3.4.1 Psychological Aspects of Physical Disease

Psychological Aspects of Physical Disease; Particular Emphasis on Possible Psychiatric Sequelae of Parkinson’s Disease, Cerebrovascular Disease, Sensory Impairments. Emotional Reaction to Illness and to Chronic ill health. Secondary and Reversible Dementias

Physical illnesses not only affect the body but also have significant psychological effects on individuals. The relationship between physical disease and psychiatric sequelae is complex and multifaceted. Parkinson’s disease, cerebrovascular disease, and sensory impairments are among the illnesses that are often associated with various psychological disorders. In this essay, we will explore the psychological aspects of physical diseases, with a particular emphasis on possible psychiatric sequelae of Parkinson’s disease, cerebrovascular disease, and sensory impairments. We will also discuss the emotional reaction to illness and chronic ill health, as well as secondary and reversible dementias.

Psychological changes in ageing:

Psychological Changes in Aging	Age	Impact on Cognitive Functions
Cognitive Assessment Complexity	–	Complicated by physical illness or sensory deficits
IQ Changes	25 years	IQ peaks
	60-70 years	IQ plateaus
	After 70	IQ declines
Performance vs Verbal IQ Decline	–	Performance IQ drops faster than verbal IQ
Problem-solving Deterioration	–	Declining abstract ability & difficulty applying the information to situations
Short-term/Working Memory Decline	–	A gradual decrease in capacity, worse with task complexity & memory load
Long-term Memory Decline	–	Declines, except for remote events of personal significance
Psychomotor Slowing & Information	–	A characteristic pattern of slowing & impairment in manipulating new information
Manipulation Impairment	–
Tests of Well-rehearsed Skills	–	Little or no decline in verbal comprehension

Psychological aspects of physical disease:

Physical diseases have significant psychological effects on individuals. Chronic illnesses can lead to depression, anxiety, and other psychological disorders. Individuals who are diagnosed with a chronic illness often experience a sense of loss of control, which can lead to feelings of helplessness, hopelessness, and despair. Coping with a chronic illness can be challenging, and individuals may need support from healthcare professionals and loved ones to manage their psychological symptoms.

Psychiatric sequelae of Parkinson’s disease:

Parkinson’s disease is a chronic and progressive neurological disorder that affects movement. It is caused by the degeneration of dopamine-producing neurons in the brain. Parkinson’s disease is associated with various psychiatric sequelae, including depression, anxiety, cognitive impairment, and sleep disorders. Depression is one of the most common psychiatric sequelae of Parkinson’s disease, with an estimated prevalence of up to 50% among patients. Depression in Parkinson’s disease is often characterized by symptoms such as loss of interest, feelings of guilt, and suicidal ideation.

Anxiety is another common psychiatric sequelae of Parkinson’s disease. Patients with Parkinson’s disease may experience anxiety due to their motor symptoms, fear of falling, or concerns about their future. Cognitive impairment is also common in Parkinson’s disease, with up to 80% of patients developing dementia in the advanced stages of the disease. Sleep disorders, such as insomnia and REM sleep behaviour disorder, are also common in Parkinson’s disease.

Psychiatric sequelae of cerebrovascular disease:

A cerebrovascular disease is a group of disorders that affect the blood vessels in the brain. It is a leading cause of disability and death worldwide. Cerebrovascular disease is associated with various psychiatric sequelae, including depression, anxiety, and cognitive impairment. Depression is a common psychiatric sequela of cerebrovascular disease, with an estimated prevalence of up to 50% among patients. Anxiety is also common, with patients experiencing symptoms such as worry, fear, and panic attacks.

Cognitive impairment is another common psychiatric sequela of cerebrovascular disease. Patients may experience difficulties with attention, memory, and executive functions. The severity of cognitive impairment varies depending on the location and extent of the brain injury. Post-stroke dementia is also common in patients with cerebrovascular disease, with up to 30% of patients developing dementia within five years of their stroke.

Psychiatric sequelae of sensory impairments:

Sensory impairments, such as vision and hearing loss, are common in older adults. They can have significant psychological effects on individuals, including depression, anxiety, and social isolation. Depression is a common psychiatric sequela of sensory impairments, with up to 50% of patients experiencing depressive symptoms. Anxiety is also common, with patients experiencing symptoms such as worry and fear.

Social isolation is another common psychological effect of sensory impairments. Patients may experience difficulties with communication and may withdraw from social activities. Social isolation can lead to feelings of loneliness and depression. Patients with sensory impairments may benefit from support from healthcare professionals and assistive technologies, such as hearing aids and visual aids.

Emotional reaction to illness and chronic ill health:

Illness and chronic ill health can have significant emotional effects on individuals. The emotional reaction to illness can vary depending on the individual’s personality, coping style, and nature of the illness. Common emotional reactions to illness include shock, denial, anger, fear, and sadness. Patients may also experience feelings of guilt and shame, particularly if they believe that they are responsible for their illness.

Chronic illness can also have significant emotional effects on individuals. Patients with chronic illnesses may experience a sense of loss, as they may not be able to perform activities that they used to enjoy. Chronic illness can also lead to social isolation and a sense of disconnection from loved ones. Patients with chronic illnesses may benefit from support groups and counselling to manage their emotional symptoms.

Secondary and reversible dementias:

Secondary and reversible dementias are dementias that are caused by underlying medical conditions or medications and are often reversible with appropriate treatment. Examples of secondary and reversible dementias include delirium, vitamin deficiencies, and medication side effects. It is essential to distinguish between secondary and reversible dementias and primary dementias, such as Alzheimer’s disease, as the treatment and prognosis are different.

Physical illnesses can have significant psychological effects on individuals, leading to various psychiatric sequelae, including depression, anxiety, cognitive impairment, and sleep disorders. Parkinson’s disease, cerebrovascular disease, and sensory impairments are among the illnesses that are often associated with various psychological disorders. Patients with chronic illnesses may also experience emotional reactions such as shock, denial, anger, fear, and sadness. Secondary and reversible dementias are dementias that are caused by underlying medical conditions or medications and are often reversible with appropriate treatment. Patients with physical illnesses may benefit from support from healthcare professionals and loved ones to manage their psychological and emotional symptoms.

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