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Health Psychology 2301 Midterm #2 > Health Psychology 2301 Midterm #2 > Flashcards

Health Psychology 2301 Midterm #2 Flashcards

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1
Q

Health Compromsing Behaviors

A
  • undermine current or future health
  • usually addicitive
  • can be modified with incentive and help
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2
Q

Addiction Definition

A
  • condition produced by repeated consumption of a natural or synthetic psychoacitve substance
  • person has become physically and psychologically dependent on the substance
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3
Q

Definition Physical Dependence

A
  • body has adjusted to a substance and incorporated it into normal functioning (need it to function normally)
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4
Q

Psychological Dependence

A
  • usually happens before the physical dependence
  • compelled by desire for the substance’s effects
  • like it and how it makes you feel
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5
Q

Definition “Substance Use Disorder”

A
  • In DSM
  • Show two characteristics of many:
    • tolerance for the substance
    • failing to fulfill important obligations
    • putting yourself or others at risk of physical injury
    • having substance-related legal problems
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6
Q

Definition Tolerance

A
  • body increasingly adapts to the substance and requires larger doses to get the same effect
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7
Q

Definition Withdrawl

A
  • unpleasant physical and psychological symptoms experienced when discontinuing or reducing using a substance on which you were dependent
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8
Q

Use: Pos / Neg

A
  • consequence increases the behaviour
    • Positive: buzz, elation (cigarettes, booze)
    • Negative: remove tension, stress, anxiety (works quickly so hard to stop)
    • Use it to avoid withdrawl symptoms (DT’s, from alcohol or shakes, nausea)
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9
Q

Substance-related Cues

A
  • (classical conditioning)
  • pairings of events, emotional state or cue with a substance can make you crave it
  • the stimuli links to the feeling of using
  • ex: friends who drink or use
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10
Q

Incentive Sensitization Theory

A

(can get dopamine release when see the cue - incentive sensitization theory

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11
Q

Expectencies and Abuse

A
  • form them young (see parents) or older (see vodka and remember getting sick on it)
  • can be negative or positive
  • idea about the outcome of the behavior
  • can influence whether someone will stop using
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12
Q

Personality and Substance Use

A
  • High impulsivity
  • Risk taker
  • Sensation seeking
  • Low self-regulation
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13
Q

Genetics and Abuse

A
  • Identical twins similar addictive behaviour
  • different genes for different substances
  • parental involvement can counteract
  • epigenics: environment can alter the genes involved
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14
Q

Smoking

A
  • Single greatest cause of preventable death
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15
Q

Who smokes?

A
  • Age: begins around 13 (Grade 8)
    • more risk if no post-secondary school
    • fewer begin after 20’s
  • Gender:
    • ​75% men
  • Sociocultural:
    • ​80% smokers in developing countries (poor health promotion, more stress, no soc. engin)
    • 18% pop in Canada
    • 58% Indigenous pop, higher on reserve
    • assoc with social class -(blue collar more likely to smoke)
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16
Q

Why smoke - psychological

A
  • perceive low risk, high benefit (teens)
  • impulsive or sensation-seeking
  • low self esteem
  • concern body weight
  • want image of cool, rebellious, glamorous
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17
Q

Why start - Social Factors

A
  • Peers: hang with other smokers
  • Family: more likely if parents smoke, reduces belief it will be harmful
  • Stressors: depression increases smoking
  • School: poor regulation/enforcement
  • Culture: standards of “thinness”
  • Media: see pop bands smoking
  • LGBTQ: if not supported can increase smoking
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18
Q

Why Keep Smoking

A
  • Psychological:
    • Affect Management Model
      • smoke to regulate emotional state
    • Behav. Conditioning: habit (linked with cues)
    • Personal Identity: ties to self image (know you are a smoker - becomes part of you)
  • Social:
    • choose friends who smoke, no support to quit
  • Biological:
    • exposure during pregnancy, heredity, (area in brain (insula)
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19
Q

Nicotine

A
  • Addictive, fast acting drug, reinforcing each hit - after 2 hours half gone after metabolism but half life
  • stimulates the nervous system (reward system)
  • can relax as well
  • makes you alert, helps concentration, arousal, psychomotor performance and can screen out irrelevant stimuli
  • Nicotine regulation model: keep level of it in blood to avoid withdrawl so even if low or light cigs just smoke more as need nicotine
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20
Q

Smoking and Cancer

A
  • lung, mouth, espophagus etc.
  • lung cancer: deadliest form of cancer
  • can lose all cilia lining bronchial tube (can’t clear foreign products including carcinogen cig ones)
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21
Q

Smoking and Cardiovascular Disease

A
  • twice the risk of CVD
  • more smoke, higher the risk
  • Nicotine constricts blood vessels, increases HR and BP and cardiac output so wear and tear on heart
  • higher plaque and risk artherosclerosis
  • if smoke more cardiac reactivity to stress
  • lower physical activity usually or other poor habits
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22
Q

Lung Disease

A
  • Emphasyma - lung tissue breaks down so poor airflow and alveoli become damaged and die so not much oxygen into bloodstream
  • COPD - high risk of pneumonia, colds , bad immunity
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23
Q

Who Drinks - Age and Culture

A
  • 15-16 yrs old (63% drink) and 35% binge (8+ drinks)
  • First Nation: more non-drinkers/ if do then heavy
  • can be associated with social life
  • Self concept: “I am a drinker”
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24
Q

Alcohol Use Disorder / Problem/ Binge

A
  • Alcohol use disorder: physical addiction, withdrawl symptoms if stop, high tolerance, no control
  • Problem drinker: might not have withdrawl effects but social, psychological and medical problems
  • Binge drinking: 5+ drinks at least once in a 30 day period
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25
Q

Alcohol Continuum

A

Psychosocial differences:

  1. perceive fewer negative (sedation) and more positive (stimulation) consequences
  2. experience high stress/trauma and live in environments that encourage drinking
  3. heightened physiological reactions (pleasure)
  4. less likely to use control strategies to not overdrink
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26
Q

Biological Reasons

A
  • Stress dampening
    • buffer stress (will decrease stress response) BUT after a few can become unstable, anxious
  • Family history/genes - develop tolerance, higher reward (positive reinforcement) less plateau,avoid withdrawl symptoms
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27
Q

Acute Effects of Alcohol

A
  • Enters via bloodstream, metabolizes in liver
  • Starts stimulant then becomes depressant (if lots)
  • Lots alcohol:
    • slurred speech/vision
    • interferes with complex though processes
    • poor coordination
    • loss of balance
  • Neural: binds to GABA receptors (quieting effect) and can even stop or slow breathing - alc. poisening, faint
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28
Q

Moderate vs Heavy Drinking

A
  • Heavy: perceive more + consequences, often have greater stress, live where encourage drinking, strong substance-reated cues
  • Moderate: more control strategies
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29
Q

Long Term Heavy Drinking Effects

A
  • Cirrhosis - liver cells die off replaced by scar tissue
    • blocks metabolism of protein, fat and carbs
    • liver cells engorge with fat and protein
    • obstruction of blood flow through liver
  • Impaired immune function
  • Cancer - breast, head/neck/liver/esoph/colorectal
    • acetaldehyde:toxic chem & carcinogen
  • High BP
  • Brain damage - perception, memory, decreased grey matter
  • Heart damage:
    • arrhythmia
    • weak heart so bad blood flow
    • increased cholesterol
    • hypertension
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30
Q

FASD

A
  • Drinking pregnant: raise risk of fetal alcohol syndrome or low birth weight or impaired learning, facial abnormalities, growth deficiencies
  • Also: miscarriages, still births, CNS disorders
  • especially dangerous in early months pregnancy
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31
Q

Capillery Hemorrhages

A
  • alcohol vasodilator when metabolized (widens)
  • vessels continue to enlarge
  • blotchy skintone, redness, broken capilleries
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32
Q

Benefits of Drinking?

A
  • Light drinking:
    • decreased risk of MI & Death
    • lower BP
    • lower risk of dying from Heart Attack
    • increase good cholesterol
  • Amount
    • 1-2 / week for women
    • if don’t drink don’t start
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33
Q

Drugs - who uses

A
  • Teens try - weed grade 7-8 20% students
  • prescription drugs tried - opiods
  • non-mainstream youth more vulnerable (street kids, those who are discrim. against, kids who had trauma)
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34
Q

Why teens use/keep using

A
  • Psych: low self-control, high sensation-seeking
  • Soc: friends use, family, celebrities - all have positive attitudes about the drugs
  • Continue:
    • makes them feel good
    • reduces anxiety and tension
    • drug-related cues
    • social pressure
    • rebellious, impulsive, illegal no problem
    • less conforming
    • less religious
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35
Q

Preventing Approaches

A

3 Approaches:

  1. Public Policy and legal
  2. Health Promotion and Education (address social refusal skills - modelling / role play) MADD speakers​
  3. Family involvement​
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36
Q

Public Policy/Legal

A
  • Taxation and higher cigarette prices
  • Age limits
  • Ride programs
  • Outlaw all use (posses, sell, use)
  • More patrols
  • Close bars
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37
Q

Health Promotion/Education

A
  • don’t focus on harm - already know that/don’t care
  • Current consequences: now: more $ if quit, more dates if don’t smell; later: fewer wrinkles, nicer teeth
  • teach refusal skills, announce intention to quit (more likely to do it)
  • Build Skills: assertiveness training, anxiety reduction, start really early then have booster sessions, involve parents; have facilitator be someone they can relate to (close to their age)
  • Media Campaigns - MADD speakers
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38
Q

Family Involvement

A
  • Many parents not aware kids are using
  • less likely to use if know parents disapprove
  • weekly sessions with parents
  • monitor behavior and use discipline
  • help teach kids to avoid peer pressure
  • reduce family conflict
  • follow up in grade 10 shows less likely to have begun
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39
Q

Quit NO Therapy

A
  • Mature Out - use often peaks at 22 then declines (getting jobs, locial norms change, in relationships)
  • Self efficacy determines if can quit on one’s own
  • Cold turkey best if paired with a reward (might take a few tries)
  • Early Intervention: screening by health prof. (check for binge drinking, crravings, other); information / advice / support
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40
Q

Treatment Methods

A
  • Psychological
  • Self-help groups
  • Inpatient / Outpatient
  • Chemical methods
  • Multidimensional programs
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41
Q

Psychological Treatments

A
  • motivational interviewing
  • reduce negative reinforcement
  • skills training - social anxiety, self-efficacy
  • congnitive restructuring - new helpful thoughts
  • Behavioural: gain control over environmental condit.
    • self-monitor
    • stimulus control
    • behavioural contracting - reward/punishment
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42
Q

Self-Help Groups

A
  • AA - largest one / Alanon, Narcon, Alateen, etc. which is “total abstinence model”
    • good cuz with others making same commitment
    • bit religious and deals with idea of powerlessness (12 step)
  • Never recover - always recovering
  • longer with AA better social functioning and less use
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43
Q

Controlled Use

A
  • e.g. non-dependent problem drinking (controlled)
  • cognitive behavioural techniques (goal setting, self-monitoring and self-control)
  • for those who have not been drinking a long time, are high functioning, employed, living in supportive environments
  • Advantages(?) maybe a more realistic goal and abstinence-based programs have high drop-out rates
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44
Q

Inpatient/Outpatient

A
  • Inpatient: detoxification - withdrawal under medical supervision (average: 28 days), limited facilities
  • Outpatient: discharge to follow-up sessions or supervised living, therapy, CB strategies
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45
Q

Chemical Methods

A
  • Smoking: nicotine replacements
    • decreases craving and withdrawal
    • helps to quit
  • Alcohol:
    • Antabuse - daily, makes you nauseous, also not learning the skills to stay sober
    • Naltrexone - blocks the “high” feelings
  • Narcotics (another lecture)
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46
Q

Multidimensional Methods

A
  • CBT + patch
  • Methadone +reward system
  • need to verify self-reports, daily phone calls, family involvement, physician involvement
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47
Q

Relapse

A
  • takes 2 weeks for body to adjust then go into the world where there are stressors
  • Bad moods, social cues
  • Stress
  • motivated reasoning / denial / decreased self efficacy after relapse
  • irrational thinking - why relapse “okay” and less likely to endorse sober life
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48
Q

Harm Reduction

A
  • Harm reduction: keep people safe cuz they’ll mess up (drugs and alcohol) - some students do use protective behavioral strategies: eat more, pick # drinks before going, alternate with water, pace yourself, know what you “can’t” drink
  • focuses on risks / consequences and not just use
  • promote safe substance use
  • focus more on reducing substance use to help minimize social and physical harm
  • normalize: relapse is not a failure, but normal/common
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49
Q

Antagonist / Agonist

A
  • Agonist: Chemical/substance - activates a receptor and causes an action
  • Partial-Agonist: -Chemical/substance -activates a receptor, with less affinity for the receptor
  • Antagonist: Chemical/substance - inhibits action by blocking or inhibiting a receptor
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50
Q

Narcotic Analgesics

A
  • produce an opiod effect in the brain
  • binds to opiod receptors
  • euphoria, relaxation, pain relief
  • high dose: death or respiratory failure
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51
Q

Dopamine

A
  • Dopamine reward pathway: ventral tegmental - limbic - nucleus accumbens
  • rat experiment - kept pressing lever to slelf medicate, even when lesioned
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52
Q

Endogenous Opiods

A
  • naturally produced in the body
  • Endorphin, Enkephalin, Dynorphin, Endomorphin, - involved in analgesia - pain regulation
  • Endorphins: sexualy behavior, pain, appetite, reward
  • most potent opiod to agonist receptor
  • Heroin and morphine (natural) bind to the same receptors
  • Others (synthetic) fentanyl, methadone
  • some 1/2 & 1/2 : oxycodone, hydromorphone
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53
Q

Prescription Opiod Use

A
  • problem if long term as can lead to addiction / abuse
  • pain subjective so doc takes patient’s word for it
  • pain can get worse - continual mu receptor agonists
  • can cause euphoria - bad if at risk for addiction
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54
Q

Fentanyl

A
  • used for palliative care
  • similar to herion
  • lollipops, patches, sublingual sprays, tabs
  • now mixed in with street drugs
  • no quality control
  • 1917 - 4 o.d.’s per day
  • higher use in males and ppl under 29
  • HIV more prevalent
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55
Q

Opiods and D.S.M. Disorder

A
  • Craving, or a strong desire or urge to use opioids.
  • Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.
  • Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
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56
Q

Symptoms Opiod Withdrawal

A
  • for Short acting opiates: first 6-12 hours
  • for Long acting opiates: 30 hours
    • yawning - trouble staying/falling asleep
    • anxiety/agitation/sweating
    • nose running, fever, muscle aches
    • racing heart / hypertension
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57
Q

Bio Factors Opiod Use

A

Use

  • History of chronic pain
  • Impulsivity

Symptomology

  • Sexual Dysfunction / Pinpoint Pupils / slurred speech/ HR, BP, Respir. and Temp up

Risks

  • Altered learning and memory, HIV, Hepatitis, Sniffing causes perforations nasal septum, death
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58
Q

Psych Factors Opiod Use

A

History of drug use or traumatic experiences

Why use?

  • Depression
  • Motivated reason (downplay the negative, play up positive affective state)
  • Personality: neuroticism
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59
Q

Social Impact Opioid Use

A

Social Impact:

stigma - users are devalued or rejected (not recognized as an illness, which it is)

marginalization of ppl with OUD leads to continuance - social exclusion leads to more use

Ppl with OUD thought to be in control over use, leading to blame, anger or punishment

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60
Q

Social Factors Opiod Use

A

Environment: partner, friends, family are users or are medical personnel and have access to opiods

Social Consequences: housing conditions, unemployment, marital difficulties

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61
Q

OUD Related Harms

A

Homelessness, prostitution, violent crime, Hep. C, HIV,

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62
Q

Biopsychosocial Model OUD

A

Bio: physiological, medications, neurochem., genetics

Psycho: emotions, attitudes, learning, beliefs, stress mgmt

Social: Family, peer, relationships, culture, socioeconomics

Dr. Gelbien: E.R. Physician / Back Pain - Percocet then crutch for: emot. pain, stress, escape. No Percocet left so then Fentanyl. Once tried that ‘s it. Addict mind stronger than rational mind. : divorce, geograph. separated from his kids, mother dies from patch. Addiction itself is a biol factor PLUS effect of stronger drug (Fentanyl). Social: police at his home, divorce. Psych: Stress.

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63
Q

Factors re Gabien’s addiction

A
  • marital difficulties
  • moved an hour from friends so isolated
  • work stressful
  • stressful relationships with staff at work
  • drank - sometimes to excess on weekends
  • Percocet presecription for hockey injury
  • Another injury - back - more Percocet
  • Recreational use of the pills when with friends
  • Then daily use for work stress - relieve pain/anxiety
  • Wife’s Ex moves closer- more drugs, withdrawal
  • Mom gives him one of her Fentanyl patches
    *
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64
Q

Opioid Stats

A
  • 2016: opiod OD more common than fatal car crash
  • major primary cause of preventable death for 19-35 year-olds in Canada
  • 285% increase since 1985 (O.D.)
  • 2436 opiod deaths in 2016
  • BC: 7 ppl die a day
  • 1013 in first 8 months in B.C.
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65
Q

Increased Opiod Use

A
  • increased use of prescription opiods
  • high bootleg synthesis and some with Fentanyl
  • Strong drug- can block even horrible pain
  • misuse can lead to coma, O.D.
  • In paliative care they are used for pain - GOOD use as knocks them out (pain mgmt necessary)
  • 2mg can cause o.d.
  • 35% increase of Fentanyl in street drugs
  • recommendation: treat it as an epidemic
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66
Q

Detox Approach

A
  • use the drug to treat the withdrawal symptoms only
  • short term treatment orientation
  • achieve abstinence with end goal of achieving function
  • tapering off method
67
Q

Harm Reduction Approach

A
  • Opiod Substitution Treatment (OST) for Harm Reduction - lower adverse affects by controlling the use vs complete abstinence
  • controlled amts. long acting opiods to reduce cravings and withdrawal symptoms
  • Improve function with end goal of abstinence
68
Q

Buprenorphine -Naloxone 12 week study

A
  • evaluate use of this vs detox for 12 weeks
  • weekly indiv. and group counseling offered
  • patients in OST sample less opiod use/less injecting
  • by week 12 16 of 78 in detox vs 52 of 74 of 12 week
  • BUT at follow up - high level of use both groups
69
Q

Biopsychosocial

A

Bio: manage physical withdrawal, replace unknown drug with known variables, treat mental/physical comorbidities

Social: reintegrate into society: family, friends, job, home and lower crime

Psych: manage psych withdrawal, address all that might cause relapse, treat mental/physical comorbidities (2 chronic disease/conditions), teach coping skills

70
Q

Drug Treatments used

A
  • Methadone
  • Suboxone
  • Naltrexone
  • Diacetylmorphine
  • Hydromorphone
71
Q

Methadone

A
  • oral narcotic analgesic, mu agonist, 24 - 59 hour metab., reduces withdrawal without euphoria, needs titration
  • 99% decrease crimes committed 6 yrs after treatment
  • can have diversion (sale, trade, theft or loss of the drug) - problem and contributes to 25% opioid related deaths
72
Q

Suboxone

A
  • Sublingual, narcotic analgesic, partial mu agonsit, half life of 37 hours
  • while bound to receptors, blocks binding of heroin/oxycodone or similar that use same receptors
  • Safer profile: made of Naloxone and Buprenorphine
  • ceiling effect cuz of the naloxone- just stops so fewer o.d’s
  • best for low to medium users
73
Q

Monitored Injection Site Video

A
  • Video: monitored injection program
  • trying to shift people to the “known” active ingredients so can intervene better
  • used to combat withdrawal
  • mental health benefits
  • controlled amount so less likely to O.D.
  • Diecetylmorphine superior to methadone maintenance for long term injection street opioids
74
Q

Benefits of OST

A
  • Reduced:
    • mortality vs. no treatment
    • HIV & HCV
    • illicit substance use
    • criminal activities and incarceration
  • Increase:
    • fulltime employment rate
    • quality of life
    • physical and mental health

Note: this is the slide that will likely be asked as well

75
Q

Diversion

A
  • disadvantage of OST treatments
  • put legal prescription drugs on black market
  • especially problematic for MMT as increases are associated with increases in methadone deaths
  • more prevalent in take home doses
76
Q

Dangers of Diversion

A
  1. Changing the route of administration without adjusting the dosage
  2. Having lower tolerance than the person the drug was originally prescribed to
  3. Use of other drugs concurrently with the black market prescription drug

Sublingual Naloxone sometimes has barcodes to limit diversion, and has poor absorption sublingually vs. high absorption if injected

77
Q

Definition Polypharmacy

A
  • use of multiple drugs concurrently
  • can lead to additive (they add together) or synergistic ( effect of each drug is increased) effects
  • Example of synergistic: mixing methadone with benzos. (both have a respiratory depressing effect)
78
Q

Psychosocial Interventions

A
  • enhance OST by concurrent use of psychological and social interventions during treatment
  • psychological interventions benefit most when used with OST
  • Why use?
    • comorbities - anxiety / depression
    • craving and drug-seeking behaviors
    • quality of life and self efficacy
    • manage stress and provide coping tools
    • relapse from treatment
79
Q

Barriers to OUD Care

A
  • comorbidity treatment and drug interactions
  • Diversion
  • Need for more randomnized, controlled study (OST and Psych interventions)
  • Access to care
  • MD education and prescription requirements (no courses on OST and addiction) and no residency in addiction medicne and doctors say being an addiction specialist not recognized (so no $$ in it)

EXAM QUESTION

80
Q

mindfulness-based stress reduction therapy

A
  • to reduce opiod use
  • video showed that the individual who suffered from pain had improvement after only a few sessions
  • helped him to hold his “ball of pain” and control it
81
Q

Approval for Methodone/Suboxone

A

Methodone:

  • Health Canada
  • College of Physician

Suboxone:

  • only approval from the College of Physicians
    *
82
Q

Access to Care

A
  • long wait times for treatment
  • geographic barriers
  • daily administered administration
  • need for regular visits to doc for EEG
  • no guidelines for Northern regions
  • lack of trained health are professionals
  • stigma: barrier to treatment
  • no financial or insurance coverage for some
83
Q

Solutions for Access

A
  • telehealth
  • increased use of Suboxone
  • less restrictions for prescribing OST (allow nurse practitioners to prescribe Suboxone)
  • review high threshold programs
  • increase coverage for OST associated costs
84
Q

Naloxone How To

A
  • Reverse an overdose
  • better safe than sorry - can’t hurt them if not overdosing
  • 2 types: nasal spray or vial with needle
  • Sign of overdose:
    • can’t wake person
    • slow breathing or irregular or none
    • deep snoring or gurgling
    • limp body
    • choking
    • fingernails and lips are blue
    • pupils small
85
Q

5 Steps to Naloxone

A
  1. Shake and Shout
  2. 911
  3. Naloxone
  4. Compressions / CPR
  5. See if working and if no change 2-3 minutes then use it again and continue CPR (get 2 needles, 2 vials)
86
Q

Biopsychosocial Benefits of OST

A
  • Reduction of crime
  • Reduction of withdrawl symptoms
  • Reduction of mortality
  • Combined treatment with social workers, psychol.
  • Lower morbidity
  • reduce risk of things like HIV, Hep C

EXAM

87
Q

Barriers Assoc with Care for OUD

A
  • Location
  • Funding
  • Who can administer
  • Stigma
  • Practice Rules

EXAM

88
Q

Processed vs. Unprocessed food

A
  • processed - less healthy
  • additives lengthen shelf life/benefit food industry
  • more sugar consumed since 80’s
  • more unhealthy fats as well (unhealthy ones don’t liquify at room temp - added hydrogen to it - hydrogenated)
  • less red meat which is good, but more sugar
89
Q

Food Categories

A
  • Fats: saturated/polyunsaturated/cholesterol
    • recommended: 10-30%
  • Carbs: simple (glucose, fructose) and complex (sucrose, lactose, starch) - energy for body
  • Protein - for new cell material / amino acids
  • Vitamins - organic chemicals regulate metabolism and bodily functions
    • convert nutrients to energy
    • break down waste products and toxins
    • fat soluble (A,E,D,K) stored in tissue
    • water soluble (C,B) not stored - secreted
  • Minerals - inorganic - calcium, phosphorus, potassium, sodium iron, iodine, zinc
90
Q

Processed Sugar

A
  • linked to insulin resistance & diabetes
  • inflammatory - cancer and cariovascular disease
  • addictive potential - creates cravings (phsiological and psychological)
  • often hidden
  • sugar - into bloodstream then to liver; use what need then on BUT liver will grab fructose even if it does not need it so can get overload and stored as fat then the fat goes into blood and elevates cholesterol, triglycerides and decreases insulin effectiveness
91
Q

Diet and Chholesterol

A
  • Cholesterol risk factors: age, cigarettes, high BP, heredity, family history
  • whether forms plaque depends on lipoproteins
  • only 15-20% from diet, rest already in body
  • fat binds with lipoproteins in blood (HDL) to get rid of it but the LDL will bind to it and form plaque
  • So: need to increase HDL
  • Statin drugs increase HDL, reduce LDL
  • Can begin early - age 5
92
Q

Diet and Sodium

A
  • BP over 140/90 - 19% Canadians
  • Sodium increases BP and reactivity when stressed and damages blood vessels
  • 77% salt from processed foods (5% added to cooking, 6% added to food, 12% natural sources)
  • need H2O to dilute too much salt so osmosis but then more blood, more force on vessesl, higher BP
  • Increase Potassium - balances the salt
93
Q

Why we eat junk

A
  • inborn - prefer sweet stuff (even as babies)
  • brain chemicals - activate pleasure centre
  • environment:
    • school machines, work, home, neighborhood
    • culture/economics: asian more salt, less fat
    • growing up: e.g. bologne sandwichesmake a “bred” liking
    • modelling in ads: see ppl eating it and liking it
    • portion size/plate size/utensil size
94
Q

Interventions to improve diet

A
  1. pick thing person at risk for and alter diet
  2. Multiple Risk Facor Intervention Trial: 2 groups men, one group modified diet only and other got counseling and famiy involvement (better), lower cholesterol
  3. Increase fruit/veg; Study with women: one written material, one with motivational interviewing as well; at 2 years 28% group 2 above baseline. NOTE: both groups reported better life and health
  4. Ideal: a) education and behavior mod b) train and coop of house c) support groups d) long term follow
95
Q

Weight conscious society

A
  • Concerns begin in childhood/adolescence
  • obsessive about having “right” body
  • overweight are teased/excluded
  • Stigma: overweight are lazy and self-indulgent
  • Risk of depression/anxiety
  • PLUS: can’t control body type
96
Q

BMI

A
  • If BMI too high - chronic illnesses shorter life span
  • misleading re body frame and muscles
  • overweight if BMI over 25 and “obese” if over 30
97
Q

Which Countries Obese

A
  • varies: nationality, socio-cultural factors, gender, age
  • Canada: most obese between 55-64 (more calories, less exercise)
  • Very high in U.S. / Mexico
  • Newfoundland/Nunuvut high:
    • cultural norms (this body type okay)
    • not populated so maybe less health promotion
    • less access to health services
  • High among First Nation, Inuit, Metis
98
Q

Why Obesity Increasing

A
  • Food industry ads
  • Larger portion sizes
  • lower avilability of healthy foods
  • promotion of “snack” foods
  • 1 in 4 eat fast food daily
  • easy to eat prepared foods
99
Q

Hunger Activation/Satiety

A

Hunger:

  • Glucose needed by cells to produce energy
  • Liver monitors glucose and if low signals hypoth. to release ghrelin (hormone) that makes us hungry

Satiety:

  • Liver detects high glucose and stimulates the Ventral Lateral Hypothalamus (satiety centre) to release leptin horm. (if lesions the V.L.H. animal eats till dies)
  • Psychosocial: if under stress, higher ghrelin so eat more (NOTE: if told food is high calorie might not produce as much ghrelin)
100
Q

Window of Vulnerability

A

NOTE: She mentioned this a dozen times so EXAM!

  • determines how potentially overweight we might be in our lifetime due to added fat cells
  • Add fat cells as child then later cells get bigger
    • moderately obese: large fat cells
    • severely obese: high # and super large cells
    • # cells will not decrease, only get smaller
101
Q

Fat Cell Hyperplasia

A
  • too many fat cells
  • struggle against a high set-pont
  • fat cells shrink when lose weight but then body thinks it’s starving and lowers metabolism
  • the fat cells retain their fat so…can take over a year to help change the set point
  • Set Point Hard to Change
102
Q

Overweight: Biol. Factors

A

Lower metabolic rate

  • If overweight have lower metab. rate: fat cells inactive and inake of fat usually higher
  • overweight ppl perceive themselves as taking in fewer calories than they really do

Genetics:

  • susceptibility (50% variance in twin studies)
  • FTO gene related to satiation & devp. fat tissue
  • MC4R prefer and consume higher dietary fat
  • heredity NOT destiny if exercise
  • Behaviors matter, not all heredity
  • Set point theory
103
Q

Overweight: Stress

A

Negative emotions: boredom, stress (sweet & high fat), risk for binge, role of ghrelin

  • stress: 1/2 eat less (usually non-dieting and non-obese), 1/2 eat more (dieting or obese eaters)
  • The dieters spend more cognitive effort during day to conserve amt. of calories but under stress are cognit. worn down and then risk of abstinence/violation effect
104
Q

Overweight: Depression

A
  • world not designed for overweight persons
  • can be persistent psychological stressor
  • Derision and rude comments / fat shaming
  • social ostracization leads to withdrawal, low self-esteem
  • Stigmatized: disability and fault of obese person
105
Q

Overweight: Personality

A
  • Assessed Big 5 (agreeableness, conscientiousness, extraversion, neuroticism, openness)
  • assessed eating style of 1000 Swiss participants

Results:

  • Neuroticism: emotional eating (anxiolitic foods)
  • Extraversion: eating out so junk food, big portions
  • Conscientiousness: restrict some foods (sweets, sugary drinks), drawn to others - planners
  • Openness: more fruits, salad, vegetalbes
106
Q

Obesity: Psychosocial Factors

A
  • Food cues: obese more sensitive to them (tastes good, desserts) and parents often encourage overweight children to ear more
  • Social network: if spouse, same sex sibling or friend obese, higher risk of becoming obese and reverse
  • Alcohol consumption lowers disposal ability of fat
  • Inactivity: low rate at which burn calories (t.v., job)
107
Q

Socioeconomics/Gender and Obesity

A
  • Women - if in high income house, low rate obesity
  • Male - high income higher obesity
  • Diseases: CHD, hypertension, diabetes, cancer - higher in low income communities
  • Women more attracted to fruit, men more to meat
  • Men and Veggies: more virtuous and moral, less “manly” BUT if woman eats meat, no change in perception of femininity
108
Q

Health Risk of Overweight

A

Degree:Excessive: high risk for illness, accumulation of fat, hard on heart, too many cells to feed / high mortality

  • Seen as “controllable” risk factor

Body / fat distribution: hip to waist ratio, abdominal fat higher risk for CHD, diabetes, hypertension, cancer: where hold weight predictor of earlier mortality; stress weight: reactivity and higher cortisol

Fitness Level: overweight but active lower mortality than sedentary people

Other: surgery, anesthesia administration, childbearing, stroke during and after pregnancy

NB: now considered a “disease” to reduce stigma and as a disability as can impede function

109
Q

Obesity Prevention

A
  • Begin early:
    • early obesity associated with later obesity
    • risk depends on age (10-13 yrs obese, more likely to be obese adult) W.O.V.
    • Preven devp. of fat cells
    • Barrier: 1/3 parents see them as an o.k. weight
  • School Nutrition Program:
    • not successful in reducing future obesity
    • menus with healthy alternatives not enough
    • intensive program needed: multi-faceted, diet, exercise, nutrition program
110
Q

Parental Role re Obesity

A
  • provide healthy food in reasonable portions
  • model good choices
  • encourage exercise / restrict T.V.
  • don’t use unhealthy food as reward
  • decrease intake of high cholesteral/sugary foods
  • desserts for special occasions only
  • healthy breakfasts
  • no night snacking on high calorie food
  • monitor BMI
111
Q

Why do we lose weight?

A
  • concerned about health - will improve BP/Cholest.
  • Increase attractiveness (not internally driven so not good; might have an unattainable standard)
  • Social stigma
  • Did “yearbook” study - rate likeability and characteristics of HS girls: based on looks/body
112
Q

Dieting Errors

A
  • in 2000 50-70% of adults had dietary behavior
  • 70% HS girls, 20% boys
  • Big business: fad diets, next big thing
  • Fad diets not achievable for long term (Atkins)
  • Skipping meals, severely reduced calories
  • diet supplements
  • yo-yo dieting - mess up metabolism and can overeat after failed yo-yo diet (heavier than when started)
  • What works? SLOW, STEADY, BUILD SELF-EFFICACY
113
Q

Compensatory Health Behaviors

A
  • trying to balance out the occasional slip and neutralize the negative feelings that come from having given in
  • bargaining: allow for indulgences (usually quick decision - i.e. cake tonight, run tomorrow) BUT if don’t run it adds up so only compensating for some of the unhealthy behaviours
114
Q

Exercise and Health

A
  • good for initial weight loss success
  • eating regulation
  • maintenance
  • speed up metabolism
  • Obese: still better if you exercise AND reduce calories than either alone
115
Q

Intensive Interventions

A
  • VLCD - less than 800 calories per day - supervised
  • Drugs: decrease fat absorption (orlistat)
  • Lipo- suck body fat out
  • Bariatric surgery - change structure of stomach or intestines (e.g. band)
  • but if try and overeat while band on can be very dangerous - really takes a complete life overhaul re food, exercise, food behaviours, etc.
116
Q

CBT and Weight Loss

A

Behavioral:

  • Nutrition and exercise counselling
  • Alter the act of eating (slower)
  • Behavioral contracting
  • Self-monitoring - food log (when eat, why, where, with whom, mood, thoughts, etc.)
  • Stimulus control: remove triggers - better choices (no t.v. eating, buy low cal food, make access easy)

Cognitive: Covert self-control (deal with barriers - more helpful thinking), motivational interviewing, problem solving training (e.g. if on holidays, away from routine or home, socializing, food temptations - study re Thanksgiving and check-in calls)

117
Q

Resistence to Dietary Change

A
  • diet for appearance rather than health
  • Hard to maintain change:
    • VWO: pre-programmed by this & set point
    • Need strong self-efficacy (how to approach gym routine, motivation
    • Strong relapse prevention techniques (in case of stressors and weaknesses)
    • diet can be restrictive or monotonous
    • Need planning / time management
    • If not social reinforcement…
118
Q

Anorexia Nervosa

A
  • Drastic reduction in food intake
  • VERY low BMI
  • Intense fear of gaining weight
  • distorted perception of body shape (dysmorphia)
  • can lead to death, kidney failure, cardiac arrest etc.
  • common among models, dancers, athletes
  • Treatment: restore weight, hospital setting (needs intense approach), behavioral techniques, high relapse rate and ongoing food issues so need family involvement to coach, support, can have depressions
119
Q

Bulemia Nervosa

A
  • Binge eating and purging (vomit, laxative, overexercising)
  • usually low positive affect, high negative affect
  • know it is abnormal, fear losing control over food
  • shame / self criticism after “episode”
  • inflammation issues (digestive tract), cardiac issues
  • Binge eating disorder: NO purging
  • NOTE: can see signs at 13-15 yrs of age (restrictive eating), often tied to trauma or life stressor then becomes compulsive
120
Q

Health Canada Tips Adults

A
  • 150 minutes exercise a week, moderate to vigorous
  • Train muscles / bones 2 days / week
  • 15% Canadians meet these guidelines
  • Even less exercise will still provide benefits (esp. if typically sedentary or low cardio fitness level)
121
Q

Psychosocial Benefits of Exercise

A
  • Lower levels of stress and anxiety
  • improved mood
  • more energy
  • improved cognition / memory
  • enhanced self-concept (feel moe attractive)
  • improved social support if team sport or gym buddy
122
Q

Exercise and Mood

A

EXAM QUESTION

  • Release endorphins and norepinephrine (blocks pain, allows pleasure
  • More competent (doing well, improving) and confident / Self-efficacy
  • Social: if exercise with other people can have group cohesion, social support, shared experiences
123
Q

Exercise & Depression

A

Study of depressed women:

  • Random assignment to:
    • Exercise condition
    • Drug treatment condition
    • Combined treatment condition

Result:

  • Exercise along condition was as effective as drug condition and combined condition
  • Post treatment: those who continued less likely to become depressed and exercise helped maintain good moods when taken off drugs
124
Q

Exercise and Cognition

A
  • Exercise linked with improved school performance
  • invigorates sudents
  • increases blood flow to areas that stimulate learning and memory
  • Neurogenesis: create new neurons (in learning and memory centre) & protect existing neurons & repairs damaged neurons
  • possible therpeutic effect for Parkinsons and Alzheimer’s
125
Q

Physical Benefits Exercise

A
  • For older ppl: less decline in flexibility, better strength endurance
  • Longitudinal study: 18 years Men 50+
    • regular exercise produced less decrease in work capacity & no increase in BP and body fat
  • Beneficial even if overweight and exerc. moderate
  • **prevention of CVD, diabetes & some cancers
  • sometimes older ppl afraid they will hurt themselves if they exercise or that they will be judged by others
126
Q

Exercise and CVD

A
  1. lowers LDL, raises HDL, reduces inflammation
  2. BP: lowers systolic and diastolic BP
  3. Reactivity to stress: lower HR and BP than unfit ppl are when stressed
127
Q

Exercise and Longevity

A
  • Study of 17000 Harvard Grads dating back to 1916

Results: least active after grad had 64% increased risk of heart attack & shorter life

2000 calories of energy in active leisure activities per week lived 2.5 years longer (i.e. 4 trips to gym)

128
Q

Exercise and Immune Benefits

A
  • Postive effect on immune system if exercise at moderate levels but too much can have a negative impact on the immune system (plus if image conscious tend to exercise too often and too hard)
  • Increases immunosurveillance - natural killer cells
  • Mice study: exposed mice to flu bug, 3 groups (rested, light workouts, exhaustive training) 50% resting mice died, 70% exhausted mice died, 12% light workout mice died
129
Q

Exercise and “other” injuries

A
  • heat exhaustion
  • collision
  • injury
  • high-impact
  • sudden cardiac death (usually pre-existing)
  • steroid use
130
Q

Who exercises:

A
  • highest levels in childhood (peak 10-13)
  • Teens - only 50% vigorous & regular exercise
  • Adults: older not as much (fear, fear of judging)
  • Males: usually high socio-economic, well-educated
  • Rural more ( farming is active work, hands on labor, trades), urban less
  • Some countries more: e.g. Holland (all cycle)
131
Q

Why don’t we exercise?

A
  • Barriers:
    • time
    • convenience
    • weather conditions
    • stress
    • cost
    • overweight or smoker
  • Beliefs:
    • underestimate enjoyment (most ppl do not exercise for fun: 1885 YMCA participants said exercise for stress reduction and to be fit and not for fun, social or adventure or challenge)- risk of relapse of not fun
    • low self-efficacy
132
Q

Why do we exercise?

A
  • Strong social support to exercise
  • high self-efficacy about exercising
  • health-related reasons
  • see themselves as “athletes” (part of identity)
  • enjoy their form of exercise
  • positive attitudes about physical activity
  • habit (part of regular activity - but need planning, money, and personal responsibility to do this)
133
Q

Canadian Health Care System

A
  • publically funded through taxes
  • “medically necessary” heath services
  • provinces determine what is “medically necessary” so some won’t cover midwiffery, abortion, fertility procedures (Quebec is best coverage for this)
134
Q

Cdn. Health Care & Prescription Drugs

A
  • NOT part of the health coverage
  • Pay “out of pocket” for these UNLESS you have an extended plan (most don’t)
  • Extended plans: dental, massage, counselling, eyes
  • Methodone treatment: covered but NOT the dispensing fee (hundreds a month)
  • some provinces seniors covered for some drugs
135
Q

Mass Psychogenic Illness

A
  • like a mass “hysteria” in Freudian sense
  • widespread symptom perception among a large goup of individuals without any evidence of cause
  • usually begins with an event then chain reaction
  • video: why? younger girls susceptible to suggestion, hearing this stuff can get in your head
  • causes:
    • emotional distress (already on edge)
    • common physical symptom so it’s vague
    • catastrophizing, one then builds on it
    • modeling - look to others for how to feel
136
Q

“Before care” recognition symptoms

A
  • interpret symptoms THEN decide if seek care
  • limited awareness of our own bodies
  • not accurate in our perceptions (BP, HR)
  • biopsychosocial can impact recognition of symptoms to move us in one direction or another
  • some ppl recognize more: hyperfocused, vigilent (“internal focused” individuals)
  • BUT can overestimate or magnify if hyperfocused
137
Q

Neuroticism and Illness

A
  • if neurotic can be anxious, self-conscious and overly concerned with bodily processes
  • Study of link between Neuroticism and BP
    • result: High N went more often to doctor and asked to get blood pressure checked
138
Q

Mood and Self-diagnosis

A
  • Good mood: rate themselves healthier, report fewer illness-related memories if looking back, less concerned about what’s going on in their body (even if have a diagnosed illness) so good state of mind will link health with all other good things in the mind e.g. when have been healthy
  • Bad mood: report more symptoms, more pessimistic about efforts to relieve them, think they are more vulnerable to future illnesses
139
Q

Attention/Focus & Diagnosis

A
  • Outward attention: symptoms less likely to be noticed (watching exciting movie, playing sports) study saw people scratch an itch less during exciting part movie
  • pain less likely noticed during the sport, more after (endogenous opiods kick in to get us through)
  • Focus: Med Students’ Disease: during rotations they reported symptoms they heard about (e.g. fatigue) and even if mild will link them to a disease; 2/3 think they have conracted one of the diseases
140
Q

Stress/Self-diagnosis

A
  • if under stress believe more vulnerable to illness
  • may interpret stress symptoms as illness (e.g. panic attack thought to be heart attack)
  • even if real symptoms (flu) it’s exagerated
  • can flair up chronic conditions
141
Q

Symptoms as Serious

A
  • If rare or never previously experienced
  • affects highly valued body parts - e.g. rash on face or hands, swollen eyes
  • affects mobility : hurt elbow vs. foot - can’t walk
  • causes pain (#1 reason) as can’t tolerate the pain
  • NOTE: can misinterpret and be fatal if miss it like stroke or for things that are “symptomless” like heart or high BP, just get better and move on but could be serious
142
Q

Commonsense Model

A
  • Exam question I think
  • ideas and expectations about illness
  • can be “bang on” or totally inaccurate
  • conceptions: cause, pathology, symptoms, timeline
  • affects health-related behavior
  • pick them up over time
  • What helps: public education to devp. accurate info to go into our brain as better commonsense models (video of woman having heart attack)
143
Q

Lay Referral Network

A
  • “informal network of family and friends who offer their own intepretation of symptoms”
  • typically before go for treatment (70% do this)
  • do this to rule our “rarities” or to see if it’s serious (Sanctioning)
  • Does help…how?
    • helps us interpret our symptoms
    • gives us treatment advice
    • gives us a remedy recommendation
    • sends us to another lay person
144
Q

Internet and Health Info

A
  • part of the lay referral network
  • look for info on symptoms, drugs, prevention
  • 96% docs say may affect health care positively because person took time to find out information
  • if goes too far: Cyberchondria - reinforces health anxiety
145
Q

Health Services and Age/Gender

A
  • Children: use most as immune system not developed and fall alot as clumsy
  • Later adulthood: develop chronic conditions
  • Gender: women more. Why?
    • many gender specific things like pregnancy, menopause, sceenings, more upper respiratory infections
    • more part time work so more time to go
    • men less hesitant to report illnesses
    • men less likely to have a family physician
146
Q

Low SES / Health Service Use

A
  • more likely to use outpatient and emergency
  • less likely to visit family physician or specialist but if do: more than 4 times per year. Why?
    • more stress and health conditions
    • less nutritious food
    • maybe not following treatment well
    • use doc as mental health counsellor
    • Study: High SES 1.8 x more likely to be offered appointment with family physician (stigma - seen as lots problems, lots of time
    • low income areas not usually where docs set up practices so less access
147
Q

Health Service/Cultural

A
  • Indigenous or new immigrants - culture affects whether go to doctor
  • accessibility: transport, costs, receiving “traditional” care, language etc.
  • fly in / fly out areas VERY costly to get them services or get them to specialist services
  • health provider: biases? language barrier? providing care in way person feels is culturally appropriate?
148
Q

Beliefs Affect Whether Seek Care

A
  • trust of competency of physician re errors, confidentiality, poor treatment, drug pusher (over-prescribing), long wait times
  • Health Belief Model: Predictive Ability
  • Emotions: Fear (e.g. of needles or procedures), Depression (less hopeful doctor can treat the problem)
149
Q

Hypochondriasis

A
  • Tendence of individuals to:
    • worry ecessively about their health
    • monitor their bodily sensations closely
    • make frequent unfounded medical complaints
    • believe they’re ill even if reassured they are not
    • drain on health care system
  • Secondary Gains: use sickness to be freed from tasks, get care from others, time off work or school, it is reinforcing that really are sick
150
Q

Doctor Vs. Counsellor

A
  • can have physical symptoms that mistake for physiological problem (panic attack/heart attack)
  • may be only option if no coverage for counsellor
  • more legit to have physical complaint (gender - men will go for physical thing then “slip in” the psychological stuff)
  • Gate Keeper: doc is gate keeper for specialists (substance abuse or eating disorder programs, etc.) but problem cuz los rely on walk-ins for primary care and long wait times
151
Q

Delay of Treatment

A
  1. Appraisal delay - time to see if are ill
  2. Utilization delay - time to actually use the treatment
  3. Total Delay - all delays added up; can be long if a lot of life stressors plus factor in there the provider delay
    note: less delay between realizing you are ill and getting treatment if it’s a “new” or “rare” thing
152
Q

Patient as Consumers

A
  • Times have changed - before would never question a doctor but now patients more proactive:
    • asking for 2nd or 3rd opinions
    • if more involved, better treatment outcome
    • patient often expert on own body / symptoms
153
Q

Communication Erosion Factors

A
  • Setting - 12-15 minutes; interrupted,lots going on at once (being examined, asking questions, having questions asked of you), very quick interaction
  • Jargon: Why?
    • ​habit / unaware
    • training
    • patient doesn’t need to know/understand?
    • reduce recognition of errors
    • elevate practitioner’s status
    • reduces patient quesions - smoke/mirrors
  • Stereotypes:
    • ​e.g. First Nations as drunk, disruptive, angry
    • Gender: women as emotional, medical intervention seen less important for females
    • elderspeak
154
Q

Doctor-Centered Style

A

Doctor-Centered: docs may not want the whole story so grab onto first thing, ask closed questions, not good listeners, might have preconceived notion of what you have / quick diagnosis, ignore patient attempts to add more info, if don’t feel listened to might not trust treatment or diagnosis

155
Q

Patient-Centered Style

A
  • open-ended questions, lets patient talk
  • empathic, warm, compassionate tone
  • open body language / chair placement

Result?

  • patient more satisfied with treatment
  • more likely to follow advice and keep appointments
  • doctor more likely to get accurate information
156
Q

Woman as Physician

A
  • often more questions asked of patient
  • more positive comments
  • more nonverbal support
  • more likely to discuss prevention
  • warmth, empathy,
  • ie: patient-centered
157
Q

Complim. Altern. Medicine

A
  • incorporate eastern approaches
  • psych. and spiritual influence on health acknowledge
  • self-help, self-healing, health education
  • more natural, low tech
  • can be subsititue or “add-on” to traditional care
  • herbal meds, chiro, massage, accupuncture, etc.
  • Who use? Women of middle class, educated with chronic health issues
  • Why use? ppl in social circle use, can afford to, used to it from home country, dissatisfied with conventional care, etc.
158
Q

Benefits from CAM

A
  • Longer and in-depth consultations with practitioner
  • more consideration of psychosocial aspects of patient’s life
  • patient-centered approach
  • more egalitarian relationship
  • improved coping, empowerment, hope, advocacy
  • more likely to make lifestyle changes
159
Q

Patient as Commun. Problem

A
  • lack of understanding - older, cognit. problems, language barrier
  • act angry or cynical (if waited 6 hours e.g.)
  • ignore treatment advice
  • insist on unnecessary procedures or meds
  • request doc certify something untrue (disability)
  • neurotic patient - exagerates, does not accept doc’s word that nothing serious
  • go in with “goal” of getting X medication
160
Q

Result of Poor Communication

A
  • patient dissatisfied with health care and less likely to use the medical service in the future
  • Note: Docs don’t get much feedback so not always easy for them either as don’t know if treatment was successful
161
Q

Solutions to Commun. Problem

A
  • Increase motivation to be interested in patient
  • teach better techniques in med school
  • teach patients how to be better patients
  • Video on Palo Alto Clinic:
    • booklet to write down concerns
    • ensures what you want to discuss will be
    • spot in booklet for treatment advice
    • get a summary after visit
    • improved satisfaction
    • ensure patient/physician on same page before patient leaves
162
Q

Burnout

A
  • occupational risk for health care professionals
    • emotional exhaustion
    • cynicism callousness toward patients (unable to get empathy back cuz exhausted)
    • low sense of self-efficacy (standards so high that can feel ineffective)
    • in survival function
    • in Cda: nurse burnout huge due to shortage, aging pop, job turnover, workplace injuries, absenteeism / more depression, chronic health conditions
163
Q

Non-Adherence

A
  • Not adopting the recommended behaviours or following treatment regimens as directed by the doctor or pharmacist
  • e.g. forget doses, stop meds, double up
  • 80% fail rate among things seen as a “treatment”
  • lowest adherence for diabetes, pulmonary disease, and sleep disorders
  • Adherence highest for HIV, arthritis, gastro disorders, cancer (even tho HIV super complex treatment plan with 30+ meds) cuz people frightened or in pain
164
Q

Increasing Adherence

A
  • Start when therapy first begins: talk about what to expect, how long treatment will be, what they need to do, what barriers they forsee and how to get around them and who migh help with that
  • Simplify: blister packs for meds
  • Sub-goals: start with goal of 1-5 pound loss
  • Check-ins and reminders
  • Comprehensive interventions: design to suit person

Study with docs: after teaching them about non-adherence, now more time giving info, patients better informed, better adherence to meds, better BP control

Health Psychology 2301 Midterm #2 (3 decks)

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