Health Psych Flashcards
Describe and contrast the biomedical model and biopsychosocial model
Biomedical - fixed with physical inter, cause explained with physiology/biology
Vs combination of social, psychological and biological factors
Define health psychology
The study of psychological and behavioural processes in health care
How steriotypes?
Information stored in schemata to save processing power.
Individuals placed in certain schemata overlooking diversity.
Prone to negative traits.
Define steriotype, prejudice and discrimination
Stereotype - overlooking individuality placing into schemata
Prejudice - negatively affects our attitudes based on stereotypes
Discrimination - affects behaviour
Avoiding reliance on stereotypes
Getting to know individuals who challenge stereotypes
Reflection
Changes in cognitive capacity with aging
Gradual linear decrease in IQ
Memory loss often linked to co-morbidities
Processing speed most affected. Fluid thinking vs crystalline.
Relationship between personality and ageing including the 4 models
Developmental model- differnt stages have different conflicts - young adult intimacy vs isolation, generation vs stagnation, integrity vs despair.
Trait model - personality made up of different traits as ageing occurs.
Disengagement model - disengagement from different social activities as an adaptive mechanism.
Activity model- successful engagement requires engagement in all areas of life
Other factors: Empty nest phenomenon Grandparent hood Friends Contact with relatives Unemployment vs retirement.
Define disability and their implications
Medical model
- problem created by impairment in physical or psychological factors (body is shaped and experienced) which restricts someone from the ‘norm’
Impairment - loss or abnormality of physical or psychological structure
Social model
- restriction or disadvantage created by a social organisation taking no account of physical impairments.
Impairment - lacking part of a limb or organ.
Medical model- without cure it is given that they are disabled
Identify barriers for people with disabilities in accessing healthcare
Physical/ environmental
Attitudinal/ behavioural - e.g. Staff not listening, different treatment
Institutional - training, policies.
Define health rated behaviour
Anything someone does to negatively or postively affect health.
Describe classical conditioning and how it can lead to a health related behaviour and how the behavior can be changed.
Pavlovs dog
Bahaviour linked to unrelated stimuli
E.g. Smoking on breaks (habit)
Elastic band to stop automatic reaction (break habit)
Operant conditioning and how it can lead to a health related behaviour and how the behavior can be changed.
Behaviour driven by short term rewards or negative affects.
E.g. Smoking and feeling good/cool
Make own rewards for not smoking
Social learning theory and how it can lead to a health related behaviour and how the behavior can be changed.
Bobo dolls.
How punishments and rewards in others lead to altering our behaviour.
Smokers do because others do
Use celebs and advertise negatives of smoking.
Identify a tool for screening patients for levels of alcohol use
Cage audit pat fast
Cage- cutdown annoyed guilty eye-opener- four questions to ask. Eye-opener do they need a drink in the morning to study nerve?
Audit - alcohol use disorders identification kit and developed by who, more complex than cage.
Pat- padding alcohol test - from audit but takes 1/5 of the time.
Fast - fast alcohol screening test- two stage initial screening taken from audit.
Describe the management of a patient with an alcohol problem
Alcohol detox _ give Vitamins B1 and B and parenteral (not GI) thymine (to prevent Wernickles Encephalopathy). Disulfiram (prevent relapse), Valium and chlordiazepoxide, chlormethaizole, Zopiclone.
Acutely - fluids, electrolytes, B1/thymine, glucose
Describe the key features and techniques used in motivational interviewing
Roll with resistance, avoid argument, support self-efficacy, develop discrepancy (between their habit and personal goals), express empathy.
Gives patients ownership of decisions and removes barriers
Define adherence compliance and concordance
Adherence - the extent to which a patient coincides with medical advice
Compliance - the extent to which a patient complies with medical advice
More patient centred as they have a right to choose.
Concordance- involvement of patient in decision making to try and improve adherence/ concordance.
Explain the relationship between concordance and adherence
Concordance adresses the patients beliefs and priorities and give them ownership over decisions.
This is likely to improve adherence
May get patients views vs evidence based medicine. Rights vs responsibilities.
Describe the extent of non-adherents across patient groups
Lowest in long term disorders which are asymptomatic or not severe e.g. Diabetes but also kidney transplants.
High in HIV, arthritis, GI, cancer.
Describe techniques for measuring adherence in individual patient cases
Indirect: Patient self report Carer report Pill counts Mechanical measure of dose
Direct:
Urine or blood sample,
Direct observation
Define intentional and unintentional adherents and identify potential reasons for both
Patient factors- memory, beliefs, symptoms, severity
Treatment factors - complex, side effects, preparation, duration, expense, administrations, labels, social stigma
Psychological factors- any point? Depression, social support, homelessness
Health care professional factors - relationship, trust, follow ups beliefs about prescriber.
Often a combination e.g. Theory’s of health related behaviour, health belief model and theory of planned behaviour.
Unintentional = memory, misunderstanding, limited resources
Intentional = beliefs, attitudes, expectation, motivation
Describe the nature and effectiveness of and problems with interventions to improve adherence
Address barriers to adherence, address perceptual factors to motivation.
Better to combine not just address a single factor.
May lack theoretic input - why interventions work. Few are patient centered.
Concordance!
Describe the physiological responses involved in stress
Fight or flight Cortisol release Increased heart rate Immune system up regulation Clotting factors Ect
Explain why stress can have positive and negative consequences
Short term - awareness, sharpness, faster thinking/ high performance, energised
Long term - tiredness, anxiety, high BO, low performance from alarm
Define stressors and describe tools to measure stress based on stressors
Stressful events within Dailey life- Hassles and uplifts
The transactional model of stress, measures stress on how individuals appraise stressors which accounts for subjectivity of stress
Use the transactional model to explain stress as a process
Series of steps taken to analysis the threat/ stressor considering a number of factors e,g. Support, self efficacy, personality and coping. This leads to a stress response. Both resources (personality, social support and coping skills) and demands (stressors) affect each other and the appraisals.
Define primary and secondary appraisal
Primary- is it a threat, how big?
Secondary- can I cope?
Reappraisal- is it easier harder to cope than I thought?
Identify important factors which moderate the impact of stress
Social support
Control over a situation
Describe the different ways stress can negatively impact health
CVS
Long term immunosupression- cortisol (anti inflam) and decreased WBC.
So more UTI, herpes, autoimmune disease
Anxiety/ depression, thinking more rigid and extreme, overgeneralising, catastrophising, rumination. Low motivation.
Substance abuse
Outline strategies for managing stress
Cognitive - hypothesis testing, restructuring
Behavioural- skills training, assertiveness and time management
Emotional - counselling, emotional disclosure, social support
Physical - exercise, meditation/ relaxation, biofeedback
Drugs
Define emotion focused coping
Change the emotion
Behavioural- distract, relax, alcohol
Cognitive - see positives/ change how you think about problem
Describe problem focused coping
Changing the problem or resources
Reduce demands of a situation e.g. Claustrophobia
Expand resources e.g. Skills/ ways to improve
Describe ways to aid patient’ scoping and give relevant examples of useful approaches for individual patient cases
Increase social support
Increase patient control- pain management, choices
Prepare patients for stressful events to reduce ambiguity - peer contacts, effective communication
Stress management - cognitive- non cognitive
Explain why patients with chronic illness are at increased risk of mental health problems
Anxiety - response to threat,
Depression - response to loss, failure or helplessness
Describe barriers to identifying psychological difficulties in patients
Symptoms attributed to disease or mental health?
Psychological state may change over time
Patient may not mention due to stigma, inevitability, judgement, adding burden, seen to be complaining
HCP may not ask e.g. Not in job description
Outline NICE guidelines for managing anxiety and depression
Depression- recognition, assessment and management
Low intensity- self help, group CBT
Severe- individual CBT, interpersonal therapy, other therapy, with drugs
Anxiety- similar but SSRI often given in low intensity.
Explain the limitations of a biomedical model for pain
Pain after symptoms/ treatment.
Pain without symptoms.
Phantom limb pain
Different levels of pain
Distinguish between acute and chronic pain
Chronic is over 3 months, rest does not help, often unknown cause, no ongoing tissue damage
Outline the gate control theory of pain
Pain comes from complex pathways between brain and tissues.
Goes through two neural relays or gates
Different factors can open or close gates
Discuss how biological, psychological and social factors affect the experience of pain
Injury, medication
Depression, stress, distraction, exercise, positive outlook/ beliefs.
Active life/ minimal involvement in life.
Describe the principles and aims of pain management programs
PMP Aims to give patients control of pain. Graded exposure back into normal life. Work on fitness, motility and posture. Coping for stress, anxiety, depression Improve ability to relax Develop social skills
Describe the key psychological therapies used within the NHS
Type A - psychological care integrated into mental health treatment Type B- eclectic (variety of sources) psychological therapy and counselling Type C (NHS) - psychodynamic, humanistic, family/systemic and CBT
Describe psychodynamic therapies
Uses therapist - transference and countertransferance.
Adresses underlying conflicts underneath symptoms.
Id crisis from a young age, for interpersonal difficulties, personality problems, interest in self exploration, capacity to tolerate mental pain
Describe systemic/ family therapies
In groups, look at patterns of interaction and their meaning, facilitate resources in system
Describe humanistic therapies
No definition
General counselling skills - empathy, warmth, unconditional personal regard
Good immediately with motivation to move on
Describe the behavioural aspects of CBT
Graded exposure to feared things
Activity scheduling
Reinforcement and reward
Role play/ modelling
Describe the cognitive aspect of CBT
Education of cognitive model
Monitor thoughts and feelings - awareness of interrelationships
Examine/ challenge negative thoughts
Rehersal coping with situations
Schema work - core beliefs, I’m unlovable ect worthless, freal
Describe the rational for usinG CBT
We use cognition to make sense of the world
Not a situation that upsets us but the view we take of it.
Changes of mood are related to he way we make sense of events.
Thoughts, physiology, emotions and behaviours all affect each other.
Identify the mental health conditions that CBT is likely to be helpful for
Depression, sexual dysfunction, anxiety, PTSD, eating disorders, phobias, OCD
Adjunctive treatment for psychotic symptoms - distracts with delusions but not good for withdrawal.
Best for active patients
Explain the concept of attachment in child development
Attachment- desire to be with Carer/ close proximity seeking behaviours and contact maintaining behaviours.
Good attachments are important for social competence, self reliance ect.
Critical period in first year but neccessary for 4
Begins at 3 months can recognise strangers. At 7-8 attachments form.
Describe attachment styles
Secure
Insecure- avoidant/independent, ambivalent or disorganised
Can tell from how mother responds to child’s signals, rapid appropriate responses, careers high Esteem.
Describe the implications of separation for the hospitalised child
Behavioural- Depression Anxiety Aggression Bed wetting Clinging behaviour Detachment Physical- Lack of sleep Depression
3 phases (Bowlby)
Protest
Despair
Detachment- often mistaken for resolution
May blame themselves
May affect adherence, experience pain or suffer from stress.
Give examples of good practice in the organisation of hospital care for children
Distractions Home like feel Visits encouraged Caring staff Explanation of not their fault Continuity of staff Allow attachment objects
Describe Piaget’s four stages of childhood cognitive model
0-2 sensorimotor- explore the world through touch. Develop Schema for where their body ends and world starts. At 8 months learn permanence.
2-7 pre operation categorise by 1 characteristic, egocentrism, cannot hold convocation
7-12 concrete operational - can categorise by more than one, can think logically but not abstract, conservation of number, mass and weight
12+ formal operational- abstract logic and hypothetical reasoning
Describe Vygotsky’s theory of social development
Affected by social interactions and shared problem solving so can increase understanding - zone of proximity
Discuss Implications of theory about children cognitive development for communication with children about illness and treatment
Children have different zone of proximity so can't judge by age. Babies use motor, not verbal. Danger of metaphors Child may assume you know how they feel. Use faces pain scale
Give examples of good practice in communication with children
Use Teddy's Pain scale Distract Ask parents to explain later Smile Use their language level to gage communication and assess level of understanding Babies- motor sensory Good body language Have stickers Congratulate child.
Give a definition of cultural diversity
The idea of belonging to a social group with its own culture. Influenced by age, gender, ethnicity, language and is defined by the individuals relationships with people in the groups they associate with.
It individually centred.
Give examples of ways in which culture can impact on patients presentation to health services
People don’t know services available to them
Different stigma about mental health
May not find treatment/ management acceptable
The way they make sense of symptoms and behaviours
Take into account pressure to conform to religion, gender roles, social norms, family expectations, sexual orientation, marriage
Give reasons why organisation and delivery of healthcare need to take diversity into account
Steriotypes lead to different groups being given unequal treatment. Denial is a problem and people fear the unknown.
Lack of time means doctors cannot understand culture identity/ patient needs - means they are less likely to adhere
Describe the NATSAL survey
National survey of sexual attitudes and lifestyles on 3 occasions
Asked in their home but a questioners a standard set of questions.
Increase in opposite sex partners.
Same sex increasing for women.
Common for sexual problems
Why is it difficult to get accurate info on sexual dysfunction
Embarrassed/ reluctant to admit to an interviewer
May not recall their sexual encounters
Not everyone sampled
Some people declined.
Explain the implications of diversity in sexual behaviour
No normal sexual behaviour
Comfortable and informed about discussing all forms of sexual behaviour
Describe diversity in patterns of dying
Age 2/3 over 75 More babies than children Socioeconomic and geographic factors May be: Gradual Catastrophic Premature
Describe the 5 stage grief model of adjusting to the idea of dying
Denial Anger- look for alternatives Bargaining- with doctor or religious figure Depression Acceptance
Explain the potential positive and negative implications of denial in coming to terms with an illness
Denial is a form of coping and so needs to be respected
It can be a barrier to good care.- needs checking and reviewing over time
Describe symptoms often experienced after bereavement.
Loss, grief, mourning
Grief is a psychological and physical reaction to bereavement. Disbelief and shock early develop awReness with guilt, anger then eventually resolution
Chronic
Emotional - depression, anxiety, Anger, guilt, loneliness
Cognitive- hallucinations, lack of concentration, memory loss, preoccupation, disturbance of identity
Behavioural- irritability, insomnia, crying, social withdrawal
Physical- immunosuppression, palpitations, fatigue, digestive symptoms
Describe the aims of palliative care
Improve QOL Manage emotional and physical symptoms Support patients to live productively Give patients some control E.g. Hospices Follow Liverpool care pathway!
Identify the risk factors for chronic grief following bereavement
Mentally disables, primary Carer, depression, spouse, social isolation, stress, if grief is discouraged, type of loss.
Describe the sexual response cycle and give examples of dysfunctions that can arise at each stage
Desire- lack or loss
Arousal- erectile dysfunction, sexual arousal disorder
Organism- rapid ejaculation, inhibited orgasm or orgasmic dysfunction (can be sensitive too)
Other- sexual aversion, lack of sexual enjoyment,vaginismus, dyspareunia, primary if never penetration or secondary from trauma, infection, pregnancy ect.
Problems lifelong or acquired, generalised or situational.
Often in both partners and a combo.
Give examples of factors that can lead to sexual problems
Precipitating- physical, phycolgical, life events, partners problems
Predisposing - false beliefs and concepts, unrealistic expectations, poor communication, physical vulnerability, early sexual trauma
Perpetuating (fear of failure) self- loss of confidence, spectating, guilt, shame, anger and fustration
Perpetuating partner- breakdown in communication, pressure to perform, criticism and hostility, guilt and self blame
Rarely a single factor.
Describe the main components of psychosexual theory
Find out relative contributions of physical dna psychological factors. Often now behavioural approach looking at cause instead of psychotherapy.
Treat couples using co-therapists
Facilitate communication
Educative counselling individual or couple
Modification of attitudes and beliefs
Specific directions for sexual behaviour - sensation focus/ dilator therapy/ start stop
What is the gender binary model?
Male and females distinguished by anatomy. Men should look and act masculine and vice versa.
What is gender identity and gender role/ expression?
Gender identity- someone’s internal perception and experience of their gender
Gender role/ expression- the way the person acts in society and interacts with others
What’s the difference between transgender and transsexual?
Transgender- gender identity differs from birth sex
Transsexual- constant desire to live life as the opposite sex
What does sexual attraction include?
Feelings, behaviour, identity
Explain how experiences of discrimination can lead to poorer health for LGBT patients
Rejection from families Bullying at work More likely to live alone and access services when older. Half experience abuse at school Transgender: Depression, suicide, isolate, unemployment much higher Increased stress Social isolation Low self esteem Increased conflict Sub culture Distrust of authorities Discriminatory healthcare e.g. Lesbians refused smears Gps refuse to treat
Define and give examples of heterosexism
Discrimination in favour of opposite sex sexuality and relationships. Presumption that people are in same sex relationships and it is the norm/ superior.
Give examples of how stereotypes about LGBT patients can affect their healthcare
Lesbians don’t have HPV/ haven’t had sex. Butch men don’t have anal sex. Lesbians don’t want children. Same sex partner is not next of kin. Gay people don’t need paternity/ maternity leave. Failure of organisations to tackle homophobia at work
Describe the specific health needs that are present in the community
HIV incidence higher. Other stis Mental health particularly transgender and bisexual Cancer - smears LGBT people want Validate identity Confidentiality respect Knowledge of HCP
Describe the specific health needs that are prevalent in the LGBT community
Illegal to discriminate
Explain the ethical and legal requirements of doctors in providing good care for LGBT patients
Illegal to discriminate
Do not let views prejudice treatment
Challenge colleagues behaviour
Respect patients and colleagues regardless of sexual expression
Explain why it is important to tell patients when there is bad news
Maintains trust Easier to treat patients Patients want to know (often) Lack of info can cause distress, anxiety and dissatisfaction Promotes open communication Allows adjustment Prevents unrealistic expectations
Explain implications for patients if bad news is not delivered well
Impact on doctor patient relationship
Impact on emotional well-being e.g. Distress and depression
Adjustment to and ability to cope affected for patients and relatives
Describe blocking behaviours in breaking bad news
Changing subject
Focusing on physical aspects
Saying distress is normal
Asking leading, closed or multiple questions
Giving advice or info before concerns are addressed.
Describe each step in the spikes model of breaking bad news
Setting Patient perception Invitation Knowledge Empathy Strategy and summary
Setting
No more than 3 staff At patients level Sitting down Who the patient wants present Privacy Listening mode No physical barriers
Patients perception
Ask what they know already
Invitation
Does the patient want to know? How much? Denial can be used to cope
Knowledge
Warning shot Small chunks Allow time for question Direct patient to diagnosis Check understanding Clear and simple explanation avoiding jargon
Empathy
Empathetic response,
Ask how they are feeling
Acknowledge connection between news and emotion
Validate/ normalise emotion
Listen to concerns- ask what is concerning them the most
Strategy and summary
Agree on next steps
Summarise main topics
Check understanding
Be optimistic but avoid inappropriate reassurance
Closure- give opportunity to ask questions, ask if they want someone called, left alone, someone to stay
