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7/23/2019 Health, Illness & Behaviour 2
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12/27/15 1
HEALTH, ILLNESS
AND ILL BEHAVIOR
Dr. Santosh kumar
Assistant Professor
Dept. of Psychiatry
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P A T I E N T
Importance of Patient
PATIENT
Primary importance
in our life
All learning &
teaching
Ultimate goal—
To treat patient
Treat the patient
Not the illness
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H E A L T H
!"# $efinition %
"ealth is a state of complete physical' mentalan$ social (ell )eing an$ not merely the
a)sence of $isease or infirmity. * Important components of health are % Physical fitness
Psychological (ell )eing Appropriate social relationships E+pecte$ le,el of functioning
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Disease , Illness and Illbehavior Disease is a characteristic grouping of
physical signs an$ symptoms' it is gi,en a
specific name an$ can often )e trace$ to a
specific causal agent.
Eg. -iral "epatitis
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Disease , Illness and Illbehavior Illness is a )roa$er term that in,ol,es
peoples beliefs a)out the state of their
physical or psychological (ell )eing.
Eg % -iral "epatitis causing /aun$ice.
A person of hepatitis )elie,es that 0aun$ice is $ue to some supernatural 1
non human factors.
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Disease , Illness and Illbehavior Illness )eha,ior refers to the (ay' the symptoms are
percei,e$' e,aluate$' an$ acte$ upon )y the patient.
E+amples
Same patient of hepatitis seeking spiritual treatment fromfaith healers' instea$ of going to $octor.
A person' $iagnose$ as a case of Angina pectoris'refuses to take treatment (ith a )elief that he has got noillness an$ $oes not re2uire any treatment.
A person suffering from mil$ chest pain $ue to skeletalmuscle spasm paying fre2uent ,isits to a car$iacemergency' inspite )eing tol$ )y $octors that he has nocar$iac pro)lem
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Disease , Illness and Ill
behavior It inclu$es%
3onsulting $octors
Taking me$ications
4i,ing up inappropriate acti,ities
Seeking help from relati,es an$ frien$s
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Disease , Illness and Ill
behavior These )eha,iours are a$apti,e in the early
stages of illness' )ut may )ecome
mala$apti,e if persist into the stage of
reco,ery' (hen the patient shoul$ )e)ecoming in$epen$ent.
Illness )eh% results from the persons con,iction
that he is ill rather than from the o)0ecti,epresence of $isease' an$ it may $e,elop
(hen no $isease is not present.
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Disease , Illness and Illbehavior Illness )eh% (ithout $isease is an important
pro)lem in the general practice' an$ once
firmly esta)lishe$ it is $ifficult to treat.
The concept of illness )eh% o,erlaps (ith that
of sick role )ut t(o are $escri)e$ separately
)1c they ha,e $ifferent origins.
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Disease , Illness and Illbehavior Sick role% Society )esto(s a special role for the people
(ho are ill' (hich is ma$e up of t(o pri,ileges
an$ t(o $uties% E+emption from certain social responsi)ilities The right to e+pect help an$ care from others
The o)ligation to seek an$ cooperate (ithtreatment
The e+pectation of a $esire to reco,er
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Disease , Illness and Illbehavior !hile the person ill' the sick role is a$apti,e.
If people continue in the sick role after illness
is o,er' reco,ery is $elaye$ since they
continue to a,oi$ responsi)ilities an$ $epen$
on others instea$ of )ecoming in$epen$ent.
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Case No. 1 A young man consults his family physician for the
complaints of %
cough since one (eek
fe,er since three $ays
chest pain since one $ay
After e+amination' the $octor re,eals that he is suffering
from chest infection. "e prescri)es certain $rugs an$asks him to pay a follo( up ,isit after t(o $ays.
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Case No. 2 A 56 yrs ol$ man seeks treatment from a $octor for three
months history of nonspecific symptoms like hea$ache')o$y aches' (eakness' e+haustion' a feeling of
gi$$iness. "e has )een treate$ )y a num)er of $octors)ut his symptoms still persist. "e has also ha$ se,eralin,estigations $one in this regar$. After a thoroughphysical e+amination an$ a $etaile$ ,ie( of his reports'the $octor conclu$es that there is no physical
a)normality.. The patient $oes not get satisfie$ an$$eci$es to go for a secon$ opinion to another specialist7
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!hat is the $ifference in illness of the patient in case
no 8 & case no 9:
Is there a $ifference )et(een $isease' illness an$ ill)eha,ior :
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Somati;ation is the psychological mechanism
(here)y psychological $istress is e+presse$ in
the form of physical symptoms.In somati;ation' $istress is referre$ to' an$
e+presse$ )y' the )o$y mostly $ue to
un$erlying psychological factors.
S O M A T I Z A T I O N
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FACTS ABOUT
SOMATIZATION The pre,alence of somati;ation at the clinic of a
primary care physicians range$ from 86< to 56<
Somati;ation is consi$ere$ to )e more pre,alent inour culture as compare$ to $e,elope$ nationsreasons )einglo( socio economic status' illetracy'lack of a(areness a)out psychological illnesses'paucity of ,er)al e+pression of stresses
Somati;ation is more common in females an$chil$ren.
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HPOCHOND!IASIS !rong )elief or preoccupation of min$ (ith
the presence of a physical illness' (hich infact is not there.
No or minimal physical symptoms arepresent )ut patient ,isits fre2uently to$ifferent $octors' ho(e,er a )ackgroun$ may)e present.
Eg = A man (hose father ha$ $ie$ ofmyocar$ial infarction' recently' has got astrong )elief that he may $ie of same illness.
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CON"E!SION DISO!DE!
#H$s%eria& 3on,ersion Disor$er is a psychological $isor$er (herepeople e+perience motor or sensory symptoms that arepsychological in origin an$ cannot )e e+plaine$ )y ame$ical con$ition. E+amples
Su$$en )ut transient loss of speech Su$$en )ut transient )ut loss of ,ision >oss of sensation in some parts of )o$y >oss of po(er in some parts of )o$y Atypical fits
Un$erlying psychological factors are responsi)le
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Case No' ( #n getting up from )e$ an$ preparing to go
to school' a stu$ent of class t(o complains
that he is feeling se,ere pain in a)$omenan$ is una)le to go to school. The parents
feel he is not (ell an$ ask him to take some
rest. After a (hile his pain su)si$es an$ in
an hour or t(o he is happily (atching
cartoons..
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MALIN)E!IN)
?alingering is the act of intentionally feigning
or e+aggerating physical or psychological
symptoms for personal gain. Person is likely to get some gains or
e+emptions )y a$opting this fake )eha,ior.
-ery commonly seen phenomenon.
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O*r a++roah %o-ards a
o.+lain% / Imagine you ha,e a slight cramp in your
stomach
!hat attri)ution (ill you make: @(hy $i$ it
occur:
!hat (ill your self $iagnosis )e:
!hat (ill you $o a)out it:
!hat factors that influence your perception
an$ interpretation of symptoms:
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PERCEIVING & INTERPRETING
SYMPTOMS Bno(le$ge
Past e+perience
Personality
E+pectations
3ultural )eliefs
?oo$ Discussion (ith someone
Differences in point of ,ie(
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SOCIAL ACTORS!
a) AGE
<5 5-14 15-44 45-64 65-74 75+
N u m
b e r o
f D o c
t o r V i s i t s P e r
Y e a r
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"# Ge$%e
P e r c e n
t a
t i n !
" e a
# t $ a s
% E & c e
# # e n
t ' o r
% V e r (
G o o
) '
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O%her "ariables c ?arital Status :
$ e$ucation me$ical care increase$ (ith
e$ucation
e family si;e care $ecreases (ith increase$
si;e
f socioeconomic statuslo( socioeconomic
status is proportionate (ith in increase$$isease )ur$en an$ less care
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'(a) *a+)os %e)e-$e
)(e (ea-$ 0o+ess 3ultural $ifferences
Place)o effect Celiefs
aith healing
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DELAIN) "S'
TA0IN) ACTION
Notice
symptoms
Am I
ill?
Do I need
professional
care?
Is that care
worth the
cost?
Enter
treatment
Appraisal
delay
Illness
delay
Utilization
delay