Psychological Factors Affecting Other Medical Conditions: Types, Symptoms, Identification, and Treatment
Liaison Psychiatry • Behavioral Medicine • Primary Care
Psychological Factors Affecting Other Medical Conditions
Psychological factors can alter the course, treatment adherence and outcomes of medical illnesses — for example anxiety worsening asthma control, depression slowing recovery after myocardial infarction, or maladaptive health behaviours impeding diabetes management. This guide helps clinicians recognise, assess and integrate treatment in routine medical care.
Concept & scope
Psychological factors affecting other medical conditions (DSM/ICD construct) refer to maladaptive psychological or behavioural processes that influence the course or treatment of an existing medical illness. These factors include stress, maladaptive coping, nonadherence, health anxiety, depressive symptoms, and behaviours that increase morbidity (smoking, sedentary lifestyle).
Common clinical examples
- Anxiety and panic provoking breathlessness and poor asthma control.
- Depression leading to poor adherence to cardiac rehabilitation after myocardial infarction.
- Health anxiety and excessive healthcare use after benign test results.
- Maladaptive coping (avoidance) worsening chronic pain disability.
- Behaviours such as smoking, harmful alcohol use, poor diet and inactivity that worsen diabetes, COPD or cardiovascular disease.
Identification — screening & history
- Ask about mood, anxiety, stress, sleep, substance use and adherence in every patient with chronic medical conditions.
- Use brief validated tools: PHQ‑9 (depression), GAD‑7 (anxiety), AUDIT‑C (alcohol), Morisky Medication Adherence Scale and chronic pain catastrophising scales where relevant.
- Explore health beliefs, illness perceptions (IPQ), and practical barriers to adherence (cost, transport, side effects) and social supports.
Assessment checklist
- Document the medical diagnosis, current treatment regimen and objective markers of disease control (e.g., HbA1c, peak flow, BP).
- Assess psychological symptoms, coping styles (avoidant vs active), illness perceptions and readiness to change.
- Evaluate adherence objectively (pharmacy records, pill counts) when available and identify cognitive or practical barriers.
- Consider referral to liaison psychiatry, psychology or behavioural medicine when psychiatric comorbidity or complex psychosocial factors are present.
Management principles — integrated care
- Adopt a biopsychosocial approach: treat medical illness while addressing psychological contributors in parallel.
- Use brief interventions in medical settings (problem‑solving, motivational interviewing, adherence counselling) and arrange stepped psychological care when indicated.
- Coordinate care between primary/specialty medicine and mental health — shared care plans and single point of contact improve outcomes and reduce duplication.
Evidence‑based interventions
- Cognitive Behavioural Therapy (CBT): effective across conditions — e.g., CBT for insomnia to improve diabetes control, CBT for panic in asthma, CBT for chronic pain.
- Motivational Interviewing (MI): enhances readiness to change for smoking cessation, medication adherence and lifestyle modification.
- Collaborative care models: nurse or case manager‑led monitoring with psychiatric/psychological supervision improves outcomes in depression with comorbid chronic illness.
- Behavioural activation, graded exercise and pacing: useful for comorbid depression and chronic fatigue/pain syndromes.
Practical strategies in medical settings
- Brief behavioural interventions: one‑session problem‑solving, brief CBT techniques, and adherence counselling integrated into clinic visits.
- Medication optimisation: treat depression/anxiety which often improves self‑care; choose agents mindful of medical comorbidity and interactions.
- Set collaborative goals: specific, measurable, achievable, relevant and time‑bound (SMART) goals for diet, activity, medication adherence and symptom targets.
- Use reminders and simplify regimens: pillboxes, blister packs, SMS reminders and community support to reduce practical barriers to adherence.
Special considerations
- Older adults: screen for cognitive impairment, polypharmacy and social isolation which affect adherence and treatment tolerance.
- Children & adolescents: involve families, schools and tailor interventions (FBT, family‑based adherence support) to developmental stage.
- Pregnancy: balance mental health treatment benefits with fetal safety—collaborate with obstetrics and perinatal psychiatry where available.
When to escalate / red flags
- Severe psychiatric comorbidity (psychosis, severe depression with suicidality), inability to adhere due to cognitive impairment, or behaviours that put patients at immediate medical risk (self‑harm, medication misuse)—urgent mental health input required.
- Poorly controlled medical illness despite optimized therapy and good adherence—consider specialist review for refractory disease vs psychosocial drivers.
Case vignette
Patient: T., 56, with type 2 diabetes and HbA1c 9.5% despite multiple medication changes. On assessment T. reports low mood, fatigue and difficulty managing complex medication regimen after spouse’s death. Management: brief MI to set one adherence goal (daily pillbox + SMS reminder), start collaborative care with nurse case manager, commence antidepressant for moderate depression, and refer to diabetes education. At 3 months HbA1c improved to 7.8% and mood scores reduced.
தமிழில் — சுருக்கம்
மருத்துவ நோய்களில் மனநிலை பாதிப்புகள் பலவகையாக தாக்கத்தை ஏற்படுத்த முடியும் — மனஅழுத்தம், மனஅச்சம் அல்லது மனச்சோர்வு போன்றவை நோயின் நிர்வாகத்தை பாதிக்கும். மருத்துவமும் மனநலமும் ஒருங்கிணைந்த சிகிச்சை முக்கியம்.
Key takeaways
- Screen routinely for psychological factors in patients with chronic medical conditions—these often explain poor disease control and are treatable.
- Use brief behavioural interventions in medical settings, treat comorbid mental health conditions, and employ collaborative care models when available.
- Coordinate care, set SMART goals and address practical barriers to adherence to improve clinical outcomes.