Chapter 11 Living with Chronic Illness
Ronald Reagan - The former president announced that he had been diagnosed with Alzheimer's disease in 1994. After his death, Congress passed the Ronald Reagan Alzheimer's Breakthrough Act of 2005 to provide increased funding for Alzheimer's disease research.
Alois Alzheimer - was a German physician who, in the early 1900s, described a set of neurological (brain) abnormalities (identifiable only upon autopsy) that seemed to correlate with psychiatric (behavioral) symptoms that were present before death.
neurological "plaques" and "tangles" - are the abnormalities Alzheimer observed. They are the deformed remnants of dead nerve fibers in the cerebral cortex and hippocampus.
the hippocampus - is the site of new memory formation. This is why Alzheimer's patients have trouble in forming new memories.
advancing age - is the single biggest risk factor for contracting Alzheimer's disease.
early vs. late onset - Cases that begin before age 60 are considered "early onset" and those that begin after age 60 are considered "late onset." The early onset type RARE, accounting for "less than 5%" of all cases.
genetic defects - are believed to important risk factors in "early onset" Alzheimer's.
"Juvenile" and "Adult" onset diabetes - are older terms for Types 1 and 2 diabetes respectively. One reason for the name changes is that Type 2 diabetes has been occurring more and more frequently in younger people (probably as a consequence of obesity and lifestyle).
apolipoprotein "e" - a heredity-related protein involved in cholesterol metabolism is thought to be an important risk factor for the late onset type. Specifically, apolipoprotein "e4" is associated with increased risk for development of the disorder. Apolipoprotein "e2" may actually serve as a protective factor against development.
other risk factors - include (1) history of stroke, (2) history of head injury, and (3) lack of mentally challenging activities in adulthood. Type 2 diabetes is also a risk factor "especially" when combined with the presence of apolippprotein "e4."
protective factors - include (1) inheriting apolipprotein "e2," (2) taking anti-inflammatory non-steroidal drugs (NSAIDs), (3) staying cognitively active, and (4) low to moderate alcohol intake.
Alzheimer's symptoms - include (1) memory deficits, (2) inappropriate (e.g., sexual and aggressive) behaviors, (3) personality change, and (4) paranoia.
memory loss and paranoia - When memory loss becomes very bad, things are constantly getting lost, so the patient may think others are taking them and paranoia develops.
differential diagnosis - Because of these symptoms, it can sometimes be difficult determining whether an older person has Alzheimer's or a psychiatric disorder.
clinical depression - Is the most common psychiatric disorder among Alzheimer's patients with about "20%" of Alzheimer's patients qualifying for this diagnosis.
treatments - (1) A number of drugs are used to slow the degeneration of brain cells and (2) behavioral interventions are used to help control problematic behaviors such as aggression and wandering off.
Alzheimer's caregivers - carry a heavy burden which causes (1) poor physical health, (2) psychological distress, and (3) decreased immune function. Most caregivers (about "70%") are women. Support groups can help provide information and emotional support.
diabetes mellitus - A disorder (really two disorders) in which the body has difficulty regulating blood sugar levels.
coma and death risk - If too much sugar accumulates in the blood both coma and death are possible.
Halle Berry - went into a diabetic coma in 1989 as a result of her Type 1 diabetes.
pancreas - An endocrine gland, located below the stomach, that produces digestive juices and hormones.
islet cells - of the pancreas produces the hormones glucagon and insulin. Together, they control blood sugar levels.
glucagon - raises blood sugar levels by stimulating the release of glucose.
insulin - acts in a way opposite to glucagon. It lowers blood sugar levels by causing cell membranes to allow sugar to pass from the blood into the cells.
Type 1 diabetes mellitus - is also called "insulin dependent diabetes mellitus" (IDDM). It is an autoimmune disorder in which the immune system attacks the insulin producing islet cells, leaving the person incapable of producing insulin. Thus, daily injections of insulin are needed. Frequent thirst and urination are common. Onset occurs before age 30 and kidney damage is possible. About "10%" of diabetics fall into this category.
Type 2 diabetes mellitus - is also called "non-insulin dependent diabetes mellitus" (NIDDM). No insulin injections are needed. Patients are typically overweight, sedentary, and of lower socioeconomic status. Onset may be during adulthood or childhood. About "90%" of diabetics fall into this category. Those with Type 2 diabetes are at "dramatically increased risk" for death from a variety of diseases but especially from cardiovascular disease.
gestational diabetes - develops in some pregnant women. Although is ends when the pregnancy is completed, it: (1) complicates the pregnancy and (2) increases the risk of the mother later developing Type 2 diabetes.
controlling diabetes - It cannot be cured. Blood sugar levels must be carefully monitored (multiple times a day) and a strict diet low in fats and carbohydrates must be followed. In insulin injections are problematic, external or implanted insulin pumps are an option as are insulin "inhalers."
hypertension-related problems - high blood sugar leads to high blood pressure so diabetics are at risk for (1) damage to the blood vessels, (2) retinal damage including blindness, and (3) kidney diseases.
sexual functioning - is often affected by diabetes as is pregnancy.
role of health psychologists - has been primarily (1) working with the ways in which diabetics view and understand their illness and (2) helping to promote treatment adherence.
complete adherence - is difficult to obtain because the serious complications of the disease are typically many years in the future.
asthma - A chronic disease in which "inflammation" causes constriction of the bronchial tubes, preventing air from passing freely and causing wheezing and difficulty breathing during attacks. It usually develops in childhood.
chronic obstructive lung disease (COLD) - shares many features with asthma but the symptoms are continuous, not sporadic as with asthma.
theories of asthma - include : (1) allergy theory, (2) diathesis stress theory, and (3) the hygiene hypothesis.
allergy theory - was an early idea, that asthma was a simple allergic reaction.
diathesis stress theory - an elaboration of allergy theory, suggests that genetics create an immune system vulnerability in some people. A study of the Hutterites, a close knit religious group, supports this theory. They have high rates of asthma-like inflammation but their rural lifestyle does not bring them into contact with many asthma "triggers."
hygiene theory - suggests that, as a result of our "sterile society," the immune systems of some infants don't get needed experience or practice in coping with environmental irritants and don't fully develop. Some evidence supports this theory (e.g., asthma is less common in rural China than in the U. S.).
obesity - is also a risk factor for asthma with obese people being two to three times more likely to have asthma.
asthma "triggers" - are environmental substances that cause attacks. Common triggers are mold, pollen, dust, and a variety of airborne chemicals and pollutants. Exercise or stress can also trigger attacks.
asthma treatment - anti-inflammatory corticosteroids decrease the chances of having an attack. During attacks when breathing is difficult, bronchodilator inhalers are used. Misuse of these inhalers can produce of type of "high" and some believe they may be overused.
human immunodeficiency virus (HIV) - A virus that attacks the human immune system, depleting the body's ability to fight infection; the infection that causes AIDS.
HIV-1 and HIV-2 - Two variants of the disease currently exist. HIV-1 is most prevalent ins the U. S. whereas HIV-2 is most prevalent in Africa.
AIDS history - AIDS originated in Africa from a virus that affects monkeys. The first recognized case was in the Congo in 1959 and the disease was identified in the U. S. in the early 1980s. Soon, the number of deaths due to AIDS will surpass the number due to the Bubonic (black) Plague in Europe in the 14th century (1500s). In 1992, the Center for Disease Control (CDC) changed the definition of HIV infection so that incidence rates from then on can not easily be compared with those of earlier years (see Fig. 11.1). There appears to be a large incidence increase in 1992 but this is actually due to the re-definition.
death rates - due to AIDS are on the decline. This is because infected individuals are living longer due to (1) more effective drugs, (2) early detection, and (3) lifestyle changes. "Highly Active Antiviral Therapy" (HAART) has contributed significantly to longer lifespan.
four distinct "epidemics" (causes) - have been identified: (1) male to male sexual contact, (2) among injection drug users, (3) heterosexual contact, and (4) transmission to newborns during childbirth ("antiretroviral" medication has greatly reduced this). Incidence rates are declining for all of the above EXCEPT for heterosexual (male-female) contact which is the fastest growing source of new cases.
health psychologists - play an important role in reducing aids cases because all modes of transmission involve "behaviors." "Primary prevention" involves efforts to change behaviors to decrease the number of new cases. "Secondary prevention" involves helping already infected persons manage their condition.
gender differences - In the U. S. and in Europe (but not worldwide) males far outnumber females with about 80% of cases being among males and 20% being among females.
acute HIV infection - occurs within a week of HIV infection. Flu-like symptoms last from a few days to a few weeks. People can then be fairly symptom free for up to 10 years.
AIDS - by definition will exist when the person's CD4 T-lymphocyte cell count drops below "200" and he or she becomes susceptible to a variety of infections. The weight loss and persistent fatigue we associate with the diagnosis will now be apparent.
symptoms - AIDS patients are not at high risk for common illnesses such as strep throat because AIDs does NOT destroy pre-existing antibodies. However, less common diseases (e.g., pneumonocystis, carinii pneumonia, Kaposi's sarcoma, tuberculosis, and toxoplasmic encephalitis) are the big risk because the normal immune response cannot take place.
concealing one's sexual orientation - actually speeds the progression of HIV and appears to be associated with faster decrease of CD4 cells, increased depression, and decreased social support.
stages of dying - Elizabeth Kubler-Ross proposed a model which includes 5 stages: denial, anger, bargaining, depression, and acceptance. Research indicates that people do go through these stages BUT not necessarily in the order she proposed.