HC 4 Flashcards
Medically unexplained physical symptoms (MU(P)S)
No medical cause or no identifiable physical distortions or disruptions of bodily processes
- often disappear spontaneously
- sometimes persist
Dependent of symptom perception & symptom interpretation
Perception, interpretation & response
perception - do you notice it?
interpretation - what does it mean?
Response - how will you act upon it?
What is perception?
physical sensations are trivial:
- increase likelihood symptom perception
- painful/disruptive
- novel
- persistent
- pre-existing chronic disease
Attention –> symptom perception
differences in the attention given to internal and external states:
- increase symptom perception –> well-published illnes
- increased perception of symptoms –> Increased knowledge of symptoms (medical student’s disease)
- reduced symptom perception –> distractions
Emotion
= symptom perception
Personality traits
OCEAN:
Neuroticism/negative affectivity increases attention to somatic symptomatology
Symptom perception is affected by:
Gender - women more likely
Coping - repression = less likely
Social situations - context influences our motivations
Perception of vulnerability - stereotypes
Cognitions - expectations & self-fulfilling prophecies
Placebo & nocebo effects
favourable/unfavourable “treatment effects” that cannot be ascribed to mechanisms of treatment itself
–> expectations of a treatment:
Placebo = improvement
nocebo = worsening
Open vs hidden treatment (placebo)
open application (treatment) has the largest psychological effect on pain reduction
formation of expectations
= learning theories
- instructions
- conditioning
- observation
Verbal suggestion (analgesia=pijnstilling)
- can reduce pain in some people
- you will receive no treatment
! placebo analgesia can sometimes even match analgesia after active agent (echte pijnstilling)
! by nocebo information: reversal of topical analgesia possible
Placebo: conditioning
placebo more effective when first active treatment (conditioning = longterm, automatic & implicit)
Pain: placebo analgesia / nocebo hyperalgesia (meer pijn)
size of effect depends on:
- clinical or mechanism trial
- effects induced/learned
- type of pain: acute, experimental & procedural pain vs. chronic
Cobi verbal suggestion + conditioning = most effective
Informing about side effects can cause them
Breast cancer patients: more cognitive problems after information about these side effects
reinterpreting side effects
“symptoms indicate the treatment is working”
implications for medical consultation:
- trust in care
- doctor-patient communication
- info about side effects
Influences on symptom interpretation
- cultural: readiness to respond/express signs of symptoms & belief in controllability (supernatural causes)
- individual differences: gender, life stage, personality, etc
- self-identity: social identity
- illness experience: difference between healthy/diagnosed people
- causal attributions: internal vs external; stable vs unstable; global vs specific
Outcomes: direct + indirect effects
direct: seeking/using/adhering medical treatment
indirect: coping
delays in seeking health advice
- appraisal delay - doorkrijgen dat je ziek bent
- illness delay - yes/no medical attention
- utilisation delay - time between needs & acting on it
5 phases medical consultation
- relationship
- reason for attendance
- physical examination
- consideration fo condition
- consideration of further treatment/investigation
Who has the power? –> approach
- professional centered approach
- patient centred approach
- shared decision-making consultation
shared decision-making consultation
- choice - ‘conveys awareness’ about a choice
- option - informed about treatment options
- decision - patient encouraged to determine their choice
Framing: positive spin
patient more likely to engage in risky health care options
Hyperalgesia
verhoogde gevoeligheid voor pijn, nocebo induced zelfs onder anesthesia
Doctor-patient communication
trust, warmth & empathy (ask open questions, listen actively, be open & transparent)
High competence + empathy =
more trust, regardless of condition severity
High competence & high empathy =
more expected surgery effect
High competence
reduced experienced side effects
improving adherence during consultation
achieving concordance: give options + get to an agreement (shared decision making & good communication)
Maximizing memory
Give important information early or late in conversation (maximize primacy & recency effects) + emphasize important information
Non-adherence behavioral programs
- confidence in ability
- intentions
- perceived control
- belief in benefits
- perceived barriers
- action planning
Relapse prevention
Identifying high-risk situations, planning to avoid or cope with them
Motivational strategies
Stepwise progression, social support –> setting achievable personal goals
How to make change habitual: reach continuous/sustained change
by not rewarding diet with cheat days –> prevents long term change
