Ineffective chronic illness behaviour in a patient with long-term non-psychotic psychiatric illness.
This case report offers a different perspective on a patient with a long-term non-psychotic psychiatric disorder that was difficult to specify. The patient, a man in his 50s, was unable to profit from outpatient treatment and became increasingly dependent on mental healthcare - which could not be understood based on his history and psychiatric symptoms alone. By separating symptoms from illness behaviour, the negative course of this patient's treatment is analysed. Focusing on ineffective chronic illness behaviour by the patient, and mutual ineffective treatment behaviour by the clinicians, it becomes clear that basic requirements of effective treatment were unmet. By making a proper diagnosis, clarifying expectations and offering a suitable therapy, ineffective illness behaviour was diminished and this 'difficult' case became much easier for both patient and clinicians. The illness behaviour framework offers a useful, systematic tool to analyse difficulties between patients and clinicians beyond psychiatric symptoms or explanations.
Institute for Professionalization, Gelderse Roos Mental Health Care, Wolfheze, The Netherlands. b.koekkoek@propersona.nl
Bauke
B
Koekkoek
Willem
W
van Tilburg
D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D002650:Child Abuse, Sexual / Q000523:psychology; D002908:Chronic Disease; D015897:Comorbidity; D003299:Cooperative Behavior; D003419:Crisis Intervention; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003937:Diagnosis, Differential; D004185:Disability Evaluation; D004213:Dissociative Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D006801:Humans; D055809:Illness Behavior; D033183:Interdisciplinary Communication; D008134:Long-Term Care; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010343:Patient Admission; D010347:Patient Care Planning; D010348:Patient Care Team; D017060:Patient Satisfaction; D010554:Personality Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D013406:Suicide, Attempted / Q000523:psychology; D017211:Treatment Failure