Health Psychology and Diversity Flashcards
1
Q
What is the biopsychosocial model?
A
Biological, social and psychological components affect each other and contribute to health and illness.
2
Q
What is a stereotype?
A
A generalisation about social groups
3
Q
What is prejudice?
A
An evaluative and affective component which combines attitude and pre-judgement.
4
Q
What is discrimination?
A
When you act on prejudices and behave differently based on a person’s group without taking into account the individual.
5
Q
What is the difference between dementia and mild cognitive impairment?
A
Dementia is when memory loss and/or loss of cognitive skills affects day to day living, causing disability
Mild cognitive impairment is when there is some loss or decline but without disability.
6
Q
What is the difference between the developmental and trait models for personality?
A
Developmental - personality is affected by past behaviour and relationships
Trait - personality formed of constituent traits
7
Q
What is the biomedical model?
A
Illness is caused by biological and physiological processes, and must be treated using physical intervention.
8
Q
What is classical conditioning?
A
Learning through association
9
Q
What is operant conditioning?
A
Unconscious association between actions and consequences.
10
Q
What is social learning theory?
A
People learn vicariously by observation and modelling. Their behaviour is focussed on a desired goal or outcome.
More motivated to perform a behaviour if it is valued or they believe they can do it.
Effective when the models have a high status or are ‘like us’
11
Q
What is the theory of planned behaviour?
A
Understanding people’s intentions through their attitude towards a behaviour, subjective normality and perceived control.
12
Q
Describe the stages of change model.
A
There are 5 stages that people pass through over the time of decision making or change.
1. Precontemplation
2. Contemplation
3. Prepare
4. Action
5. Maintenance
Change isn’t linear and people may relapse. Often go through a number of times before permanent change.
13
Q
What is cognitive dissonance theory?
A
People feel discomfort when they hold inconsistent beliefs, or when an action/event doesn’t fit with their beliefs.
Adding health information which may be uncomfortable can prompt a change in behaviour, but can also be counter-productive.
14
Q
What is the difference between low risk, hazardous and severely dependent drinkers?
A
Low risk - within health guidelines
Hazardous - drinks too much but currently has no problems
Severe dependent - typically drink in the morning every day. Has complex needs.
15
Q
What do you do in a case of acute intoxication?
A
Monitor vitals and electrolytes, glucose
Inject vitamin B
Watch for withdrawal
16
Q
What processes does the activation of the acute stress response change?
A
Increase respiratory and heart rate Liberate glucose and decrease insulin sensitivity Up-regulate immune system Reduce sexual response and digestion Improved mental functioning
17
Q
Why is long-term physiological stress damaging?
A
Upregulation of the body systems is maintained which depletes them and eventually leads to exhaustion.
E.g. Depressed immune system/gland function
18
Q
What is the transactional model of stress?
A
Stress is subjective and the physiological response depends on how we process it.
It weighs up demands and resources.
19
Q
What are the three stages of appraisal in stress?
A
Primary appraisal - is it a threat? How much?
Secondary appraisal - do I have the resources to cope?
Reappraisal - reconsider situation during and after
20
Q
What are some physical effects of chronic stress?
A
Mainly cardiovascular - high heart rate and blood pressure. Can cause ischaemia and activate coagulation/inflammatory processes which cause atheroma
21
Q
How can chronic stress impact the immune system?
A
Causes chronically high cortisol levels which increases susceptibility to infection as it suppresses the immune system.
22
Q
Give some stress management strategies.
A
Cognitive - restructure hypotheses, focus on appraisal.
Behavioural - skills training to give a coping strategy
Emotional - counselling, draw on emotional support
Physical - exercise and relaxation training
Non cognitive - drugs
23
Q
What conditions can cognitive behavioural therapy be used to treat?
A
Depression Anxiety Eating disorders Sexual dysfunction Psychosis (adjunctive with medication to help respond to delusionary beliefs)
24
Q
What is psychoanalytic/psychodynamic therapy?
A
Identifying conflicts arising from early experiences using a focus on the relationship between the patient and therapist
25
What conditions can psychoanalytic/psychodynamic therapy be used to treat?
```
Interpersonal difficulties (relationships)
Personality problems
```
26
What is cognitive behavioural therapy?
A combination of techniques and concepts used to change maladaptive thoughts, feelings and behaviours, in order to relieve symptoms.
27
What is systemic therapy?
Treating a 'system' with more than one person, such as couples, focussing on the relationship concepts to address patterns of interaction and feeling
28
What problems can systemic therapy be used to treat?
Interpersonal problems
| Used in child psychiatry as the family are the main product of their environment
29
What is humanistic therapy?
Using a focus on warmth and compassion to support people coping with an immediate crisis.
30
What can humanistic therapy be used to treat?
Subclinical depression
Anxiety
Relationship problems
Life effects
31
What are the core principles of cognitive behavioural therapy?
We aren't passive recipients of stimuli. The way we interpret the world through values, beliefs, expectations and attitudes affects our reaction to situations.
32
Describe some of the behavioural aspects of cognitive behavioural therapy.
Graded exposure to feared situations
Activity scheduling, such as in depression
Reinforcement of positive behaviour
33
Describe some of the cognitive aspects of cognitive behavioural therapy
Education to allow the patient to understand their disorder and its effect
Record thoughts, feelings, behaviour and context to develop awareness
Examine or challenge negative thoughts
Behavioural experiments
34
Describe some of the diversity in death.
Women live approximately 4 years longer than men
Death rates increase with age
The wealthy live longer in better health
35
What are the three main patterns of death?
Gradual
Catastrophic
Premature
36
Describe the grief mode.
```
Denial
Anger
Bargaining
Depression
Acceptance
- They are common emotional reactions which aren't necessarily all experienced or in this order.
```
37
What are some symptoms of grief?
Emotional reactions e.g. disbelief, shock
Increased risk of illness and mortality
Physical e.g. SOB, palpitations, fatigue
Behavioural e.g. insomnia, irritability, crying
Emotional e.g. depression, anxiety, anger, guilt
Cognitive e.g. loss of consciousness/memory, hopelessness
38
When is psychological support helpful in grief?
In high-risk patients with chronic, high-level grief.
39
What are the risk factors for chronic, high-level grief?
```
Prior bereavement
Mental health issues
Type of loss (young, violent, suicide, caring status)
Lack of social support
Stress from other crises
```
Can be complicated and prolonged if the expression or ending of grief is discouraged
40
What are the aims of palliative care?
```
Improve quality of life
Manage emotional and physical symptoms
Support the patient to live productively
Give the patient some control
Shift the focus away from medical intervention (focus on emotional and spiritual needs)
```
41
What is culture?
Each person in relationship to the group or groups with whom they identify.
Based on heritage, individual circumstances, and personal choice. Cultural identity may be affected.
42
What are some problems that may be encountered due to diversity in healthcare?
Lack of knowledge about specific cultures
Self protection/denial that differences are significant
Fear of the unknown
Feeling of pressure due to time constraints, so may not look in depth into an individual's needs
Missing expectations
Miscommunication
Misunderstanding of the patients perspective
43
How can service presentation be influenced by culture?
The way we think about mental health and problems
The way they make sense of symptoms and behaviour
The view of potential services and those they accept
The way in which mental health is perceived
Issues of access, service experience, and visibility of services
44
What problems may young people have related to culture?
Pressure to conform to the family religion or practices
Pressure to conform to gender roles
Pressure to conform to social norms
Pressure to conform to family expectations
Sexual orientation
Impending forced marriages
Difficulty reconciling the culture in private and public domains
45
What is the difference between gender identity and gender role?
Identity - someones internal perception and experience of their gender
Role - the way a person lives in society and interacts with others
46
Why does discrimination lead to poor health for minorities?
```
Increased stress
Low self esteem
Isolation
Increased conflict
Subculture
Distrust of authority
Discriminatory healthcare
```
47
What are challenges to the early biomedical theory of pain?
Some people continue to feel pain after wound healing
Experience pain with no physical damage
Amputees with phantom limb pain
Some people have little pain with serious injury
Placebo effect
Different pain for same injury
48
What is pain?
An unpleasant sensory and emotional experience associated with actual/potential tissue damage, or described in terms of such damage
49
What is the difference between acute and chronic pain?
Acute - short term to attract attention to damage. Lasts as long as healing takes place.
Chronic - lasts more than 12 weeks, isn't useful, often debilitating. Arises from a variety of conditions/diseases or can have no known cause. Level of pain isn't necessarily the same all the time.
50
What is the gate control theory for pain?
Pain experienced through complex pathways from the damage or disease source.
Different types of pain receptor use important neuronal relays/gates for messages. Located in the dorsal horn of the spinal cord.
The extent that gates are open/closed affects the experience of pain.
51
Give some psychological factors that can affect pain perception.
Fear
Expectation
Emotion
Belief
52
What factors can 'open' a gate in the gate control theory for pain?
```
Injury
Over/underactive
Sensitivity
Focus on pain
Negative emotion
Negative belief
Minimal involvement in life
```
53
What factors can 'close' a gate in the gate control theory for pain?
```
Medication
Counter stimulation
Exercise
Relaxation
Positive emotion/belief
Active life
Control over administering analgesic
```
54
What are the limitations of the gate control theory for pain?
No physical structures have been identified
Assumes there is still an organic basis for pain
Still sees physical and physiological processes as separate
55
What is the guided practice for patient managed pain?
Reinforce acceptance of the reality of chronic pain
Improve fitness, mobility and posture
Address fear of consequences of movement
Develop ways to cope with stress, anxiety, depression and anger
Improve ability to relax
Graded return to activities of daily living
Facilitate appropriate medication use
Improve communication skills
Reduce use of unhelpful aids and equipment
56
How can you aid coping as a physician?
Mobilise social support
Increase personal control
Prepare for stressful events
57
What is the difference between emotion-focussed and problem focussed coping?
Emotion focus involves using behavioural or cognitive changes to alter emotions
Problem focus involved changing the problem itself or the resources to deal with it
58
What are the outcomes of successful coping?
Tolerating or adjusting to negative events
Reducing threat
Promote a positive self image
Emotional equilibrium
59
What is anxiety?
A response to a threat with is disproportional
60
Give some symptoms of anxiety.
Palpitations
Dry mouth
Chest pain
Feeling of panic or dread
61
What are some symptoms of depression?
```
Persistent low mood
Sadness
Loss of interest
Despair
Insomnia
Hypersomnia
Feeling of worthlessness
```
62
How can comorbid depression affect chronic conditions?
Exacerbate pain and depression
| Less likely to adhere to treatment
63
Give some barriers to diagnosing anxiety and depression in chronically ill patients.
Symptoms may be inadvertently missed (attributed to illness/treatment)
Patient may not disclose symptoms or feelings
Health professional may avoid asking
64
What is the difference between compliance and adherence?
Compliance - the extent to which the patient complies with medical advice
Adherence - the extent to which patient behaviour coincides with medical advice
65
Give a condition with high rate of adherence.
HIV
Arthritis
GI disorders
Cancer
66
Give a condition with a low rate of adherence.
Pulmonary disease
Diabetes
Sleep disorders
67
What are some issues with measuring adherence?
What counts as adherence?
Treatment usually continues over a period of time - when do you measure?
Efficient adherence levels depends on the medication
Lack of consistency in measures
68
What are some direct measures of adherence?
Urine test - check levels of drug/effect of treatment
| Observation - mainly in-patient context
69
What are some indirect measures of adherence
Pill counts
Mechanical/electronic measures
Self reporting
Second hand reports (from HCP/family)
70
What factors are involved in the multidimensional model of adherence?
```
Patient factors
Psychosocial factors
Healthcare factors
Illness factors
Treatment factors
```
71
Give some illness/disease factors contributing to whether a patient adheres to treatment.
Symptoms - better when a patient sees improvement
Severity
Preparation - treatment setting, waiting time, convenience, reputation
Character - complexity/duration, degree of behaviour change, expense
Administration - supervision, continuity of care
Consequences - physical/social effects, stigma
72
Give some patient factors contributing to whether a patient adheres to treatment.
Understanding information and context of the consultation
Ability to recall details about when to take drug, frequency, duration of treatment
Health belief model (how does the treatment adhere to their beliefs)
Beliefs about illness
Beliefs about medication
73
Give some psychosocial factors contributing to whether a patient adheres to treatment.
Psychological health - cognitive deficit/psychological problems
Social support and context - more socially isolated are less likely to adhere, homelessness
74
Give some healthcare factors contributing to whether a patient adheres to treatment.
Organisational setting - follow up, continuity
Prescriber - beliefs and attitudes
Perceived manner - warm, caring, friendly, interested
Communication
Perceived competence
75
What is the difference between intentional and non-intentional causes of non-adherence?
Intentional - arising from beliefs/attitudes/expectations that influence the patient's motives
Non-intentional - arises from capacity and resource limitations that prevent patients from following treatment regimes
76
What is concordance?
Negotiation over treatment regimes, respecting patients beliefs and priorities.
The patient is active in decision making
77
What are the three stages of a child's behaviour when removed from their attachment figure?
Protest - depressed, cling to substitute, can last hours/days
Despair - intermittent crying, withdrawn, helplessness
Detachment - sociable, interested, apathetic/remote towards carer
78
What behavioural or psychological changes can be seen in children with an absent attachment figure?
```
Aggressive
Anxious
Reduced play
Detached
Bed wetting
Clingy
```
79
What would you see in a child with secure, specific attachments?
Peer relations
Self-reliance
Good physical and emotional health
Positive outcomes
80
What would you see in a child with insecure attachments?
Avoidance
Ambivalence
Disorganisation
81
Why do infants cry?
Proximity seeking
| Contact maintenance
82
Describe sensorimotor development in 0-2 year olds
Mainly using senses
Motor coordination development
No abstract concepts
Object permanence
83
Describe pre-operational development in 2-7 year olds
```
Language development
Symbolic thought
Imagination
Lack understanding of reversibilty
Egocentricism
```
84
Describe mature operational development in 12+ ages
Hypothetical and abstract reasoning
| May not be fully mature
85
Describe concrete operational development in 7-12 year olds
Hard to use deductive or abstract reasoning
| Able to think logically
86
How should you interact with babies/infants?
Using mainly sensory or motor functions
| Non-verbal cues
87
How should you interact with older children?
Use their language level as a guide to how much they will understand
Children over 10 can understand simple concepts
Use consistent non-verbal cues
88
How is communicating with special needs children different?
Don't make assumptions, but assess their understanding and communication
Use visual cues
They may have sensory impairments
You may want to explain things to the parent who can then explain it to their child
89
Why is it important to break bad news well?
```
Maintain trust
Reduce uncertainty
Stop unrealistic expectations
Appropriate adjustment
Open communication
```
90
What are the implications if bad news isn't delivered well?
Affects the doctor-patient relationship
Emotional wellbeing e.g. Distress
Ability of the patient and their relatives to cope
91
What does SPIKES stand for in relation to breaking bad news?
```
Setting
Perception
Imparting knowledge
Knowledge (patient's)
Empathy
Strategy and summary
```
92
Describe the ideal setting when breaking bad news.
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Face to face
Private with enough time
Check who the patient wants with them
No more than 3 staff, explain who is there and why
Sit down with no physical barriers
Have tissues available
Use silence and reflection
```
93
In SPIKES, how can you approach the patient's perception?
Check what they currently know about their condition so far.
94
In SPIKES, how can you approach information for the patient?
Don't assume that they want to know everything
| Allow for denial and offer them the opportunity for further discussion.
95
In SPIKES, how can you approach giving knowledge?
Give a warning first
Give information in small chunks, allowing the patient to ask questions. Should be directing them to a diagnosis.
Check their understanding
Avoid jargon and align language with what the patient says.
96
In SPIKES, how can you approach empathy?
Ask how they are feeling
Acknowledge the connection between the news and emotion.
Validate or normalise the emotion.
Listen to the patient's concerns and try to reassure them.
97
In SPIKES, how can you approach strategy and summary?
Summarise the main points
Check the understanding
Discuss strategy and agree on the next step
Be optimistic without inappropriate reassurance
Signal closure and allow them to ask questions.
98
Describe what is meant by a predisposing factor for sexual dysfunction. Give an example.
Early experiences which make an individual vulnerable to developing sexual difficulties at a later stage.
Restrictive upbringing, inadequate information, traumatic early sexual experiences
99
Describe what is meant by precipitants of sexual dysfunction. Give an example.
Events or experiences associated with the initial experiences of dysfunction.
Childbirth, infidelity, dysfunction in a partner, depression, random failure, physical illness
100
Describe what is meant by a maintaining factor in sexual dysfunction. Give an example.
Intervening factors which allow the dysfunction to persist.
Performance anxiety, guilt, poor communication, relationship discord, restricted foreplay, environmental factors
101
Why is talking about 'normal' sexual behaviour unhelpful?
It is difficult to know what is normal due to issues collecting accurate data
Normal is a judgemental term rather than descriptive
Reflects stereotypes and overlooks diversity
Behaviours and social norms change over time, culture, age groups, orientation, and social context
102
Describe motivational interviewing.
Identifying and exploiting ambivalence to move people into considering a change in their behaviour.
Express empathy and avoid arguing, develop discrepancy, support self-efficacy, roll with resistance
103
Why might patients not engage fully with a pain management programme?
Don't want to accept their pain as chronic and incurable
Don't want to go to a 'psychological' service as they think it implies that pain is 'all in their mind'
Unprepared to take part in exercises as they believe that pain means damage
Barriers to participation such as not speaking English, hearing deficit, depression
Unable to get transport or other practicable difficulties
Engaged in insurance claims or employment tribunals where participation may jeopardise the claim
104
Give two factors which can cause people to have complications following bereavement.
Ending of grief discouraged
| Expression of grief discouraged
