Interdisciplinary View Cases of illhealth Dr Craig Jackson

Interdisciplinary View Cases of ill-health Dr. Craig Jackson Senior Lecturer in Health Psychology Faculty of Health BCU www. hcc. bcu. ac. uk/craigjackson

Traditional model of Disease Development Pathogen Modifiers Lifestyle Individual susceptibility Disease (pathology)

Biopsychosocial model of Illness Hazard Illness (well-being) Psychosocial Factors Attitudes Behaviour Quality of Life

Recap Sociology of ill health

Recap Psychology of ill health

Recap Physiology of ill health

Case #1 – Mrs Burroughs • 30 -year-old married woman • married 6 years • secretary in company • hospitalized about one month ago for pneumonia • responded well to erythromycin • discharged after 5 days • completed a 14 -day course of antibiotics • within 2 weeks of discharge, she noted: increasing shortness of breath & low-grade fever similar to what she had before she was hospitalized

Case #1 – Mrs Burroughs • • • history of asthma as a child (not had problems since) no history of heart disease, diabetes, allergies, lung disease in her family, or other ill family members who are currently ill denies any history of blood transfusions or sex outside of marriage has a 4 -year-old son not taking any medications except for paracetamol prn On interview with attending physician; possible recurrent pneumonia shortness of breath chest pain fever slight hypertension some skin rash

Case #1 – Mrs Burroughs AVENUES OF INVESTIAGTION – COMMUNITY EXPOSURES • • Home exposures General Consumer products smoking pesticides air fresheners soft furnishings Hobbies Building materials Heating system Take-home toxins

Case #1 – Mrs Burroughs AVENUES OF INVESTIAGTION – OCCUPATIONAL EXPOSURES • Other workers ill? • Hazardous substances Chemical Biological • Other Hazards Psychosocial Physical Ergonomic

Case #1 – Mrs Burroughs PSYCHOLOGICAL ISSUES? PHYSIOLOGICAL ISSUES? SOCIOLOGICAL ISSUES? Symptoms

Case Summary of a Chronic Patient #2 Date Symptoms Referral 1985 (16) Anorexia Secure unit teenagers 1986 (17) Suicide attempt Secure unit teenagers 1986 (17) Self-harm (A levels) Secure unit Psychiatry CAMHS 1987 -9 (18 -20) Self-harm. Anorexia (university) UMC 1990 (21) Working as au pair GP monitoring & anti-depressants (left university) 1993 (24) Self-harm (joined commune) ECT Secure unit admission Female. Abused by father from 6 to 15. Moved to boarding school, then to grandparents Insomnia - Feeling worthless – Guilt - Recurrent morbid thought - Bleak views - Self harm – Suicide Ideation Scholastically bright. University. Dropped out. Tried own business. Business failed.

Case Summary of a Chronic Patient #3 Date Symptoms Referral 1985 (17) Pervasive low mood 1986 (18) Suicide attempt GP monitors Child Psychiatry 1986 (18) Self-harm Psychiatry 1987 (19) Anorexia. Self-harm Psychiatry – CPN 1988 (20) Suicide attempt (failed romance) Psychiatry – CPN 1989 (21) Suicide attempt (failed romance) Psychiatry – CPN 1990 (22) Fertility worries Psychiatry – CPN – fertility counselling 1990 (22) Working in office GP monitoring & anti-depressants 1992 (24) Self-harm 1996 (26) Chronic Fatigue MH unit (open door policy) CPN 1998 (28) Fibromyalgia MH unit (open door policy) CPN

Potential Health Risks Multivariate Symptoms and Effects 3 x Cardiovascular problems “High Effort Low Reward” “High Demand Low Control” 3 x Back pain 2 x Substance abuse 2 -3 x Injuries 5 x Certain cancers 2 -3 x Infections 2 -3 x Conflicts 2 -3 x Mental health problems Shain & Kramer 2004

Summary of ill-health processes