Illness, Family Dysfunction and Family Intervention Flashcards
What is our primary role as doctors?
institute behavioral change in patients
[SOAP]
What subjective info should you get?
Chief complaint, HPI, ROS
[SOAP]
What objective info should you get?
Vital signs, measurements, PE, Lab, Dx tests
[SOAP]
What assessment should you give?
Dx, Differential Dx
[SOAP]
What plans should be made?
Treatment plans
[SCOAP]
What does C stand for and what does it include?
Context; psychosocial aspects that
might affect management: ethnicity, culture,
family practices, how family deals with illness,
how family is taught to deal with illness
Which statement is false regarding family life cycle theory?
a. Transitions, successful or not, cause emotionalor stress-related disorders
b. . Psychosocial difficulty is accompanied by biomedical difficulty
c. Illness can cause a family to get stuck in a life cycle stage
d. AOTA
e. . NOTA
A
What happens when a family fails to accomplish the second-order changes of a previous stage?
They get “stuck”
True about families that are “stuck” except
a. Getting stuck will not affect recovery from illness
b. Getting stuck could be manifested by illness
c. Psychosocial interventions can help patient get better
d. AOTA
e. NOTA
A
A philosophy that searches for the causes of
behavior, not in the individual alone, but in the
interactions among the members of a group.
Family Systems Theory
[Analogy]
families with great flexibility:_____:::inflexible families: _____
adapt;break
[Identify] list of critical events and how the family copes with them (i.e. getting married)
Lifeline
[Identify] Crises defined by life cycle changes
Normative crises
[Identify] crises e.g. earthquake,
typhoons, accidents; shows ability of family to cope given such crises
Non-normative crises
T/F Superimposing lifeline and clinical records will give you a better picture of the events. The lifeline will place the clinical records in context
T
[Identify] Illness that are expected to happen in a specific
life cycle stage
In-phase illness
heart attack happens during adolescent stage
a. In-phase
b. Out-of-phase
B
a heart attack in a launching stage/later in life stage
a. In-phase
b. Out-of-phase
A
When an adult playing a major role in the
family is seriously ill or dies.
a. In-phase
b. Out-of-phase
B
Which statements are true?
a. Illness always exerts a centripetal effect
b. Illness occurring in a family with young children is more difficult to deal with than illness occuring in family with adolescents
c. A newly wed couple is in a centripetal phase
d. NOTA
A;
Unattached young adult
a. Centripetal
b. Centrifugal
B
Newly married couple
a. Centripetal
b. Centrifugal
B
Family with young children
a. Centripetal
b. Centrifugal
A
Family with young adolescents
a. Centripetal
b. Centrifugal
B
Launching family
a. Centripetal
b. Centrifugal
B
Family in later life
a. Centripetal
b. Centrifugal
A
True about the family system except
a. Criteria for membership include emotional significance and enduring ties
b. Limited to blood and marriage ties
c. Circular thinking is more applicable
d. AOTA
B; Not limited to blood or marriage ties
[Identify] a state achieved after change wherein a
new level of functioning exists that may or may not be similar to the one that the system had before or connotes a certain orderliness in the behavior of the family system; “condition is stable”
Equilibrium
[Identify] resistance to change; tendency to go
back to previous ways; can be beneficial since everyone tries to cope with the changes introduced into the family; can be bad since it doesn’t distinguish between good and bad changes (a family can resist good changes)
Homeostasis
A family is functional when
a. Parents depend their self-esteem on children
b. Loyalty to family of origin greater compared to nuclear family
c. Grandparents do not get involve in teaching the young generations
d. Spouses prioritize each other over the children
D
A family is not functional when
a. Parents have well-differentiated sense of self.
b. Clear separation of generational boundaries
c. Realistic perceptions and expectations by parents of
each other and of their children
d. The family close themselves from others
D
A family is functional when
a. Encouragement of identity development and
autonomy for all family members.
b. Non-possessive warmth and affection expressed
c. Open, honest, clear communication to deal with
issues.
d. Realistic, caring, adult-to-adult relationships between
spouses and in-laws.
e. AOTA
E
The ff are traditional Filipino rules about authority in the family EXCEPT
a. Children should support the family as soon as
they are able.
b. Parents continue to have authority over
children as long as their children are under their roof
c. If the eldest takes over as surrogate parent, he
has authority over the younger siblings.
d. Children should do nothing to disgrace the family.
B; they have authorityfor as long as they live
The ff are traditional FIlipino rules about utang na loob EXCEPT
a. All individuals should recognize their debts of gratitude.
b. Filial piety is the children’s way of repaying their debts of gratitude to parents who gave them life and raised them.
c. Debt of gratitude remains forever
d. NOTA
D
The ff. are traditional Filipino rules about expressing feelings and thoughts EXCEPT
a. It’s okay to show love publicly but never anger
b. Do not reveal your feelings.They make you vulnerable and may hurt others.
c. Negative feelings should be kept and never revealed
d. It is good to show favorable attitude all the time
e. All except B
E
neither love nor anger could be expressed;you can reveal negative feelings when pushed against the wall; it is not good to show a favorable attitude all the time because this will make other people doubt your sincerity
What does APGAR stand for?
Adaptation, Partnership, Growth, Affection, Resolve
I am satisfied with the way my family talks about things with me and shares problems with me. (Cooperate with each other)
a. Adaptation
b. Partnership
c. Growth
d. Affection
e. Resolve
B
I am satisfied that I can turn to my families for help when something is troubling me. (Address problems)
a. Adaptation
b. Partnership
c. Growth
d. Affection
e. Resolve
A
I am satisfied with the way my family and I share time together. (Commit time and resources)
a. Adptation
b. Partnership
c. Growth
d. Affection
e. Resolve
E
I am satisfied with the way my family expresses affection and responds to my emotions. (express and accept feelings)
a. Adptation
b. Partnership
c. Growth
d. Affection
e. Resolve
D
I am satisfied that my family accepts
and supports my wishes to take on new activities or directions. (reach potential)
a. Adptation
b. Partnership
c. Growth
d. Affection
e. Resolve
C
How will you interpret APGAR scores?
8-10:Highly functional
6-7: mildly functional
4-5:moderately functional
0-3:highly dysfunctional
Can a 5-item questionnaire tell you about functionality
of a family?
NO
The APGAR score has a high specificity but low sensitivity. What does this mean?
Has HIGH SPECIFICITY: a positive is probably a
positive. If one member answers that he is not happy, regardless of the score, there is dysfunction
Has LOW SENSITIVITY: doesn’t rule out family
dysfunction even if score is high.
What are the elements of family systems?
Rules, Boundaries, Mapping, Roles
GIve the types of boundaries, description and their representation in a diagram
Clear - explicitly stated and negotiable; dashed line
Rigid - non-negotiable; solid line
Diffuse - intrusions that are no longer appropriate but still accepted by the other; dotted line
Daughter wants to go to party. Mother says
no. Daughter says she’s going with many friends.
Mother allows but sets early curfew and daughter agrees.
a. clear
b. rigid
c. diffuse
A
Father says “You’re in my house, follow my
rules! I pay for your tuition, no boyfriend, no party
for you! ”
a. clear
b. rigid
c. diffuse
B
Mother intrudes into the life of son and his
wife. Son accepts intrusion
a. clear
b. rigid
c. diffuse
C
Mother intrudes into the life of son and his
wife. Son fights back and will not accept it.
a. clear
b. rigid
c. diffuse
B
[medical roles]
first consulted in times of ilness
family physician
[medical roles]
assists the “family physician”
nurse/first assistant
[medical roles]
conferred with when a second opinion is needed since he has special knowledge on a particular medical issue
specialty consultant
[medical roles]
major decision-makers
medical board of directors
[special roles]
Doesn’t have to be a symptom or a biomedical
illness, can be a misbehavior
identified patient
[special roles]
What you learn as a child, you bring to adulthood (i.e. being overly responsible)
spousal child
[special roles]
detours conflict
symptom carrier
[special roles]
Family with addiction problems; member/s allow/s addiction to continue just so the family stays intact
enabler
[identify Special role]
Pt arrives with chest pain, hyperventilate
because he fought with wife. After fight, pt.
becomes okay. Root of problem is family
dysfunction.
Identified patient
[identify Special role]
Mother went away. Daughter left with father.
Father starts treating her like the wife, talks to
her. Daughter gives father advice on what to do.
Because father has a problem, daughter feels
burdened even at young age.
Spousal Child
[Identify Special Role]
Father gets addicted to alcohol and drugs. He
loses his job. He asks wife to pay for some of the
family bills. After a few months, he demands wife
to pay for all the bills. Wife agrees and even
gives husband money when he asks. Wife
enables husband because she is afraid to lose
him
Enabler
[Identify Special Role]
Father and mother always argue. Everytime
this happens, son suffers from asthma. Parents
stop arguing and bring son to hospital. Son’s
signs and symptoms (i.e. asthma) pacifies
parents’ argument. Son is also the identified
patient.
Symptom carrier
Resonance vs. Disengagement
Resonance (enmeshment): too sticky; iyak isa, iyak
lahat
Disengagement : Family member dies. Brother says,
“Can I have his slippers?” Walang pake. Apathetic.
