IPS/MED 2.4 Flashcards
What is chronic pain according to Loeser and Melzack?
Chronic is less the duration of pain, rather the inability of the body to get back to homeostasis
What is the primary gain of pain according to Freud?
Primary Gain (Intrapersonal)
- Infantile unconscious conflict that is the main cause of disease
- E.g. alcoholic not aware of problems because he/she drinks it away
What is the secondary gain of pain according to Freud?
Secondary Gain (Interpersonal)
- Someone holds on to disease because of alleged or real benefits
- E.g. social benefits, insurance money etc.
What is the tertiary gain of pain according to Freud?
Tertiary Gain
- Social gains that a person gets because of someone else’s sickness
- E.g. Wife feeling good for caring for alcoholic husband
What are common problems that develop when pain behavior is supported?
- Dramatisation
- Disuse
- Drug abuse
- Dependency
- Disability
What is pain according to the neuromatrix?
Pain is not a passive registration of the brain, but more an active collection of subjective experiences
What is the first dimension of the neuromatrix regarding pain?
- Awareness of pain
- Brain stem, thalamus, somatosensory cortex
What is the second dimension of pain according to the neuromatrix?
- Integration and processing
- Insular cortex, anterior cingulate cortex, prefrontal areas
What is the third dimension of pain regarding the neuromatrix?
- Emotional component
- Connection with limbic system → amygdala
Persists after injury has healed and results from significant functional and structural changes in nervous system
What is meant here?
Chronic pain
What type of memory is chronic pain?
Nociceptive memory
What functions in chronic pain do the primary and secondary cortices have?
→ Lateral pain pathway
→ Responsible for sensory dimension of pain
What function does the anterior cingulate cortex have in pain?
→ Medial pain pathway
→ Important for pain affection
- Accept that you have persistent pain…. And then begin to move on
- Get involved - building a support team
- Pacing
- Learn to prioritise and plan out your days
- Setting Goals/Action Plans
- Being patient with yourself
- Learn relaxation skills
- Stretching & Exercise
- Keep a diary and track your progress
- Have a set-back plan
- Team Work
- Keeping it up…putting into daily practice the tools from 1-11
What is described here?q
The pain toolkit
What is peripheral sensitization?
- Increased response and lowered threshold level of nociceptive neurons in periphery
→ To stimuli in their receptive field
What is central sensitisation?
Increased response of nociceptive neurons in CNS to normal afferent input or even by afferent input
→ Below threshold level
What are components of successful chronic pain education and therapy?
- Pain education
- Cognitive behavioral therapy (graded exposure and graded activities)
- Therapy based on acceptance
What are the 3 phases of graded exposure?
- Cognitive behavioral phase
- Analyzing the pain
- Is there catastrophizing or kinesiophobia?
- Use TSK or PHODA - Education phase
- Use fear avoidance model to explain pain behavior
- Motivate patient to participate in treatment that might provoke fear - Exposure treatment phase
- Gradual exposure to activities that provoke fear and pain
- Gradual increase of activity level
What is the overall goal in graded activity?
Increase activity level despite pain!!
Time contingent instead of pain contingent
Extinction of pain behaviour → Positive reinforcement of healthy behavior
What are bottlenecks of care in the transition from child to adult?
Psychosocial factors
Taking control and responsibility for oneself
Gaps of knowledge
What is Virchow‘s Triade?
Venous stasis
Hyper co-agulability
Blood vessel damage
What are cardiovascular effects of immobility?
Virchow‘s Triade
Initially increased venous return, intracranial pressure, HR and SV
Later orthostatic hypertension and stasis
What is the ABCDE screening for skin cancer?
Asymmetry
Border
Colour
Diameter
Evolving
What are the 4 steps of breast cancer treatment ?
- Shrink the tumour with chemotherapy
- Remove the solid tumour with surgery
- Radiation therapy after surgery
- Chemotherapy as precaution after surgery in case a few cancer cells have broken away to lymph node or adjacent tissue
What are the 5 standard treatment options for cancer?
Local:
1. Surgery
2. Radiation
Systemic:
3. Hormone therapy
4. Chemotherapy
5. Targeted therapy
How does hormone therapy work?
Exogenous administration of hormones leads to manipulation of endocrine system
What is targeted therapy in cancer?
- Type of chemotherapy
- Target cancer cell‘s inner mechanisms and doesn’t harm a lot of healthy cells
- E.g. blocking chemical signaling, changing proteins, stopping vascularisation
What is curative or primary surgery in cancer treatment?
To remove cancer/tumour
What is debulking surgery in cancer?
Removal of cancer but not entirely because of damage to or delicate surrounding tissue
What is supportive surgery in cancer treatment?
Port-a-Cath implantation for infusions
What is a single gene trait?
Change in 1 gene with reproductive cells
What is a chromosomal defect?
DNA fragments are displaced or lost
Inherited tendency to develop genetic disorders following exposure to environmental factors is called?
Multifactorial
How many single gene disorders are known?
6000
If both parents carry an autosomal recessive gene and have 4 kids how would they be affected by it?
1 healthy child, 2 carrier children and 1 sick child
If one parent is sick an autosomal dominant gene and the other one is healthy (no dominant or recessive gene) how would their 4 kids be affected?
2 kids affected, 2 kids healthy
What type of autosomal disease is Huntington’s disease?
Autosomal recessive
Which disease is an example of x-bound inheritance?
Duchenne‘s muscular dystrophy
How many people of the world‘s population suffer from multifactorial genetic disorders?
10%
Which episode of embryonic development is most critical?
first 2 months → Most critical time because of basic and rapid development
What happens if there is severe exposure to negative environmental factors in the first 2 weeks of embryonic development?
Often death
Which prenatal screening tool can be used to screen for high risk maternal infections?
TORCH
Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes
What can alcohol use during pregnancy lead to in the embryo?
Fetal alcohol syndrome
How can cocaine use influence the embryo and baby?
→ Premature birth
→ High risk of further illnesses
→ Sudden infant death syndrome
How does smoking effluence development of the infant?
Low birth weight
High risk of still birth
Which parts of the brain lead to biological developments in adolescence?
Hypothalamus and pituitary gland
What does the release of gonads lead?
Development of secondary sex organs
What are common characteristics of Cushing‘s disease?
Obesity
Acne
Fatigue
High BP
Increased thirst
Depression
Anxiety
Increased incidence of infection
Bigorexia is what type of disorder?`
Eating disorder
The Adonis complex
What are the 3 types of scoliosis?
Structural scoliosis
Degenerative scoliosis
Functional scoliosis
Joint swelling or discomfort lasting more than 6 weeks in children is an indicator for what?
Juvenile RA
How many patients have full remission of juvenile RA?
50%
What is osteomyelitis and which area is mainly affected?
- Infection of bone
- Complication after fracture or other trauma
- Common causative organism is Staphylococcus aureus
- Most common site of infection in adolescents is the metaphysis
What are the 2 types of acne?
- Type 1: Comedones, often called whiteheads or blackheads
→ Noninflammatory - Type 2: Involves a severe inflammatory response and infection
What is the Klinefelter syndrome?
Chromosomal disorder
affects males owing to the presence of an additional X chromosome (XXY instead of XY)
What is the Turner syndrome?
Chromosomal disorder
→ monosomy X in which one X chromosome is missing
→ affects sexual development in females and causes other abnormalities as well
What is presbyopia?
Change in vision of elderly
Lense gets stiffer and vision declines
What effect might DNA changes have on memory in elderly?
reduce expression of genes involved in learning and memory
What effect do changes in dopamine have in elderly?
Loss of dopamine responsible for increased rigidity
Problems with cognitive flexibility
WHat effects do changes in serotonin have in elderly?
- Decreased levels can cause insomnia or depression
What effects can changes in glutamate have in elderly?
Decreased levels in aging
Neurotransmitter used to transfer signals
Which organs and areas are involved in stress response?
- Hypothalamus
- Pituitary Gland
- Sympathetic nervous system
- Adrenal medulla
- Adrenal cortex
Which effects does a stress response have on the body?
- Increased HR and BP
- Bronchodilation and increased ventilation
- Increased blood glucose levels
- Increased arousal of CNS
- Decreased inflammatory and immune responses
What are potential stress-related diseases?
- Elevation of BP and arrhythmias can lead to heart damage
- Chronic infections due to low immune response
- Cancer due to low immune response
What are the 5 stages of anxiety?
- Anxiety
- Abnormal Anxiety
- Panic Attacks
- Anxiety Disorder
- Hypochondria
What does the 4KDL questionnaire assess?
- Helps to map out mental complaints in clients
- Provides insight into complaints by taking four domains into account:
- Depression
- Distress
- Anxiety
- Somatisation
Which type of therapy is most promising in hypochondria?
Cognitive behavioral therapy
What are somatisation disorders?
- Accumulation of many disorders in different domains
- Severe limitation in social, occupational functioning
What needs to be given to diagnose a somatisation disorder?
Each of the following have to be met to be diagnosed:
- 4 pain symptoms
- 2 gastrointestinal symptoms
- 1 sexual symptom
- 1 pseudoneurological symptom
Which symptoms may occur in PTSD?
- Revisiting or reliving the event
- Avoidance of certain activities and lack of emotional response
- Dissociative state in which person is non-responsive
When are opioids mainly used?
Post-surgery, cancer, chronic pain
Sleepiness
- Bowel and bladder retention
- Nausea
- Vomiting
- Reduction in sports and exercise performance
These are common side effects of which drug?
Opiods
Opioids can lead to which states of mind?
- Euphoric
- Despised
- Dazed
- Confused
What are psychotropic drugs and what types are there?
Target specific locations in CNS
Fight mental illness
- Hypnotics
- Anxiolytics
- Antipsychotics
- Antidepressants
What are hypnotics used for?
Remedies for sleep -> sleeping deeper
What are anxiolytics used for?
Relaxing, soothing and anxiety reducing
What are antipsychotics used for?
Means against delusions and hallucinations
What are antidepressants used for?
Mood enhancement
What are the 2 main effects of antipsychotics?
Hypokinesia
- Reduced ability to move
- Pseudoparkinsonsim
Hyperkinesia
- Tardive dyskinesia
- Rhythmic movements of tongue, neck and jaw
What are potential effects of hypnotics?
- Skills and alertness decrease → more accidents
- Alcohol and drug enhancing effect
- Sedative and muscle relaxation → risk of falling
- Hyperreflexia
- Myoclonus
- Stiffness
- Hyperthermia
- Diaphoresis
- Thermal changes
These are side effects of which type of drugs?
Antidepressants
How are stress and anxiety often treated?
- Cognitive behavioral therapy
- Often in combination with psychotropic drugs
What are SSRIs?
- Specific serotonin re-uptake inhibitor
- Inhibits serotonin re-uptake into neurons
- Effect shows after 1-2 weeks
- Frequent side effects in 1-10%
- Initial increase in anxiety
- Gastrointestinal disorders at start of treatment
- Sleep disorders
- Headache
- Joint pain
- Sexual dysfunction
These are common side effects of which drug?
SSRI
What are TCAs?
- Tricyclic antidepressants
- Inhibits re-uptake of noradrenaline and especially serotonin
- Notifiable after 1 week
- Alpha1-adrenolytic, anticholinergic, antihistamine properties
- Frequent side effects in 1-10%
- Dry mouth
- Constipation
- Cognitive dysfunction and confusion in elderly
- Potential weight gain
These are common side effects of which drug?
TCA
What are the 4 different types of addiction?
- Substance addiction
- Behavioral addiction
- Mental addiction
- Physical addiction
What are effects of alcohol abuse?
- Liver cirrhosis
→ Liver is overloaded, can no longer keep up its blood cleaning function - Toxicity
→ Especially in blood brain barrier - Affect on neurotransmitters and receptors
→ Loss of coordination and sensation - Vasodilation
→ BP eventually rises - Binge drinking
→ Strong fluctuations in BP - Vitamine and nutrition deficiency
What is a problem drinker?
Long history of drinking
→ Problems in daily life, work or health
→ 10% of Dutch people between 16-69
→ 1.1 million people
What is an alcoholic?
→ Need for alcohol
→ Wants to but can‘t stop
→ Keeps using alcohol despite damage
→ 0.7% of Dutch people between 18-64
→ 83000 people
What is the CAGE questionnaire?
- 4 item questionnaire that can indicate potential problems with alcohol abuse
- 2 or more „yes“ may indicate problem
What causes neurological problems in alcoholics?
vitamin B1 shortage leading to poly neuropathy
What is Wernicke‘s encephalopathy?
→ Necrosis with inflammatory response in the brains followed by atrophy
Result of alcohol abuse
Korsakoff‘s syndrome is a result of?
Alcohol abuse
How does alcohol abuse effect the brain?
- Spikes in dopamine and reward system of the brain
- Brain adapts → more alcohol is needed
- Effects on:
→ Self-control (frontal cortex)
→ Motor control (cerebellum)
→ Memory (hippocampus)
