Chronic disease Flashcards
What is the most abundant organic molecule in nature?
Carbohydrates
Name the main functions of carbohydrates
- Immune functions
- Intercellular communication
- Structural components
- Energy source
- Energy storage `
What is the simplest form of sugar
Monosaccharides (1 sugar unit)
How many sugar units do oligosaccharides contain?
3 to 10 sugar units
What is the generic name of a monosaccharide with 3 carbons. State an example too
Generic name: triose
Example: glyceraldehyde
What are the most common functional groups in monosaccharides
- Aldoses (-ose) (aldehyde function)
- Ketoses (-ulose) (ketone function)
Define isomers
Compounds that have the same chemical formula but different structures
Epimers
Carbohydrate isomers that differ in configuration around only one specific carbon atom
What are enantiomers?
Pair of structures that are mirror image of each other
What are the most naturally occurring sugars (D or L isomers)?
- D isomers
Most monosaccharide with 5 or more carbon atoms from a ring structure. TRUE OR FALSE
TRUE
What is a pyranose ring
A cyclic monosaccharide with 5 carbon atoms and 1 oxygen atom
What is a furanose ring
A cyclic monosaccharide with 4 carbon atoms and 1 oxygen atom
Cyclization creates an anomeric carbon centre. TRUE OR FALSE
TRUE
What is an anomeric carbon atom?
A carbon that is derived from the carbonyl carbon compound of the open - chain form of the carbohydrate molecule
Name some features of fructose
- it is sweeter than glucose
- source: fruits, vegetables and honey
What is glucose the primary energy source for?
- the brain
- cells with few or no mitochondria
- essential in exercising muslce
Where can glucose be obtained?
Diet
Degradation of glycogen
Gluconeogenesis
What is the feature of galactose and where can it be found
- less sweet than glucose
- source: dairy products
What does maltose consist of?
Glucose + Glucose
Galactose + glucose =
Lactose
Glucose + ___ = sucrose
Fructose
What is the bond between sugars called?
- Glycosidic bond
How are glycosidic bonds formed
Through condensation reactions
Where is sucrose found
Sugar cane and sugar beets
What kind of bond is in maltose
1,4 - glycosidic bond (alpha)
How is maltose formed
By the degradtion of starch
What bonds are in sucrose
1, 2- glycosidic bond (beta)
What kind of bonds are in lactose?
1,4 glycosidic bonds
Where is lactose found?
In mammalian milk
What are the 3 important polysaccharides
. Cellulose - structural
. Starch - storage
. Glycogen - storage
What bonds are in cellulose and cellulose is a major component of …… (1)
- 1,4 glycosidic bonds (beta)
- (1) plant cell walls
What are the two types of starch?
- Amylose: unbranched, alpha 1,4 glycosidic bonds
- Amlopectin: branched - alpha 1,6 glycosidic bonds & alpha 1,4 glycosidic bonds
Glycogen has a branched structure and is similar to amylopectin. TRUE OR FALSE
TRUE
What causes lactose intolerance?
The inability to produce insufficient amounts of lactase so lactose does not get broken down.
State another sugar intolerance (not lactose)
Isomaltose/ Sucrose
What are the symptoms of sugar intolerance
- Undigested carbohydrate will pass into the large intestine cause OSMOTIC DIARRHOEA
- Bacterial fermentation of carbohydrate produces lot of CO2 and H2. > causes ABDOMINAL CRAMPS, DIARRHOEA and FLATULENCE (farting)
How do you manage sugar intolerance?
- withholding dietary sugar (not always possible as sucrose is also found in fruits etc.)
- enzyme replacement therapy (lactase/sucrase is taken when ingesting meals that contain lactose/sucrose)
What is galactosaemia?
Inability to metabolise galactose - leads to accumulation of galactose which is then oxidised and reduced to toxic metabolites
Glucose is broken down via glycolysis into ….. (1)
(1)Pyruvate
in anaerobic conditions: Lactate
Glucose > Pyruvate > Acetyl Co A > CO2
Metabolism of glucose
What cells are monosaccharides absorbed by?
Intestinal mucosal cells
Glucose and galactose are actively transported by what?
Sodium - dependent glucose (SGLT - 1)
Fructose is actively transported by what?
Sodium - independent monosaccharide (GLUT - 5)
How are carbohydrates digested?
- Mouth - amylase breaks down carbohydrates
- Stomach - stomach acid kills any bacteria
- Small intestine (duodenum) - pancreatic amylase breaks down carbohydrates into Dextrin and Maltose
Small intestine makes lactase, sucrase and maltase
Sugars absorbed into small intestine - Liver - absorbed sugar is processed by liver and storage as glycogen
- Other glucose is moved through the body by bloodstream
What does pancreatic amylase break down carbs into ?
Dextrin and Maltose
What are health behaviours?
Behaviours that affect our health positively or negatively
Why is the behaviour for health promotion and prevention important?
Because most diseases e.g cardiovascular or diabetes could be avoided by reducing obesity, smoking, physical inactivity and improving diet
What does the biomedical approach to medicine assume?
It assumes that all disease can be explained using physiological process and that treatment is for the disease, not the person
- ignores the social factors (e.g class difference - lower class more likely to develop certain illnesses)
- ignores the psychological factors on health (e.g stress, attitude towards certain health related behaviours)
How can it be proved that psychological factors are also involved in the treatment of diseases?
- the placebo effect
What is the approach to medicine called that is more holistic?
- Biopsychosocial approach
- takes into consideration
1. Bio (virus, bacteria)
2. Psychological (Behaviour, Beliefs, Coping, Stress, Pain & emotions)
3. Social ( class, employment, culture and ethnicity)
How can your health behaviour have a reactive influence?
Drinking alcohol due to stress or taking too many painkillers due to pain
How can your health behaviour have a proactive influence?
Deciding to regularly exercise in order to prevent high cholesterol, deciding to eat healthily to stay a healthy weight,
How can we help patients change behaviours (e.g stop smoking) and take up health protective behaviours (e.g more exercise)
By understanding why people carry out health risk behaviours
How can a doctor explore a patient’s attitude towards smoking?
By asking questions like:
- What do you think about smoking?
- What are the good/bad things about smoking?
- What do your friends and family think about smoking
- Would you want to give up smoking for someone?
- Do you think you can give up smoking?
- If you tried smoking what things would make it difficult for you to succeed?
- Have you ever thought about giving up smoking?
Define health
Health is a state of complete, physical, mental and social wellbeing and not merely the absence of disease and infirmity.
What is health psychology?
A branch of psychology hat studies the psychological processes in health, illness and health care
What are the 3 main goals of health psychology?
- Understand psychological factors
- Promote and maintain health
- Prevent and treat illness
Name some differential diagnosis for widespread musculoskeletal pain
- Inflammatory arthritis
- Fibromyalgia
- Myositis (inflammation in muscles)
- Hypothyroidism
What are the features of widespread pain? (SOCRATES)
Onset: Progressive
Timing: Pain worse in the morning
Site: Difficult to localize the pain
Stiffness: worse in the morning and lasts more than 30 minutes
What some associated symptoms of widespread msk pain?
- Temporal headaches
- Blurred vision
- Rashes, mouth ulcers and Raynaud phenomenon
- Abdominal pain and confusion
What blood tests can be carried out for widespread msk pain?
- ESR and CRP to check for inflammatory arthritis
- Calcium levels (low in osteomalacia)
- Parathyroid hormone levels (to exclude hyperparathyroidism)
- Vitamin D levels (to exclude osteomalacia)
What is osteomalacia?
Softening of bone usually caused by vitamin D deficiency
What is fibromyalgia?
Widespread chronic pain that is non - specific
What are the associated symptoms of fibromyalgia?
- Depression
- Insomnia
- Altered bowel habits
- Poor concentration
- Allodynia - (pain even though the stimulus isn’t painful)
How common is fibromyalgia?
2-5%
What are the main risk factors of fibromyalgia?
- Women (between 30 and 60)
- Middle age
- Stressful life events
What is a key feature of fibromyalgia?
Poor response to analgesia
What investigations can be carried out for fibromyalgia?
- No specific investigations: most investigations should be done to rule out other conditions
How do you manage fibromyalgia?
- Educate patients about their condition, reassure that they do not have destructive arthritis, explain why further investigations might not be useful
- Physiotherapy/exercise
- Cognitive behavioural therapy: encourages patients to develop coping mechanism to deal with their symptoms
- Drug therapy: Antidepressants, Ketamine or Tramadol can be administered.
What are the finding upon examining a patient with fibromyalgia?
- Tender points
- No muscle weakness
- No synovial inflammation
What are the causes of fibromyalgia?
CAUSE IS STILL NOT FULLY DISCOVERED
- Infection: pain follows viral infections in 20%
- 20% have persistent symptoms after Lyme Disease
- Trauma e.g Neck/Leg fracture etc.
Could have genetic associations (HLA)
Fibromyalgia could also have psychological impact on wellbeing. TRUE OR FALSE
TRUE
Give three examples of macronutrients
- Carbohydrates
- Fats
- Proteins
These are converted to energy
Which of these 3 (carbs, fats or protein) have the highest energy content
- Fats (9.5kcal/g)
2. Protein (5.7kcal/g)
After macronutrients are absorbed, where does the energy come from (what cycle?
- Tricarboxylic acid
- The mitochondrial process of oxidative phosphorylation
Metabolic pathway for converting macronutrients:
Carbohydrates > … (1)… > Acetyl CoA > …..(2)… > oxidate phosphorylation
(1) Glucose and other sugars
(2) TCA cycle
Metabolic pathway for converting macronutrients:
….. (1)… > amino acids > ….(2)…> TCA cycle > Oxidative phosphorylation
(1) Protein
(2) Acetyl CoA
Negative energy balance results in weight gain. TRUE OR FALSE
FALSE - Positive energy results in weight gain and the deposition of the fat and glycogen
What is the basal metabolic rate (BMR)?
The energy used by the body to maintain basic physiological function.
What factors affect BMR?
- Age
- Obesity
- Climate
- Medications
- Disease
Name some examples of micronutrients
- Vitamins
- Trace elements (zinc, iodine, magnesium)
- Electrolytes
What are macro and micronutrients
Macronutrients: nutrients we need in larger quantities to provide us energy
Micronutrients: nutrients we only need in small amounts
How are vitamins classified?
According to their solubility in fat or water
Most vitamins function as …..(1)….. and …(2)..
(1) Coenzyme
(2) Antioxidants
How do vitamins act as antioxidants?
They provide protection from damage caused by free radicals
- Vitamin E,C and A form non-reactive, stable radicals
Name 1 source for each vitamin
- A
- D
- E
- K
- B1
- B2
- B3
- Biotin
- Milk and milk products
- UV exposure to skin, egg yolks
- Vegetables, nuts etc.
- Green vegetables
- Cereals, Grains, beans
- Milk& milk products
- Meat and cereal
- Egg yolk
- What condition can vitamin A deficiency cause?
- What can acute overdose of vitamin A cause?
- What can high doses of V.A cause?
- Night blindness
- Nausea and headaches
- Liver damage
- What function of Vitamin D?
- What can vitamin D deficiency lead to?
- What can high doses of vitamin D cause?
- Preventing rickets and Osteomalacia
- Osteomalacia
- Hypercalcaemia
What is the function of Vitamin E?
- helps maintain cell membrane structure
- it affects DNA synthesis and cell signalling
- involved in the anti- inflammatory and immune system
What is the use of warfarin?
- blood thinning medication against stroke, valvular heart disease
Define nutrient
A food derived chemical which the body needs for growth and metabolism
Name features of vitamin C deficiency (scurvy)
- Severe joint pain or leg pain
- Skin that bruises easily
- Swollen, bleeding gums
- Fatigue
What are some functions of Vitamin C?
- Tissue antioxidant
- Aids wound healing
- Involved in synthesis of collagen, hormones and neurotransmitter
- Enhances absorption of non haem iron
What selenium deficiency lead to?
- Keshan disease (cardiomyopathy)
- Hypothyroidism (poor cognition, extreme fatigue etc. )
What is the role of selenium in the body?
. Anti- cancer (stabilises DNA)
. Anti - ageing
. Supports immune function (stimulates neutrophils
. Component of an enzyme that activates thyroid hormones
What are some weight - reduction programmes for obesity?
- Low carbohydrate
- Portion control
- High protein, high fat which induce ketosis
- Bariatric surgery (changes to digestive system)
What is ketosis
Physiologic ketosis is a normal response to low glucose availability, such as low-carbohydrate diets or fasting, that provides an additional energy source for the brain in the form of ketones.
What is the role of protein in weight loss and maintenance?
- greater weight loss and preservation of lean mass after higher protein energy restriction diet.
- protein supplementation enhances the effect of resistance exercise in the attenuation of age related loss muscle mass versus exercise along
Name government action on obesity resulting from Covid -19
- Online and TV adverts for food high in fat, sugar and salt banned before 9pm
- Buy one get one free
- More discounts on food like fruit and vegetables
- Alcohol calorie labelling
Define public health surveillance
The ongoing , systematic collection, analysis and interpretation of health- related data essential to planning, implementation and evaluation of public health practise
Name 3 functions of public health surveillance
- Describe the burden of or potential for disease
- Detect sudden changes in disease occurrence and distribution
- Identify priorities
- Monitor changes in disease prevalence over time
- Monitor changes in health behaviours
State the state the steps in surveillance:
- Detect - detect the disease
- Code - code the date
- Analyse - analyse the data
- Disseminate - pass on the data to the right person
- Action - prepare action plan
Define incidence:
The rate of occurrence of new cases
conveys information about the risk of contracting the disease
Define prevalence:
The proportion of cases in the population at a given time
indicates how widespread the disease is
Define morality rate
Measure of the frequency of occurrence of death in a defined population during a specified interval
Define a case fatality rate
Measure of deaths assigned to a specific cause during a given time interval, relative to the total number of cases
Define
- Outbreak
- Epidemic
- Pandemic
- A sudden increase in occurrences of a disease1. 2. A serious outbreak in a single community, population or region
- An epidemic which is spreading around the world
Define an endemic
The habitual presence of a disease within a given geographic area
How can we monitor the global prevalence of diseases?
International Classification of Diseases
- By a set of codes:
Each condition has a distinct code that is used by all health professionals throughout the world
What is the Global Burden of Disease study?
- largest study in the world that summaries global surveillance data
- gives us a picture of the health status of the world at a global, regional, national and even local level.
What is the point of pain and what are its limitations?
- it calls for attention (its for survival and is usually difficult to ignore
Limitations - We also attend to pain we can do nothing about (doesn’t help survival)
- If there is a distraction it could also reduce the intensity of the pain
Name some features of acute pain
- clear reason for occurrence
- good likelihood of resolving with healing/recovery
- good response to treatment where available
Name some features of chronic pain
- less clear cause
- poor response to available treatment
- psychological component needs assessing and if needed managing.
Chronic pain affect 1 in 4 of the population. TRUE OR FALSE
FALSE - affects 20%
Psychological factors have a significant influence on pain and disability and are strong determinants of outcome than the biomedical factors. TRUE OR FALSE
TRUE
Why do psychological factors play a role in pain?
Individuals might have different attitudes about the origin of the pain, seriousness of the pain, and how to react to the pain
- they might be distressed
- they might have different coping strategies
What are some cognitions of pain?
- Over generalization (the pain will never stop)
- Jumping to conclusions
- Should thinking (I should be able to do x and I cannot)
- Catastrophizing (I am afraid the pain will get worse)
- Rumination ( I keep thinking about how much it hurts.
- Expectations ( This should have recovered by now)
What are the significant emotions in chronic pain
- Fear and Anxiety
Name some interventions against anxiety
- Education: helping patients understand that chronic pain does not indicate underlying pathology
- Relaxation techniques: e.g guided imagery
How can depression be tackled in chronic pain?
- working to challenge unhelpful or negative thoughts using cognitive behavioural techniques
- Education the patient
- Realistic goal stetting
- Graded and paced activity and exercise
What is the cognitive behavioural therapy?
- originally developed for depression
- talking therapy that can help you manage your problems by changing the way you think and behave
Name some stress management and relaxation techniques
- Breathing techniques (diaphragmatic breathing)
- Exercise
- Listening to sounds from nature
- Guided imagery relaxation exercises
- Hypnosis
- Massage and cold/heat pads
- Acupuncture
- Chiropractice
What is act?
Acceptance and commitment therapy
ACT uses acceptance and mindfulness skills to produce greater psychological flexibility and to help people live a more meaningful life
- it attempts to control and avoid internal negative experiences
- teaches psychological skills on how to deal with painful thoughts
What are some factors helping acceptance
- if the patient understands why their pain persists, limitations of existing treatments, further treatments will not cure the pain, and they can make changes which will improve things
- support from health professionals, family, friends employers
- a sense of identify which is not entirely tied up with the pain
What are chronic conditions?
- disease lasting more than 3 months
- no cure
- disease would normally result in a significant adjustment for the individual and increased contact with medical services
Name 5 examples of chronic diseases
- Arthritis
- Cancer
- COPD
- Crohns Disease
- Diabetes
- Epilepsy
- HIV/AIDS
- Multiple sclerosis
- Parkinson disease
- Cystic fibrosis
What is the leading cause of death in women?
Alzheimer and dementia disease
The number of people with diabetes is meant to decrease. TRUE OR FALSE
FALSE - it is meant to decrease
Who is involved in managing chronic disease?
- Practise nurses in primary care
- District nurses in elderly and housebound
- GP might be the main person responsible for the other team members, initiate treatment and make diagnosis for chronic disease
What members of the MDT are responsible for managing chronic disease?
- Specialist teams
- GP
- Other health professionals e.g optician, OT
- Social services, Home care
- Mental health professionals e.g counsellors, psychologists and psychiatrists
- Pharmacists
- Voluntary agencies e.g self help groups
What is included in the regular reviews of chronic ?
- Progression of disease
- Checking patients understanding
- Monitoring side effects, effectiveness and adherence of treatments
- Assessing/monitor/ treating risk factors
- Effects on feelings - sick role, self esteem, stigma
- Effects on life (relationship, dependency, parenting, work, finance, mobility, housing etc. )
- Effects on family/carers
What are the main effects of chronic illness?
- Physical
- Psychological
- Behavioural
- Social
- Spiritual/Existential
What are doctors response to chronic illness
- Curative medicine approach (trying to cure the illness)
- Sense of failure (not being able to cure the disease)
- Feeling overwhelmed by needs of patient
- Perspective of palliative medicine
What is palliative medicine?
Interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex illness
What is co- morbidity
When chronic diseases co exist in patients
Name 2 co morbidities in diabetes
- Hypertension
- Retinopathy (damage to retina)
Name 2 co morbidities in dementia
- Hypertension
- Depression
What is the prevalence of hypertension
20%
What causes comorbidity?
- One disease might cause another ( e.g diabetes and renal failure)
- Both conditions share a common cause (e.g lack of exercise and smoking)
What are the 2 unmodifiable risk factors for chronic disease
- Age
- Genetic risk
State some partially modifiable risk factors for chronic disease
- Diet
- Exercise
- Smoking
- Pollution
- Alcohol consumption
- Obesity
What is chronic back pain
Back pain that persists for more than three months
What are the economical costs of back pain
- cause for long term sickness (days of work)
-
What team members would be involved in chronic back pain
- GP or nurse practitioner
- Community physiotherapist
- Radiology service
- Pain clinic
- Rheumatologist
- Orthopaedic surgeon
What are the features of the development of chronic back pain
First 2 months: - Active coping, belief pain is controllable 2 - 6 months: - Testing different coping styles - Depression might occur and varying between increased and decreased activity 6 - 24 months: - Hope of a cure diminishes - Reduced activity - Belief pain is uncontrollable
Define stress
When the demands of a situation exceed our resources to cope with it
What are some symptoms of stress
- Anxiety
- Depression
-Restlessness
-Diarrhoea - Irritability
Sleeping problems - Hopelessness
etc.
Name the 4 types of stressors:
- Internal (the way we make sense of a situation)
- External (events out of our control)
- Acute ( sudden illness, exams etc.
- Chronic (long illness, relationships and work)
- Major life events ( divorce, bereavement)
In chronic stress, responses remain …(1)…. for longer and can lead to ….(2) of the body
- Active
2. Wear and tear
What does chronic stress affect (broadly)
- Mental and physical health
- Onset of illness
- Recovery and response to treatment
Name 3 behavioural responses to stress:
- Unhealthy diets
- Smoking, alcohol etc
- Tiredness/lack of sleep/ concentration
- less likely to prioritise wellbeing
Name 3 health problems linked with stress
- Hypertension
- Muscular pain
- Diabetes
- Anxiety/depression
What are the two psychological approaches to stress management?
- Cognitive behavioural approaches
- Mindfulness- based approaches
What is the cognitive behavioural approach used for?
It focuses on appraisal and coping strategies in order to help people manage stressors and perceived stress better
What is the mindfulness - based approach used for?
- Focuses on mental and physical relaxation (mindfulness, relaxation, mediation and yoga)
Do psychological approaches to stress management work?
Yes partially,
- reduces depression and anxiety
- increases self esteem
- improves quality of life and wellbeing
- improve performance at work
No:
- has little or no impact on morbidity or mortality
- no substantial differences between types of intervention
Stress triggers a flight or fight response. TRUE OR FALSE
TRUE
Who is more likely to develop stress?
- People who have precursors of disease
- People that have pre- existing vulnerability
Describe the flight or fight response
- Hypothalamus sends signal to the adrenal gland (medulla) - this stimulates the production of epinephrine
- Epinephrine will bind to the proteins on top of the hepatocytes
- In the liver a signal transduction pathway is activated (glycogen is converted to glucose)
- Glucose moves through the body and gets broken into ATP (energy currency)
- Epinephrine increases respiratory rate, heart rate and slows down digestion
- Causes vasodilation in muscles.
Name the six classes of the Registrar General’s classification
- Professional (A)
- Managerial and technical (B)
- Skilled non - manual (C1)
- Skilled manual (C2)
- Semi- skilled (D)
- Unskilled (E)
What are the 3 explanations for disparity in health, illness and mortality?
- Cultural/ behavioural (diet, smoking, exercise)
- Materialist (e.g economic inequality > less fortunate people are less likely to afford healthcare)
- Social selection ( people that are higher up have more connections & are for example more likely to be selected for a job)
What are the social determinants of health?
- Age, Sex and constitutional factors (e.g hereditary predisposition to certain conditions)
- Individual lifestyle factors
- Social and community networks
- Living and working conditions (unemployment, water and sanitation, work environment, education, housing
- General socio-economic, cultural and environmental conditions
List the national statistics socio- economic classification
1 Higher managerial, administrative and professional occupations
1.1 Large employers and higher managerial and administrative occupations
1.2 Higher professional occupations
2 Lower managerial, administrative and professional occupations
3 Intermediate occupations
4 Small employers and own account workers
5 Lower supervisory and technical occupations
6 Semi-routine occupations
7 Routine occupations
8 Never worked and long-term unemployed
Define autonomy
It is the capacity to think, decide and to act on the basis of such thought and decision, freely and independently
Define beneficence
Do what is best for the patient
Define non- maleficence
Do no harm
Define justice
- Patients in similar situations should normally have access to the same healthcare
- We must try and distribute our limited resources fairly
Define impairment
Deterioration in the functioning of a body part, organ or system that can be temporary or permanent > can results from injury or disease
Define function
The way in which something operates
Define disability
An illness, injury or medical condition that makes it difficult for someone to do things that other people do.
What is the medical model
It states that disability is a direct consequence of an underlying disease or disorder therefore disability reduction can only be achieved through improvement of underlying pathology.
DISADVANTAGE OF THIS MODEL: Doesn’t take into account the social and psychological factors that contribute to a disability
What is the social model
The social model of disability emphasises that limitations in activity and restrictions in participation
of individuals result from social and environmental restrictions
What is the psychological model
This model argues that depressed or anxious people are more likely be limited due to
their mental state and mind frame rather than the disease itself.
For example, individuals who believe that they can overcome their disability, find the activity more
rewarding or see family or friends as being more supportive are more likely to engage in the activity
than someone else.
What is the name for the three theoretical models (social, medical and psychological)
The ICF (International classification of Functioning, Disability and Health ) model
What is disease surveillance?
- can be used to monitor disease trends and plan public health programs
- disease surveillance can be active (government is actively looking for information>contacting nhs etc.) or passive (notifiable diseases)
State 2 uses of wearable devices (e.g activity trackers >fitbit)
- Prevention of diseases/maintenance of health
2. Managing disease/adopting healthier habits
Name a few examples of pathological pain
- Chronic back pain
- Neuropathic pain syndrome e.g phantom leg
- Cancer pain
- Fibromyalgia
What is neuropathic pain
Pain arising from a lesion or disease of the somatosensory nervous system
What is the sick role?
The sick role is a concept in medical sociology regarding sickness and being ill. It
deals with two things.
- The rights of a sick person
- The responsibilities of a sick person
Name the two responsibilities of the sick role and the two rights:
The rights:
• The sick person is exempted from carrying out some or all of normal social duties (e.g.
work, family).
• The person is not responsible for assuming the sick role. (e.g the sick person didn’t
originally want to be sick)
The responsibilities:
• The sick person should try to get well as soon as possible
• The sick should get help and cooperate with medical experts
The functions of the ‘sick role’ in modern healthcare are:
• Control illness
• To reduce the disruptive effects on the social systems by returning the ill to good health as
quickly as possible.
What is a placebo?
- Something that looks like real medicine but doesn’t have any direct action in the condition or symptoms
- can also cause:
- dependence, withdrawal and increase in dose over time
What is nocebo?
- Adverse effects not due to any pharmacological mode of action
- happens in patients that expect side effects
- in patients who previously had side effects
- pt with mental health problems
Name the types of placebo?
- Pure: sugar pill
- Impure: some active ingredients with no effects (vitamins)
- Procedure ( injections etc.)
Why do placebos work?
- patients believes doctors have the authority and their expectations should be followed
- pt are expected to get better so they try to (sick role)
- pt believe medicine is evidence based and effective
- patient believes it will work as medicine helped them before