Psychological Defenses and Coping Styles in Patients Following a Life-Threatening Attack of Asthma: Conclusion

Psychological Defenses and Coping Styles in Patients Following a Life-Threatening Attack of Asthma: ConclusionThe results of this descriptive study have important clinical implications. First, a higher than usual level of denial is probably normal and adaptive in asthma. This may be increased following a NMAD or may be a risk factor for a NMAD, and this clearly needs further investigation. Second, high denial and the presence of psychiatric disorder is probably the worst combination, and psychiatric referral would seem appropriate. Clinicians should routinely make a note of their patients past and family psychiatric histories to help predict the patients* future style of coping. Third, clinicians have to be aware of the need to compromise in these high risk patients between attempting to modify excessively high levels of denial seen in these patients while trying to minimize the risk of psychiatric decompensation with its potential for increased anxiety and dependence.

Lifestyle and attitude changes which allow patients to manage chronic illnesses well, yet remain socially relatively normal, need further investigation. Fourth, the evidence is strong that NMAD patients minimize their symptoms and are consequently unreliable historians. Just as a single peak flow reading is known to be unreliable in asthma, so is a single history. The need for a corroborative history from a close family member is essential to allow accurate clinical assessment of asthma severity in this high risk group. In this study, interviewing patients with their relatives has led to, in several cases, the discovery that patients were engaging in certain high risk behaviors that they had not told their treating physicians about, and which were endangering them. Finally, treating patients with chronic illnesses like asthma will be greatly helped by family involvement in the therapeutic process. This is likely to both reduce family tensions at home leading to less conflict and more appropriate management of asthma, as well as to give the treating clinician a more accurate perception of levels of disability suffered by their patient.