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ORIGINAL ARTICLE
Year : 2014  |  Volume : 36  |  Issue : 4  |  Page : 397-399  

Assessing abnormal illness behavior in post-stroke patients: A preliminary report


Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India

Date of Web Publication15-Sep-2014

Correspondence Address:
Dr. Geetha Desai
Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore - 560 029, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7176.140725

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   Abstract 

Background: Abnormal illness behavior (AIB) can contribute poor functioning in an individual along with significant increase in health care utilization. It has been studied in various disorders. This study examined the feasibility of assessing abnormal illness behavior in individuals with stroke who were undergoing treatment in a psychiatric and neurological rehabilitation center. Materials and Methods: Subjects who were admitted to the department of psychiatric and neurological rehabilitation ward for post-stroke rehabilitation treatment were assessed using screening version of Illness Behavior Questionnaire (SIBQ). Results: The total number of subjects who were screened was eight. The mean score of SIBQ was 6.125 ± 1.35. With the cut off score of 7, five subjects had abnormal illness behavior. Conclusions: The above study highlights that it is feasible to screen individuals with stroke undergoing rehabilitation for possibility of abnormal illness behavior.

Keywords: Abnormal illness behavior, post-stroke, rehabilitation


How to cite this article:
Desai G, Waghmare A, Chaturvedi SK. Assessing abnormal illness behavior in post-stroke patients: A preliminary report. Indian J Psychol Med 2014;36:397-9

How to cite this URL:
Desai G, Waghmare A, Chaturvedi SK. Assessing abnormal illness behavior in post-stroke patients: A preliminary report. Indian J Psychol Med [serial online] 2014 [cited 2019 Nov 15];36:397-9. Available from: http://www.ijpm.info/text.asp?2014/36/4/397/140725


   Introduction Top


The concept of illness behavior was introduced by Mechanic in 1962 [1] who defined it as 'the ways in which given symptoms may be differentially perceived, evaluated, and acted (or not acted) upon.' In 1964, Parsons [2] described the concept of sick role, which has some overlap with the concept of illness behavior. The sick role is characterized by features, such as recognition that the individual is not held responsible for the primary illness, normal social functioning is modified proportionate to the severity of the illness, the ill person is obligated to strive to return to a healthy state, and for the above, the person has to seek help and cooperate in the process of getting well. Sick roles are dynamic, changing with severity and phase of illness. The person may move in and out or between various phases. Also, what may be acceptable at one stage may be abnormal in another.

On the other hand, in 'normal' illness behavior, the type of sick role accepted or sought by the patient is proportionate to the clinician's assessment of objective pathology and congruent with the sick role assumed. However, if the patient's illness behavior is disproportionate to the clinician's assessment of objective pathology and patient persists in the sick role, then this is a form of abnormal illness behavior. The concept of abnormal illness behavior (AIB) was introduced in 1969 by Issy Pilowsky. [3] AIB was described as "The persistence of a maladaptive mode of experiencing, perceiving, evaluating, and responding to one's own health status despite the fact that a doctor has provided a lucid and accurate appraisal of the situation and management to be followed (if any) with opportunities for discussion, negotiation, and clarification and based on adequate assessment of all relevant biological, psychological, social, and cultural factors. AIB has been studied in various conditions and situations, which include chronic pain, somatoform disorders, and certain medical conditions like rheumatoid arthritis, infection, myocardial infarction and others, and the findings are varied. [4],[5],[6],[7],[8],[9],[10] Presence of depression and anxiety often co-exist with abnormal illness behavior and interfere with recovery of the person from an illness and result in significant disability to the individuals with illnesses. In a study on illness behavior in subjects with stroke, a longitudinal design study was undertaken, with assessments on admission to and discharge from rehabilitation, and six and 12 months after discharge. Ninety-four 12-month stroke survivors who had undergone an inpatient rehabilitation program were recruited. AIB was assessed using the Illness Behavior Questionnaire. AIB was apparent in nearly 30% of patients at discharge and persisted for 12 months. Patients with AIB scored more poorly than non-AIB patients on functional, social, and psychological indicators. [11] The authors also conducted a study to look at the relative effects of depression and AIB in long-term rehabilitation outcome for stroke and concluded that depression and AIB appeared to have quite distinct effects on outcome. AIB emerged as a key determinant of long-term functional disability, while depression was associated with poorer social functioning. [12] The authors have re-established that AIB does determine long-term rehabilitation outcome for stroke in further study. [13] The concept of AIB has not been revisited in patients with stroke following the above studies. The current study describes the feasibility of assessment of AIB in post-stroke patients who are admitted to a rehabilitation ward. Such a study has not been reported from our country.


   Materials and Methods Top


The study was conducted at National Institute of Mental health neurosciences, Bangalore, India, which is a tertiary care for specialties in mental health, neurology, and neurosurgery and specializes in rehabilitation for both individuals with neurological and mental health problems. Subjects who were admitted to the department of psychiatric and neuro rehabilitation ward for post-stroke rehabilitation treatment were approached for the study. Informed consent was sought from the participants. The assessment was done by a qualified psychiatrist using screening version of Illness Behavior Questionnaire (SIBQ). [14] This screening version of the Illness Behavior Questionnaire (SIBQ) is derived from two subscales of the Illness Behavior Questionnaire and has 11 items disease conviction and psychological versus somatic focusing. The responses are rated as yes or no. A semi-structured form was used to collect the demographic details and other psychiatric diagnosis. The study was approved by the Institutional ethics committee.


   Results Top


The total number of subjects who were screened was eight. The details of the subject are provided below. There were two women and six men in the sample. The mean age of the sample was 37 ± 15.8 years. The details of the diagnosis, neurological findings at the time of assessment are given in [Table 1]. Four of the subjects had alcohol dependence syndrome and nicotine dependence syndrome before the onset of the stroke. Two subjects had a diagnosis of depression.
Table 1: Clinical and demographic details of the subjects

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The mean score of SIBQ was 6.125 ± 1.35. The maximum score was 10, and the minimum was 2. With the cut off score of 7, five subjects had abnormal illness behavior. The details of the items of SIBQ are given in [Table 2]. The mean score of disease conviction was 5 ± 1.26 in patients who had abnormal illness behavior and 3 ± 1.26 in patients who did not have abnormal illness behavior. The mean score for psychological versus somatic focusing in patients who had AIB was 4.6 ± 0.89 and 3.4 ± 0.89.
Table 2: Frequency distribution of SIBQ items

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   Discussion Top


The above study highlights that it is feasible to screen individuals with stroke undergoing rehabilitation for possibility of abnormal illness behavior. Abnormal illness behavior could be due to underlying motor deficits, emotional problems, depression, and anxiety. Presence of AIB in stroke patients could lead to poor recovery and longer duration of stay in the rehabilitation centers. The caregiver burden may be enhanced by the presence of abnormal illness behavior.

In a sample of eight subjects, half of them possibly had abnormal illness behavior; however, were not recognized. Further studies are being planned to include duration of stay, participation the activities, and long term outcomes. Since this is a cross-sectional study, we don't have details in terms of its interference in participation of the patients in the intervention that was being provided.

For health professionals, presence of AIB could be frustration and also could lead to poor doctor-patient relationship and increased utilization of services. Early identification of AIB could lead to proper management of these cases and thus reducing the disability and also improving therapeutic relationship. AIB could also result in multiple consultation and increased use of health resources. Hence, early recognition should help the clinicians to manage better.

Prospective studies in the area of stroke rehabilitation and illness behavior are essential to establish its role in rehabilitation process in the Indian setting. It is also essential to study the care givers in the role of abnormal illness behavior in the patients.

 
   References Top

1.Mechanic D. The concept of illness behavior. J Chronic Dis 1962;15:189-94.  Back to cited text no. 1
    
2.Parsons T. Social Structure and Personality. London: Collier MacMillan; 1964.  Back to cited text no. 2
    
3.Pilowsky, I. Abnormal illness behaviour. Br J Med Psychol 1969;42:347-51.  Back to cited text no. 3
    
4.Pilowsky I, Spence ND, Waddy JL. Illness behaviour and coronary artery by-pass surgery. J Psychosom Res 1979;23:39-44.  Back to cited text no. 4
    
5.Savastano M, Maron MB, Mangialaio M, Longhi P, Rizzardo R. Illness behaviour, personality traits, anxiety and depression in patients with Menière's disease. J Otolaryngol 1996;25:329-33.  Back to cited text no. 5
    
6.Schweitzer R, Robertson DL, Kelly B, Whiting J. Illness behaviour of patients with chronic fatigue syndrome. J Psychosom Res 1994;38:41-9.  Back to cited text no. 6
    
7.Varma VK, Malhotra A, Chaturvedi SK. Illness behaviour questionnaire (IBQ): Translation and adaptation in India. Indian J Psychiatry 1986;28:41-6.  Back to cited text no. 7
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8.Pilowsky I, Spence ND. Patterns of Illness behaviour in patients with intractable pain. J Psychosom Res 1975;19;279-87.  Back to cited text no. 8
    
9.Grassi L, Righi R, Makoui S, Sighinolfi L, Ferri S, Ghinelli F. Illness behaviour, emotional stress and psychosocial factors among asymptomatic HIV-infected patients. Psychother Psychosom 1999; 68:31-8.  Back to cited text no. 9
    
10.Grassi L, Rosti G. Psychiatric and psychosocial concomitants of abnormal illness behaviour in patients with cancer. Psychother Psychosom 1996;65:246-52.  Back to cited text no. 10
    
11.Clark MS, Smith DS. Abnormal illness behaviour in rehabilitation from stroke. Clin Rehabil 1997;11:162-70.  Back to cited text no. 11
    
12.Clark MS, Smith DS. The effects of depression and abnormal illness behaviour on outcome following rehabilitation from stroke. Clin Rehabil 1998;12:73-80.  Back to cited text no. 12
    
13.Clark MS, Smith DS. Psychological correlates of outcome following rehabilitation from stroke. Clin Rehabil 1999;13:129-40.  Back to cited text no. 13
    
14.Chaturvedi SK, Bhandari S, Beena MB, Rao S. Screening for abnormal illness behaviour. Psychopathology 1996;29:325-30.  Back to cited text no. 14
    



 
 
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