5/6/2023 0 Comments Carla bartolucci illnessStudies are recommended to evaluate how patients experience a long-term illness to begin to build an experience-based and patient-centered medicine. Consequently, the disease, both acute and chronic, gives rise to lasting bio-psychosocial functional experiences or mutations (immunity and allergy, pathobiographical modification, changes in the feeling of own life and in the way of living). The fact of contracting a disease is not always pure incomprehensible chance it influences a conscious and subconscious disposition of a human person in front of his own biography "The patient does not have a disease, but he does his illness". And a psychosocial moment of intra-psychic elaboration of the feeling of illness, where general or basic components intervene (the psychic consequences of the biological or somatic alterations), and the personal ones as the constitution of the individual, the type of illness (acute, where predominate feelings of affliction and threat or chronic, where the feelings are more biographical), the social-historical situation, sex, race, etc., which are both conscious (changes in the feeling of one's life: Distress, threat, solitude, and resource), and subconscious (phenomenon of transference), and interpretative (punishment, chance, challenge, test). A biological moment, partly conscious (post-infectious immunity and allergy) that marks the whole experience of life, and also partly subconscious: The individual temperament, education, etc., that direct our behaviors. The experience of the disease has a complex structure where there is a biological and a psychosocial moment form a plot. The cognitive and emotional representations developed by subjects when they have to cope with an illness or a perceived health threat are subsumed under the concept of illness perception and may be assessed by the Brief Illness Perception Questionnaire. Specific instruments are available for both types of denial. Denial may concern both physical and psychiatric symptoms. The assessment of illness denial should consider that a certain degree of denial may sometimes prevent patients from overwhelming psychological distress resulting from life-threatening or stigmatized diseases. Kellner's Illness Attitude Scales appear to be the gold standard for the measurement of the hypochondriacal spectrum, which includes several clinical conditions, such as nosophobia, thanatophobia and health anxiety. Both Kellner's Symptom Questionnaire and Derogatis' Symptom Checklist-90 include a scale for somatic symptoms, and other questionnaires were specifically designed to measure their frequency and severity. Thus, more atheoretical terms, such as functional somatic symptoms and medically unexplained symptoms, were introduced. The concept of somatization was criticized because it implies the presence of psychological distress or an underlying psychiatric disturbance when an organic cause for somatic symptoms is not found. Pilowsky's concept of abnormal illness behavior encompasses several clinical conditions characterized by a maladaptive mode of experiencing, perceiving, evaluating and responding to one's own health status. The term illness behavior was introduced by Mechanic and Volkart to describe the individuals' different ways to respond to their own health status.
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