Illness Behavior In Patients Research Articles

S156. PUBLIC ATTENTION TO CRIME OF SCHIZOPHRENIA AND ITS CORRELATION WITH USE OF MENTAL HEALTH SERVICES IN PATIENTS WITH SCHIZOPHRENIA

BackgroundThis study was performed to examine the effects of the public attention to ‘crime of schizophrenia’ on the use of mental health services in patients with schizophrenia using big data analysis in Korea.MethodsData on the frequency of internet searches for ‘crime of schizophrenia’ and the patterns of mental health service utilization by patients with schizophrenia spectrum disorders by month were collected from Naver big data and the Health Insurance Review and Assessment Services in Korea, respectively. Their correlations in the same and following month for lagged effect were examined.ResultsThe number of outpatients correlated negatively with public attention to ‘crime of schizophrenia’ in the same month. The lagged relationship between public attention and the number of admissions in psychiatric wards was also found. In terms of sex differences, the use of outpatient services among female patients correlated negatively with public attention in the same month while the number of male patients’ admissions in both same and following month correlated positively with public attention.DiscussionThese findings suggested that public attention to ‘crime of schizophrenia’ could negatively affect illness behavior in patients with schizophrenia.

Self-reported illness behaviour related to chronic obstructive pulmonary disease and rehabilitation: a theory-guided qualitative study.

Illness behaviour effects the quality of life of patients with chronic obstructive pulmonary disease (COPD) but is scarcely described in literature. The aim of this study was to explore self-reported illness behaviour of patients with COPD, who have declined nonpharmacological rehabilitation. The study has a qualitative design using semi-structured interviews. The subsequent analysis is a theory-guided mapping of actions reported by the patients in order to manage symptoms. These actions are understood and categorised according to the styles of coping described by Alonzo. Four categories of illness behaviour are identified: containment of symptoms, coping with symptoms through formal and informal interventions, adjustment of situations through compensating and economising interventions and crisis coping by surrendering. The analysis shows that behaviour that may seem unhelpful from a healthcare perspective may seem rational in the everyday life perspective of the patient. Findings show that reluctance to participation in rehabilitation should not only be interpreted as lack of motivation or health literacy. In the patients' perspective, nonpharmacological interventions might be perceived as a threat that could tip the delicate balance of everyday life with severe COPD.

The mediating effect of health anxiety in the relationship between functional somatic symptoms and illness behavior in Chinese inpatients with depression

BackgroundFunctional somatic symptoms in depression disorder may cause inappropriate illness behavior hindering the treatment process. Health anxiety may play a role in this relationship, but few studies have examined it. The current study aimed to investigate the role of health anxiety in the relationship between functional somatic symptoms and illness behavior in patients with depression.MethodsThe present study recruited 323 hospitalized patients with depression to complete the Patient Health Questionnaire-15, Whiteley-Index-7, and Scale for the Assessment of Illness Behavior, then constructed a structural equation model to examine whether health anxiety mediated the relationship between functional somatic symptoms and illness behavior.ResultsThe results showed significant correlations between any two of the three variables of interest. More importantly, health anxiety played a partially mediating role (42.86%) in the relationship between functional somatic symptoms and illness behavior. Further analysis suggested that elderly patients reached higher health anxiety than younger patients when their functional somatic symptoms were mild.ConclusionsThese results highlight that health anxiety may mediate the influence of functional somatic symptoms on illness behavior. The implications of assessing and intervening in health anxiety in patients with depression were discussed.

Effectiveness of an Educational Physiotherapy and Therapeutic Exercise Program in Adult Patients With Hemophilia: A Randomized Controlled Trial

ObjectiveTo assess the efficacy of an educational physiotherapy home exercise intervention for physical improvement, pain perception, quality of life, and illness behavior in patients with hemophilic arthropathy. DesignSingle-blind randomized controlled trial. SettingHome. ParticipantsPatients with hemophilia (N=20) were randomly allocated to an educational intervention group or to a control group. InterventionsThe educational intervention was performed every 2 weeks over a 15-week period, and home exercises were carried out once a day, 6 days a week, over the same period. Main Outcome MeasuresJoint status was evaluated using the Gilbert scale; pain was assessed using the visual analog scale; illness behavior was evaluated using the Illness Behavior Questionnaire; and the perception of the quality of life was evaluated using the A36 Hemophilia-QoL questionnaire. ResultsWe observed significant differences in the intervention group and the control group for both quality of life and illness behavior. There was no significant improvement in joint status; however, an improvement was noted in terms of perception of pain in the ankle. ConclusionsA physiotherapy program based on educational sessions and home exercises can improve the perception of pain in patients with hemophilic arthropathy of the ankle. It improves some variables in the perception of the quality of life and illness behavior.

The Heterogeneity of Illness Behaviors in Patients with Medically Unexplained Physical Symptoms.

To investigate the heterogeneity of illness behavior in patients with medically unexplained physical symptoms (MUPS), we clustered patients in regard to their degree of engaging in different aspects of illness behavior and identified related variables with these behaviors. A sample of N = 224 patients attending treatment in primary care with a history of MUPS (at least two symptoms) was investigated by analyzing different aspects of illness behavior with the self-reported number of doctor visits during the last 6months and the Scale for the Assessment of Illness Behavior (SAIB; e.g., expression of symptoms). Two distinct clusters were identified by cluster analysis: a low (n = 106) and a high (n = 118) illness behavior clusters. The high illness behavior cluster exhibited a significantly higher rate of health anxiety than the low illness behavior cluster. Regression analysis revealed a particular effect of sex in the high illness behavior cluster: whereas being male was associated with increased illness behavior as measured by the SAIB, being female was linked to a higher number of doctor visits. Increased health anxiety was associated with the SAIB illness behavior in both clusters. Depression and anxiety did not show incremental associations with all aspects of illness behavior. Knowledge of the pattern of illness behavior in patients with MUPS enables us to improve psychological treatments that directly address specific aspects of illness behavior or health anxiety. Differences between sexes in illness behaviors require more differentiated consideration in future research.

The Influence of HIV, HCV and Inhibitors on the Quality of Life and Behavior of the Disease in Patients with Haemophilia: An Observational Study

Background: Inhibitors are the main complication in the treatment of haemophilia. A high percentage of adult patients were infected in past decades by HIV and HCV through factor concentrates. This study compared the quality of life of patients with hemophilia (QoL) and illness behavior in adult patients with haemophilia according to the development of inhibitors and HIV or HCV co-infection. Method: This is an observational clinical study. 69 adult patients with haemophilia participated. We used A36 Hemophilia-QoL and IBQ questionnaires to measure the QoL and illness behavior, respectively. The dependent variables were type and severity of haemophilia, type of treatment, development of inhibitors, HIV and HCV infection, or both. Results: We observed significant differences in the perception of QoL and illness behavior in patients according to the development of inhibitor and coinfection with HIV-HCV. We obtained four groups: the first and second group, which comprise 67% of the sample, exhibit behavior patterns indicating good adaptation to the disease and good QoL. The other two groups, which comprise 33% of the sample show behavior that is not well adapted to the disease, and poor quality of life. Conclusion: The development of inhibitors itself does not influence the quality of life and illness behavior in patients with haemophilia. Patients infected with HIV or HCV do not have a worse illness behavior compared to those uninfected. The development of inhibitors and HIV-HCV co-infection has a negative impact on quality of life and illness behavior in patients with haemophilia.

The Relationship Between Catastrophic Thinking and Hand Diagram Areas

To evaluate the relationship between the total area marked on pain and numbness diagrams and psychosocial factors (depression, pain catastrophic thinking, and health anxiety). A total of 155 patients marked painful and numb areas on separate hand diagrams. Patients also completed demographic, condition-related, and psychosocial (Pain Catastrophizing Scale, Patient-Reported Outcomes Measurement Information System Depression Computer Adaptive Test, and Short Health Anxiety Inventory) questionnaires. Bivariate and multivariable analyses were used to determine factors associated with total area marked on the pain and numbness diagrams. The total area marked on the pain diagram correlated with catastrophic thinking, symptoms of depression, and health anxiety. In multivariable analysis, catastrophic thinking was the sole predictor of marked pain area, accounting for 10% of variance in the hand pain diagram. The total area marked on the numbness diagram correlated with the interval between onset and visit, diagnosis, catastrophic thinking, and symptoms of depression. In multivariable analysis, the interval between onset and visit, a diagnosis of carpal tunnel syndrome, and catastrophic thinking were independently associated with total area marked on the hand numbness diagram. Catastrophic thinking was independently associated with larger pain and numbness areas on a hand diagram. This suggests that larger symptom markings on hand diagrams may indicate less effective coping strategies. Hand diagrams might be used as a basis for discussion of coping strategies and illness behavior in patients with upper extremity conditions. Diagnostic III.

Illness Behavior in Patients With Chronic Low Back Pain and Activation of the Affective Circuitry of the Brain

Patients with chronic low back pain (cLBP) show a range of behavioral patterns that do not correlate with degree of spinal abnormality found in clinical, radiological, neurophysiological, or laboratory investigations. This may indicate an augmented central pain response, consistent with factors that mediate and maintain psychological distress in this group. Twenty-four cLBP patients were scanned with functional magnetic resonance imaging while receiving noxious thermal stimulation to the right hand. Patients were clinically assessed into those with significant pain-related illness behavior (Waddell signs [WS]-H) or without (WS-L) based on WS. Our findings revealed a significant increase in brain activity in WS-H versus WS-L patients in response to noxious heat in the right amygdala/parahippocampal gyrus and ventrolateral prefrontal and insular cortex (at a VoxelPThreshold = 0.01). We found no difference between groups for heat pain thresholds (t(22) = -1.17, p = .28) or sensory-discriminative pain regions. Patients with cLBP displaying major pain behavior have increased activity in the emotional circuitry of the brain. This study is the first to suggest an association between a specific clinical test in cLBP and neurobiology of the brain. Functional magnetic resonance imaging may provide a tool capable of enhancing diagnostic accuracy and affecting treatment decisions in cases where no structural cause can be identified.

Physical dysfunction and nonorganic signs in patients with chronic neck pain: exploratory study into interobserver reliability and construct validity.

Repeated-measurement design. To explore interobserver reliability of the modified physical dysfunction severity (mPDS) as a measure for impairment of the cervical spine and the modified cervical nonorganic signs (mcNOS) as a measure for behavioral signs, and to explore construct validity of the mPDS and mcNOS. The PDS has been used for evaluation of treatment efficacy in controlled trials in primary care. The cervical nonorganic signs were developed to assess illness behavior in patients with neck pain. Two observers independently assessed the mPDS and mcNOS in 51 patients with chronic neck pain in an outpatient tertiary rehabilitation setting, with a 3-week interval between assessments. Interobserver reliability for total scores of the mPDS and mcNOS was expressed as an intraclass correlation coefficient. Interobserver agreement for individual mcNOS tests was calculated as absolute agreement and Cohen kappa. Construct validity was expressed as Spearman correlation between the mPDS and mcNOS with the Neck Pain and Disability Scale and numeric pain rating scale for pain. The interobserver reliability of the mPDS and mcNOS had intraclass correlation coefficients of 0.72 and 0.78, respectively. Agreement for individual mcNOS tests ranged from 63% to 88%, and kappa values ranged from 0.14 to 0.54. Correlation with the Neck Pain and Disability Scale was 0.26 for the mPDS and 0.49 for the mcNOS, and the correlation with the numeric pain rating scale was 0.32 for the mPDS and 0.37 for the mcNOS. Interobserver reliability of both the mPDS and mcNOS was acceptable. The interobserver agreement for the individual mcNOS tests ranged from poor to acceptable. Construct validity of the mPDS and mcNOS appeared satisfactory.

The illness behaviour is different in coronary and valvular patients after cardio-surgical operation

The way coronary or valvular patients behave after cardiac operation may be conditioned by pre-operative differences in the duration, complexity and psychological impact of the disease. Psychological reactions to illness after operation may affect adherence to rehabilitation, secondary prevention, quality of life and long-term outcome. Aim of this work is to evaluate whether the type of cardiac pathology is actually associated to differences in the illness behaviour of patients who underwent to cardiac operation. Methods: The Illness Behaviour Questionnaire (IBQ) and the Hospital Anxiety and Depression Scale (HADS) test were administered to 1323 patients admitted to our rehabilitative cardiology unit after coronary artery bypass graft (CABG, N=845) or valve replacement (VR, N=478). All patients have been operated on-pump and in sternotomy. We registered age, marital status (single/couple), and educational level (from 1=elementary degree to 4=university degree). Significance of differences between CABG and VR were assessed by Mann-Whitney test at p<0.05. The independence of results from the gender of the patients was evaluated by multivariate analysis. Results: The male gender prevailed among CABG patients (80%), not among VR patients (53%). There were no significant differences between CABG and VR in age (66.3 +0.4 vs. 65.1 +0.6 yrs, M +SEM), educational level (2.32 +0.03 vs. 2.28 +0.05), or in scores of anxiety (6.3+0.1 vs. 6.4 +0.2) and depression (5.6 +0.1 vs. 5.6 +0.2). By contrast, among IBQ scores (see table), psychosomatic concern was significantly higher in CABG while denial was significantly higher in VR. Multivariate analysis showed that these two significant differences were independent from the gender of the patients. View this table: IBQ scores by type of surgery Conclusions: Significant differences related to the type of pre-operative cardiac disease do exist between CABG and VR patients in the psychological response to illness. These differences may have relevance in the rehabilitative phase and in the clinical outcome after surgery.

Measuring Illness Behavior in Patients With Systemic Sclerosis

Illness behaviors (cognitive, affective, and behavioral reactions) among individuals with systemic sclerosis (SSc; scleroderma) are of clinical concern due to relationships between these behaviors and physical and mental quality of life, such as pain and symptoms of depression. Self-report measures with good psychometric properties can aid in the accurate assessment of illness behavior. The Illness Behavior Questionnaire (IBQ) was designed to measure abnormal illness behaviors; however, despite its longstanding use, there is disagreement regarding its subscales. The goal of the present study was to evaluate the validity of the IBQ in a cohort of patients with SSc. Patients with SSc (n = 278) completed the IBQ at enrollment into the Genetics Versus Environment in Scleroderma Outcome Study. Structural validity of previously derived factor solutions was investigated using confirmatory factor analysis. Exploratory factor analysis was utilized to derive SSc-specific subscales. None of the previously derived structural models were supported for SSc patients. Exploratory factor analysis supported an SSc-specific factor structure with 5 subscales. Validity analyses suggested that the subscales were generally independent of disease severity, but were correlated with other health outcomes (i.e., fatigue, pain, disability, social support, and mental health). The proposed subscales are recommended for use in SSc, and can be utilized to capture illness behavior that may be of clinical concern.

Illness attribution of patients with medically unexplained physical symptoms in China

The illness behavior of patients with medically unexplained physical symptoms (MUS) depends largely on what the patient believes to be the cause of the symptoms. Little data are available on the illness attributions of patients with MUS in China. This cross-sectional study investigated the illness attributions of 96 patients with MUS in the outpatient departments of Psychosomatic Medicine, biomedicine (Neurology, Gynecology), and Traditional Chinese Medicine in Shanghai. Patients completed the Illness Perception Questionnaire (IPQ) for illness attribution, the Screening Questionnaire for Somatoform Symptoms, the Hospital Anxiety and Depression Scale for emotional distress, and questionnaires on clinical and sociodemographic data. The physicians also filled out a questionnaire regarding the cause of the illness (IPQ). In contrast to previous research, both physicians and patients from all three areas of medicine most frequently reported "psychological attributions." The concordance between the physicians' and the patients' illness attributions was low. Emotional distress was an important predictor of psychological attributions. Further research should include large-scale studies among patients from different regions of China and qualitative studies to deepen our understanding of cultural influences on illness attribution.

The Cross-sectional Construct Validity of the Waddell Score

In 1980 the Waddell score, consisting of 8 non-organic or behavioural signs, was developed to measure illness behaviour in patients with low back pain. There is some debate about whether the Waddell score is a valid screening instrument for illness behaviour and psychological distress, or whether it merely reflects elevated pain levels and diminished functional physical capacities. The purpose of this study was to examine the construct validity of the Waddell score. In this cross-sectional study, a total of 20 hypotheses about the associations between the Waddell score and measures from different domains were formulated a priori, based on a Medline database search (1980-2010). These hypotheses were tested in a sample of 229 patients with chronic low back pain who attended an outpatient rehabilitation centre. The percentage of hypotheses that were confirmed for the association between the Waddell score and the domain pain was 100%, for the domain physical 80%, for the domain illness behaviour 80% and 50% for the domain psychological. Correlation coefficients and kappa values varied between 0.06 and 0.44 for the measures that were expected to be associated with the Waddell score. Most of our challenging a priori hypotheses were accepted, and the Waddell score was found to have satisfactory cross-sectional construct validity. However, the presence of Waddell signs does not indicate exactly what the specific problems are and must therefore be conceptualized and understood in the total clinical picture of the patient. The association between the Waddell score and measures from different domains is weak. The Waddell score cannot be regarded as a straightforward psychological "screener".

Alexithymia in fibromyalgia syndrome: Associations with ongoing pain, experimental pain sensitivity and illness behavior

ObjectiveAlexithymia, a lack of emotional awareness, is common in chronic pain patients. The aim of the study was to investigate the relationship of alexithymia to ongoing pain, experimental pain sensitivity, and illness behavior in patients with chronic musculoskeletal pain. MethodsSixty-eight women with fibromyalgia (age: average, 43.4 years; range, 19–72 years) completed self-report measures on alexithymia (20-Item Toronto Alexithymia Scale), ongoing pain [Visual Analogue Scale, Questionario Italiano del Dolore (QUID), Margolis], psychological distress (Center for Epidemiology Studies—Depression Scale, State–Trait Anxiety Inventory Form Y), and illness behavior (Illness Behavior Questionnaire). Psychophysical tests were performed to assess experimental pain sensitivity, including pain thresholds for mechanical (von Frey, tender point count) and thermal (heat, cold) stimuli, and cold pressor pain threshold and tolerance. ResultsAlexithymia “difficulty identifying feelings” (DIF) was related to higher ratings of the affective—but not the sensory—dimensions of ongoing pain (QUID) and to a lower cold pressor pain tolerance, while alexithymia scores were independent of all pain thresholds. Multiple regression demonstrated that alexithymia DIF ceased to uniquely predict affective ongoing pain when psychological distress or illness behavior was separately controlled for. Higher alexithymia DIF scores were predictive of hypochondriacal illness behavior, over and above what was explained by psychological distress and affective pain. ConclusionAlexithymia is associated with increased affective pain and hypochondriacal illness behavior. The former relationship is better explained, and possibly mediated, by psychological distress and illness behavior. The hypothesis of a generally increased sensitivity to unpleasant stimuli in alexithymic chronic pain patients is not supported by the data.

Illness behavior in patients on long-term sick leave due to chronic musculoskeletal pain

Background and purpose Methods for identification of patients with illness behavior in orthopedic settings are still being debated. The purpose of this study was to test the association between illness behavior, depressed mood, pain intensity, self-rated disability, and clinical status in patients with chronic musculoskeletal pain (CMP).Methods We examined 174 consecutive sick-listed patients (90 women). Musculoskeletal function was estimated by range of motion, muscle strength, and motor and sensory function. The degree of illness behavior was measured by Waddell signs (WS).Results WS were observed in 47/174 (27%) of the patients, 16% of whom manifested excessive illness behaviour. In general, more patients with WS were depressed (OR = 4.4; 95% CI: 1.8–11) and experienced greater pain (OR = 2.9; CI: 1.1–7.7). No abnormal physical function could be observed in two-thirds of the patients. Other predictive factors for manifesting WS at the clinical examinations were longer sick leave and previous full sick leave (p < 0.05).Interpretation Excessive illness behavior is related to psychological distress in patients with CMP and long-term disability. Thus, some patients may also require psychological assessment. Looking for WS during consultation is useful for targeting other factors that may be important in the diagnostic process.

Conducta del enfermo ante el dolor crónico

To describe the illness behaviour in patients with chronic pain. We conducted semi-structured interviews to 53 patients during 2000, in a tertiary care center. We explored their initial interpretations, responses and subsequent practices to chronic pain, until they received a diagnosis that satisfied them. Illness behaviour was determined by pain intensity and disability; beliefs regarding pain causes, trust in social networks, and quality and satisfaction with the health care systems. In terms of the decision to seek care, the first option was to go to the popular sector, followed by consulting a general physician, and as last resort, to go to a tertiary care center ("with a specialist"). Illness behaviour should be conceptualized as a process, which combines the use of different health care sectors by the same subjects, as a result of care provided sequentially by each previous sector.

Workers' Compensation and Litigation Status Influence the Functional Outcome of Patients With Neck Pain

The purpose of this study was to determine if workers' compensation (WC) and litigation status were associated with long-term functional limitation in patients with neck pain. Understanding what physical and psychologic variables are related to long-term functional limitation is an important aspect of clinical decision-making and understanding illness behavior in patients with neck pain. Seventy-nine patients reporting neck pain participated in this study. Of these, 27 had either a WC case or had injury-related litigation (WC=9, motor vehicle accident litigant=14, and personal injury litigant=4). Upon initial presentation to physical therapy and 12 weeks later, the patient's functional status was evaluated using the Neck Disability Index (NDI). An NDI score of 15 or more at 12-weeks was operationally defined as long-term functional limitation. Mean NDI scores at initial presentation and at 12-weeks were significantly higher for those with WC/litigation involvement (mean=18.9, SD=9.7) than for those without (mean=9.4, SD=7.3). Those with WC/litigation involvement also had a higher percentage of long-term functional limitation than those who did not have WC/litigation involvement, 70.4% and 19.2%, respectively. The odds for developing long-term functional limitation were 9.5 times greater for those with WC/litigation involvement than for those without. Results from this study suggest that patients with WC/litigation involvement exhibit more long-term functional limitation than patients who do not have WC/litigation involvement. These results underscore a need for future research in this area.

Analysis of Illness Behavior in Patients After “Failed” Antireflux Surgery

Patients complaining of problems after antireflux surgery may have differences in illness behavior that could influence the decision to perform a revision procedure or its outcome. A prospective comparative questionnaire survey of consecutive series of patients. University teaching hospital. Those undergoing esophageal pH and manometric studies from July 1, 2001, through July 1, 2004, for investigation of new or recurrent symptoms after previous antireflux surgery. There were 52 eligible patients, of whom 4 were excluded because of refusal to enter the study (n = 1) or communication difficulties (n = 3). Of the remaining 48 patients, 22 underwent revision surgery and 26 did not. These 2 groups were compared with 167 patients with primary gastroesophageal reflux disease investigated during the same period. Self-administered, validated illness behavior questionnaire completed after informed consent was obtained. Illness behavior categories derived from the questionnaire answers: general hypochondriasis, disease conviction, psychological vs somatic illness perception, affective inhibition, affective disturbance, denial, irritability, Whiteley index of hypochondriasis, affective state, and disease affirmation. There were no significant differences in illness behavior category scores between the 2 groups with postoperative problems and patients with primary gastroesophageal reflux disease. Patients with problems after antireflux surgery have an illness behavior profile similar to that in patients with primary gastroesophageal reflux disease irrespective of whether there is objective evidence of recurrent reflux disease.

Relation between prognosis and the quality of sleep,the quality of life,illness behaviour in patients with chronic fatigue syndrome

目的 探讨慢性疲劳综合征患者的预后与睡眠质量、生活质量及患病行为之间的关系.方法根据患者症状变化情况评定其预后;引入量表评定并比较好转与未好转患者的睡眠质量、生活质量及患病行为特点.结果 51例慢性疲劳综合征患者中,好转27例,未好转24例;匹兹堡睡眠质量指数中的7个因子、患病行为问卷中的4个因子及简明健康调查问卷(SF-36)的6个维度得分值两组间比较均有统计学差异(P<0.05或P<0.01).好转组患者的睡眠质量、生活质量状况好于未好转组患者;与好转组相比,未好转组患者的病感强;不良情绪明显.结论睡眠质量差、病感强、负性情绪明显会对CFS患者的预后转归产生不利的影响,也可能是CFS的危险因素。

Cognitive-processing bias in chronic pain: a review and integration.

Do patients with chronic pain selectively process pain- and illness-related stimuli? The evidence with regard to attention, interpretation, and recall biases is critically reviewed. A model is proposed to account for the findings in which it is suggested that biases in information processing in chronic pain are the result of overlap between 3 schemas: pain, illness, and self. With frequent repeated or continued experience of pain, the pain schema becomes enmeshed with illness and self-schemas. The extent of the enmeshment and the salient content of the schema determine the bias. A fundamental assumption is that all patients with pain selectively process sensory-intensity information. A clinical implication of the results is that processing biases that extend beyond this healthy and adaptive process to enmesh the self-schema with pain and illness schemas could maintain and exacerbate distress and illness behavior in patients with chronic pain.