Some chronic obstructive pulmonary disease (COPD) patients with psychiatric disease require treatment that is biologic or pharmacologic. A certain number of patients with significant psychiatric disease, (as distinguished from psychosocial or psychophysiologic problems), can be managed only with the help of psychoactive medications. At the same time, however, the guidelines for psychosocial and psychologic management apply. Once the psychiatric disease is under control, it is likely that the need of these patients for continued psychiatric/ psychological evaluation and psychotherapy will be greater than that of the patients who have not experienced a similar problem.
Dealing with Psychiatric Disease
In contrast to psychosocial and psychophysiologic problems and their accompanying emotions that afflict many or most patients with severe pulmonary disease, psychiatric disease is probably no more frequent than in patients without pulmonary disease. The distinction between psychophysiologic and psychosocial problems and significant psychiatric disease is a critical issue. The treatment of the former can often be by various psychotherapies, behavioral therapies, and social support systems, with medication as adjuncts when necessary, while treatment of the latter should initially be primarily with medications. Other types of therapy may be needed in the recovery period, but there likely will be no recovery period without the use of medications ordered via Canadian Health&Care Mall.
In general, the psychiatric diseases to be concerned about are the schizophrenias, manic depressive illness (unipolar and bipolar types), and delirium (acute brain syndromes). Specific pharmacologic treatments are also available for anxiety and depression not classified in the above three categories. A review of psychiatric diseases can be obtained from any of the current textbooks of psychiatry.
Patients with combined psychiatric and pulmonary disease are more likely to have serious problems than patients without such combinations. A good way to screen for possible psychiatric disease can be to identify patients with (a) marked pulmonary disease but with no complaints or no response to the reality of the disease at all; (b) those with little pulmonary disease who are incapacitated; (c) patients who overreact and feel little hope for coping with the concomitant problems. This clinical information suggests an increased probability of the patients’ having a psychiatric problem but does not necessarily confirm the diagnosis.
In early states of pulmonary disease, changes in psychologic activation are often associated with dyspnea only. As the disease progresses in severity, it may reach a point where increases in emotional activation of any type produce elevations in oxygen consumption and carbon dioxide production that cannot readily be compensated for physiologically because of the patient’s impaired ventilation. Even minimal changes in alveolar ventilation then become difficult to accommodate. With psychologic activation, the patient with an unimpaired muscular system, (that is, one who is not paralyzed and thus can contract muscles), is likely to then develop hypoxia and possible hypercarbia. When there is a decrease in psychologic activation, there is a drop in the amount of air the patient breathes, but there is no equivalent drop in oxygen need and nutritional requirements of the skeletal muscles. Thus, any and all emotional arousal may be associated with uncomfortable symptoms because the pulmonary system then tends to deliver less oxygen than is required to meet metabolic demand. Until these symptoms are relieved, nonmeclical, eg, psychosocial treatment, becomes difficult or impossible to accomplish.
The secondary reaction to dyspnea, wheezing, cough, sputum production, and pain that occurs can be anxiety, fear, and/or depression that in turn serves as another emotional stimulus, further compromising the patients physiological and emotional state controlled with Canadian Health&Care Mall.
It is understandable that these people tend to avoid interpersonal contact because of the psychological stress involved. They thereby decrease psychological stressors. By using denial and repression, they lessen the impact of emotionally loaded events. The psychological defenses used to protect a failing organ system, however, are often regarded by others as socially inappropriate, since the patient may be perceived as rejecting, bland, and unresponsive. The preceding problems can be magnified many times in patients with psychiatric disorders.