Exam 3 Flashcards
Alcohol
A depressant that acts on the central nervous system and produces a variety of sensations that many people experience as pleasurable including relaxation, euphoria and loss of inhibitions among others
A standard drink in the United States
12 g pure alcohol
Safe drinking limits
No more than 4 standard drinks in a day for men (14 weekly) and no more than 3 standard drinks per day for women (7 weekly).
Drinking levels in excess of these limits place individuals at risk for negative health effects and problem drinking.
Problem drinking
Encompasses a wide range of drinking behaviors from at-risk drinking to binge drinking to alcohol dependence.
Binge drinking
Defined by blood-alcohol content (BAC) but is generally considered 5+ drinks in one setting for men and 4+ drinks for women
At-risk drinking
Drinking in excess of the limits defined above by NIAAA
Alcohol abuse and alcohol dependence are what type of disorder?
Substance abuse disorders
Alcohol abuse
Maladaptive pattern of alcohol use causing impairment or distress as manifested by at least one of the following criteria in a 12-month period:
Recurrent use resulting in failure to fulfill major role obligations at home, work or school
Recurrent use in situations in which it is physically hazardous
Recurrent alcohol-related legal problems
Continued use despite persistent or recurrent social or interpersonal problems known to have been caused or exacerbated by the alcohol use
Alcohol dependence
Three or more of the following criteria in a 12-month period:
Tolerance
Withdrawal
Alcohol taken in larger amounts or over longer periods than intended
Persistent desire or unsuccessful efforts to cut down or control alcohol use
Great deal of time spent in activities necessary to obtain, use or recover from effects of alcohol
Social, occupational or recreational activities are given up or greatly reduced because of alcohol use
Alcohol use is continued despite knowledge of persistent physical or psychological problems that are known to be caused or exacerbated by alcohol use
Tolerance
Need for more alcohol to achieve the same effect, or reduced effect from the same amount of alcohol
Withdrawal
Characteristic alcohol withdrawal syndrome in absence of alcohol or consumption of alcohol to avoid withdrawal symptoms
List two factors that are associated with effective alcohol treatment programs.
Factors include six to eight weeks of participation, identification of triggers and skills to cope with them, provision of aftercare and involvement of significant others in treatment.
Leading cause of preventable death in the United States
Smoking
There is no safe level of cigarette smoking like alcohol.
Illicit drugs
Marijuana, cocaine, heroin, methamphetamine and methylenedioxymethamphetamine (MDMA), or ecstasy, among others
Prescription medications
Can also be abused and lead to addiction.
Primary among these medications are narcotics or opioids
Marijuana
Most commonly abused drug in the world, with the highest rates of use in the United States, Canada and Australia
Achieves its effects on the body by mimicking the neurotransmitter dopamine in the brain.
One of the functions of dopamine is to regulate sensations of pleasure. The rewarding features of dopamine are the prolonged sensations of pleasure as it floods the brain, which is what causes many people to want to use it repeatedly
NOT a harmless drug
Health effects of repeated use of marijuana include short-term memory deficits, increased blood pressure and consequent risk of heart attack, sexual dysfunction, weakened immune functioning and increased risk of cancer.
Contains 50–70 percent more carcinogens than tobacco cigarettes
Cocaine
Cocaine and its less-refined version, crack, are derived from the coca plant most prominently found in South America.
Both forms are extremely addictive.
Acts on the dopaminergic system of the brain; blocks the ability of neurons to reuptake dopamine, thereby producing prolonged feelings of elation and euphoria.
Negative health effects: increased body temperature, heart rate, blood pressure and irregular heartbeats; increased risk of heart attack or cardiac arrest, can cause seizures, abdominal pain, nausea, nosebleeds and other gastrointestinal problems.
Heroin
Heroin produces an initial feeling of euphoria, followed by an extremely sedated period that alternates between low-level wakefulness and drowsiness.
Negative health consequences: collapsed veins from repeated injections, increased risk of infectious diseases such as HIV/AIDS and hepatitis, liver disease, infection of the heart lining and risk of death from depressed respiratory system when users stop breathing.
Methamphetamine
Stimulant that is exceptionally addictive and produces many sensations similar to those of cocaine
Acts on the dopamine receptors of the nervous system.
Health risks: damage to the central nervous system, increased heart rate, blood pressure and irregular heartbeats. Hyperthermia, convulsions, anxiety, irritability, insomnia and confusion.
MDMA (ecstasy)
Produces an intense high and stimulation.
Negative health effects: interference with the body’s ability to regulate its temperature, extreme thirst, liver, kidney and cardiovascular complication
Prescription Drugs
3 main classes of prescription medication that are commonly abused: opioids, depressants and stimulants
Opioids
Aka narcotics; are prescribed to treat pain and include morphine-based and codeine-based medicines.
Common opioids: hydrocodone (Vicodin) and oxycodone (OxyContin, Percocet).
Inhibit the experience of pain by blocking opioid receptors in the brain. Also produce a sedative effect and when taken in higher doses than prescribed can lead to respiratory depression, cognitive problems, drowsiness, constipation and even death
Depressants
Medications that are commonly used to treat anxiety and include barbiturates (phenobarbital) and benzodiazepines.
Barbiturates are prescribed much more rarely than benzodiazepines because of the dangers associated with overdose.
Common benzodiazepines: alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan).
Benzodiazepines work by enhancing the function of the neurotransmitter GABA in the brain and produce a sedative, hypnotic effect as well as muscle relaxation.
Run a high risk of addiction and can produce tolerance and withdrawal.
Other negative effects when misused include lowered blood pressure, dizziness and disorientation as well as unconsciousness and death.
Stimulants
Prescribed to enhance energy and increase attention and are often prescribed for individuals with attention-deficit/hyperactivity disorder (ADHD).
When misused, they can produce feelings of increased motivation, wakefulness and productivity as well as improving mood and inducing feelings of euphoria. Common stimulants: amphetamine (Adderall) and methylphenidate (Ritalin).
Can increase blood pressure and heart rate as well as body temperature and feelings of irritability and paranoia.
Theories of Addiction
Cognitive-Affective Social Learning Conventional Commitment Personality Trait Integration
Cognitive-Affective theory of addiction
Three factors that increase likelihood of substance use:
- Positive attitudes about substance use
- Endorsement of use by others
- Perception that benefits outweigh costs
Social learning theory of addiction
Role models, such as friends, parents and so on, who model use of substances
Conventional commitment theory of addiction
Commitment to conventional social institutions (school, family, etc.) buffer against substance use. Weak ties increase likelihood of use.
Personality Trait theory of addiction
Stress and low self-esteem increase likelihood of substance use as means of coping.
Integration theory of addiction
Includes elements of all of the above theories as well as problem-behavior theory which states involvement in one problem behavior (e.g., truancy) increases likelihood of other problem behaviors such as substance use.
Cardiovascular disease
Aka coronary heart disease or heart disease
General term that refers to illnesses caused by atherosclerosis, the narrow- ing of the coronary arteries, the vessels that supply the heart with blood
Leading cause of death in the US
Many of the risk factors are preventable and in some cases reversible (high cholesterol, BP, obesity)
Cardiovascular reactivity
The tendency of the cardiovascular system to react in the presence of stress
Contributing factor in development of heart disease
Hard to control, but can control stress
How does stress play an indirect role in the development of heart disease?
In presence of stress, cardiovascular system may respond with increased HR and BP which is triggered by sympathetic nervous system
People vary in reactivity and latency back to normal
Leading causes of death in US
Heart disease Cancer Chronic respiratory disease Cerebrovascular disease Accidents Alzheimer's Diabetes Kidney disease Influenza and pneumonia Suicide
Metabolic syndrome
Cluster of risk factors that are precursor to heart disease
Strong risk factor for many health problems like heart disease, heart attack, stroke, and diabetes
Components are abdominal obesity, raised triglycerides, hypertension, insulin resistance and glucose intolerance, proinflammatory state, and prothrombotic state
How can atherosclerosis be described as a mediator in stress-heart attack relationship?
Stress can lead to negative health behaviors such as eating a diet high in fat and becoming less active physically. These behaviors can lead to the development of atherosclerosis, which can result in temporary blocking of oxygen to the heart resulting in heart attack.
What major systems of the body are involved in the effect of cardiovascular reactivity on heart disease?
Cardiovascular and nervous systems
What are three sources of stress that have been linked to heart disease?
Job stress, low SES, negative emotionality, imbalance between control and life demands, social instability
Hostility has received a great deal of attention for its role in heart disease. Describe the sources of hostility and when would be a good time to intervene in this development.
Hostility seems to develop in childhood and may result from insecurity about self. Hostility may be partially a result of genetic influences and abusive or punitive parenting as well as conflicted early environments. It makes most sense to intervene early before these risk factors can develop into a hostile orientation in the child.
Type 1 diabetes
Typically genetic
Affects 5-15% of Americans
Typically 1st diagnosed in late childhood or adolescence
Failure of pancreas to produce sufficient insulin
Can lead to hypertension, heart disease, heart attack, stroke, kidney failure, neuropathy, amputations, and blindness
Insulin
Hormone secreted by the pancreas that is used to convert the sugars and starches form food to usable energy for the body
Type 2 diabetes
Disorder of lifestyle
Onset in adulthood or late adolescents
Over 90% of diabetes
Pancreas may not produce enough insulin or body may be insensitive to insulin
Rates have increased dramatically in recent decades
Obesity is strong risk factor
Treatment adherence especially difficult for adolescents and children
Why is obesity a strong risk factor for type 2 diabetes?
Possibly due to the greater number of fat cells within obese people. Fat cells may be more resistant to insulin than muscle cells, making insulin generally less effective in obese individuals than those with healthy weights.
Barriers to effective treatment of diabetes
Changing eating and exercise habits
Treatment adherence
Low SES, harder to find and afford healthy food
Prediabetes
Presence of elevated blood glucose levels that have not yet risen so high as to meet diagnostic criteria for diabetes
Critical moment for intervention efforts
The deadly quartet
Type 2 diabetes
Hypertension
Dyslipidemia
Obesity
Common risk factors for cardiovascular and endocrine disorders
Smoking Alcohol consumption Obesity Lack of physical exercise Tend to cluster Modifiable and cheap to fix
Given the strong link between type 2 diabetes and lifestyle factors, how would you design an intervention targeting adolescents with prediabetes? What would your message be and how would you deliver it? What aspects of health promotion do you think would be relevant and what model of health behavior might apply?
Consider teachable moments in designing your intervention. If you are focusing on exercise, you may want to incorporate your message into a physical education class. If your intervention includes a diet component, you may want to deliver your message around mealtimes or in areas where adolescents tend to eat. I suspect you would want to incorporate both diet and exercise in your intervention as both are linked with improved health and outcomes among prediabetics. Be cautious of using scare tactics as these are known to not be particularly effective, especially among adolescents. Focusing on empowerment (how adolescents have the power and ability to make these changes) is likely an important component of a successful intervention.
Given the strong link between type 2 diabetes and lifestyle factors, how would you design an intervention targeting adolescents with prediabetes? What would your message be and how would you deliver it? What aspects of health promotion do you think would be relevant and what model of health behavior might apply?
More generic form of immunity in that the functions of the cells that comprise natural immunity are to attack foreign invaders in the body generally. Granulocytes, including macrophages, are part of natural immunity, as are natural killer cells
Specific immunity
Targets specific pathogens in the body.
Lymphocytes including B and T lymphocytes are part of the specific immunity system.
Further subdivided into humoral and cell-mediated immunity.
Humoral immunity
B cells that produce antibodies
Cell-mediated immunity
T cells that produce cytokines
Immune response to Immediate short-term stress
Increased natural immunity
Decreased specific immunity
Ex: bad grade, car accident
Immune response to short-term stress
No change in blood cell coutnt
Decreased cellular immunity
Increased humoral immunity
Ex: studying, new job, doctor appointment
Immune response to chronic stress
Global negative immune response
Decreased cellular immunity and humoral immunity
Ex: poverty, unemployment, chronic illness, caregiving
Inflammation
One of the first functions of the immune system in response to infection or pathogens
Increased blood flow and cytokines
Measurement of immune system functioning in studies of stress and immunology
# WBCs, NK cells, and lymphocytes Inflammation
Correlates of improved immune functioning
Positive affect Social support Optimism Active coping strategies Emotional disclosure Positive behavior during conflict Personal control Exercise Relaxation Mindfulness meditation Finding benefits of stress
Correlates of impaired immune functioning
Insecure attachments Avoidant coping strategies Pessimism Caregiving Chronic interpersonal stress Martial disruption/conflict Bereavement Loneliness Depression
Sleep
May be important for consolidating and organizing memory, rehearsing new learning or behaviors, preventing unproductive energy expenditure, conserving energy, and enabling psychological adaptation through dreams
7 hours per night associated with best health benefits
Promotes function of immune system
Stress=poorer sleep
Sleep deprivation
Lower T helper cells and NK cells
Reduced response of lymphocytes to mitogens
Chronic sleep deprivation has more harmful effects than acute
Parsimonious hypothesis
Explains multiple phenomena in the simplest terms possible
For example, the associations of cardiovascular problems, negative affect, and immune disorders in the face of stress may be explained by a more general psychobiological reactivity
Supports biopsychosocial approach to health
HIV/AIDS symptoms
Developed in the 70s
HIV: headache, fever, diarrhea, sore throat, yeast infections, muscle aches, fatigue, rash, mouth sores, swollen lymph glands
AIDS: chills, fever, rash, weakness, night sweats, swollen lymph glands, weight loss
HIV/AIDS rates
Higher among lower SES and minorities
Rise among minority women
Two explanations for rise of AIDS among women in the US
- Initially AIDS was just between homosexual men and eventually women become infected also
- Involvement in sex trade or prostitution
Four main categories of cancer
Carcinomas
Sarcomas
Leukemia
Lymphomas
Carcinomas
Cancers of the epithelial cells which are found in skin, glands, and organs including the bladder, liver, prostate, and breasts
Sarcomas
Cancers of soft tissues such as muscle, nerves, fat and tendons
Leukemia
Cancer that derives from tissues that produce blood, such as bone marrow, including uncontrolled proliferation of white blood cells.
Lymphomas
Cancers of the lymphatic system
Patient satisfaction
Becoming increasingly important in the new landscape of healthcare delivery.
Patients are increasingly encouraged to be partners in their healthcare
Common sense model of illness
Perceived causes of illness of patients are summarized into three dimensions: physical/nonphysical, stable/unstable and controllable/uncontrollable.
Factors that affect patient compliance
Patient understanding
Patient recall
Patient satisfaction
Difficulty or complexity of the recommendation
Domains of health literacy
Fundamental literacy (reading, writing, speaking) Scientific literacy Civic literacy (public health, media) Cultural literacy (customs)
3 areas of healthcare that health literacy affects
Access and use of healthcare system
Interaction between patient and provider
Self-care and health behaviors among patients
Lay referral network
An informal network of family and friends who offer their own interpretations of symptoms, often well before any medical treatment is sought
Characteristics of health compromising behaviors
Habitual and sometimes addictive Modifiable Window of vulnerability in adolescence Many tied to peer culture Many are pleasurable Dangerous Risk factors for more than one major chronic disease Develop gradually All substance abuse predicted by same factors (parental conflict, poor self-control) More common in lower social classes
Obesity
An excessive accumulation of body fat Risk factor for many disorders like cancer, cardiovascular disease, atherosclerosis, hypertension, Type II diabetes, and heart failure Chief cause of disability Prone to psychiatric conditions Social and economic consequences Childhood is window of vulnerability
Yo-yo dieting
Successive cycles of dieting and weight gain
Lowers metabolic rate
Set point theory of weight
The idea that each individual has an ideal biological weight, which cannot be greatly modified
Some people have a higher set point than others, leading to a risk for obesity
Anorexia nervosa
An obsessive disorder amount- ing to self-starvation, in which an individual diets and exercises to the point that body weight is grossly below optimum level, threatening health and potentially lead- ing to death.
Most sufferers are young women, but gay and bisexual men are also at risk
Bulimia
Characterized by alternating cycles of binge eating and purging through such techniques as vomit- ing, laxative abuse, extreme dieting or fasting, and drug or alcohol abuse
Physical dependence
When the body has adjusted to the substance and incorporates the use of that substance into the normal functioning of the body’s tissues
Often involves tolerance
Craving
A strong desire to engage in a behavior or consume a substance. It results from physical dependence and from a conditioning process
Addiction
Occurs when a person has become physically or psychologically dependent on a substance following repeated use over time
Alcoholism
Includes the need for daily use of alcohol, the inability to cut down on drinking, repeated efforts to control drinking through temporary abstinence or restriction of alcohol to certain times of the day, binge drinking, occasional consumption of large quantities of alcohol, loss of memory while intoxicated, continued drinking despite known health
problems, and drinking of non-beverage alcohol, such as cough syrup.
Placebo drinking
Consuming nonalcoholic beverages or alternating an alcoholic with a nonalcoholic beverage.
Synergistic effects of smoking
Smoking and cholesterol interact to produce higher rates of heart disease
Stress and smoking increases BP or reactivity
Smoking and low SES
Weight and smoking
Smoking and depression/anxiety
Passive smoking/secondhand smoke
3rd leading cause of preventable death in US
Cardiac invalidism
Can be one consequence of MI
Patients and their spouses see the patient’s abilities as lower than they actually are
John Henryism
A personality predisposition to cope actively with psychosocial stressors.
It becomes a lethal predisposition when active coping efforts are likely to be unsuccessful
Tied to hypertension
Psychoneuroimmunology
Refers to the interactions among behavioral, neuroendocrine, and immunological processes of adaptation
Rheumatoid arthritis
Affects the small joints of the hands and feet, as well as the wrists, knees, ankles, and neck
Autoimmune
Osteoarthritis
Smooth lining of a joint, known as the articular cartilage, begins to crack or wear away because of overuse, injury, or other causes
Tends to affect the weight- bearing joints: the hips, knees, and spine
Medical students’ disease
As they study each illness, many medical students imagine that they have it
Commonsense model of illness
People hold implicit commonsense beliefs about their symptoms and illnesses that result in organized illness representations or schemas
Lay referral network,
An informal network of family and friends who offer their own interpretations of symptoms, often well before any medical treatment is sough
Delay behavior
A person may live with one or more potentially serious symptoms for months without seeking care.
Appraisal delay
The time it takes an individual to decide that a symptom is serious
Illness delay
The time between the recognition that a symptom implies an illness and the decision to seek treatment
Behavioral delay
The time between deciding to seek treatment and actually doing so
Medical delay
The time that elapses between the person’s calling for an appointment and his or her receiving appropriate medical care
Private, fee-for-service care.
Used to be the norm
Health maintenance organization (HMO)
An employer or employee pays an agreed-on monthly rate, and the employee can then use services at no additional (or a greatly reduced) cost. This arrangement is called managed care. In some cases, HMOs have their own staff, from which enrollees must seek treatment.
Preferred-provider organizations (PPOs)
A network of affiliated practitioners have agreed to charge preestablished rates for services, and enrollees in the PPO must choose from these practitioners when seeking treatment.
Colleague orientation
Because the patient no longer pays directly for service, and because the provider’s income is not directly affected by whether the patient is pleased with the service, the provider may not be overly concerned with patient satisfaction. The provider is, however, concerned with what his or her colleagues think, because it is on their recommendations that he or she receives additional cases.
Creative nonadherence
Modifying and supplementing a prescribed treatment regimen.
Complementary and alternative medicine (CAM)
A diverse group of therapies, products, and medical treatments that include prayer, potions, natural herb products, meditation, yoga, massage, homeopathic medicines, and acupuncture, among other treatments.
Holistic medicine
An approach to treatment that deals with the physical, psychological, and spiritual needs of the person
Traditional Chinese Medicine
Based on the idea that a vital force, called qi (pronounced “chee”), flows throughout the body through channels called meridians that connect the parts of the body to each other and to the universe
Ayurvedic medicine
Although people are born into a state of balance, events in their lives can disrupt it, compromising health, and so bringing these forces back into balance alleviates illness and maintains good health
India
Homeopathy
Interprets disease and illness as caused by disturbances in a vital life force.
Guided imagery
A meditative procedure that has been used to control discomfort related to illness and treatment, especially cancer.
Patient is instructed to conjure up a picture that he or she holds in mind during a procedure or during the experience of discomfort.
Integrative medicine
The combination of alternative medicine with conventional medicine
