Psychological factors affecting other medical conditions: Management
- James L Levenson, MD
James L Levenson, MD
- Professor of Psychiatry, Medicine, and Surgery
- Virginia Commonwealth University School of Medicine
Psychological factors affecting other medical conditions (PFAOMC) is a disorder that is diagnosed when a general medical condition is adversely affected by psychological or behavioral factors; the factors may precipitate or exacerbate the medical condition, interfere with treatment, or contribute to morbidity and mortality . In addition, the factors are not part of another mental disorder (eg, unipolar major depression).
This topic reviews the management of PFAOMC. The epidemiology, pathogenesis, clinical features, assessment, diagnosis, and differential diagnosis of PFAOMC are discussed separately. (See "Psychological factors affecting other medical conditions: Clinical features, assessment, and diagnosis".)
WHEN TO REFER
For psychological factors affecting other medical conditions, we suggest consultation with a mental health clinician when the:
●Factors appear to represent a poorly controlled psychiatric disorder, such as depressive disorders (eg, unipolar major depression), anxiety disorders (eg, generalized anxiety disorder), or personality disorders (eg, borderline personality disorder).
●Psychological factors are extreme, persistent, or interfering significantly in treatment, or patients are unable to change maladaptive behaviors.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
- Groves MS, Muskin PR. Psychological responses to illness. In: The American Psychiatric Publishing Textbook of Psychosomatic Medicine: Psychiatric Care of the Medically Ill, Second edition, Levenson JL. (Ed), American Psychiatric Publishing, Inc, Washington, DC 2011. p.45.
- Horvath AO, Greenberg LS. Working Alliance Inventory. In: Handbook of Psychiatric Measures, Second Edition, Rush Jr AJ, First MB, Blacker D. (Eds), American Psychiatric Publishing, Inc., Washington, DC 2008. p.187.
- Smith RC, Dorsey AM, Lyles JS, Frankel RM. Teaching self-awareness enhances learning about patient-centered interviewing. Acad Med 1999; 74:1242.
- McCord RS, Floyd MR, Lang F, Young VK. Responding effectively to patient anger directed at the physician. Fam Med 2002; 34:331.
- Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005; 353:487.
- Cramer JA, Roy A, Burrell A, et al. Medication compliance and persistence: terminology and definitions. Value Health 2008; 11:44.
- Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther 2001; 23:1296.
- Velligan DI, Weiden PJ, Sajatovic M, et al. The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. J Clin Psychiatry 2009; 70 Suppl 4:1.
- American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder, third edition. Am J Psychiatry 2010; 167 (supplement):1.
- American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition, 2010. http://www.psychiatry.org/practice/clinical-practice-guidelines (Accessed on July 09, 2014).
- Hedegaard U, Kjeldsen LJ, Pottegård A, et al. Improving Medication Adherence in Patients with Hypertension: A Randomized Trial. Am J Med 2015; 128:1351.
- Kamal AK, Shaikh Q, Pasha O, et al. A randomized controlled behavioral intervention trial to improve medication adherence in adult stroke patients with prescription tailored Short Messaging Service (SMS)-SMS4Stroke study. BMC Neurol 2015; 15:212.
- Bingel U, Placebo Competence Team. Avoiding nocebo effects to optimize treatment outcome. JAMA 2014; 312:693.