as the abusers denied their emotional and physical pain in childhood. Seven women reported decreased health care use once they associated symptoms with abuse experiences. Nine women reported spousal abuse. Somatization and childhood abuse may involve a paradoxical pattern of hiding feelings and reality, while seeking acknowledgment of suffering. Patient insight may decrease health care use. Therefore, the exploration of patient experiences may be useful for women with somatization disorder and a history of childhood abuse. The risks of spousal abuse and denial and rejection in the physician-patient relationship could also be important.

Relation between psychiatric disorder and abnormal illness behaviour in patients undergoing operations for cervical discectomy

OBJECTIVETo test the hypothesis that depression in patients being considered for cervical disc surgery is associated with severe organic pathology. Secondly, to test whether depression and abnormal illness attitudes recorded...

Hypochondriacal fears and beliefs in obsessive-compulsive disorder.

The relationship of obsessions and compulsions with hypochondriasis is receiving increasing attention, but has not been substantiated by adequate research. The Illness Attitude Scales (IAS), which identify hypochondriacal patients, were administered to 30 patients with DSM-IV obsessive-compulsive disorder and 30 healthy control subjects matched for sociodemographic variables. All IAS scales were significantly higher in patients with obsessions and compulsions. However, there were no significant differences between patients and controls in the number of subjects whose symptom intensity exceeded a clinical threshold for hypochondriasis and disease phobia. Furthermore, hypochondriacal fears and beliefs were poorly correlated with obsessions and compulsions. The results suggest the presence of mild abnormal illness behaviour in patients with obsessive-compulsive disorder, unlike the situation in patients with panic disorder and depression.

Psychiatric and Psychosocial Concomitants of Abnormal Illness Behaviour in Patients with Cancer

Previous studies of medically ill patients suggest that abnormal illness behaviour (i.e. high hypochondriasis, disease conviction, dysphoria and irritability) is associated with depressive symptoms. The present study was carried out in order to examine more in detail the role of psychiatric and psychosocial variables in moulding abnormal illness behaviour in patients with cancer. Two-hundred and one newly diagnosed cancer patients were submitted to a semistructured interview to assess past and current psychiatric disorders (DSM-III-R) and social support. Self-report questionnaires were also given in order to evaluate psychological stress symptoms (Symptom Check List-90-R-SCL-90-R), external locus of control (ELC) and illness behaviour (Illness Behaviour Questionnaire-IBQ). A pattern of abnormal illness behaviour was shown in patients with a life-time history of psychiatric disorders (n = 33) and in those with a current DSM-III-R diagnosis (n = 101). IBQ dimensions were associated with SCL-90-R, ELC and low social support. The patients' tendency to deny life events other than cancer was related both to the progression of the illness and to their receiving chemotherapy. The study confirms the association between psychological disorders and abnormal illness behaviour and points out a role for personality variables (external locus of control) and low social support in favouring maladaptive responses to cancer.

Screening for abnormal illness behaviour.

A screening test for detecting abnormal illness behaviour in patients with somatic symptoms is described here along with its psychometric properties. This screening version of the Illness Behaviour Questionnaire (SIBQ) is derived from two subscales of the Illness Behaviour Questionnaire and has 11 items. The study was carried out on 78 consecutive patients with prominent somatic complaints and 22 normal volunteers. The SIBQ was administered to the subjects and the sensitivity, specificity and hits positive rates were computed for different cut-off scores. A score of 7 and above gave a sensitivity of 86%, a specificity of 83% and a hits-positive rate of 0.7537, and this seems the optimal cut-off score. The SIBQ may prove to be a sensitive screening instrument to detect probable cases of abnormal illness behaviour and especially useful for busy clinics or centres.

"Abnormal" illness behaviour in chronic fatigue syndrome and multiple sclerosis

To investigate the presence of abnormal illness behaviour in patients with a diagnosis of chronic fatigue syndrome. A cross sectional descriptive study using the illness behaviour questionnaire to compare illness behaviour scores and illness behaviour profiles of patients with chronic fatigue syndrome and patients with multiple sclerosis. A multidisciplinary fatigue clinic and a teaching hospital neurology outpatient clinic. 98 patients satisfying the Oxford criteria for chronic fatigue syndrome and 78 patients with a diagnosis of multiple sclerosis. Responses to the 62 item illness behaviour questionnaire. 90 (92%) patients in the chronic fatigue syndrome group and 70 (90%) in the multiple sclerosis group completed the illness behaviour questionnaire. Both groups had significantly high scores on the general hypochondriasis and disease conviction subscales and significantly low scores on the psychological versus somatic concern subscale, as measured in relation to normative data. There were, however, no significant differences in the subscale scores between the two groups and the two groups had identical illness behaviour profiles. Scores on the illness behaviour questionnaire cannot be taken as evidence that chronic fatigue syndrome is a variety of abnormal illness behaviour, because the same profile occurs in multiple sclerosis. Neither can they be taken as evidence that chronic fatigue and multiple sclerosis share an aetiology. More needs to be known about the origins of illness beliefs in chronic fatigue syndrome, especially as they are important in determining outcome.

Illness behaviour in patients with arthritis.

To determine if there are specific patterns of illness behaviour in patients with arthritis, and if abnormal patterns of illness behaviour are associated with withdrawal from trials of anti-inflammatory drugs, and to examine which aspects of illness behaviour are perceived by rheumatologist to be related to the disease process. The illness behaviour questionnaire (IBQ) was administered to 211 patients with rheumatoid arthritis (RA) and 107 patients with osteoarthritis (OA) participating in five drug trials of NSAIDs at the beginning of the studies, and was commented upon by 17 clinical rheumatologists. Factor analysis of 211 patients with RA produced a unique factor solution. RA patients were more preoccupied with their illness and its effects and worried more about their health than patients with OA. Patients who withdrew from drug trials showed behaviour patterns similar to those of chronic pain patients, and different from those of patients who completed the studies. When asked to account for a rheumatoid patient's response to the IBQ, rheumatologists focused on physical symptoms and did not recognise some of the psychological issues which patients saw as being relevant. We have demonstrated differences in illness behaviour between patients with OA and with RA. Patients withdrawing from drug trials of NSAIDs showed differences in illness behaviour compared with those successfully completing the trials. Rheumatologists underestimated the impact of the disease on their RA patients' psychological well being.

Patients with terminal cancer who use alternative therapies: their beliefs and practices

AbstractThis paper examines the extent to which patients who have been diagnosed as having terminal cancer choose to use non‐medical therapies. In particular it is concerned with the illness behaviour of patients who are receiving conventional cytotoxic drug and radiation treatments, who also decide to use a wide range of ‘alternative’ medications and therapies. The paper discusses the findings of a study of 152 patients with metastatic cancer that examined the extent to which they used alternative cancer therapies, as well as the beliefs and attitudes they have about their cancer, its treatment, and the practitioners providing that treatment. Four groups of users of alternative therapies, who differ according to their commitment to and the type of therapies they use, were identified. Results of logistic regression analyses indicate that those using alternative therapies were different in range of social attitudes. These differences were primarily their greater reported ‘will to live’ and desire for control over treatment decisions, and the differing beliefs they hold about their disease.

Symptom complaints, psychiatric disorder and abnormal illness behaviour in patients with upper abdominal pain.

Seventy patients presenting to the gastroenterologist with upper abdominal pain were examined by a psychiatrist to establish the presence of psychiatric disorder, illness behaviour and to record in detail their symptom pattern. The 37 patients who had no organic cause for their abdominal complaints were subdivided into those with and without psychiatric disorder. The former (21 patients) demonstrated more illness behaviour, they complained of more abdominal symptoms and their pain was both more severe and more persistent than in the patients with organic disease and those with non-organic illness who did not have psychiatric disorder. The latter group reported no symptoms of 'psychoneurosis' and should probably be regarded as a separate group if the aetiology of functional abdominal pain is to be clarified. Those with non-organic abdominal complaints who had psychiatric illness could be distinguished by the presence of three symptoms, namely depression, anxiety and fatigue. Detection and treatment of their psychiatric disorder might lead to a decrease in their symptomatic complaints and illness behaviour.

Experiences of depression and illness behavior in patients with intractable chronic pain.

Studied the relationships between depth of depression, anaclitic and introjective depressive experiences, and dimensions of illness behavior in 37 chronic pain patients. Depth of depression and degree of introjective depressive experiences showed similar positive covariation with a broad range of illness behavior: Namely, hypochondriasis, disease conviction, affective inhibition, affective disturbance, and irritability. The findings suggest that depression characterized by feelings of guilt, worthlessness, and self-doubt, rather than themes of abandonment, is associated differentially with disturbances in the illness behavior of chronic pain patients.

Utilization of medical services by psychiatric patients.

The relationship between medical and psychiatric utilization of services was examined in a two-year study of two groups of psychiatric patients: high users of psychiatric services (more than ten visits in one year) and low users of psychiatric services (ten or fewer visits in one year). The high-utilization group made more than 60 per cent of the total psychiatric visits in the two-year period, but only 21 per cent of the total medical visits. However, patients in this group increased their utilization of medical services when psychiatric utilization was reduced, raising the question of whether high-utilization patients tend to substitute medical visits for psychiatric visits. In contrast, patients in the low-utilization group were able to hold their medical utilization constant when they reduced psychiatric utilization. Analysis of factors influencing utilization patterns might allow illness behavior in patients to be predetermined and lead to better and more cost-effective health care.

Measurement of illness behaviour in patients on haemodialysis and awaiting cardiac surgery

A 34-item, self-administered questionnaire, designed to measure aspects of illness behaviour, was completed by 30 patients admitted for cardiac surgery. Analysis of the data from 27 of the items was carried out and a comparison made with results of a previous study of 30 patients undergoing long-term haemodialysis. Principal components analyses of the data from the two groups, both separately and combined, yielded ‘dimensions’ of illness behaviour defined by their patterns of factor loadings of items. Encouraging similarities were found between the cardiac and dialysis patients on 8 dimensions which were labelled: “hostility to illness as destructive enemy”, “distressing preoccupation”, “helpless non-involvement”, “positive appraisal and involvement”, “surrender”, “acceptance/rejection of illness”, “fight”, and “helpless dependence”. Differences between the groups generally corresponded with clinical experience.

Aspects of illness behavior in patients with facial pain

Results of recent studies have suggested that factors other than clinical signs and symptoms have a significant role in determining whether people seek treatment for perceived facial pain and mandibular dysfunction. The concept of "illness behavior" can be used to investigate this problem. Knowledge of a patient's illness behavior patterns helps enable the dentist to understand who seeks care for symptoms of facial pain and mandibular dysfunction; why the care is sought; the meaning of the symptoms to the patient; and the patient's response to treatment.

Patterns of illness behaviour in patients with intractable pain

A 52 item self-administered questionnaire was constructed to assess illness behaviour. It was administered to 100 patients referred for the management of pain that had not responded adequately to conventional treatment. Responses were factor analysed using principal component analysis and rotated to orthogonal structure. Seven meaningful factors accounting for 63·3% of the the variance were extracted and labelled as follows: general hypochondriacal factor, disease conviction factor, psychological vs somatic factor, affective inhibition factor, affective disturbance factor, denial factor and irritability factor. The significance of these dimensions of illness behaviour was discussed.