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

Denial was measured on two scales given to the patients. The nine item lie scale on the Eysenck Personality Inventory was scored in a manner suggesting high levels of denial, “faking good” or illness minimization. The NMAD patients had a mean score of 4.6 (range 2 to 9; standard deviation 2.1) which was greater than normal control subjects who averaged 2.310 (p<0.05) and greater than a group of 36 age- and sex-matched patients with asthma who had not had a NMAD who averaged 3.7 (range 1 to 8; standard deviation 1.8) (p<0.05). The five item denial scale on the Illness Behaviour Questionnaire showed a mean score of 3.8 (range 1 to 5; standard deviation 1.4) for the NMAD patients which was significantly higher than seen in the control asthma patients (mean 3.2; range 0 to 5; standard deviation 1.2) (p<0.05), in control psychiatric patients (mean 2.4; standard deviation 1.7) (p<0.001), and in general practice patients (mean 2.9; standard deviation 1.7) (p<0.01).

Table 1 shows the results of the questionnaire data that are significantly different (p<0.05) between the group of ten patients diagnosed as having a psychiatric disorder and the 15 patients who were not so diagnosed.
It can be seen that the psychiatrically diagnosed patients score higher on the GHQ and MHQ which are scores of “psychiatric caseness,” perceive themselves as having a lower quality of life on the QL Index, have more symptoms of hyperventilation/hy-pocapnia on the Asthma Symptom Checklist and much lower levels of denial on the IBQ denial scale. Of interest, also, were the EPI Lie Scale results where the psychiatrically diagnosed patients scored an average of 3.9 and the nondiagnosed patients an average of 5.0. This trend did not, however, reach significance (p = 0.2). Source

The psychiatrically diagnosed patients also had significantly more frequently a positive past psychiatric history and family psychiatric history. Seven of these ten patients had psychiatric treatment or assessment prior to their NMAD, whereas none of the 15 nondiagnosed patients had undergone this. Three of these patients had been assessed clinically by the author prior to their NMAD. Of these three patients, one had longstanding bulemia, another had a generalized anxiety disorder, while the third displayed abnormal illness behavior and had a borderline personality disorder. The four patients not seen by the author reported that they had been treated for, respectively, depression with ECT, depression with psychotherapy, an anxiety disorder, and alcohol abuse. One of the other three psychiatric cases also had a positive family psychiatric history, her mother having been treated for a severe postpartum depressive illness.
There were no significant differences between the groups of diagnosed and undiagnosed patients on a variety of other medical and epidemiologic parameters, although there was a trend for the psychiatrically diagnosed patients to appear to be somewhat more chronically ill, having been younger when their asthma was diagnosed, having had asthma for longer periods of time before their NMAD, and having had more hospital admissions before this event.
Physiologic data on these patients will be reported separately. Early analysis of these data, however, suggests that the psychiatrically diagnosed NMAD patients tended to have similar or slightly better lung function than the nonpsychiatrically diagnosed patients refuting the impression that this group was actually more severely medically impaired and that this factor might have been related to their psychiatric decompensation.

Table 1—Differences in Questionnaire Results Between Psychiatrically Diagnosed (10) and Nondiagnosed (15) NMAD Patients

DiagnosedPatients UndiagnosedPatients p Value
GHQ 6.6 (6.0) 2.6 (3.4) 0.04
MHQ 33.0 (13.8) 22.3 (9.9) 0.03
Q-L Index 7.4 (2.4) 9.1 (1.3) 0.04
ASC-Hyperventilation/hypocapnia 1.9 (0.8) 1.2 (0.3) 0.01
IBQ Denial 2.8 (1.6) 4.5 (0.6) 0.001
Past psychiatric history + ve -ve 0.001
Family psychiatric history + ve -ve 0.04
NB SD in brackets