Psychologyof the patient and of the doctor,

Health and illnessthe basic

terminology Health – the state of a full physical, psychological and social well-being, more than just an absence of an illlness or a malfunction

Illness x disease

Biological, psychological and social context of an illness

The integration of the somatic and the psychological factor in the outbreak and process of the illness – a psychosomatic attitude

The illness and a change of the life needs

Unchanged, modified and newly formed needs

The need for a social contact, understanding and help

The need for safety and security

The need for activity and stimuli

The need for the realization of the long term and short term goals (the perspective)

Always determined by the personality of the patient, their life situation, the nature of the disease and the prognosis

The context of the illness

An impact on the self-perception, occasionally also the self-evaluation of the patient

Changes of the social role and the social status

The social help network - the purpose in the treatment and in the reconvalescence

Psychosomatic context of the illness – the need to know the life story as a context and the basis for interpretation

The ill patient as a part of a family system

An illness as a difficult life situation

Reaction on a difficult situation – the adaptability varies

A dynamic process

Strategies focusing on the solution of the problem x strategies focusing on coming to terms with the emotional state

Aggression (direct, transferred, passive aggression, self-aggression)

Regression

More unconscious defense mechanisms

Strategy of handling demanding situations

To lower the threat

To accept, what can‘t be changed

Protection of a positive self-perception

Care for the psychological balance

Looking for ways towards regeneration

Importance of the social contacts

Privacy

The confidential information Respect towards the privacy – organizational and operational condition

An empathetic attitude

Sensitive information

Exposure of the patient

An intimate space

Lowering the tension by describing and explaining the actions

The ability to cope with an illness

Dependent on:

A. The direct subjective damage of the illness

The prospects of an early change for better

The extent of powerlessness and dependency

The extent of severity of the illness

B. The personality of the ill, their life situation, their social background, their previous experiences

C. The attitude and the nature of the medical care

Personality of the patient

A personality structure – the temperament, interpersonal characteristics, the ability to self-control, the available adaptation mechanism, the frustration tolerance

The intelligence of the ill patient – in a sense of the capacity for understanding the situation and evaluation of the implications

Age

Life situation

Social background, close relations

Previous experiences (with an illness, with a treatment, with the crisis situations)

Regressive reactions

Types of the attitude of the patient towardss the illness

1. Realistic

2. Heroic

3. Belittling

4. Denying

5. Nosophobic

6. Nosophillic

7. Hypochondriac

8. Opportunistic

Is the patient ill at all?

Profit from the illness

An escape into the illness

Simulation x aggravation of the struggles

Munchausen syndrome (by proxy)

Dissimulation

Factitive derangement x issues of psychogenic nature

Dissociative issues

Hypochondria as mirrored in psychopathology (a personality trait, OCD, a somatoformic derangement or even a delusional symptomatic)

Casuistry OP

A 35-year old man, unmarried, childless, lives with his mother, currently unemployed

The carrier history contains some interesting and demanding jobs, but only as a matter of past. Mainly manual auxiliary job experiences from the past several years, unemployed for the past two years.

The reasons for the therapy are anxieties that won‘t let him function fully neither in his work nor in the personal life, connected to fears of contracting a disease.

Reports a yeast infection on the tongue, an increased fatigue that he interprets as a result of a haematogenesis derangement and a „prýštění“ around the kidneys.

Irritable, isnsist on an alternative treatment

Convinced about the lethal character of his disease

After a psychiatric and psychological examination, a widespread production of both delusional and hallucinative nature becomes apparent

Had been administrated as a hypochondrical disorder by the general practitioners he had been visiting frequently

Casuistry HS A boy died at 4 years of age. Had been admitted to a hospital 25 times, had been

admitted to a pediatrician over 300 times

Had struggled with several issues already at the first year of age. Chronical infections, asthma, allergies, eating complications related mostly to vomiting.

When the boy reached three years of age, the consillium suggested a presence of a child psychiatrist, which the mother refused. The child had been vomiting repeatedly, had been visiting the pediatrician almost daily for the digestive issues and a nearly permanent diarrhea.

When the boy died, the mother had been accused of the murder of the child as the examination showed his death was a result of a chronic poisoning. The histological examination showed that the continuous poisoning. Must have lasted 2 – 3 years.

The mother confessed to having given the child the preparate, but only a several times in the last months of his life. She stated she wanted to give him a nice tasting treat.

None of the relatives, friends and acquaintances believed that she would have been capable of harming the child. She had serious issues with lying, usually in relation to the desire to gain attention (leukemia, chemotherapy, dialysis). No symptoms of a psychological disorders were found on her.

Attitude of the patient towards the illness

The same patient can shift their attitudes drastically in relation to the context of the illness, the stance may change (and often does) over time

Ambivalent attitude towards the illness

High-risk : inferiority, resignation, hopelessness (principles of the communication with a high-risk patient)

Attitude towards the illness and the treatment – essential for the healing process

The medical can influence the patient by the means of communication

The psychology of the medic

 Difficulty of the profession, suitable personality aptitudes

The burn out syndrome – how to prevent it

The perception of the medic on an axe: safety x threat, trust x distrust, an authority to be respected x to be rebelled against

Attitude of the medic towards the illness – objectively examinable symptoms

To always see the suffering person behind the illness

The medic – patient relationship

An expert vs a partner

Paternalism, hyperprotectivity

Rules of the productive behaviour

Introduction to the healing environment (explanation of the unfamiliar)

Ambition to reduce the negative emotions (fear, anxiety, shame, hopelessness) by the available means

A self involved attitude towards the patient (showing interest, listening to him, showing reasonable affection)

Help and support (not to be alone with one‘s struggles)

Sustaining the contact with the patient, an optimistic atmosphere

Ambition to activise the patient (encouragement, increasing the competences of the patient)

Patience, interest, appreciation

Communication

Communication skills as a part of the profession

Social communication x structured communication x therapeutic communication

Effective communication

Understandability

Preservance of the dignity

Selection of the important information

Space for questions and discussions

Congruence

How to give the information

Truthfully, tactfully, understandably and empathically – in context of the state of health and the life situation

Timing, information division, word selection, teamwork

Always with the consideration of the reaction of the patient (the individual personality)

Information about the diagnosis and the treatment is always the a competence of the doctor!

Reliability- fulfill-able promises, showing interest, restraining the feelings of hopelessness of the patient, hope

Space for opinions, worries and expectations of the patient, in an ideal case the patient as a partaker in the decision process for the further treatment

Strengthening the competence of a patient