Download Health Psychology

Health Psychology
Chapter 11
Living with Chronic Illness
Tuğba Yılmaz
2009-2010 Fall Semester
Topics
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Dealing with HIV and AIDS
Living with Alzheimer’s Disease
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An interview with a case example
1. Dealing with HIV and AIDS
AIDS - Acquired Immune Deficiency Syndrome
EBES
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Edinilmiş Bağışıklık Eksikliği sendromu
A disorder in which immune system (I.S) loses its
effectiveness, leaving the body defenseless againts
invaders
Result of exposure to HIV (Human Immunodeficiency
Virus) which is a contagious virus
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Two variants: HIV-1 nd HIV-2
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HIV-1: AIDS cases in US
HIV-2: AIDS cases in Africa
Incidence and mortality for
HIV and AIDS
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Recognized in 1981- identified in 1983
1980s - # of new cases and deaths from AIDS
Mid 1990s death rates in US
2001- ~ 40 million infected people
1992 definition of HIV altered – graphs are not comparable
but after 1992, AIDS cases decline
Greatest mortality decline b/w 1996 and 1998.
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Reasons:
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HIV infected people live longer
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Effective drug therapies – antiretroviral drugs
Early detection
Lifestyle changes- giving up unhelthy habits
HIV and AIDS Epidemics
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4 distinct epidemics in US and Europe. They are about
Declined during
different ways of AIDS transmission
1990s but still
First epidemic
leading cause in
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Male-male sexual contact- many AIDS cases in USA
Heterosexual sex- many AIDS cases in Africa and Asia
Second epidemic
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Injection drug users
Percent of cases
remain the same
USA
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Third epidemic
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Heterosexual contact
Number is increasing!
Women more likely to be
infected thru this route
Fourth epidemic
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From women to their children during delivery process
Decreased sharply
due to antiretroviral
medication
In USA and Europe;
M>W in terms of HIV infection
W thru heterosexual contact or injection of drug use
Worldwide
W - 46% of AIDS cases and half of deaths
majority in sub-Saharan Africa
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Factors related with AIDS
1. Ethnic Background
In USA affected disproportionately by
epidemics for heterosexuals
epidemics for injection drug users
From largest segment of AIDS population to smallest
African American>European American>Hispanic American>Asian Americans
Declining rates of HIV trend X apply rapidly for minorities as it does for
European Americans
2. Age
Birth process transmission (4th epidemic)- children HIV +
Young adults are most risky group
risky behaviors, lack of HIV info, lack power for protection
gender and ethnicity- most are M and belong to ethnic minorities
People over 50 – less likely to be infected than youngers but if they did,
develop AIDS more rapidly and get more infections
Symptoms of HIV and AIDS
HIV progresses over a decade or Fourth stage: CD4+ T-lymphocyte cell
count drops to 200/ less per cubis
more thru 4 stages;
millimeter of blood. I.S. Loses its
defensive capacity. Symptoms are
exacerbated. I.S. More susceptible to
invaders- viruses, bacteria, fungi etc.
Third stage: patients have a group of
symptoms like swollen lymph nodes,
fever, fatigue,loss of appetite and weight
and diarrhea
Second stage: it is a latent period
lasts as long as 10 years. People
seem asymptomatic end experience
mild symptoms
First stage: symptoms are not easily
distinguisable from other diseases.
Examples: sore throat, fever, skin rash
and headache. Duration is b/w 1 and 8
weeks
The transmission of HIV
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HIV is an infectious organism but transmission of the virus from
person to person is not easy.
Main routes of transmission are sex, pregnancy/birth and direct
contact w/ blood or blood products.
Concentrations of HIV are esp. high in semen and blood
Contact w/ saliva, urine, tears is less risky
Using same utensils, cups of infected people, kissing and
touching X transmit HIV
People at high risk for HIV are those affected by four epidemics
1. male-male sexual contact, 2. injection drug use,
3.heterosexual contact, 4. from mother to baby
1. Male- Male
Sexual Contact
- Early years- majority of AID cases; Now- HIV infection
among gay and bisexual men
- Still the largest risk group
- Damaged rectum is a route for virus to enter body
- Receptive partner is at high risk
- Remember : Semen has high concentration of HIV virus
- Condom use is essential for protection
-Common in old gay men but not in younger ones
-Risk taking- unprotected sex is risky
2. Injection Drug
Use
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Sharing unsterilized needles
Second most frequent source of HIV infection in USA
Causes: Intoxication and Lacking immediate access to
sterile equipment
Great percentage of African & Hispanic Americans >
European Americans
Higher percentage of infected women
Behavioral factors:
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# of sex partners
Sex for $ or drugs
Financially dependent women on men are at risk
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X refuse sex w/ infected partner
3. Heterosexual
Contact
- Leading source of HIV infection in Africa
- Fastest growing source in USA
- African & Hispanic Americans disproportionately represented and W>M
- Gender asymmetry: male to female = 8 x female to male transmission
- An Interesting result:
-Trust and confidence of one’s partner in heterosexual relationship is
not a good predictor about who will become infected w/ HIV or not.
- Unprotected sex is due to belief that one is invulnerable to serious
diseases
4. Birth Process
- Children born to HIV positive women
- Transmission during birth process or breast feeding
- HIV + children:
- HIV + women still get pregnant; 15-30 % of their children are infected
Percentage could be lowered to 8 % by prenatal care
Our role…
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Combating the spread on infection
Primary prevention: change in behavior to
decrease HIV transmission
Secondary prevention: helping HIV + people
to live with the infection, counseling and help
dealing w/ social aspects of disease
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Contribute to length of survival of HIV infected
people
1. Encouraging protective measures
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Most people have control in protection from HIV virus
Causal contact w/ infected people has low risk
Changing high risk behaviors:
 Limiting # of sex partners
 Using condoms
 Avoiding sharing needles
Health care workers- special protective equipmentgloves, mask etc.
Don’t base judgments on appearance- HIV infection has
long incubation w/out symptoms
2. Helping people w/ HIV Infection
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Testing for HIV is difficult decision
Benefits: learn serostatus; if +, begin treatment to prolong their
life, reduce behaviors that put others at risk
Costs: increased anx, depr, anger, distress
Coping:
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Avoidance coping- deny reality and hold on to illusionary hope- high
level of stress, low levels of CD4 cells
Active coping- problem solving & seeking support- better adjustment
Finding meaning and positive experience IMP
Help with adherence to complex regimens:
min. three different antiretroviral drugs,
drugs for side effects for antiretroviral drugs
drugs to fight for opportunistic infections
A dozen drugs
2. Living with Alzheimer’s Disease
An interview with a case
example
Alzheimer’s Disease
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A degenerative disease of the brain
Major source of impairment among older people
Half of people over 85 affected
Better diagnosed with autopsy
Early onset vs Late onset
EO: before 60 age- rare- 1%- genetic defect
LO: after 65 age- apolipoprotein e (cholesterol metabolism)
can occur w/out family history
Genetic and environmental/experiential factors interact:
Type 2 diabetes
Mild brain trauma
Aluminum concentrations in drinking water
Protective Factors:
Low levels of alcohol consumption
Nonsterodial anti-inflammatory drugs
Folic acid
Cognitive activity 
Age is the biggest risk factor; disease
sharply w/ age
Symptoms are similar to psychiatric disorders, so it is difficult
to diagnose
memory loss
language problems,
agitation and irritability
sleep disorders,
suspiciousness and paranoia
incontinence
sexual disorders
Distress for the patients and their caregivers
Most common psychiatric problem is depression and depressed
mood- Esp. Common in EO
Symptoms of Alzheimer patients
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Memory loss
Characteristic of Alzheimer’s
First appear as small
ordinary failures of
memory e.g. “Şey”
Progress into failure to
recognize family
members
At early phases, patient is
aware of the problem and
feel distressed
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Agitation, irritability
Even violence symptoms appear
Outbursts of anger are possible
Paranoia and suspiciousness
Related with cognitive impairments
Forget where they put belongings, accuse others of taking them
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Sleep problems
Difficulty staying asleep- more severe than peers
Wander at all times of the day and night
Opportunity to injure themselves
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Incontinence
Stressing for patients and caregivers
Incontinence common in advanced cases
Helping the patient
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Alzheimer’s is treatable but not curable
Drugs to delay the progression of cognitive
deficits, reduce agitation,
Music
For relaxation
Pets
Behavioral approaches
Alterations in environment
Changes in patient behaviors
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Taking notes
An interview with a case example
Helping the family
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Symptoms of the illnes are particularly
distressing to the families
Memory impairments- fail to recognize
members
Cognitive impairment- changes in personality
Suspiciousness and accusations hurt
Violent acts upset family functioning
Caregivers
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In USA- mostly women: wives or daughters
Men receive more help than wome in care giving
Caregivers experience stress and strain exhibit
symptoms:
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Fatigue
Frustration
Helplessness
Grief
Shame
Embarrassment
Anger
Depression
Caregivers
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Interest of PNIs: effect of chronic stress on I.S.
The more impaired the patient, the more stressed the
caregiver
CBT help caregivers to manage negative emotions
Support groups- sharing feelings, getting info about
caring
Caregivers experience feelings of loss for the
relationship that they once shared w/ the patient
~ bereavement