Management of Chronic Illness

1
Management of Chronic Illness

• 50 of the US pop has a chronic condition that
  requires medical management
• Psychological Adjustment
• Psychological Comorbidity

2
Management of Chronic Illness

• Quality of Life
• Multidimensional construct
• Physical symptoms
• Functional status
• Social functioning
• Emotional status
• Cognitive and intellectual functioning
• General energy level
• Perceptions of ones own health
• General satisfaction with life

3
Psychological Assessment in Medical Settings

• MMPI
• SCL-90-R
• Millon Behavioral Health Inventory
• Sickness Impact Profile
• Cook-Medley Hostility Inventory
• MHLC scale
• MOS 36-F

4
Kubler-Rosss Five-Stage Theory

• Denial
• Anger
• Bartering
• Sadness
• Acceptance

5
Cerebrovascular Disorders
6
Stroke Symptoms

• Sudden numbness or weakness of the face, arm, or
  leg
• Sudden confusion, trouble speaking or
  understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of
  balance
• Sudden, severe headache with no known cause

7
Strokes

• Sudden onset that cause brain damage
• Area of dead or dying tissue produced by a stroke
  is called
• infarct
• 2 types
• Cerebral hemorrhage
• Cerebral ischemia

8
strokes

• Cerebral hemorrhage
• Bleeding occurs in the brain when a cerebral
  blood vessel ruptures and blood seeps into
  surrounding neural tissue and damages it
• Bursting aneurysm
• Pathological balloonlike dialation that forms in
  the wall of a blood vessel

9
strokes

• Cerebral Ischemia
• Disruption of the blood supply to an area of the
  brain
• 3 main causes of cerebral ischemia
• Thrombosis
• Plug (thrombus) is formed blocking the blood flow
  
• Thrombus may consist of fat, oil, air bubble
• Embolism
• Similar except the plug (embolus) is carried by
  the blood from a larger vessel where it was
  formed to a smaller one, where it becomes lodged
• Arteriosclerosis
• Walls of blood vessels thicken and the channels
  narrow

10
Risk factors

• BP
• Smoking
• Heart disease, diabetes
• High cholesterol, obesity
• Family history
• High red blood cell count
• ETOH
• TIA
• Jonas Mussolino (2000)

11
Stroke Sequelae

• Most disabling chronic illness
• Most common deficit?
• Aphasia
• Receptive versus Expressive
• Visual disorders
• Visual Neglect
• Emotional Lability
• Depression

12
Strokes

• Glutamate
• Excitatory neurotransmitter
• NDMA receptor blockers or calcium-channel blockers