HC 4

Question 1

Medically unexplained physical symptoms (MU(P)S)

Answer 1

No medical cause or no identifiable physical distortions or disruptions of bodily processes
- often disappear spontaneously
- sometimes persist

Dependent of symptom perception & symptom interpretation

Question 2

Perception, interpretation & response

Answer 2

perception - do you notice it?
interpretation - what does it mean?
Response - how will you act upon it?

Question 3

What is perception?

Answer 3

physical sensations are trivial:
- increase likelihood symptom perception
- painful/disruptive
- novel
- persistent
- pre-existing chronic disease

Question 4

Attention –> symptom perception

Answer 4

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

Question 5

Emotion

Answer 5

= symptom perception

Question 6

Personality traits

Answer 6

OCEAN:
Neuroticism/negative affectivity increases attention to somatic symptomatology

Question 7

Symptom perception is affected by:

Answer 7

Gender - women more likely
Coping - repression = less likely
Social situations - context influences our motivations
Perception of vulnerability - stereotypes
Cognitions - expectations & self-fulfilling prophecies

Question 8

Placebo & nocebo effects

Answer 8

favourable/unfavourable “treatment effects” that cannot be ascribed to mechanisms of treatment itself

–> expectations of a treatment:
Placebo = improvement
nocebo = worsening

Question 9

Open vs hidden treatment (placebo)

Answer 9

open application (treatment) has the largest psychological effect on pain reduction

Question 10

formation of expectations

Answer 10

= learning theories
- instructions
- conditioning
- observation

Question 11

Verbal suggestion (analgesia=pijnstilling)

Answer 11

1. can reduce pain in some people
2. 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

Question 12

Placebo: conditioning

Answer 12

placebo more effective when first active treatment (conditioning = longterm, automatic & implicit)

Question 13

Pain: placebo analgesia / nocebo hyperalgesia (meer pijn)

Answer 13

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

Question 14

Informing about side effects can cause them

Answer 14

Breast cancer patients: more cognitive problems after information about these side effects

Question 15

reinterpreting side effects

Answer 15

“symptoms indicate the treatment is working”

Question 16

implications for medical consultation:

Answer 16

• trust in care
• doctor-patient communication
• info about side effects

Question 17

Influences on symptom interpretation

Answer 17

• 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

Question 18

Outcomes: direct + indirect effects

Answer 18

direct: seeking/using/adhering medical treatment
indirect: coping

Question 19

delays in seeking health advice

Answer 19

1. appraisal delay - doorkrijgen dat je ziek bent
2. illness delay - yes/no medical attention
3. utilisation delay - time between needs & acting on it

Question 20

5 phases medical consultation

Answer 20

1. relationship
2. reason for attendance
3. physical examination
4. consideration fo condition
5. consideration of further treatment/investigation

Question 21

Who has the power? –> approach

Answer 21

• professional centered approach
• patient centred approach
• shared decision-making consultation

Question 22

shared decision-making consultation

Answer 22

• choice - ‘conveys awareness’ about a choice
• option - informed about treatment options
• decision - patient encouraged to determine their choice

Question 23

Framing: positive spin

Answer 23

patient more likely to engage in risky health care options

Question 24

Hyperalgesia

Answer 24

verhoogde gevoeligheid voor pijn, nocebo induced zelfs onder anesthesia

Question 25

Doctor-patient communication

Answer 25

trust, warmth & empathy (ask open questions, listen actively, be open & transparent)

Question 26

High competence + empathy =

Answer 26

more trust, regardless of condition severity

Question 27

High competence & high empathy =

Answer 27

more expected surgery effect

Question 28

High competence

Answer 28

reduced experienced side effects

Question 29

improving adherence during consultation

Answer 29

achieving concordance: give options + get to an agreement (shared decision making & good communication)

Question 30

Maximizing memory

Answer 30

Give important information early or late in conversation (maximize primacy & recency effects) + emphasize important information

Question 31

Non-adherence behavioral programs

Answer 31

• confidence in ability
• intentions
• perceived control
• belief in benefits
• perceived barriers
• action planning

Question 32

Relapse prevention

Answer 32

Identifying high-risk situations, planning to avoid or cope with them

Question 33

Motivational strategies

Answer 33

Stepwise progression, social support –> setting achievable personal goals

Question 34

How to make change habitual: reach continuous/sustained change

Answer 34

by not rewarding diet with cheat days –> prevents long term change