Assessment Of Comorbid Medical Conditions

In contrast to comorbidities such as panic or personality disorder, cognitive therapists do not have a direct role in evaluating medical comorbidities. They should review the patient's medical history and current medications nevertheless, and evaluate whether the presenting problems may be due, at least in part, to side effects of medications, or to the neuropsychiatric effects of a medical condition. Cognitive therapists should also assess psychosocial issues related to the patient's medical condition, such as functional impairment, the interpersonal impact of the illness, and health-related quality of life. Numerous assessment instruments have been developed for these purposes, but only some of them have been used in conjunction with CT for medical patients. For example, the Depression Interview and Structured Hamilton (DISH), a semistructured interview for assessing depression in medically ill patients (Davidson et al., 2006; Freedland et al., 2002), was developed for the multicenter Enhancing Recovery in Coronary Heart Dis ease (ENRICHD) clinical trial and has since been used in a number of other studies.

A variety of questionnaires have been used to assess causal attributions about specific medical illnesses, such as heart disease. The Illness Perception Questionnaire (IPQ; Weinman, Petrie, Moss-Morris, & Horne, 1996), which has been used in a number of recent studies, evaluates the extent to which the patient believes that emotional distress in the form of stress, anxiety, depression, and so forth, has contributed to the onset or progression of his/her medical illness. Therapists can use this information to determine whether to emphasize the potential health benefits of overcoming depression, coping with stress, and so forth, when inducting the patient into CT and working to maintain his/her motivation to participate fully in treatment.

The 36-item Short-Form Health Survey (SF-36), a widely used measure of health-related quality of life (Stewart et al., 1989), assesses the perceived impact of medical problems on activities, role functioning, and emotional well-being. Therapists can use it to determine whether the patient's medical problems are a significant source of distress and impairment. It yields physical and mental factor scores. CT can have differential effects on these scores, particularly with patients whose physical health status is declining over time. Treatment for depression can help them maintain or improve the mental component of their quality of life, even while the physical component is deteriorating.

Do Not Panic

Do Not Panic

This guide Don't Panic has tips and additional information on what you should do when you are experiencing an anxiety or panic attack. With so much going on in the world today with taking care of your family, working full time, dealing with office politics and other things, you could experience a serious meltdown. All of these things could at one point cause you to stress out and snap.

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