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Esa 3 > Health Psych > Flashcards

Health Psych Flashcards

0
Q

Describe and contrast the biomedical model and biopsychosocial model

A

Biomedical - fixed with physical inter, cause explained with physiology/biology

Vs combination of social, psychological and biological factors

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1
Q

Define health psychology

A

The study of psychological and behavioural processes in health care

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2
Q

How steriotypes?

A

Information stored in schemata to save processing power.
Individuals placed in certain schemata overlooking diversity.
Prone to negative traits.

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3
Q

Define steriotype, prejudice and discrimination

A

Stereotype - overlooking individuality placing into schemata
Prejudice - negatively affects our attitudes based on stereotypes
Discrimination - affects behaviour

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4
Q

Avoiding reliance on stereotypes

A

Getting to know individuals who challenge stereotypes

Reflection

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5
Q

Changes in cognitive capacity with aging

A

Gradual linear decrease in IQ
Memory loss often linked to co-morbidities
Processing speed most affected. Fluid thinking vs crystalline.

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6
Q

Relationship between personality and ageing including the 4 models

A

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.
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7
Q

Define disability and their implications

A

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

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8
Q

Identify barriers for people with disabilities in accessing healthcare

A

Physical/ environmental
Attitudinal/ behavioural - e.g. Staff not listening, different treatment
Institutional - training, policies.

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9
Q

Define health rated behaviour

A

Anything someone does to negatively or postively affect health.

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10
Q

Describe classical conditioning and how it can lead to a health related behaviour and how the behavior can be changed.

A

Pavlovs dog
Bahaviour linked to unrelated stimuli
E.g. Smoking on breaks (habit)
Elastic band to stop automatic reaction (break habit)

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11
Q

Operant conditioning and how it can lead to a health related behaviour and how the behavior can be changed.

A

Behaviour driven by short term rewards or negative affects.
E.g. Smoking and feeling good/cool
Make own rewards for not smoking

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12
Q

Social learning theory and how it can lead to a health related behaviour and how the behavior can be changed.

A

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.

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13
Q

Identify a tool for screening patients for levels of alcohol use

A

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.

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14
Q

Describe the management of a patient with an alcohol problem

A

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

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15
Q

Describe the key features and techniques used in motivational interviewing

A

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

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16
Q

Define adherence compliance and concordance

A

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.

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17
Q

Explain the relationship between concordance and adherence

A

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.

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18
Q

Describe the extent of non-adherents across patient groups

A

Lowest in long term disorders which are asymptomatic or not severe e.g. Diabetes but also kidney transplants.
High in HIV, arthritis, GI, cancer.

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19
Q

Describe techniques for measuring adherence in individual patient cases

A 
Indirect:
Patient self report
Carer report
Pill counts
Mechanical measure of dose

Direct:
Urine or blood sample,
Direct observation

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20
Q

Define intentional and unintentional adherents and identify potential reasons for both

A

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

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21
Q

Describe the nature and effectiveness of and problems with interventions to improve adherence

A

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!

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22
Q

Describe the physiological responses involved in stress

A 
Fight or flight
Cortisol release
Increased heart rate 
Immune system up regulation
Clotting factors 
Ect
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23
Q

Explain why stress can have positive and negative consequences

A

Short term - awareness, sharpness, faster thinking/ high performance, energised
Long term - tiredness, anxiety, high BO, low performance from alarm

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24
Q

Define stressors and describe tools to measure stress based on stressors

A

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

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25
Q

Use the transactional model to explain stress as a process

A 
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.
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26
Q

Define primary and secondary appraisal

A

Primary- is it a threat, how big?
Secondary- can I cope?
Reappraisal- is it easier harder to cope than I thought?

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27
Q

Identify important factors which moderate the impact of stress

A

Social support

Control over a situation

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28
Q

Describe the different ways stress can negatively impact health

A

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

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29
Q

Outline strategies for managing stress

A

Cognitive - hypothesis testing, restructuring
Behavioural- skills training, assertiveness and time management
Emotional - counselling, emotional disclosure, social support
Physical - exercise, meditation/ relaxation, biofeedback
Drugs

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30
Q

Define emotion focused coping

A

Change the emotion
Behavioural- distract, relax, alcohol
Cognitive - see positives/ change how you think about problem

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31
Q

Describe problem focused coping

A

Changing the problem or resources
Reduce demands of a situation e.g. Claustrophobia
Expand resources e.g. Skills/ ways to improve

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32
Q

Describe ways to aid patient’ scoping and give relevant examples of useful approaches for individual patient cases

A

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

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33
Q

Explain why patients with chronic illness are at increased risk of mental health problems

A

Anxiety - response to threat,

Depression - response to loss, failure or helplessness

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34
Q

Describe barriers to identifying psychological difficulties in patients

A

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

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35
Q

Outline NICE guidelines for managing anxiety and depression

A

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.

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36
Q

Explain the limitations of a biomedical model for pain

A

Pain after symptoms/ treatment.
Pain without symptoms.
Phantom limb pain
Different levels of pain

37
Q

Distinguish between acute and chronic pain

A

Chronic is over 3 months, rest does not help, often unknown cause, no ongoing tissue damage

38
Q

Outline the gate control theory of pain

A

Pain comes from complex pathways between brain and tissues.
Goes through two neural relays or gates
Different factors can open or close gates

39
Q

Discuss how biological, psychological and social factors affect the experience of pain

A

Injury, medication
Depression, stress, distraction, exercise, positive outlook/ beliefs.
Active life/ minimal involvement in life.

40
Q

Describe the principles and aims of pain management programs

A 
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
41
Q

Describe the key psychological therapies used within the NHS

A 
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
42
Q

Describe psychodynamic therapies

A

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

43
Q

Describe systemic/ family therapies

A

In groups, look at patterns of interaction and their meaning, facilitate resources in system

44
Q

Describe humanistic therapies

A

No definition
General counselling skills - empathy, warmth, unconditional personal regard
Good immediately with motivation to move on

45
Q

Describe the behavioural aspects of CBT

A

Graded exposure to feared things
Activity scheduling
Reinforcement and reward
Role play/ modelling

46
Q

Describe the cognitive aspect of CBT

A

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

47
Q

Describe the rational for usinG CBT

A

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.

48
Q

Identify the mental health conditions that CBT is likely to be helpful for

A

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

49
Q

Explain the concept of attachment in child development

A

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.

50
Q

Describe attachment styles

A

Secure
Insecure- avoidant/independent, ambivalent or disorganised
Can tell from how mother responds to child’s signals, rapid appropriate responses, careers high Esteem.

51
Q

Describe the implications of separation for the hospitalised child

A 
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.

52
Q

Give examples of good practice in the organisation of hospital care for children

A 
Distractions
Home like feel
Visits encouraged
Caring staff
Explanation of not their fault
Continuity of staff
Allow attachment objects
53
Q

Describe Piaget’s four stages of childhood cognitive model

A

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

54
Q

Describe Vygotsky’s theory of social development

A

Affected by social interactions and shared problem solving so can increase understanding - zone of proximity

55
Q

Discuss Implications of theory about children cognitive development for communication with children about illness and treatment

A 
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
56
Q

Give examples of good practice in communication with children

A 
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.
57
Q

Give a definition of cultural diversity

A

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.

58
Q

Give examples of ways in which culture can impact on patients presentation to health services

A

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

59
Q

Give reasons why organisation and delivery of healthcare need to take diversity into account

A

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

60
Q

Describe the NATSAL survey

A

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

61
Q

Why is it difficult to get accurate info on sexual dysfunction

A

Embarrassed/ reluctant to admit to an interviewer
May not recall their sexual encounters
Not everyone sampled
Some people declined.

62
Q

Explain the implications of diversity in sexual behaviour

A

No normal sexual behaviour

Comfortable and informed about discussing all forms of sexual behaviour

63
Q

Describe diversity in patterns of dying

A 
Age
2/3 over 75
More babies than children
Socioeconomic and geographic factors 
May be:
Gradual
Catastrophic
Premature
64
Q

Describe the 5 stage grief model of adjusting to the idea of dying

A 
Denial
Anger- look for alternatives 
Bargaining- with doctor or religious figure
Depression
Acceptance
65
Q

Explain the potential positive and negative implications of denial in coming to terms with an illness

A

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

66
Q

Describe symptoms often experienced after bereavement.

A

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

67
Q

Describe the aims of palliative care

A 
Improve QOL
Manage emotional and physical symptoms
Support patients to live productively 
Give patients some control
E.g. Hospices
Follow Liverpool care pathway!
68
Q

Identify the risk factors for chronic grief following bereavement

A

Mentally disables, primary Carer, depression, spouse, social isolation, stress, if grief is discouraged, type of loss.

69
Q

Describe the sexual response cycle and give examples of dysfunctions that can arise at each stage

A

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.

70
Q

Give examples of factors that can lead to sexual problems

A

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.

71
Q

Describe the main components of psychosexual theory

A

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

72
Q

What is the gender binary model?

A

Male and females distinguished by anatomy. Men should look and act masculine and vice versa.

73
Q

What is gender identity and gender role/ expression?

A

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

74
Q

What’s the difference between transgender and transsexual?

A

Transgender- gender identity differs from birth sex

Transsexual- constant desire to live life as the opposite sex

75
Q

What does sexual attraction include?

A

Feelings, behaviour, identity

76
Q

Explain how experiences of discrimination can lead to poorer health for LGBT patients

A 
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
77
Q

Define and give examples of heterosexism

A

Discrimination in favour of opposite sex sexuality and relationships. Presumption that people are in same sex relationships and it is the norm/ superior.

78
Q

Give examples of how stereotypes about LGBT patients can affect their healthcare

A

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

79
Q

Describe the specific health needs that are present in the community

A 
HIV incidence higher. Other stis
Mental health particularly transgender and bisexual
Cancer - smears
LGBT people want
Validate identity
Confidentiality respect
Knowledge of HCP
80
Q

Describe the specific health needs that are prevalent in the LGBT community

A

Illegal to discriminate

81
Q

Explain the ethical and legal requirements of doctors in providing good care for LGBT patients

A

Illegal to discriminate
Do not let views prejudice treatment
Challenge colleagues behaviour
Respect patients and colleagues regardless of sexual expression

82
Q

Explain why it is important to tell patients when there is bad news

A 
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
83
Q

Explain implications for patients if bad news is not delivered well

A

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

84
Q

Describe blocking behaviours in breaking bad news

A

Changing subject
Focusing on physical aspects
Saying distress is normal
Asking leading, closed or multiple questions
Giving advice or info before concerns are addressed.

85
Q

Describe each step in the spikes model of breaking bad news

A 
Setting
Patient perception
Invitation
Knowledge
Empathy
Strategy and summary
86
Q

Setting

A 
No more than 3 staff
At patients level
Sitting down
Who the patient wants present 
Privacy 
Listening mode
No physical barriers
87
Q

Patients perception

A

Ask what they know already

88
Q

Invitation

A

Does the patient want to know? How much? Denial can be used to cope

89
Q

Knowledge

A 
Warning shot
Small chunks 
Allow time for question
Direct patient to diagnosis
Check understanding 
Clear and simple explanation avoiding jargon
90
Q

Empathy

A

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

91
Q

Strategy and summary

A

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

Esa 3 (5 decks)

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