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11-03-2013 | Mental health | Article

Scale identifies bipolar disorder patients reluctant to give up ‘sick role’


Free abstract

medwireNews: Researchers have highlighted the importance of recognizing patients with bipolar disorder who may have difficulty adjusting out of the "sick role," so that useful psychological treatment strategies can be provided.

They say that the Illness Cognitions Scale (ICS) - a 17-item validated scale that measures cognitive factors associated with the sick role - may be a useful adjunct to clinical assessment for people with bipolar disorder.

"The ICS assesses a clinically meaningful, frequently overlooked aspect of adjustment to illness, and provides an additional dimension to conceptualizing intractable illness," comment Michael Berk (Deakin University, Geelong, Victoria, Australia) and colleagues in the Journal of Affective Disorders.

Patients' acceptance of the presence and consequences of a chronic illness, such as bipolar disorder, is necessary in order for them to seek appropriate treatment, adjust their lifestyle and manage their condition, the team explains.

But some individuals assimilate illness into their identities and behavior to the point that serves to make the illness more intractable, "possibly providing a dysfunctional cognitive set or behavioral foil for life's challenges," they note.

The ICS, designed by the researchers to identify such individuals, scores patients on factors such as: not accepting illness - fighting against treatment advice, seeing advantages to being ill, and a belief that the individual is not getting the treatment or support needed. Responses are scored from a minimum of 17 to a maximum of 85.

Using the measure to assess 89 patients with bipolar I disorder or schizoaffective disorder, they found that high scores on the measure correlated with severe depression, worse general health, worse functioning, and worse scores in psychosocial measures including general health hope (State Hope Scale), perceived social support (Social Provisions Scale), and self-esteem (Rosenberg Self-Esteem Scale).

"If these factors modulate health-seeking behavior, treatment engagement and adherence, they may play a key role in predicting outcome and prognosis," note Berk et al.

The ICS may therefore "provide treating clinicians an opportunity to introduce strategies that target these difficulties potentially leading to better outcomes for these individuals."

Such strategies may include encouraging activity, self-management, and focus on the positive aspects of recovery, the team concludes.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Lucy Piper, Senior medwireNews Reporter

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