1. Interdisciplinary View Cases of ill-health Dr. Craig Jackson Senior Lecturer in Health Psychology Faculty of Health BCUwww.hcc.bcu.ac.uk/craigjackson

2. Pathogen Disease (pathology) ModifiersLifestyle Individual susceptibility Traditional model of Disease Development

3. Hazard Psychosocial Factors AttitudesBehaviour Quality of Life Illness (well-being) Biopsychosocial model of Illness

4. Recap Sociology of ill health

5. Recap Psychology of ill health

6. Recap Physiology of ill health

7. Case #1 – Mrs Burroughs 30-year-old married woman married 6 years secretary in company hospitalized about one month ago for pneumonia responded well to erythromycin discharged after 5 days completed a 14-day course of antibiotics within 2 weeks of discharge, she noted: increasing shortness of breath & low-grade fever similar to what she had before she was hospitalized

8. Case #1 – Mrs Burroughs history of asthma as a child (not had problems since) no history of heart disease, diabetes, allergies, lung disease in her family, or other ill family members who are currently ill denies any history of blood transfusions or sex outside of marriage has a 4-year-old son not taking any medications except for paracetamol prn On interview with attending physician; possible recurrent pneumonia shortness of breath chest pain fever slight hypertension some skin rash

9. Case #1 – Mrs Burroughs AVENUES OF INVESTIAGTION – COMMUNITY EXPOSURES Home exposures General Consumer products smoking pesticides air fresheners soft furnishings Hobbies Building materials Heating system Take-home toxins

10. Case #1 – Mrs Burroughs AVENUES OF INVESTIAGTION – OCCUPATIONAL EXPOSURES Other workers ill? Hazardous substances Chemical Biological Other Hazards Psychosocial Physical Ergonomic

11. Case #1 – Mrs Burroughs Symptoms PSYCHOLOGICAL ISSUES? PHYSIOLOGICAL ISSUES? SOCIOLOGICAL ISSUES?

12. Case Summary of a Chronic Patient #2 DateSymptoms Referral 1985 (16)AnorexiaSecure unit teenagers 1986 (17)Suicide attemptSecure unit teenagers 1986 (17)Self-harmSecure unit CAMHS (A levels)Psychiatry 1987-9Self-harm. AnorexiaUMC (18-20)(university) 1990Working as au pairGP monitoring & anti-depressants (21)(left university) 1993Self-harmSecure unit admission (24)(joined commune)ECT Female. Abused by father from 6 to 15. Moved to boarding school, then to grandparents Insomnia - Feeling worthless – Guilt - Recurrent morbid thought - Bleak views - Self harm – Suicide Ideation Scholastically bright. University. Dropped out. Tried own business. Business failed.

13. Case Summary of a Chronic Patient #3 DateSymptoms Referral 1985 (17)Pervasive low moodGP monitors 1986 (18)Suicide attemptChild Psychiatry 1986 (18)Self-harmPsychiatry 1987 (19)Anorexia. Self-harm Psychiatry – CPN 1988 (20)Suicide attemptPsychiatry – CPN (failed romance) 1989 (21)Suicide attemptPsychiatry – CPN (failed romance) 1990 (22)Fertility worriesPsychiatry – CPN – fertility counselling 1990 (22) Working in officeGP monitoring & anti-depressants 1992 (24) Self-harmMH unit (open door policy) CPN 1996 (26) Chronic FatigueMH unit (open door policy) CPN 1998 (28) FibromyalgiaMH unit (open door policy) CPN

14. “High Effort Low Reward” “High Demand Low Control” 2x Substance abuse 2-3x Injuries 2-3x Infections 3x Back pain 5x Certain cancers 2-3x Conflicts 2-3x Mental health problems 3x Cardiovascular problems Potential Health Risks Multivariate Symptoms and Effects Shain & Kramer 2004

15. Summary of ill-health processes