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IMPACT OF DIFFERENT CHRONIC CONDITIONS:Psychosocial Factors in Epilepsy

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Lesson 29
IMPACT OF DIFFERENT CHRONICCONDITIONS
1. Epilepsy
Epilepsy is a condition marked by recurrent,sudden seizures that resultfrom electrical disturbances of the
cerebral cortex. Although the seizures epilepticsexperience can vary greatly, the twomost common types
arethe:
1. Grand mal (or"tonic-clonic") attack, which is the mostsevere form and entailstwo phases. It begins
with a very brief tonic" phase, in which the person losesconsciousness and body is rigid. It thenprogresses
to a longer "clonic" phase thatlasts 2 or 3 minutes andincludes muscle spasms andtwitching. The body
maythen relax until the personawakens soon. Sometimes before a grand mal attack epilepticsexperience an
aurawhich consists of unexplained sounds,smells, or othersensations.
2. Petit mal (or "absence")attack, which involved diminished consciousness, and in which the person stares
blanklyfor a short while, perhaps only a few seconds, and may show slight facial twitching. When the
episodeends, the person simply resumeswhatever he or she wasdoing, sometimes not even being aware
that the event happened. Petit malattacks occur mainly in childhoodand usually disappear by adulthood.
Estimates of the prevalence of epilepsy vary somewhat, but it afflicts about l % of people worldwide. There
areprobably over 2 millioncases of epilepsy in the UnitedStates, perhaps half of which are undiagnosed
anduntreated. Over 100,000 newcases are diagnosed eachyear. Although the conditioncan develop at any
age, the great majority of epilepticsexperience their firstseizures by 20 years of age.
WhatCauses Epilepsy?
Sometimesphysicians find a specific neurological defect that is the cause of an epileptic's disorder, but
usually the reasons are unknown.Risk factors for developingepilepsy include a strong family history of the
condition,severe head injury, infections of the central nervous system, andstroke.
MedicalRegimens for Epilepsy
Anticonvulsantdrugs provide the mainmedical treatment for epilepsy.These medications must be taken
regularly to maintain the most effective serumconcentrations throughout the dayand can haveundesirable
sideeffects, such as facial hair in women, and blurred visionand nausea if the dose is too high. A promising
new treatment involves using an implanted device that deliversstimulation to the Vagalnerve.
Epileptics whose seizures result fromclear neurological defects mayhave the option of surgical treatment if
they have frequent, severe attacksand other treatments do notwork or cause problematic sideeffects.
Neuro-psychologists conduct tests to pinpoint the affectedarea of the brain and minimize cognitive and
motorimpairments the surgery mightproduce. After surgery, as many as 80% of patients becomeseizure-
free in the next few years. But undergoing surgery without becomingseizure-free may lead to subsequent
psychosocialdifficulties, such as heightened anxiety and depression.
PsychosocialFactors in Epilepsy
Becauseindividuals who are having epileptic episodes lose control of their behavior and "actstrange", their
conditionstigmatizes them among people who do not understand it. Longago, many people believed that
individualswith this condition werepossessed by the devil. Although few people in advanced societies
today shun victims of epilepsy, witnessing an attack may still arousefeelings of fear andaversion.
Aside from the reactions theirattacks produce in people, what otherproblems do epileptics face as a result
of their illness? Having strongseizures, especially with a loss of consciousness, is sometimesassociated with
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importantcognitive and motorimpairments that can limiteligibility for certainactivities and jobs: such as
thosethat involve high workloads or danger from heights or machinery.
Epilepsy seems to be related to psychosocialprocesses in two ways. First, some evidence suggeststhat
emotionalarousal, such as of anxiety, mayincrease the likelihood or severity of epileptic episodes. Second,
epilepticsand their families sometimesadjust poorly to the disorder, especially if episodes are frequentand
severe.Emotional difficulties, such as with anxiety or depression, oftenlead clients to drop out of
rehabilitationprograms. Many of the adjustmentproblems that epilepticsface can be reducedthrough
counselingwhen the diagnosis is madeand through the work of support groups.
What to Do for a Seizure
Peoplereact negatively to seeing a grandmal attack for manyreasons, one of which may be that they don't
know what to do to help. Actually, there is little one can do otherthan to remain calm andtry to protect the
epileptic from injury as he or shefalls or flails about during the tonic or clonic phases. If you witness a
seizure, the following six actionsare recommended:
1. Prevent injury from falls or flailing. Break the fall if possible and provide a cushion, such as a coat,
between the person's head and the ground.
2. Do not put anything in the person's mouth. Many people believe they must put a spoon or other object
in the mouth to prevent the epileptic from swallowing his or her tongue, whichactually can nothappen.
3. Loosen tight clothing around the neck.Turn the person on his or her side so that salivadoes not obstruct
breathing.
4. Do not restrain the person. If you believe the epileptic could be injured while flailing near a hard object,
try to move the object.
5. If the person does not comeout of the attack in about 5 minutes, call an ambulance.
6. After the person wakes up, describe what happened and see if he or she needs help whenready to leave.
Epileptics are often disoriented after an attack.For the most part, the role of the bystander requirescalm
andcomposed caring and common sense.
2. Nervous SystemInjuries
Manythousands of people in the United Statesand many more all around the world suffer injuries to the
brain or spinal cord each year, leaving them debilitated for life. Neuro-psychologists and health
psychologists play important roles in assessingthese patients' impairments andhelping them adapt to their
conditions. In this section, we will focus on the impact of having a spinal cord injury.
Prior to the 1940s, medical practitioners knew almost nothing about treating people who suffered a severe
injury to the spinal cord. In World War I, 80% of the soldiers who receivedsuch injuries died within 2
weeks.People who survived severespinal cord injuries had a poorprognosis for their future health, which
wascharacterized by major health complications and a short life span. As a result,patients and practitioners
had a defeatist attitude, and little attempt was made towardrehabilitation.
But in World War II, Englandestablished special medical units to develop and provide comprehensivecare
andrehabilitation for people withspinal cord injuries. These medical units served as a model for others to
be developed in countries around the world.
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The Prevalence, Causes and Physical Effects of Spinal CordInjuries
The term spinal cord injury refers to neurological damage in the spine thatresults in the loss of motor
control,sensation, and reflexes in associated body areas. Thedamage may be caused by disease or by an
injurythat compresses, tears, or severs the cord. When the cord is badly torn or severed, the damage is
permanentbecause little or no nervetissue will regenerate; but if the cord is compressed or has an abrasion,
somefunction may be recoveredwhen the pressure is removed or healingoccurs.
Thedegree to which the person'sfunction is impaired depends on the amount of damage and itslocation.
If the cord is completely severed in the neck region, quadriplegia results. Actor, Christopher Reeve's
(Superman) horse-riding accident left him quadriplegic. If a lower portion is severe, paraplegia results. If the
cord is not completely severed, partialfunction remains.
Millions of people around the world are livingwith spinal cord injuries; in the UnitedStates, there aremore
than250,000 people with this affliction,and about 8,000 new casesoccur each year. Abouthalf of these
people suffer neck injuries and arequadriplegics. The greatmajority of Americans whoreceive spinal cord
injuries are males, and most of them are between 10 and 30 years of age at the time. The most common
cause is automobile and motorcycle accidents, and the remainder result mainly fromfalls, sporting
activities,and wounds, such as from a gunshot or stabbing.
Thephysical effects patientsexperience after spinal cord injuries change over time andprogress through
twostages:
1. Short-term effects
Theimmediate physiological reaction is called"spinal shock", which usuallylasts between a few daysand 3
months. In spinal shock, neuralfunction is devastated either by the cord being severed or by inflammation
at the site of lesser damage.The result is that the body cannot regulate blood pressure,temperature,
respiration, and bladder and bowelfunction. Medical personnelmust intervene to control these functions.
Usually, the shorter the period of spinal shock, the better the prognosis of recovery.
2. Long-term effects
Thefull extent of spinal cord damagemay not be clear forsome time, and long term predictions are
difficult to make during the first 6 months or so. If the cord is not severed,considerable functionalrecovery
mayoccur over a long period of time. If the cord is severed, some autonomic functions will recover, but
otherfunctions will not. Peoplewho survive severe damage to the higher regions of the cord aretypically
fullyparalyzed and unable to breathe without a respirator.
Theinitial care these patientsreceive typically focuses on their medical needs, withlittle or no attention to
theirpsychological reactions. They receive very little information abouttheir prognosis because it is so hard
to predict, and medical staff want to avoid the depression their speculationsmight produce. Oncethe
condition of these individuals hasstabilized, the process of rehabilitationbegins. Almost all spinal cord
injurypatients enter rehabilitationexpecting to regain totalfunction and are notprepared to cope with the
reality of permanent functional losses. A major goal for psychologists at this time is to help these people
adjust to the demands and limitations of the rehabilitation process.
Physical Rehabilitation
Theprocess of physical rehabilitationfor people with spinal cord injuries is geared toward helping them (1)
regain as much physical function as the neurological damage will allowand (2) become as independent in
theirfunctioning as possible. This processfocuses initially on training the patients to develop bladder and
bowelcontrol and on assisting them in moving paralyzed limbs to maintain theirrange of motion.
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Hygienic bladder care is extremely importantbecause a common cause of death in these patients after the
spinalshock period is kidneyfailure from repeated infections.
Thenext phase of rehabilitationextends the focus of physical therapy toward maintaining andimproving
the function of muscles overwhich the person has somecontrol. For example,quadriplegics receivespecial
attentiontoward improving respiration; paraplegics do exercises to strengthen the upper body. When some
neural connection to affected parts of the bodyremains, therapy with biofeedback to `re-educate' the
muscles in those areas appears to help some, but not all, patients.
Thelast phase of physicalrehabilitation extends the therapy as much as possible to include activities of daily
living.Those patients who haveregained sufficient functionlearn how to performself-care activities
independently and to use devices to compensate for permanentphysical losses. Somedevices today are
highlysophisticated and usecomputers, allowing paralyzedindividuals to turn on lights, answer the
telephone, and operate computer keyboardswith voice commands.
PsychosocialAspects of Spinal CordInjury
The victims' main challenges after spinal cord injury are to make the most of their remaining abilities and
lead as full a life as possible.What can health careworkers, family, and friends do to help? Psych-
physiologists John Adams and ErichLindemann described andcontrasted case studies of two young men,
17 and 18 years of age, whohad suffered spinal cord injuries that rendered them quadriplegic. One adapted
successfully,and the other didnot.
Thepatient who adapted wellwas able to accept the injury and abandon the part of his self-conceptthat
wasassociated with his being a fine athlete. He then turnedhis energies toward academicpursuits and
eventually became a history teacher. He also coached a localbasketball team from hiswheelchair.
Theother patient provides a strikingcontrast. He was never able to accept the injury or the permanence of
hiscondition. He became extremelywithdrawn and depressed--at onepoint he was spending much time in
bedwith the curtains drawn andfrequently with the sheetover his head. A Fewyears later, he wasre-
admitted to the hospital after taking an overdose of medication. At last contact, he wasliving at home, still
clinging to the hope that he would walk again.
Why did these young men adapt so differently to their similarphysical conditions? Adams andLindemann
noted the strikingly different waysthese patients' families and friends responded to their condition. In the
case of the patient who adaptedwell to his condition, hisparents and friends alsoaccepted his paralysisand
provided an environment in which he could redefine his self-concept. Forinstance, his parents installed
ramps in their home and widened doorways to accommodate a wheelchair.The other patient's familyand
friends were not able to accepthis condition or provide the support he needed to help himadapt.
Family and friends can also help by providing social supportwithout being overprotective and`taking over'
when the patient has difficultyperforming self-help tasks. Having a disabled individual in the household
increases the stress of all familymembers. They need to makemany adjustments in daily livingand, while
doingso, try not to make the person feel like a burden. If the patient is a husband or wife, his or her spouse
faces very difficult adjustments. Rolechanges occur immediately--atleast for a while, andperhaps
permanently.
The healthy spouse, with or without the help of other familymembers, must suddenly take on full
responsibility for providing the family's income, maintaining the household, caring for the children, and
caringfor the disabled person.Sexual-problems brought on by the patient's injury may become a major
source of stress in the marital relationship.
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Disabled people also experience manyunpleasant thoughts about themselves,their future, their relations
withother people in general, andphysical barriers in society. They find that many places they once liked to
go to are inaccessible by wheelchair,for example. Further more, people in general act strangelytoward
them--staring, or quickly averting their eyes, or behaving awkwardly or uncomfortably in theirpresence.
Theseexperiences tend to reduce the self-esteem of disabled people many of whom have heightened levels
of depression and drug and alcohol use. Adapting to becomingdisabled takes time, and a couple of years
maypass before many individualswith spinal cord injuries report improvements in their adjustmentand
quality of life.
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Table of Contents:
  1. INTRODUCTION TO HEALTH PSYCHOLOGY:Health and Wellness Defined
  2. INTRODUCTION TO HEALTH PSYCHOLOGY:Early Cultures, The Middle Ages
  3. INTRODUCTION TO HEALTH PSYCHOLOGY:Psychosomatic Medicine
  4. INTRODUCTION TO HEALTH PSYCHOLOGY:The Background to Biomedical Model
  5. INTRODUCTION TO HEALTH PSYCHOLOGY:THE LIFE-SPAN PERSPECTIVE
  6. HEALTH RELATED CAREERS:Nurses and Physician Assistants, Physical Therapists
  7. THE FUNCTION OF NERVOUS SYSTEM:Prologue, The Central Nervous System
  8. THE FUNCTION OF NERVOUS SYSTEM AND ENDOCRINE GLANDS:Other Glands
  9. DIGESTIVE AND RENAL SYSTEMS:THE DIGESTIVE SYSTEM, Digesting Food
  10. THE RESPIRATORY SYSTEM:The Heart and Blood Vessels, Blood Pressure
  11. BLOOD COMPOSITION:Formed Elements, Plasma, THE IMMUNE SYSTEM
  12. SOLDIERS OF THE IMMUNE SYSTEM:Less-Than-Optimal Defenses
  13. THE PHENOMENON OF STRESS:Experiencing Stress in our Lives, Primary Appraisal
  14. FACTORS THAT LEAD TO STRESSFUL APPRAISALS:Dimensions of Stress
  15. PSYCHOSOCIAL ASPECTS OF STRESS:Cognition and Stress, Emotions and Stress
  16. SOURCES OF STRESS:Sources in the Family, An Addition to the Family
  17. MEASURING STRESS:Environmental Stress, Physiological Arousal
  18. PSYCHOSOCIAL FACTORS THAT CAN MODIFY THE IMPACT OF STRESS ON HEALTH
  19. HOW STRESS AFFECTS HEALTH:Stress, Behavior and Illness, Psychoneuroimmunology
  20. COPING WITH STRESS:Prologue, Functions of Coping, Distancing
  21. REDUCING THE POTENTIAL FOR STRESS:Enhancing Social Support
  22. STRESS MANAGEMENT:Medication, Behavioral and Cognitive Methods
  23. THE PHENOMENON OF PAIN ITS NATURE AND TYPES:Perceiving Pain
  24. THE PHYSIOLOGY OF PAIN PERCEPTION:Phantom Limb Pain, Learning and Pain
  25. ASSESSING PAIN:Self-Report Methods, Behavioral Assessment Approaches
  26. DEALING WITH PAIN:Acute Clinical Pain, Chronic Clinical Pain
  27. ADJUSTING TO CHRONIC ILLNESSES:Shock, Encounter, Retreat
  28. THE COPING PROCESS IN PATIENTS OF CHRONIC ILLNESS:Asthma
  29. IMPACT OF DIFFERENT CHRONIC CONDITIONS:Psychosocial Factors in Epilepsy