Clinical Characterization of Demoralization

Fava, Giovanni A.; Guidi, Jenny

doi:10.1159/000530760

Cited by 17 publications

(17 citation statements)

References 55 publications

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“…On the other side of the spectrum, there are various forms of health-damaging behavior that range from unrealistic optimism to delay in seeking medical care, from partial or total lack of adherence to complete denial of diagnosis and of the need for treatment [211]. As important is relating illness denial to affective disturbances that may influence its expression, such as anxiety, depression, demoralization, and irritable mood [22, 213].…”

Section: Discussionmentioning

confidence: 99%

Illness Denial in Medical Disorders: A Systematic Review

Patierno

Fava

Carrozzino

2023

Psychother Psychosom

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Introduction: Illness denial pertains to medical patients who do not acknowledge the presence or severity of their disease or the need of treatment. Objective: This systematic review was performed to clarify the clinical role and manifestations of illness denial, its impact on health attitudes and behavior, as well as on short- and long-term outcomes in patients with medical disorders. Methods: The systematic search according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines was conducted on PubMed, Scopus, and Web of Science. Results: The initial search yielded a total of 14,098 articles; 176 studies met the criteria for inclusion. Illness denial appeared to be a relatively common condition affecting a wide spectrum of health attitudes and behavior. In some cases, it may help a person cope with various stages of illness and treatment. In other situations, it may determine delay in seeking treatment, impaired adherence, and reduced self-management, leading to adverse outcomes. The Diagnostic Criteria for Psychosomatic Research (DCPR) were found to set a useful severity threshold for the condition. An important clinical distinction can also be made based on the DCPR for illness denial, which require the assessment of whether the patient has been provided with an adequate appraisal of the medical situation. Conclusions: This systematic review indicates that patients with medical disorders experience and express illness denial in many forms and with varying degrees of severity. The findings suggest the need for a multidimensional assessment and provide challenging insights into the management of medical disorders.

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Section: Discussionmentioning

confidence: 99%

Illness Denial in Medical Disorders: A Systematic Review

Patierno

Fava

Carrozzino

2023

Psychother Psychosom

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“…Depressed patients often experience demoralization which can be characterized as a prolonged feeling of being unable to cope and a sense of hopelessness [23]. Allostatic overload (i.e., chronic stress associated with illness becomes intolerable), and poor quality of life associated with depression may cause a state of demoralization independent of the depression and thus contribute to a worsening of total symptom load [23,24]. Help-seeking through the act of presenting for psychotherapy suggests that individuals believe that the forthcoming treatment might provide a course of action that will be beneficial.…”

Section: Discussionmentioning

confidence: 99%

Symptom Change during Waitlist for Medicated and Nonmedicated Patients with Chronic Depression

Høstmælingen,

Nissen-Lie,

Wampold

et al. 2023

Psychother Psychosom

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Introduction: Patients seeking psychotherapy often spend time on waitlist (WL), the effect of which is largely unknown. WL patients may forego alternative non-psychotherapeutic assistance and thus do more poorly than had they not been placed on a WL. The course of symptoms might also be influenced by use of antidepressant medication (ADM), an issue that remains unexplored in the literature. Objective: In a naturalistic setting, WL symptom change before inpatient psychotherapy (mean weeks of waiting = 22.6) was assessed in a sample (N = 313) of chronically depressed patients. Methods: Using the Beck Depression Inventory-II, patients’ symptoms were tracked at assessment, when admitted to treatment (i.e., after WL), at posttreatment and 1-year follow-up. Multilevel growth curve analysis was used to examine waitlist change for the whole sample as well as for ADM users and nonmedicated patients. Results: Symptoms were reduced significantly from assessment to admittance (Cohen’s d = 0.47). Symptoms reduced less for ADM users (d = 0.39) than for nonmedicated patients (d = 0.65). Conclusion: The findings indicate that chronically depressed patients experience a decrease in symptoms during WL, quite likely due to treatment expectations. We discuss whether less symptom improvement for ADM users could be attributed to iatrogenic comorbidity and a higher degree of demoralization in this group.

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“…In DSM-5 [3], assessment is mainly restricted to the identification of major depressive episodes or persistent depressive disorders, omitting a large part of the patient’s distress, problematic areas, and biography [6]. There is an increasing amount of research that points to the importance of demoralization in the medically ill, a feeling state characterized by the patient’s consciousness of having failed to meet his/her own expectations (or those of others) or being unable to cope with some pressing problems [7]. Subjective incompetence, discouragement, helplessness, and hopelessness are the clinical hallmark of the syndrome.…”

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confidence: 99%

“…Subjective incompetence, discouragement, helplessness, and hopelessness are the clinical hallmark of the syndrome. Both diagnostic criteria and a clinimetric rating scale (the Clinical Interview for Demoralization) are available [7]. This expansion of the targets of clinical evaluation should be associated with a careful qualitative appraisal of symptoms and the differential diagnosis with those that are part of the symptomatology of medical disorders.…”

mentioning

confidence: 99%

“…Finding a common ground for certain psychological manifestations would be the next logical step. Even though a major depressive episode and demoralization may coexist, in many cases they may occur independently and the two syndromes are not connected by a hierarchical relationship (i.e., depressed patient may not suffer from demoralization and demoralized patients may lack the symptoms of a major depressive disorder) [7]. Indeed, demoralization, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR) [24], consists of very specific symptoms, is unlikely to respond to antidepressant medications, may benefit from psychotherapy but also, because of its strong link with allostatic load, from lifestyle medicine [7].…”

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confidence: 99%

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Management of Depression in Medical Patients: The Role of Clinical Evaluation

Fava,

Guidi

2023

Psychother Psychosom

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Clinical Characterization of Demoralization

Cited by 17 publications

References 55 publications

Illness Denial in Medical Disorders: A Systematic Review

Illness Denial in Medical Disorders: A Systematic Review

Symptom Change during Waitlist for Medicated and Nonmedicated Patients with Chronic Depression

Management of Depression in Medical Patients: The Role of Clinical Evaluation

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