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Abstract: Across all health care settings, certain patients are perceived as ‘difficult’ by clinicians. This paper’s aim is to understand how certain patients come to be perceived and labelled as ‘difficult’ patients in community mental health care, through mixed-methods research in The Netherlands between June 2006 and October 2009. A literature review, a Delphi-study among experts, a survey study among professionals, a Grounded Theory interview study among ‘difficult’ patients, and three case studies of ‘difficult’ patients were undertaken. Analysis of the results of these qualitative and quantitative studies took place within the concept of the sick role, and resulted in the construction of a tentative explanatory model. The ‘difficult’ patient-label is associated with professional pessimism, passive treatment and possible discharge or referral out of care. The label is given by professionals when certain patient characteristics are present and a specific causal attribution (psychological, social or moral versus neurobiological) about the patient’s behaviours is made. The status of ‘difficult’ patient is easily reinforced by subsequent patient and professional behaviour, turning initial unusual help-seeking behaviour into ‘difficult’ or ineffective chronic illness behaviour, and ineffective professional behaviour. These findings illustrate that the course of mental illness, or at least the course of patients’ contact with mental health professionals and services, is determined by patient and professional and reinforced by the social and mental health care system. This model adds to the broader sick role concept a micro-perspective in which attribution and learning principles are incorporated. On a practical level, it implies that professionals need to look into their own role in the perpetuation of difficult behaviours as described here. [Copyright &y& Elsevier]

Hypothyroidism is associated with a disturbance of behaviour and mood. There are also individuals, not classified as hypothyroid, with low to ‘low normal’ thyroid hormone levels and normal thyroid-stimulating hormone (TSH) levels who have mood and behavioural changes. As the peripheral thyroid hormones decrease, TSH is expected to increase. However, there are a number of physiological mechanisms known to suppress TSH. In the present study, we report on thyroid hormone regulation in a rat model of neuropathic pain and altered social behaviour that is usually transient, but is persistent in a sub-group of the population. Following ligation of the sciatic nerve, male Sprague-Dawley rats were assessed for social dominance towards an intruder: 20% showed persistently decreased social dominance. Plasma levels of thyroid hormones, TSH and corticosterone were measured before and on days 2, 3, 4, 5 and 6 after injury in 21 rats. The mean plasma thyroxine (T4), free thyroxine (fT4) and triiodothyronine (T3) levels decreased significantly post-injury in rats with persistently changed behaviour compared to rats with unchanged behaviour (P ≤ 0.002). There was no significant difference between groups for mean change in free triiodothyronine (fT3) or TSH. There was a correlation between decreased dominance behaviour and decrease in both T4 (r = 0.62, P = 0.009) and fT4 (r = 0.71, P = 0.001), but no correlation with TSH. In a sub-population of rats, decreased thyroid hormones did not result in the expected increased levels of TSH to restore pre-injury levels, nor did they show increased hypothalamic thyrotrophin-releasing hormone mRNA expression, indicating altered hypothalamic-pituitary-thyroid axis regulation. Because T3 availability to the brain is dependent on both circulating T3 and T4, decreased peripheral thyroid hormones may result in changed neural function, as expressed in altered complex behaviours in this sub-population of rats. [ABSTRACT FROM AUTHOR]

Time permeates all aspects of our everyday lives but its very centrality often renders it invisible. This article examines how temporal understandings and priorities shape and inform lay and professional constructions of illness, understandings of symptoms and help-seeking behaviour, based on semi-structured interviews with 20 GPs and 16 parents of children with asthma. This identifies the significance of a temporal perspective for beliefs about the nature of asthma as episodic or linear, the appropriate sequences and timing of symptoms and treatment, patterns of help-seeking, and perceptions of speed and treatment choices. Comparing GPs' and parents' accounts highlights both the concordance and divergences in temporal perspectives. We argue that understanding the complexity of illness behaviours requires engagement with the ways in which temporal understandings shape and inform behaviours throughout the illness trajectory and may vary among different social and cultural groups. [ABSTRACT FROM AUTHOR]

Over 3% of the entire Polish population migrate for a job within the European Union, most are aged 18–44 years. The main destinations are Germany, the United Kingdom and Ireland. Immigration is connected with the use of many public services, including healthcare services. Assuming Polish immigrants require medical consultations in the countries they reside in, the authors have analysed the reasons for patients’ visits to general practitioners (GPs) in Poland in order to predict possible reasons why Polish patients living abroad may make appointments with GPs in other countries. Data from 22 769 visits to GP practices between June 2005 and May 2006 by Polish patients aged 18–44 years were collected electronically. Age was categorised into three groups (18–24, 25–34 and 35–44 years) and the reason for the visit was categorised according to the ICD 10 coding system. Among the 12 535 patients registered with GPs, 73.1% of women and 68.6% of men required consultations during the year the study was conducted. The highest percentage of visits was recorded for women aged 35–44 years, while men of the same age were the least likely to visit a GP. The mean number of visits per patient ranged from 1.89 for men aged 25–34 years to 3.11 for women aged 35–44 years. The means were similar for 18- to 24-year-old men and women. Women aged 35–44 years had a higher mean number of visits compared with women aged 18–24 years, whereas the opposite was true for men. The analysis of reasons for visits within the age groups indicated that the percentage of appointments for respiratory problems and general and unspecified problems dropped by more than half from the 18–24-year-olds to the 35–44-years-olds, while visits for musculosceletal, cardiovascular, and mental and behavioural problems increased by a factor of four. The presented results intend to enable healthcare services meet Polish immigrants’ healthcare needs. [ABSTRACT FROM AUTHOR]

The article focuses on the early and problem-solving phases of the child's illness trajectory and on how child allergies are constructed and organized by the parents in a moral everyday context. The parents' narratives were reconstructed as narratives, describing the pathways parents take before they decide to seek professional medical aid as well as showing how they construct themselves as responsible parents. Before consulting health professionals the parents have often tried a range of different ways to define, control and manage their children's various problems. Allergy problems were interpreted and responded to differently, depending on the way they emerged in everyday life. Acute reactions quickly led to an illness definition and a diagnosis. Gradual and diffuse problems were not so easily defined. They were at first interpreted and responded to as normal infant problems, but, through the parents' readiness and various situational and temporal clues, they were organized as symptoms of illness. Parents seek medical aid when their own strategies fail or do not fully work, but their decisions are also formed within a pre-problem context of their moral accountability as parents. [ABSTRACT FROM AUTHOR]

Illness behaviour refers to the activities undertaken by people that feel ill for the purpose of defining their state of health and discovering suitable remedies. This is influenced by cultural factors among others. The study is aimed at identifying and describing the illness behaviour of the Kambari, an ethnic group in the northern part of Niger State, Nigeria. A descriptive survey design was adopted and with the help of questionnaire, data was collected from 231 household heads in three communities of Magama Local Government Area, 75-80% of whose population constitute the Kambari. About 62.3% of the household heads were 31-50 years old, 88.7% were Muslims while 28.1% were followers of the Kambari traditional religion. Between 35-61% of household heads indicated malaria, skin diseases, diarrhoea and vomiting, dysentery/haemorrhoids, measles and typhoid fever as the most occurring illnesses among members and majority believed that the diseases are caused by natural, supernatural and mystical factors like contaminated water/food, germs, witchcraft, sorcery and evil spirits. A cumulative 65.8% indicated that they use traditional medicine for treatment and only 34.2% indicated the use of modern medicine alone. Findings reveals that 35.5% indicated that the household heads usually initiate the process of help seeking for sick members of the household and 50.6% revealed that household meetings are usually called to take decision about sick members. About 37.2% provide home treatment usually with herbs, a cumulative 48.9% engage the services of traditional healers while only 11.7% source treatment solely from the hospitals/clinics. [ABSTRACT FROM AUTHOR]

Background: Somatoform disorders can be understood to mimic supposedly more 'legitimate' physical disorders. To the extent that mental disorders are now also often considered legitimate, might clinicians expect to encounter the psychiatric equivalent of somatoform disorders, 'psychiatriform disorders'? Method: The relevant literature on somatoform disorders is reviewed in light of the tendency for mental and physical symptoms to co-occur. Discussion: Illness attribution and behaviour may explain some of the recent rise in the prevalence of mental disorder. Hypotheses regarding the cause and nature of somatoform disorders are applied to their proposed psychiatric equivalent. Despite lack of current recognition, there is a strong theoretical basis for the existence of psychiatriform disorders. Psychiatriform disorders can be expected to have similar causes, comorbidity, and response to treatment, as somatoform disorders. A variety of cultural forces may be contributing to a rise in prevalence. Conclusion: As with somatoform disorders, psychiatriform disorders present problems in their distinction from conscious fabrication and from the 'legitimate' disorders they mimic. Given their likely prevalence and associated impairments, psychiatriform disorders warrant further examination, despite the methodological difficulties this presents. [ABSTRACT FROM AUTHOR]

Objective. To describe the illness behaviour in patients with chronic pain. Material and Methods. We conducted semi-structured interviews to 53 patients during 2000, in a tertiary care center. We explored their initial interpretations, responses and subsequent practices to chronic pain, until they received a diagnosis that satisfied them. Results. Illness behaviour was determined by pain intensity and disability; beliefs regarding pain causes, trust in social networks, and quality and satisfaction with the health care systems. In terms of the decision to seek care, the first option was to go to the popular sector, followed by consulting a general physician, and as last resort, to go to a tertiary care center ("with a specialist"). Conclusions. Illness behaviour should be conceptualized as a process, which combines the use of different health care sectors by the same subjects, as a result of care provided sequentially by each previous sector. [ABSTRACT FROM AUTHOR]

Background: It is possible that patients with advanced cancer, who are from the medical profession, have different or additional care needs than other patients. Previous training, professional experiences and access to information and services may influence their needs and subsequent illness behaviour. Caring for 'one of our own' may also evoke particular feelings and emotions from health professionals involved in their care and pose unique challenges in the delivery of equitable patient-centred care. Aim: To explore the experiences of palliative care physicians when caring for members of the medical profession with advanced incurable cancer. Participants and methods: Semi-structured interviews exploring the experiences of senior palliative care physicians were recorded and transcribed verbatim. Transcripts were analysed using interpretative phenomenological analysis (IPA) for emergent themes. Data were collected from ten senior palliative care physicians with a combined total of 107 years of palliative care career experience, caring for a reported combined estimate of 120 doctor-patients. Results: On the basis of their reflections, palliative care physicians reported that doctor-patients appear to find it difficult to assume a patient role, especially at a time they are likely to be truly vulnerable. This patient group will routinely attempt to maintain control of their care and environment using various strategies. These include self-referrals, accessing their own tests, directing the consultation and putting barriers up to psychosocial aspects of palliative care. Doctor-patients' general practitioners are at risk of exclusion from the management of care, and referral to palliative care services appears to occur later in the illness journey of doctor-patients compared to lay patients. Participants recalled how caring for colleagues evokes powerful emotional responses, such as a strong desire to provide the best care possible as well as feelings of anxiety. They frequently find themselves under pressure to disclose confidential information from medical colleagues not involved in the doctor-patients' care. Doctor-patients frequently receive what other healthcare professionals perceive as preferential treatment, which may unintentionally result in suboptimal care. Conclusion: The core needs of doctors with advanced cancer could be assumed to be the same as other patients. However, the juxtaposition of role from professional to patient appears to evoke unique care needs from the patient, and behaviour responses from the professional. Forewarning and awareness of these issues may help prevent potential problems in this patient group's cancer journey as well as the experience of the professionals involved in their management. [ABSTRACT FROM AUTHOR]

Abstract: Asthma affects a considerable proportion of the population worldwide and presents a significant health problem in Australia. Given its chronic nature, effective asthma self-management approaches are important. However, despite research and interventions targeting its treatment, the management of asthma remains problematic. This study aimed to develop, from a theoretical basis, an asthma self-management model and implement it in an Australian community pharmacy setting in metropolitan Sydney, using a controlled, parallel-groups repeated-measures design. Trained pharmacists delivered a structured, step-wise, patient-focused asthma self-management program to adult participants over a 9-month period focusing on identification of asthma problems, goal setting and strategy development. Data on process- clinical- and psychosocial-outcome measures were gathered. Results showed that participants set an average of four new goals and six repeated goals over the course of the intervention. Most common goal-related themes included asthma triggers, asthma control and medications. An average of nine strategies per participant was developed to achieve the set goals. Common strategies involved visiting a medical practitioner for review of medications, improving adherence to medications and using medications before exercise. Clinical and psychosocial outcomes indicated significant improvements over time in asthma symptom control, asthma-related self-efficacy and quality of life, and negative affect. These results suggest that an asthma self-management model of illness behaviour has the potential to provide patients with a range of process skills for self-management, and deliver improvements in clinical and psychosocial indicators of asthma control. The results also indicate the capacity for the effective delivery of such an intervention by pharmacists in Australian community pharmacy settings. [Copyright &y& Elsevier]

Background: The abnormal illness behaviours characterising somatisation disorder may be learnt responses acquired through exposure to parental illness and health anxiety in childhood. In this observational study we explore this hypothesis by examining patterns of interaction in mothers and their school age children. Method: A sample of 136 mother and child pairs in 3 groups (42 mothers with somatisation disorder, 44 organically ill mothers and 50 healthy mothers) completed a battery of self-report and interview measures. Their interaction in semi-structured play tasks and a meal was videotaped and later analysed for the presence of ‘needs’ and ‘offers of care’ by researchers who were blind to maternal group membership. Results: During play, a greater proportion of the children of somatising mothers expressed ‘health and safety’ needs than did children of other mothers. In contrast, during a meal, these children expressed fewer needs of all types. Children of somatising mothers were more likely than other children to ignore their mothers’ offers of care. The somatising mothers expressed more health and safety needs during the meal than did other mothers and were generally less responsive to all needs expressed by their children. Conclusions: Our study suggests that mothers with somatisation disorder and their children interact differently than other mother–child pairs. This finding supports the theory for environmental influences in the development of this disorder. [ABSTRACT FROM AUTHOR]

Abstract: Objective. – The aim of the present study was to examine whether psychiatric morbidity can influence the type of illness behaviour of neurological inpatients. Methods. – For this purpose, we compared neurological inpatients with and without psychiatric disorders (DSM-IIIR criteria) for the seven scales of Illness Behaviour Questionnaire (IBQ) and searched for possible differences between the two patient subgroups. Results. – Of the 105 neurological inpatients who participated in the study, 54 (51.4%) were diagnosed as having some type of psychiatric disorder. These patients scored significantly higher than patients without psychiatric morbidity in the scale of Irritability. A suggestive trend for higher scores in the scales of Hypochondriasis, Disease Conviction, and Affective Disturbance, and significantly lower score in the scale of Denial, in patients with psychiatric morbidity, were also found. Conclusion. – The present study has shown that neurological inpatients with psychiatric morbidity tend to develop more intense illness behaviour than those without. The effect of psychiatric morbidity on certain components of illness behaviour in neurological patients can be taken into account when therapeutic strategies are planned. [Copyright &y& Elsevier]

Abstract: Many cancer patients receiving chemotherapy experience fatigue, disturbed circadian rhythms, anorexia and a variety of dyspeptic symptoms including nausea. There is no animal model for this ‘chemotherapy-related malaise’ so we investigated the behavioural and molecular effects of a potent chemotherapeutic agent, cisplatin (CP, 6 mg/kg, i.p.) in rats. Dark-phase horizontal locomotor activity declined post-CP reaching a nadir on day 3 (P <0.001), before recovering after 7 days. CP''s effect was most marked in the late part (05.00–07.00) of the dark-phase. Food intake reached a nadir (P >0.001) at 2 days, coincident with an increase in gastric contents (cisplatin 9.04±0.8 vs. saline 2.32±0.3 g; P <0.001). No changes occurred in hypothalamic mRNA expression for AGRP, NPY, HCRT, CRH, IL-1, IL-6, TNFα, ABCG1, SLC6A4, PPIA and HPRT mRNA but tryptophan hydroxylase (TPH) mRNA was decreased (47%, P <0.05) at day 21 post-CP. This shows that despite marked behavioural effects of cisplatin, only a discrete change (TPH) was found in hypothalamic mRNA expression and that occurred when the animals'' behaviour had recovered. Findings are discussed in relation to the neuropharmacology of chemotherapy-induced malaise. [Copyright &y& Elsevier]

Stressors such as illness, injury and hospitalisation are likely to accurate attachments behaviours. The way people react to these stressors (i.e their illness behaviour); varies widely; and is strongly correlated with their attachment style. In this paper we briefly review attachment theory, with reference to difficult patient behaviours, including compulsive self-reliance, compulsive care seeking and rejection of staff coupled with exaggerated help-seeking behaviour. We conclude by suggesting simple interventions that can easily be applied to enable staff to cope, and thus be more able to help patients with difficult illness behaviours.

Abstract: Purpose: The aim of this study was to examine the illness beliefs and locus of control of patients with recent onset pseudoseizures and to compare these with patients with recent onset epilepsy. Methods: Twenty consecutive patients with pseudoseizures of recent onset (mean duration 5.4 months) were compared with 20 consecutive patients with recent onset epilepsy on their responses to (a) the Illness Behaviour Questionnaire (IBQ) and (b) a measure of locus of control, a dimension of the tendency to attribute events to internal or external factors. Results: In comparison with patients with epilepsy, patients with recent onset pseudoseizures believed that psychological factors were less important than somatic ones were (P<.005) and had a greater tendency to deny nonhealth life stresses (P<.0001). No significant differences were detected in disease conviction or illness worry. Patients with pseudoseizures had a more external locus of control (P<.001), Conclusions: Patients with pseudoseizures are less likely than those with epilepsy to see psychological factors as relevant to their symptoms, more likely to deny that they have suffered from life stress and also to have a more external locus of control. The implications for treatment are discussed. [Copyright &y& Elsevier]

Most of the studies about chronic insomnia focused only on specific features, providing in this way a partial outlook of the problem. The aim of this study was to examine a sample of chronic insomniacs from different points of view, by estimating the prevalence of stress, psychopathological symptoms, psychiatric disorders, changes in quality of life and illness behaviour. Forty-three patients (54.4%) experienced some psychosocial stressors in the last 6 months preceding the enrolment in the study. More than 55% of insomniacs reported symptoms of psychopathology. One or more than one psychiatric disorder was diagnosed in 61.5% of insomniacs. Life events could play a role in facilitating the transformation of a psychopathological symptom in a psychiatric disorder, since patients with a psychiatric diagnosis showed a higher percent of stress. The more noticeable disability in the group of insomniacs with psychiatric disorders and the absence of a corresponding worsening in illness behaviour suggests that insomniacs feelings about their health status are so negative to be not fatherly worsen by comorbidity in spite of a worsen disability. The evaluation of insomniacs should be as much detailed as possible, without neglecting tests for the evaluation of disability and illness behaviour, which are important not only for a correct diagnosis but also for monitoring the effects of therapies. [Copyright &y& Elsevier]

Effects of illness and disability on job separation result from both voluntary and involuntary processes. Voluntary processes range from the reasoned actions of workers who weigh illness and disability in their decision-making, to reactive stress-avoidance responses. Involuntary processes include employer discrimination against ill or disabled workers. Analyses of the effects of illness and disability that differentiate reasons for job separation can illuminate the processes involved. This paper reports on an evaluation of effects of illness and disability on job separation predicted by theories of reasoned action, stress, and employer discrimination against ill and disabled workers. Effects of four illness/disability conditions on the rate of job separation for 12 reasons are estimated using data from a longitudinal study of a representative sample of the Canadian population—the Survey of Labour and Income Dynamics (SLID). Two of the four effects that are statistically significant (under conservative Bayesian criteria for statistical significance) are consistent with the idea that workers weigh illness and disability as costs, and calculate the costs and benefits of continuing to work with an illness or disability: (1) disabling illness increases the hazard of leaving a job in order to engage in caregiving, and (2) work-related disability increases the hazard of leaving a job due to poor pay. The other two significant effects indicate that: (3) disabling illness decreases the hazard of layoff, and (4) non-work disability increases the hazard of leaving one job to take a different job. This last effect is consistent with a stress-interruption process. Other effects are statistically significant under conventional criteria for statistical significance, and most of these effects are also consistent with cost–benefit and stress theories. Some effects of illness and disability are sex and age-specific, and reasons for the specificity of these effects are discussed. [Copyright &y& Elsevier]

The course of severe anxiety surrounding health issues is unknown. The available literature suggests that adults who are overly anxious about health issues often interpret or misinterpret their bodily signs and symptoms to be indicative of a serious illness. The construct of health anxiety has not been examined in children and, to date, there has not been an instrument developed for this purpose. The Illness Attitude Scales is one of the most commonly used instruments for evaluating fears, beliefs, and attitudes that are associated with hypochondriasis and abnormal illness behaviour in adults. We sought to adapt the Illness Attitude Scales for use with children ages 8-15 years. The adapted Illness Attitude Scales was renamed the Childhood Illness Attitude Scales. Revisions to the adult version consisted of simplification of language, revision of Likert scale (i.e. 5-point to 3-point scale), and the addition of 7 questions to evaluate the role parents/guardians play in facilitating medical attention or treatment. Correlations between Childhood Illness Attitude Scales total scores and other self-report measures were supportive of the construct-related validity of the Childhood Illness Attitude Scales and suggested that it is a useful measure of health anxiety in school-age children. Practical and theoretical implications of the present results are discussed. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to develop a scale to assess the different aspects of illness behaviour and to evaluate the measure in depressive and somatising patients. Methods: The psychometric properties of the scale were assessed in the following diagnostic groups: patients with major depression (n=36), major depressives with an additional somatisation syndrome (n=40), patients with somatisation syndrome (n=37), and a control group (n=37). After multiple test construction procedures and factor analysis, we developed the Scale for the Assessment of Illness Behaviour (SAIB). Results: The scale included 26 items (originally 58 items) and comprised five factors: (1) verification of diagnoses, (2) expression of symptoms, (3) medication, (4) consequences of illness, and (5) scanning. The intercorrelations between these factors were low confirming the multidimensional structure of illness behaviour. Physicians'' rating partially confirmed the factors. All patient groups had elevated scores for illness behaviour. Correlational analyses demonstrated that illness behaviour was closely related to anxiety (such as health worries and phobic anxiety), even after controlling for other factors. Somatisation had medium associations with some aspects of illness behaviour. Symptom Checklist (SCL) results revealed that illness behaviour is not associated with the distress of single symptoms, but with the general number of symptoms. Conclusion: A suitable instrument to assess illness behaviour has been developed and should be further analysed in subsequent studies. [Copyright &y& Elsevier]

Objective: Acceptance of, and adaptability to illness, are major determinants of adherence to treatment and functional recovery. This paper addresses the major psychosocial factors associated with bipolar disorder and the role of psychological interventions in symptom management and adaptability to the illness experience. A new model is presented highlighting the role of developmental experiences and temperament in determining reactions to bipolar disorder. The authors propose that by addressing reactions to the illness experiences and effects on self-concept through schema-focused cognitive therapy, functional recovery is more likely to occur among those patients functioning below expectation. Method: A systematic review of the current literature including an Index Medicus/MEDLINE search was conducted, focusing on risk factors, cognitive vulnerabilities and triggers associated with bipolar disorder. Psychological treatments available for the treatment of bipolar disorder are reviewed and details of a novel schema-focused cognitive model for this condition are presented. Traditional models of adaptation to chronic illness are outlined and incorporated into the proposed model. Schema-focused cognitive therapy is proposed as an approach to help patients reduce cognitive vulnerability to relapse in addition to adopting effective mood management strategies. Results and Conclusions: There is a need for psychological treatments which reduce the risks associated with poor functionality in patients with bipolar disorder. Schema-focused cognitive therapy specifically targets the temperament, developmental experiences and cognitive vulnerabilities that determine adjustment to illness. This proposed treatment, combined with pharmacotherapy, may offer new psychotherapeutic options for the future. [ABSTRACT FROM AUTHOR]

Background: Patients who frequently change physicians without letters of referral are common, and this has become a source of concern among primary care doctors in Japan. Previous studies have shown a correlation between psychiatric disorders and patient dissatisfaction and the utilization of medical resources. Abnormal illness behaviours such as hypochondria and inappropriate treatment seeking have been associated with various psychiatric disorders. The relationship between illness behaviour and self-referral in Japan has yet to be fully explored.Objectives: Our aim was to describe the characteristic illness behaviour and satisfaction level of self-referred patients in the general medicine clinic of Saga Medical School Hospital.Methods: Using the Japanese version of the Illness Behaviour Questionnaire (J-IBQ), we examined the illness behaviour of 277 self-referred patients visiting the clinic. Patient satisfaction with previous medical care was examined with the use of our original Patient Satisfaction Questionnaire. The results were compared with those for physician-referred patients.Results: Self-referred patients differed significantly from original-visit patients on the GH (general hypochondriasis), DC (disease conviction), AD (affect disturbance) and I (irritability) scales and from physician-referred patients on the GH and DC scales. In comparison with physician-referred patients, self-referred patients showed significant dissatisfaction with their most recent medical visit elsewhere. Dissatisfaction toward the medical staff, especially the doctors, was stronger than that toward the medical environment, waiting time or the on-site medical equipment.Conclusions: It is important to give patients appropriate overall support, not only physical but also emotional, when they first visit a general physician for medical advice. The J-IBQ may be a useful instrument for primary identification of self-referral patients with probable somatization syndromes. Open doctor-doctor and patient-doctor communication is necessary to increase patient satisfaction, which may be helpful to minimize the self-referral phenomenon in Japan. [ABSTRACT FROM AUTHOR]

Background: Information on physicians' illness behaviour is to a large extent based on studies of selected groups of physicians. The objective of this paper is to study self-treatment and help-seeking behaviour in a nationwide representative sample of physicians. Results: In total, 70% of 1,476 physicians answered a mailed, anonymous questionnaire as a part of the Norwegian Medical Association's health survey. Of these, 75% had performed self-treatment during the last three years. Treatment by spouse, friends, and colleagues was also frequent. Of those who used prescription medicine, 73% were self-prescribing it; 13% of the physicians had negative experiences with self-treatment. Some 56% stated that they would prefer to seek help for somatic problems from a physician to whom they had no personal ties, and 50% would seek help for mental problems elsewhere than in the mental health care facilities located where they lived. Conclusion: Most physicians practise self-treatment when they are ill, and although they prefer to be treated by a physician they do not have personal ties to, many contact friends and colleagues when they need help from another physician. [ABSTRACT FROM AUTHOR]

Return to work (RTW) is the primary goal in the rehabilitation of patients with chronic low back pain. In spite of expensive rehabilitative efforts, many patients do not RTW. To increase cost effectiveness, predictive tests for non-RTW are needed to select patients for rehabilitation. The reliability of these tests must be high, to prevent exclusion of patients who might improve. This study evaluates the reliability and predictive validity of four tests and the following psychosocial factors for non-RTW: nationality, off-work duration, unemployment and work load. It was designed as a prospective cohort study of 99 patients with chronic low back pain. Upon entry, physical work load, time off work, unemployment and nationality were recorded. The study investigated four tests with an anticipated prognostic value for non-RTW: the Numeric Pain Rating Scale (NRS, 9–10 of a maximum of 10), the Step Test and Pseudo Strength Test (precipitous cessation) and Behavioural Signs. After 12 months, the RTW rate was obtained from the physicians responsible for sick-listing by postal survey. The response rate regarding RTW was 91% at 1 year. The RTW rate at 1 year was 20%. All investigated tests significantly correlated with non-RTW. Regression analysis showed that the best prediction of non-RTW was obtained when at least two out of the four tests were positive (positive predictive value 0.97, sensitivity 0.45). Unemployment, time off work, nationality and physical work load were less predictive. The results show that the combination of the four prognostic tests allows a very reliable prognosis of non-RTW. The cost effectiveness of rehabilitation aiming at RTW will, therefore, be increased by excluding patients with two or more positive tests. [ABSTRACT FROM AUTHOR]

Background: Physicians seem to have problems in accepting their own illness, and they tend to avoid taking sick leave. This study reports the diseases that physicians bring to work, and discusses selected factors associated with the behaviour of working when ill. Methods: Of a random sample of 1,476 Norwegian physicians, 70% answered a mailed, anonymous questionnaire as a part of The Norwegian Medical Association's health survey. Results: During one year, 80% of the physicians had worked during an illness for which they would have sick-listed their patients. More than half of the physicians in the study had worked whilst having an infectious disease. Factors independently associated with the behaviour of working when ill include being in the age group 30-39 years, working as a clinician outside hospital, having received medical treatment during the last three years, and having low job satisfaction. Conclusion: A large number of physicians work whilst having infections and other diseases. This behaviour might be harmful to the physicians themselves as well as to their patients and staff members. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe the prevalence of forgoing care and forgoing sick leave among primary care physicians (PCPs) in Switzerland and to investigate associated factors. Methods: A random sample of 1,000 PCPs in French-speaking regions of Switzerland (participation rate: 50%) was asked whether they had forgone care and sick leave during the last year. Sociodemographic, personal and occupational characteristics were recorded. Logistic regressions were performed to study these behaviours. Results: 37% of respondents reported at least one episode of forgoing care and 29% reported an episode of forgoing sick leave. No associations were found between individual characteristics and forgoing care. A heavy workload was the most common reason evoked for forgoing care. Coming to work when sick (presenteeism) was associated with female sex, younger age, having a chronic illness, working in a suburban area and working full-time. Conclusion: A high proportion of PCPs in Switzerland is forgoing own care and continues to work despite sickness. New generations of PCPs should require careful monitoring, and specific solutions should be sought to reduce these harmful behaviours., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Cohidon, Mahler, Broers, Favrod-Coune, Moussa and Sebo.)

The aim of this ethnographic study was to explore how a group of nine Danish people with schizophrenia managed physical health issues as they naturally occurred in everyday life. Qualitative methods were used to generate of data. Thematic analysis led to the description of two typical strategies used by participants to manage debilitating physical health issues in everyday life. Modifying everyday life to manage discomfort was a strategy employed to manage potential or actual discomfort associated with ongoing poor physical health, while retreating from everyday life to recover was a strategy used by participants who experienced recurring discrete episodes of poor physical health characterized by fast deterioration. Both management strategies were inexpedient as they failed to produce any positive progress in terms of the participants regaining health. The social context of participants' everyday life was characterized by a lack of interactions with others about their prevailing and ongoing physical health issues. Repeated use of these inexpedient strategies to manage physical health caused potential worsening rather than improvements to physical health. There is a need for future research that explores aspects of beneficial management of physical health issues among people with severe mental illness. Relevant foci of such research include enhancing self-management of physical health, active help-seeking behaviours, and opportunities to engage in interactions with others about physical health issues., (© 2021 John Wiley & Sons Australia, Ltd.)

A framework for the study of coping, illness behaviour and outcomes This paper presents a theoretical framework for the study of coping, illness attribution, health behaviour and outcomes. It is based upon models developed within health psychology and aims to provide a theoretical basis for nurse researchers to utilize psychosocial variables. It is an interactionist model which views outcomes as dependent upon both situation and person variables. The situation is viewed as the health threat or illness symptoms as well as the psychosocial context within which the person is operating. This context includes socio-economic factors, social support, social norms, and external factors such as the mass media. The experience of health threat is dependent upon individual appraisal, and the framework incorporates Folkman and Lazarus' transactional model of stress, as well as Leventhal's illness representation model. Behaviour and the perception of threat are also dependent upon outcome expectancies and the appraisal of one's own coping resources, and so the concepts of locus of control and self-efficacy are also incorporated. This framework allows one to identify determinants of behaviour and outcome, and will aid nurses in identifying areas for psycho-social intervention. [ABSTRACT FROM AUTHOR]

Background: Chronic low back pain (CLBP) is a symptom commonly presented to GPs, accounting for a significant proportion of their workload. It is also a common reason for sickness absence, and thus of national economic importance.Objectives: This qualitative study aimed to provide an understanding of how GPs understood CLBP, how they approached the consultation with CLBP patients and how they conceptualized the management of this problem.Method: Qualitative research techniques were employed. Twenty GPs working in North-West England were interviewed. Interviews were semi-structured and recorded on audio-tape. Transcripts of these interviews were then subjected to constant comparative qualitative analysis.Results: Subjects described their difficulties in responding to and managing CLBP. They acknowledged the link between CLBP and psychological distress, and that it legitimizes long-standing illness behaviour. They were pessimistic about the chances for successful cure or palliation of CLBP.Conclusion: Subjects seemed to be cognisant of collusion between doctor and patient, in cases where the patient's explanatory model of back pain is not challenged. We argue that this can be accounted for by the patient operating within a physical model of pain causation, while doctors operate using a model that stresses psychosocial factors. The incommensurability of these models lies at the root of the CLBP consultation as a problem. [ABSTRACT FROM AUTHOR]

Conclusions about the aetiology and maintenance of the Mandibular Pain Dysfunction Syndrome (MPDS) are largely based on clinic populations, but there are indications that sufferers who seek help about their symptoms are not typical of the general population of sufferers. This raises important problems in extrapolating findings from the patient population to the general one. This paper argues that future epidemiological studies should take the various influences on the decision to seek advice into account so that conclusions about MPDS can be reached. Specific additions to research designs are noted. [ABSTRACT FROM AUTHOR]

The problems associated with the management of a patient with deafferentation pain are highlighted by the great variety of therapies suggested, which indicates the lack of understanding of the mechanism of this type of pain. The treatment of these patients will remain a lottery until there is a clearer concept as to the underlying mechanisms. This means there is a need for more clinical research, since there is as yet no reliable experimental model. [ABSTRACT FROM PUBLISHER]

The objective of this study was to (1) to describe the relationship between chinook conditions and illness related behaviour in women, aged 20-49 years, and (2) to examine the possibility of the existence of subgroups of chinook-sensitive women. At present no empirical evidence is available regarding a relationship between chinook conditions and illness related behaviours. This study comprises the secondary analysis of a large survery of various health and health-related factors of urban women aged 20-49 years, carried out in 1985-1986 in Calgary. The interview date was used to link behaviours to chinook conditions. We found no evidence of a significant relationship between the behaviours investigated and chinook conditions in the general population. However, the data strongly supported the concept of chinook sensitivity. Women with a history of chronic health problems were more likely to visit a health care professional on chinook days than healthy women and women in the subgroup aged less than 35 years cut down their usual daily activities during chinook conditions. Women with a history of recurring migraine headaches were less likely to take prescription medication on chinook days, and women with a history of emotional disorders were more likely to have higher scores on the accident scale and to report bursts of energy or excitement during chinook days. More research is needed to identify subgroups of susceptible persons, as well as to determine whether chinook sensitive persons are equally susceptible to weather changer of other types. [ABSTRACT FROM AUTHOR]

The nosological status of the putative clinical entity of compensation neurosis and the relationship of chronic pain complaints to compensation are explored. It is concluded that, using the traditional criteria of diagnostic validity, there is no support for the view that a specific type of psychiatric disorder related to compensation or litigation can be demonstrated. Although it has been generally considered that chronic pain complaints reflect an underlying disease state, recent evidence has shown that in the medico-legal setting the nature of the compensation system and the level of available benefits have a marked influence on both the rate of chronic pain complaints and the duration of pain related work incapacity. [ABSTRACT FROM AUTHOR]

Even though cognitive education programs are essential for the treatment of diabetics, long term efficacy often seems to be poor. Problems of coping with illness could be the reason for a lack of transfer of knowledge into daily practice. Small discussion groups with the aim of modifying attitudes towards illness might be a good possibility to face this problem. 54 IDDM, FbA 10.7±2.3% (median±SD) absolved our 5-day education program for outpatients, in which daily group sessions (90 min), supervised by a group-therapist, were integrated. Follow-up sessions took place after 1, 4 and 8 months. The efficacy was measured by HbA and different questionairs on diabetologic knowledge, life satisfaction (FLZ) and complaints (BL). 4 months after the education program HbA had decreased to 9.0 (median±SD) and remained stable within small range during the rest of the study-period. Diabetologic knowledge increased from 70% (median±SD) to 87% (median±SD) 1 month after the education and remained stable during the rest of the study-period. Complaints decreased within one month from a level above average somatic illness to the normal level for healthy subjects. However, in regard to their life satisfaction our patients were significantly less satisfied concerning their health, whereas family life and friendship were declared to be more satisfying (after 8 months). We believe that more intensiv communication in the family (encouraged by the group-therapy) and parallel more critical attitudes towards illness lead to this results. As basic elements for long term modification of illness behaviour these emotional aspects seem to be essential. [ABSTRACT FROM AUTHOR]

This study explores determinants of I) general practitioner (GP) visits and II) referrals (outpatient and hospitalization). The analyses were performed with regression models on a set of data from a comprehensive population study of 3533 men and 3578 women aged 40–42 in a county in Northern Norway. Among the various health status dimensions included, self-rated health was found to be the most important determinant, regardless of type of service. Factors, other than health status aspects affecting GP visits, were preoccupation with health and help seeking attitude. Volume of resources (GP per population), socio-demographic characteristics and social networks did not appear as important. Several inequitable effects were revealed on referrals: First, higher rate of referral of patients with higher educational achievement indicates a bias towards higher social status groups. Second, high GP/population ratio and residence in municipalities with referral care facilities were both found to be associated with higher probability of referral. [ABSTRACT FROM PUBLISHER]

Two hundred and eight individuals were interviewed in order to study the behaviour they adopt in relation to the most common somatic and emotional symptoms of mental ill-health. Illness behaviour included ignoring, brooding, self-help and consultation of others. Older individuals tended more frequently to resort to meditation, native healers and doctors. Males consulted doctors more than females. Brooding was more frequent in well educated subjects. A group of married expatriates who left their wives in their original countries were the most likely to consult doctors. Education and marital status were the most predictive of brooding and self-help behaviour.Self-help was the most commonly adopted illness behaviour. The results are explained in terms of the social and cultural background of the individuals studied because this influences their methods of expressing distress and their action in relation to symptoms. [ABSTRACT FROM PUBLISHER]

In the frame of the ABC (Age, Beginning and Course) Schizophrenia Project we studied the influence of age and sex on first-ever onset, symptom manifestation and early course up to first admission in schizophrenia by using a large, representative sample of first-admitted schizophrenic patients. The results showed that the two variables had suprisingly little bearing upon the core symptoms, particularly on negative and other most frequent symptoms and on first-rank symptoms. In 70% of the cases schizophrenia started solely with negative symptoms, in 20% with negative and positive and in 10% with positive symptoms only. In most of the cases symptoms accumulated exponentially up to the first acute episode with positive symptoms appearing considerably later. The age differences observed concerned secondary phenomena associated with developmental factors. Such phenomena, i.e. anxiety, depression and the cognitive formation of delusions, can be interpreted as responses to the psychosis. Also the sex differences, which culminated in far more frequent socially negative disease behaviour in males, were limited to secondary phenomena. This positive and negative core symptomatology of schizophrenia seems to be astonishingly uniform and fairly independent of age and sex at this early stage of the disease. The only remarkable difference was a three to four years higher mean age of onset in females. We were able to show in animal experiments and to confirm in a clinical study that this finding is attributable to a neuromodulatory effect of estrogens on the sensitivity of D receptors in the brain. Apparently, estrogens raise the vulnerability threshold until menopause and have a slight neuroleptic-like effect on the symptomatology in acute schizophrenic episodes. [ABSTRACT FROM AUTHOR]

The article presents information on the relationship between a doctor and a patient. The various rules for making sense of the patient's symptoms are of two types, namely constitution rules and regulation rules. The doctors should consider what the symptoms mean for the patient and the steps taken by the patient for the same. The problem facing the therapist in the diagnosis, is that there might be a difference of what the symptoms mean for the patient and what is understood by the therapist.

Objective: To explore the gender difference in reporting headache and neck or shoulder pain, we analysed the association between reported own headache and reporting the same complaints among first grade relatives. Based on these associations we discuss 'learning' of illnesses within the family structures.Method: A cross-sectional study based on a self-administered postal questionnaire of musculoskeletal complaints in the total population aged 20-70 years was carried out. A population based study was conducted in the municipality of Bardu, northern Norway. A total population of men and women aged 20-70, altogether 2409 people, were sent a questionnaire. After one postal reminder 1939 questionnaires were returned, a response rate of 80.5%. The return rate was slightly higher among the eldest. The sex distribution was the same in both the responders and the non-responders.Results: The females in the family and the brothers and sisters were the main family members imprinting the way in which the children were deciphering symptoms like headache and neck or shoulder pain later in life. These illnesses were changed to a very little extent by the impact from the spouse. [ABSTRACT FROM AUTHOR]