The authors of this case report, “Ineffective chronic illness behaviour,” illustrate how difficulties in treatment interactions need analysis beyond the patient’s presumed diagnosis or disorder
– especially when patients’ behaviour during treatment is unusual or unexpected related to the primary symptoms.

The authors describe their patient’s behaviour as “a form of ineffective chronic illness behaviour that has been jointly but inadvertently created by patient and professional. Analyzing the situation from this perspective, another strategy – apart from referral or “pampering and dithering” – is within reach: making a fresh start in the treatment process of the so-called
“difficult” patient.”

“Such an endeavour includes, but is not necessarily limited to: a disentanglement of symptoms and (learned) illness behaviour, an analysis of the dynamics of the treatment alliance, a reconsideration of the given diagnosis and available treatment options, and – preferably – a discussion with the patient about aforementioned issues. In this case, the authors choose to discuss the issues openly with the patient, starting from the concept of the “difficult” patient, who runs the risk to be expelled from every health care system available.”

They then jointly establish a “explanatory theory of patient’s claim on care: an enduring lack of recognition of qualities and vulnerabilities by important others.”

Particularly interesting in this case was the role of a community nurse (and researcher) who assumed “a case-manager role, coordinating efforts to ameliorate social problems (including work and meaningful contacts), to structure access to additional psychiatric care (e.g. crisis intervention, hospitalization), and to be a trusted person in the background.”

The case report describes in lucid detail how these joint efforts between multiple stakeholders have decreased the patient’s symptoms, improved his social functioning, and limited his health care use.

Rakesh Biswas
Deputy Editor

Ineffective chronic illness behaviour in a patient with long-term non-psychotic psychiatric illness