Psychological Co-morbidities of Physical Illness

Evidence for the efficacy of behavioral approaches to the treatment and management of physical illness is mounting, as is the evidence for behavioral interventions for psychological disorders. A pressing question that remains is how to effectively treat co-morbid physical and psychological illnesses. Diseases co-occur more often than not, and the co-occurrence of physical and psychological illnesses is associated with greater impairment and healthcare costs. Unfortunately, the treatment literature has traditionally been disease-specific, with fewer insights and discoveries regarding the underlying processes of co-morbid physical and psychological illnesses, and even fewer of approaches to treatment.Research on co-morbidities between physical and psychological illnesses has focused primarily on depression. Quite extensive literatures describe the negative impact of depression on type 2 diabetes, cardiovascular disease, cancer, obesity, pain, and other physical illnesses. More recently, higher rates of physical illness have been documented in individuals with bipolar disorder, anxiety disorders, schizophrenia, and impulse control disorders. Studies emanating from the National Comorbidity Survey-Replication (NCS-R), the only U.S. population-based database that includes diagnostic information on all DSM-IV psychological disorders, have revealed strong links between a number of physical and psychological illnesses. These data draw attention to the prevalence of physical and psychological co-morbidities at the population level, which has stimulated research on the biobehavioral mechanisms of those co-morbidities, with the goal of developing and improving treatment approaches. As this area of research grows, practical resources are needed for clinicians and researchers who encounter individuals with co-morbid physical and psychological illnesses in their work. This book is the first to provide a comprehensive overview of psychological co-morbidities of physical illness, biological and behavioral mechanisms of those co-morbidities, and implications for treatment. Each chapter focuses on a physical condition, such as obesity, type 2 diabetes, HIV infection, tobacco dependence, cardiovascular disease, cancer, asthma, pain, irritable bowel syndrome, autoimmune disorders, and obstetric/gynecological conditions. Chapters are structured to cover 1) the epidemiology of the most prevalent co-morbid psychological disorders within that physical condition (e.g., depression and other mood disorders, anxiety disorders, psychotic disorders, impulse control disorders, and eating disorders; 2) biobehavioral mechanisms of the co-morbidity; 3) a review of the behavioral treatment literature including evidence-based practice guidelines (where available); and 4) treatment considerations including issues of stepped care, evidence-based treatment decisions, treatment sequencing, treatment blending, treatment interactions, and contraindications. Content is guided by available research evidence and relevant theoretical models, and it is presented in such a way as to inform clinical practice, identify important gaps in the research literature, and provide directions for future research. The book serves as a tool for clinicians and researchers who work in the area of behavioral medicine in medical, academic, and/or training settings. Patients with psychological and medical co-morbidities may be encountered by clinicians working in either mental health or medical settings, where the presenting problem could be either the psychological disorder or the medical disorder. As such, assessment and treatment issues are discussed from both perspectives. For the clinician, the book reviews brief assessment tools, provides practical summaries of the treatment outcome literature and treatment considerations (e.g., treatment sequencing, contraindications), and includes treatment decision hierarchies that help the clinician incorporate each facet of evidence-based decisions (the evidence, patient characteristics, and their own expertise). For the researcher, the book brings together the literature for the medical and psychological disorder, highlighting still unanswered research questions relevant to the co-morbidity. Literature relevant to the underlying biobehavioral mechanisms of the co-morbidity as well as treatment are summarized. While a vast literature exists for the treatment of these disorders in isolation, one important purpose of this book is to bring together this literature to uncover specific areas in need of future study that will further our understanding of why different disorders co-occur and the best ways to treat them when they do.

First book to address psychological and medical co-morbidities from a behavioral medicine perspective Information on assessment, treatment outcome, and treatment decision considerations relevant to clinicians and researchers Emphasis on evidence-based behavioral practice Includes supplementary material: sn.pub/extras

Auteur

Dr. Sherry Pagoto is an assistant professor of medicine in the Division of Preventive and Behavioral Medicine in the University of Massachusetts Department of Medicine. She is a licensed clinical psychologist and a staff psychologist in the UMass Weight Center. Her clinical work in the Weight Center informs her program of research, which focuses on understanding and treating obesity in the presence of comorbid psychological disorders. She also is completing an NHLBI career development award on emotional eating, and has recently received three private foundation grants (Boston Obesity and Nutrition Research Center, Worcester Foundation of Biomedical Research, University of Massachusetts Clinical and Translational Science Pilot Project Program) to study behavioral and biological mechanisms of stress and depression on obesity and insulin resistance. She is also actively involved is skin cancer prevention research and is principal investigator of the Sunless Study, a randomized clinical trial sponsored by the National Cancer Institute. She was also the recipient of the Society of Behavioral Medicine's Early Career/Young Investigator Award in 2006.

Texte du rabat
The scenario is all too common, patients presenting with medical conditions who have co-occurring psychological disorders, and vice versa. Clinical challenges include poor treatment outcome, low adherence, and impaired quality of life. Yet as a common clinical phenomenon, these co-morbidities tend to be understudied by researchers and undertreated by practitioners. Psychological Co-Morbidities of Physical Illness is the first comprehensive reference addressing the topic from a behavioral medicine perspective and focusing on evidence-based practice. This accessible volume explains the physiological and behavioral mechanisms underlying co-morbid physical and psychological disorders, addresses treatment approaches and challenges with this population, and synthesizes findings across the disciplines. Each chapter focuses on a chronic medical condition and the most prevalent co-morbid psychological disorders for each, such as depression, anxiety, and psychotic disorders. For each condition, contributors review the treatment outcome literature and provide detailed information about effective psychological and pharmacological interventions, assessment instruments, treatment considerations (e.g., sequencing, contraindications), and, where relevant, cultural issues. Among the medical conditions covered:Obesity Type 2 diabetes Cardiovascular disease Tobacco dependence Chronic pain CancerDementia Chronic obstructive pulmonary disease Irritable bowel syndrome Multiple sclerosis Psychological Co-Morbidities of Physical Illness is an invaluable decision-making resource for practitioners and trainees working with co-morbid patients in clinical, public health, and academic settings, including psychologists and other mental health professionals, primary care and …