Understanding successful community living by individuals with serious and persistent mental illness.

34 volunteers diagnosed as chronically mentally ill were administered a questionnaire to evaluate what factors were important in preventing rehospitalization. The volunteers were divided into two groups based on their relapse history. Analysis showed the nonrelapse group were more likely to attribute factors such as in-home therapy, taking medication, and having fun with friends than did the group who had experienced at least one relapse in the past 24 months.     

Understanding the relationship between attachment style, pain appraisal and illness behavior in women

Insecure attachment has been hypothesized to be an important factor for understanding the experience of pain. Considering the Attachment-Diathesis Model of Chronic Pain developed by Meredith, Ownsworth, and Strong (2008), this cross-sectional study examines the relationship between attachment style, pain appraisal, and illness behavior. Two hundred healthy women recruited from community contexts completed a battery of self-report measures including the Short-form McGill Pain Questionnaire, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Vigilance and Awareness Questionnaire, Illness Attitude Scales, Beck Anxiety Inventory, Beck Depression Inventory, and the Experiences in Close Relationships Questionnaire-Revised. The results showed that attachment anxiety was significantly correlated with pain catastrophizing, pain-related fear, depression, and illness behavior. However, attachment anxiety and avoidance were not associated with pain intensity. Attachment anxiety moderated the relationship between pain catastrophizing and illness behavior, and between pain hypervigilance and illness behavior. Pain catastrophizing and pain-related fear partially mediated the effect of attachment anxiety on illness behavior. The findings highlight potential contributions of attachment style and pain appraisal for explaining illness behavior. This study supports earlier reports and suggests the usefulness of assessing attachment style for early identification of people who might exhibit a high risk of dysfunctional responses to pain. Our findings also suggest that increasing people's insight about their attachment style and modifying some associated dysfunctional responses may be important in the treatment of chronic pain.     

Neurodevelopment and chronic illness: Mechanisms of disease and treatment

Successful treatment of many childhood diseases once considered terminal has resulted in the emergence of long-term effects of the disease or consequences of treatment that were previously unrecognized. Many of these long-term effects involve the central nervous system (CNS) and are developmental in the way that they emerge over time. Because we are now able to observe the natural history of childhood diseases such as sickle cell anemia or HIV, or the consequences of treatment of disease such as leukemia, brain tumors, or kidney disease, we are also able to study a number of biological mechanisms that result in long-term neurocognitive impairment. While some of the neurodevelopmental outcomes can be directly linked to structural damage of the CNS, other systems (e.g., hematologic, immunologic, pulmonary) appear to play crucial indirect roles in the development of the CNS and neurocognitive abilities because of the way that they affect the course of brain development and activity of the brain across time. Important interactions between acute disease factors, biological mechanisms, age at the time of disease or treatment effect, and disruptions in patterns of development after successful treatment or management all provide support for a neurodevelopmental model of childhood chronic illness. Testing this model may make it possible to more accurately predict the timing and degree of severity of long-term neurodevelopmental consequences, provide guidance for improved treatment and prevention, and offer better understanding of neurodevelopmental disruptions that occur in other non-chronic illness related disabilities.     

Understanding smoking after acute illness: An application of the sentinel event method

The sentinel event theory provides a stepwise approach for building models to understand how negative events can spark health behaviour change. This study tested a preliminary model using the sentinel events method in a sample (N = 300) of smokers who sought care for acute cardiac symptoms. Patients completed measures on: smoking-related causal attribution, perceived severity of the acute illness event, illness-related fear and intentions to quit smoking. Patients were followed up one week after the health event and a seven-day timeline follow back was completed to determine abstinence from tobacco. Structural equation models were performed using average predictor scale scores at baseline, as well as three different time anchors for ratings of illness severity and illness-related fear. Quit intentions, actual illness severity and age were the consistent, positive and independent predictors of seven-day point prevalence abstinence. Additional research on the influences of perceptions and emotional reactions is warranted.     

Harmful dysfunction, disorder, disease, illness, and evolution.

Can psychiatric disorders be conceptualized as "harmful dysfunctions" (J. C. Wakefield, 1992a, 1992b, 1999; S. O. Lilienfeld & L. Marino, 1995)? Wakefield's (1992a) central concept of disorder as "harmful dysfunction" is discussed by placing it in the context of a complementary discussion of disease, illness, the sick role, and evolution (D. F. Klein, 1978). S. O. Lilienfeld and L. Marino (1995) contended that proper biological function cannot be determined. This argument obscures the key significance of involuntary impairment of evolved functions. The claim that the Roschian concept has no counterpart in reality is incorrect and does not support the conclusion that dysfunctions are irreducibly evaluative and therefore arbitrary. J. C. Wakefield's (1999) views in this area are supplemented. The role of monothetic and polythetic categorization, extremal terms, and the concept of normality in nosology is considered. This analysis refutes the implication that deviance and illness are equivalent. The resolution of this debate is practically relevant to emphasizing areas of research investment, such as therapeutics.     

The relationship between illness perceptions and panic in chronic obstructive pulmonary disease

BackgroundElevated levels of anxiety and panic are common in respiratory disease. To date the cognitive-behavioural model of panic has been utilised to help explain and manage panic in respiratory disease. This cross-sectional study investigated the relationship between illness perceptions and panic in chronic obstructive pulmonary disease (COPD) within a self-regulatory framework of adaptation to physical illness.MethodsFifty-nine participants with COPD completed questionnaires measuring illness perceptions, anxiety and depression, frequency and severity of panic attacks and impact of disease on daily life and well-being. The percent forced expiratory volume in the first second (FEV₁%) was used as an objective measure of lung function.ResultsHigh levels of clinical anxiety and depression were reported (35% and 19% respectively). Sixty-three percent of participants reported experiencing a panic attack during the previous year and of these 51% during the previous month. Panic was unrelated to level of disease severity. Specific illness perceptions (beliefs relating to illness identity, timeline, consequences and emotional representations) were important in differentiating between panickers and non-panickers.ConclusionsThe results highlight the importance of assessing illness perceptions within the framework of the self-regulatory model to provide an additional theoretical perspective for investigating and managing panic in chronic respiratory disease.     

Managing stress and managing illness: Survival and quality of life in chronic disease

Interest has been steadily building in the impact of stress on psychological and physiological functioning, in particular on immune system responses, furthering the concept of a strong connection between the mind and the body. Implications for prevention of disease onset or treatment of stress-induced illness or immunocompromised conditions have been explored through the implementation of stress management techniques. Cognitive behavioral stress management interventions, biofeedback, relaxation, guided imagery, hypnosis, individual and group psychotherapy, aerobic exercise, and guided self-efficacy treatment are briefly reviewed to identify possible treatment mechanisms that may affect immune function and promote quality of life. The application of behavioral techniques to reduce distress and sharpen coping skills has great promise in reducing the costs associated with chronic disease and in enhancing quality of life among those afflicted.Presented at the APA Presidential Miniconvention, To Your Health: Psychology Through the Life Span, Session VIII, Assuring a Healthy Lifestyle: Psychology Delivers. Chair: Diane J. Willis, Ph.D. The third author received partial funding through the Terry Fox Research Fellowship 5257, National Cancer Institute of Canada.     

Understanding community re-entry of former prisoners with mental illness: a conceptual model to guide new research

Criminal justice, mental health, and social service professionals face a myriad of role expectations in working with prisoners with mental illness to facilitate community re-entry. These expectations include those related to law enforcement, social welfare, and administrative efficiency. The challenge for front line workers and the multiple systems that employ them is to integrate all these expectations effectively on behalf of the individual as well as the community. Current models of re-entry for individuals leaving prison with mental illness focus on the management and interaction of service systems. This paper presents a model of prisoner re-entry that incorporates a larger social context, illustrating dynamics related to both individuals with mental illness leaving prison and their interaction with the community setting. This model was generated through an interdisciplinary team effort. It was refined through a focus group process that included advocates, community members and other informants from mental health and criminal justice systems in five states. The model is designed to generate new questions for research that address both individual and community level issues.     

Understanding psychological distress in Meniere's disease: a systematic review

It has long been suspected that psychological disturbance is common in Meniere's disease (MD), but there has been no systematic review of research on this topic since 1977. The aim of this review was to investigate whether components of post-traumatic stress disorder (PTSD) or health anxiety contribute to distress, so that support and psychological therapy can be tailored better to the particular problems of people with MD. We systematically identified all studies of psychological factors associated with MD between 1977 and 2004. We then tabulated the findings from each of the 28 studies to match them to the components of PTSD and health anxiety. Levels of psychosocial impairment and distress were comparable to patients with similar illness. Evidence was found for some of the components of both PTSD and health anxiety. We conclude that more specific research into PTSD-like symptoms and health anxiety in MD is needed. There was a general lack of research into psychological mechanisms contributing to distress in this population, many studies had methodological weaknesses, and only one qualitative and one longitudinal study had been carried out.     

Understanding speaker attitudes from prosody by adults with Parkinson's disease

The ability to interpret vocal (prosodic) cues during social interactions can be disrupted by Parkinson's disease, with notable effects on how emotions are understood from speech. This study investigated whether PD patients who have emotional prosody deficits exhibit further difficulties decoding the attitude of a speaker from prosody. Vocally inflected but semantically nonsensical ‘pseudo‐utterances’ were presented to listener groups with and without PD in two separate rating tasks. Task 1 required participants to rate how confident a speaker sounded from their voice and Task 2 required listeners to rate how polite the speaker sounded for a comparable set of pseudo‐utterances. The results showed that PD patients were significantly less able than HC participants to use prosodic cues to differentiate intended levels of speaker confidence in speech, although the patients could accurately detect the polite/impolite attitude of the speaker from prosody in most cases. Our data suggest that many PD patients fail to use vocal cues to effectively infer a speaker's emotions as well as certain attitudes in speech such as confidence, consistent with the idea that the basal ganglia play a role in the meaningful processing of prosodic sequences in spoken language ( Pell & Leonard, 2003 ).     

Terminal illness and suicide

Case vignette: Henry, age 19, has been under medical care struggling for 5 months with a non-Hodgkin's lymphoma that has been resistant to treatment. Proven chemotherapy protocols have failed to sustain a remission, and it is evident that his condition is terminal, although not immediately so. When not in temporary remissions he is in extreme pain. The quantity of analgesic medication needed to control the pain also leaves him feeling, in his own words, "too snowed out to do anything." During his last hospital admission, a week ago, he had talked obliquely about ending his life when signs of another painful relapse become evident. Today he appeared in the outpatient clinic, although he had no appointment scheduled. He sought out several of the people who had cared for him over the past few months to thank them and to "say good-bye." He gave some prized personal possessions to one or two of the staff with whom he felt especially close. As this was happening, some of the staff members realized that Henry had a sufficient stock of narcotics at home to end his life. Our commentators are Sanford Leikin, MD, and Richard A. McCormick, SJ.