Final Flashcards
How soon do people generally recognize symptoms before actually getting sick?
Half a day to a full day
What factors influence symptom recognition?
Individual difference/personality Cultural difference Situational factors Stress Mood
How do individual differences effect symptom recognition?
Personality impacts your psychological disposition and therefore your health
Hypochondriacs and neuroticism automatically assume the worst case
People with depression and anxiety get sick more often but deny getting sick
How do cultural differences affect symptom recognition?
Difference in emotional responses
Certain cultures talk about illness more than others
Ex. Asia does not talk about being sick and goes to work sick
Some look for symptoms while others ignore them
What is medical students disease?
Learn about disease in med school
Students paying attention begin showing these symptoms
Changes every lecture and students believe they have begun expressing what they are learning
What is an illness representation (schéma)?
A patients own implicit common sense belief about their illnesses
Begins as soon as symptoms appear or you get diagnosed
What you know about the disease and its symptoms
What are the five distinct components of illness schémas?
Identify(label) Consequences Causes Duration Cure Well defined schémas are less stressful as they have these five components
What occurs as you go higher up in the medical chain?
Less likely to have an answer
What are the three models of illness?
Acute: bacterial or viral, short duration
Chronic: multi-factorial, long duration
Cyclic: alternating periods of activity
What other factors can influence the interpretation of symptoms?
Lay referral network: input from friends, family, and peers
Internet: background info, lifestyle modification
How does age influence the use of health services?
Infants and the elderly are more likely to use health services that those in late adulthood
How does gender influence the use of health services?
Women tend to seek help more because they have kids and are more proactive about their health
How does socio-economic status influence the use of health services?
Those who have more money tend to use the system less but see specialists more
Those who have less money are more likely to express illness more and seek general care
How does culture influence the use of health services?
Visible minorities more commonly visit a physician
The language barrier is sometimes a déférant for visiting health services
Minorities seek fewer visits to specialists
Perceived quality of care
How does social psychological influence the use of health services?
Your beliefs about the system effects your level of care
Individuals attitudes and beliefs about symptoms and health care
Health belief model states predictors include: perceived threat to health and belief of efficacy of interventions
Why might a person seek the use of health services for emotional disturbances?
Individuals report physical symptoms which are triggered by psychological drivers
- university disease
- inappropriate assessment by physician
- limited access to psychologists
What are worried we’ll individuals?
Individuals that place over emphasis on symptoms due to heightened self-care
Hypervigilant and constantly worried
End up using the system a lot for small things
What are somaticizers?
Individuals who express symptoms after personal emotional insult
Get dumped and feel terrible so go to the doctor for these symptoms, display physical symptoms with an emotional root
Why do people deny their symptoms having a psychological root?
Medical disorders are perceived as more legitimate than psychological disorders
Allowed more access to benefits and secondary gains
Tests occur faster if medical based
What are secondary gains?
Downstream benefits arising from the illness
- time off/rest
- removal of responsibility
- medical symptoms vs psychological symptoms
What is delay behaviour?
Patients live with one or more potentially serious symptoms without proper care
Delay is defined as the time between recognition and treatment
What are the periods of delay behaviour?
Appraisal delay: realize symptom is serious
Illness delay: realize symptom implies and illness
Behavioural delay: time between recognition and treatment
Medical delay: time between appointment and treatment
What are some predictors of delay behaviour?
Elderly appear to delay less Lack of regular physician Personal views/fears about medical cares Frequency of occurance of the symptoms Personal safety assessment of the symptom
What are the different factors about the personal safety assessment of the symptoms?
Highly visible
Degree of pain
Degree of change
Incapacitating
Why would treatment delay occur after the primary visit?
Curiosity satisfies by the first visit
Fear/alarm of symptoms and diagnosis
What is patient consumerism?
Patients want to be involved and are more active in decision making process
What is the structure of the health care delivery system? What are some disadvantages?
Primary health care providers are the first point of entry, gatekeepers deciding where you belong
Secondary providers are usually specialists
Disadvantages: require a referral, many don’t have a primary physician
What is CAM?
Complementary and alternative medicine
Include massage therapy, chiropractic care, acupuncture, etc
More holistic approach that gives people a sense of control
Who are the main users of CAM?
Female, middle aged, highly educated with multiple chronic issues
Generally paid out of pocket so used by more wealthy
What are some examples of barriers to care?
Poor communication: doctor doesn’t listen
Use of jargon
Baby or simplistic talk
Elderspeak
Nonperson treatment
Stereotypes of patients: cultural stereotypes, sexism
What is treatment nonadherence?
A patient does not follow prescribed treatment: 26%
Antibiotics: 1/3
Lifestyle changes: %80
What is creative non adherence?
Patients modify and/or supplement prescribed treatment
Ex. I forgot to take a pill this morning so I am just going to take 2 tonight
What are some causes of treatment non-adherence?
Poor communication
Perceived satisfaction: higher adherence with positive experience
Treatment regimen: complexity
Type of treatment: medical=high, vocation=lower, social/psych=lowest
What is the placebo effect?
Any medical procedure/agent that produces an effect in a patient because of its therapeutic intent and not its specific nature, whether chemical or physical
Patients will report therapeutic effect
How does the placebo effect work?
Not simply a psychological phenomena
Indirect psychological responses
May reduce anxiety or lower stress response
Pain areas are dampened by placebo in anticipation and during pain
What factors influence placebo effect?
Interaction with health care provider/researcher
Patient characteristics: optimist vs pessimist, anxious people show higher placebo effect
Physical appearance and administration of the placebo
What are the two classifications of pain?
Acute: caused by soft tissue damage such as infection or inflammation
Chronic: linked to long term illness or disease, may have no apparent cause and be difficult to assess or diagnose, can trigger other issues
What are the types of chronic pain?
Chronic benign: 6 months +, intractable to treatment (low back pain)
Recurrent acute pain: series of intermittent episodes (migraine, tmj)
Chronic progressive: 6 months +, increasing severity (rheumatoid arthritis)
What are some factors that can influence symptoms of pain? Why do these make pain difficult to study?
Cultural differences: some report sooner and more intensely, linked to cultural norms
Gender: women more sensitive, with menstrual cycle an indirect contributor as it is linked to différents in emotional processing of pain
Coping style: carastrophizing heightens pain, resilience and positive emotions lower pain
Describe verbal reports used to assess pain
Pt use experience and vocal to describe pain
Ex. Throbbing vs shooting vs dull pain
Pain catastrophizing questionnaire
McGill pain questionnaire
What is the pain catastrophizing scale?
13 questions interested in the thoughts and feelings you have when you are in pain
Each describes a different thought or feeling that may be associated with pain
Uses degrees like not at all to all the time
Describe pain behaviour as a way of measuring pain
Observable behaviours that arise from pain
1) facial and audible expressions of distrust
2) distortions in posture and fait
3) negative affect
4) avoidance of activity
What is nociception?
The system that carriers signals of damage and pain to the brain
Nociceptive neutrons have cell bodies in dorsal root ganglia
Can detect mechanical, thermal, and chemical stimuli
Polymodal nociception
Describe nociception transmission
Bidirectional axons synapse in dorsal horn of spinal cord
Signals continue to the brain where it’s processed
What are the different types of peripheral nerve divers through which nociception occur?
A delta fibre: small, myliented fibers, first and sharp pain rapidly affecting sensory aspects of pain and opening gate
C fibers: unmyelinated fibers, secondary silk or aching pain, affects motivation and affective elements of pain, opens gate
A beta fibre: large, myelinated, information about vibration and position, concurrent stimulation can suppress pain from c fibres, closes gate
What is the traditional model of pain?
Pain resumed from transmission of pain signals to the brain
Degree of pain was dictated by tissue damage
What is the gate control theory of pain?
Proposed that psychological factors contributed to pain experience
Neural pain gate can open/close to modulate pain signals to the brain
Fibres as well as physical, emotional, or cognitive factors open and close gate
What open and close the pain gate for the three different factors?
Physical: extent and inappropriate activity level open, medication and counter stimulation close
Emotional: anxiety, worry, tension, depression open, positive emotions, relaxation close
Cognitive: focus on pain/boredom opens, distension or life activities close
What are some weakness of the gate control theory?
Unable to explain phantom limb pain
Neuromatrix theory: felt representation of a unified physical self, genetically determined initially, neurosigniture can give rise to pain
How does the body manage pain?
Natural pain suppression system of the body
Produces endogenous opioids: beta endorphins, proenkephalin, prodynorphins
Acute stress and physical activity reduces sensitivity to pain
What are some traditional pain management techniques?
Pharmacological: pain medications
Surgical: lésions of pain fibers
Sensory techniques: counterirritation, exercise
What are some psychological pain-management techniques?
Biofeedback Relaxation Hypnosis Acupuncture Distraction
How is the management of chronic pain different from actifs pain?
Chronic pain can develop maladaptive coping strategies
Control strategies of different as chronic pain involved physiological, psychological, social, and behavioural components
Chronic pain induces individual, familial, and societal challenges
What is the neurotic triad and which traits belong to it?
Personality traits can influence the experience of pain
Chronic pain pts show elevated scores in three areas known at neurotic triad:
Hypochondriacs, hysteria, and depression
What is the osycontin story?
OxyContin is a time release formulation of oxycodon
Similar to morphine
Used to modulate severe pain but hard a high abuse liability, addiction potential, and synergistic effects with alcohol
One of the most popular street drugs
Recently banned
What factors influence chronic illness?
Genetics (Alzheimer’s, MS)
Environmental (cancer, asthma)
Lifestyle (CVD,HIV,goût)
Previous injury or prolonged strain (lower back pain, tinnitus)
Who are chronic conditions more common in?
Women
Lower income
Seniors
Certain ethnic subpopulations (aboriginal people)
What is the prevelence and impact of chronic illness?
58% of population has one 81% in elderly population 2/3 of Canadian health spending More than 63% of death globally Staggering economic consequences
What psychological contributions does quality of life help determine?
Depression
Anxiety
Distress
Stress (contributor)
What are the components of quality of life?
Physical functioning
Psychological status
Social functioning
Disease or treatment-related symptomology
What does quality of life assessments determine?
Gauge the extent to which normal life activities have been compromised
Why is evaluating quality of life useful?
Population norms can be established
Allows for a comparative analysis across conditions between countries