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PHTY2230 > L4: Introduction to Psychiatry > Flashcards

L4: Introduction to Psychiatry Flashcards

1
Q

How is psychiatry relevant to physiotherapy?

A
  • Exposure to pain and suffering:
    • CU
    • Oncology Units
    • Burns
    • Child Health
  • Responding to the emotional concerns of patients and families
  • Responding to complex and challenging patients
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2
Q

People with mental illness die _____ (earlier/later). What are 2 reasons for this?

A

Earlier

  1. Due to suicide
  2. Due to lifestyle (medication is costly and exercise might be limited)
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3
Q

____ and ____ can help with mental illnesses.

A

Exercise; rehab

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4
Q

Those with _______/________ died 7.9 years earlier than other persons.

A

anxiety/depression

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5
Q

Anxiety/depression associated with elevated risk of ______.

A

mortality

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6
Q

Suicide is a huge health burden. Globally 1 person kills themselves every _____secs

A

40

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7
Q

Suicides are preventable with the correct measures. What are the 6 effective preventative measures for suicide?

A
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8
Q

A central aspect of health professional-patient communication is _____ and provision of ____ support

A

validation; emotional

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9
Q

What are 2 reasons why inter-professional communication is critical?

A
  1. Cohesion of multi-disciplinary team depends on good communication
  2. Good communication means that our colleagues listen to us and that we listen to them
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10
Q

What are 5 benefits of good communication?

A
  1. Enhanced patient understanding and recall of information
  2. Less emotional distress in patients
  3. Higher patient satisfaction
  4. Possibly reduced staff stress
  5. Possibly reduced litigation
    • Less likely to be sued –> poor communicators are more likely to be sued
      • “I could forgive him/her if they didn’t treat me with content (dismissive, rude, rushed..etc)”
      • Sued not in regards to money but don’t want to same thing to happen to others
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11
Q

Good communication skills can reduce _____.

A

distress

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12
Q

A study showed that with patients with advanced cancer (with recruitment through to death), what are 6 benefits of having end-of-life (EOL) discussions at baseline?

A
  1. Likely to be referred to hospice earlier
  2. Less physical distress in last week of lie
  3. Less likely to be ventilated
  4. Less likely to die in ICU
  5. Save money (on false hope options)
  6. Better quality of remaining life
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13
Q

What are 7 key components of good communication?

A
  1. Good eye contact
  2. Clarification of the patient’s concerns (easy to have a pre-conception of the concerns)
  3. Responding to cues (indirect communication) that are suggestive of emotional distress
  4. Asking questions about the patient’s feelings
  5. Enquiring about the situation at home
  6. Making supportive comments
  7. Handling interruptions well
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14
Q

What are 5 ways to promote disclosure of concerns?

A
  1. Use of open questions
  2. Focus on, and clarification of psychological aspects
  3. Empathic statements
  4. Summarizing
  5. Making educated guesses
    • Eg. Looks tired –> “It looks as though things have really been tough for you, can you tell me what’s been happening?”
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15
Q

What are 12 ways for facilitating emotional expression?

A
  1. Express empathy:
    • “I know this must be terribly hard for you”
  2. Active listening, open body posture:
    • Leaning forward, “Go on..”
  3. Ask open questions:
    • “How are you feeling?” (vs. “Are you feeling OK?”)
  4. Not interrupting
  5. Acknowledge emotions:
    • “I can see you are quite worried right now”
  6. Normalise emotions:
    • “A lot of people would feel anxious in your situation”
  7. Indicate your concern about the patient:
    • “Your emotions are really important, and I’m concerned about how this is affecting you right now”
  8. Explore the main source of the emotion:
    • “What’s making you feel so down right now?”
  9. Allow silence / sit with emotions without trying to “fix”
  10. Avoid premature reassurance or giving advice until all facts are known
  11. Check the person’s understanding:
    • “So you mean…?”
  12. Clarify any points about which the patient is uncertain
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16
Q

What is a way to express empathy?

A

“I know this must be terribly hard for you”

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17
Q

What is a way to actively listen and use open body posture?

A

Leaning forward, “Go on..”

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18
Q

What is way to ask open questions as oppose to closed questions?

A

“How are you feeling?” (vs. “Are you feeling OK?”)

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19
Q

What is a way to acknowledge emotions?

A

“I can see you are quite worried right now”

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20
Q

What is a way to normalise emotions?

A

“A lot of people would feel anxious in your situation”

21
Q

What is a way to indicate your concerns about the patient?

A

“Your emotions are really important, and I’m concerned about how this is affecting you right now”

22
Q

What is a way to explore the main source of the emotion?

A

“What’s making you feel so down right now?”

23
Q

What is a way to check the person’s understanding?

A

So you mean…?”

24
Q

Why is asking how your patient is feeling important?

A

Depression can have significantly negative outcomes.

  • If you get depressed after a heart attack –> you are more likely to die
  • If you get depressed after a stroke –> more likely to have worse rehab outcomes
25
Q

What is blocking and why is it a pitfall in communication?

A

any behaviour that inhibits the expression of emotional concern or distress

26
Q

What are 4 ways people do blocking during communication?

A
  1. Giving premature reassurance
  2. Focusing on physical symptoms rather than emotional symptoms
  3. Changing the topic
  4. Cheering the patient up
27
Q

Health professionals are very uncomfortable with uncertainty so they rather reassure their patients. However, patients are not expecting us to fix everything just be open to___ and show ____.

A

listen; interest

28
Q

What are 7 reasons why we “block”?

A
  1. Fear of how the patient will respond, or of harming the patient
  2. Fear that we won’t be able to handle the situation if patient is distressed
  3. Lack of support from within the system
  4. Fear of appearing ignorant or saying “I don’t know”
  5. Past experiences of loss and grief
  6. Belief that nothing can be done
  7. Lack of training!
29
Q

What are 11 emotional cues of anxiety?

A
  1. Rapid speech / jumbled words
  2. Agitation / restlessness/anger
  3. Lots of questions or repeating questions
  4. Nervous laughter
  5. Rapid breathing
  6. Palpitation and sweating
  7. Distracted
  8. Fatigue / sleeplessness
  9. Impaired concentration / decision-making
  10. Sleep disturbance
  11. Excessive reassurance-seeking
30
Q

What are 6 responses to anxiety?

A
  1. Encourage patient to take regular slow breaths
  2. Explore main source of anxiety
  3. Check informational needs
  4. Repeat information
  5. Explore how they’ve coped with anxiety in the past
  6. Make referral if appropriate
31
Q

Context : Discussion of discharge planning

Verbal Cue : “I don’t know. I just don’t know how I’m going to cope at home.”

Non-Verbal Cue : Wringing hands. Tone of voice higher than usual.

This scenario shows ANXIETY

What are 2 examples of a blocking responses? Why

A

False reassurance, e.g., “You’ll be fine. You’ve managed really well so far, and I know you’ll get through this too.”

Mind reading/not exploring reason for distress, e.g., “Don’t worry, we’ve sorted out the home help.”

32
Q

Context : Discussion of discharge planning

Verbal Cue : “I don’t know. I just don’t know how I’m going to cope at home.”

Non-Verbal Cue : Wringing hands. Tone of voice higher than usual.

This scenario shows ANXIETY

What an example of a facilitating response? Why

A

E.g., “It’s a bit difficult to think about coping on your own after you’ve been so sick. Can you tell me what you’re most worried about? Lets talk about your concerns.”

Empathy. Acknowledgement of emotions. Open questions. Exploring main source of anxiety.

33
Q

What are 6 emotional cues of distress?

A
  1. Eyes downcast
  2. Sighing
  3. Hunched / closed posture
  4. Short responses to questions
  5. Crying
  6. Verbal indications of sadness and distress
34
Q

What are 6 responses to distress?

A
  1. Sit through tears
  2. Offer tissues
  3. Express empathy
  4. Give the patient your attention
  5. Explore supports available
  6. Resist the desire to cheer the person up!
35
Q

Context : Just been told that a below-knee amputation is required because of severe vascular disease

Verbal Cue : “I guess I thought that the doctor would have something else to offer.”

Non-Verbal Cue : Tears. Poor eye contact.

This scenario shows DISTRESS

What are 2 example of a blocking responses? Why

A

E.g.,

  1. “The prostheses are fantastic”
  2. “You’ll feel so much better when you don’t have pain from your foot”

Premature reassurance. Changing the topic.

36
Q

Context : Just been told that a below-knee amputation is required because of severe vascular disease

Verbal Cue : “I guess I thought that the doctor would have something else to offer.”

Non-Verbal Cue : Tears. Poor eye contact.

This scenario shows DISTRESS

What are 2 example of a facilitating responses? Why

A

E.g., (Silence)………. “I can see this is a shock for you…….What’s going through your mind?”

Silence. Acknowledgement of emotions. Open question. Checking patient’s

37
Q

What are 8 emotional cues of anger?

A
  1. Raised voice
  2. Flushed face
  3. Angry words
  4. Withdrawal
  5. Sarcastic comments
  6. Dismissive comments
  7. Complaints about other staff
  8. Interrogatory questioning
38
Q

What are 9 reasons why people become angry?

A
  1. Pain
  2. Previous adverse experiences with health professionals
    • eg. spoken rudely to
  3. Fear of rejection/low self-esteem
  4. Guilt/regret
  5. Mental illness e.g. psychosis, depression
  6. Drug intoxication/withdrawal
  7. Response to a crisis - regression
  8. Feeling overwhelmed e.g. bereavement, social adversity
  9. Our own contribution - keeping patients waiting, failing to introduce ourselves, failing to explain the purpose of examination etc.
39
Q

Our response is crucial in determine the ____ in cases where personality and recent events play a major role.

A

outcome

40
Q

What are 9 responses to anger?

A
  1. Stay calm - take your own pulse
  2. Do not take it personally/get defensive
  3. Do not yell back/argue
  4. Explore reasons for anger
  5. Focus on their needs, not their manner or words
  6. Apologise if it is your fault
  7. Indicate your desire to work with the patient to address his/her concerns
  8. Brainstorm options and offer help
  9. Look for other emotions (fear, sadness) and explore appropriately
41
Q

Context : Discussion of diagnosis of spinal injury

Verbal Cue : “I wouldn’t be in this situation if the doctors had treated me properly in the first place. They wrote me off right from the beginning. Maybe I should have been killed in the accident – life’s a bloody mess now”

Non- Verbal Cue : Raised tone of voice, clenched fists.

This scenario shows ANGER

What are 2 example of a blocking responses? Why

A

E.g.,

  1. “I think if you look back you’ll see that you’ve had excellent treatment.”
  2. “You’re welcome to get a second opinion if you like, but I think you’d be wasting your time.”

Defensiveness. Taking it personally. Intimidating.

42
Q

Context : Discussion of diagnosis of spinal injury Verbal Cue : “I wouldn’t be in this situation if the doctors had treated me properly in the first place. They wrote me off right from the beginning. Maybe I should have been killed in the accident – life’s a bloody mess now” Verbal Cue : Raised tone of voice, clenched fists. This scenario shows ANGER What are 2 example of a facilitating responses? Why

A

E.g.,

  1. “Oh, Greg….” “This is just the worst news for you. I can’t imagine how frustrated and angry you must feel.”
  2. “This must all feel like a bad dream.”

Focus on patient’s distress and fear.

43
Q

What are 6 factors which affect the appraisal of the news given to a patient?

A
  1. Personality style
  2. Past experiences esp. of loss
  3. Social situation/financial status
  4. Family role and responsibilities
  5. Occupation and aspirations
  6. The way the news is given
    • Can be part of ongoing stress if given in a lousy way

DON’T PRESUME

44
Q

What are 6 features of the setting to follow when breaking bad news?

A
  1. Privacy and freedom from interruptions
  2. Introduction - yourself and others
  3. Sit down!
  4. Do NOT give sad/bad news when patient is vulnerable
    • e.g. disrobed!
  5. Posture
  6. Preservation of dignity
45
Q

What are 6 features of the process to follow when breaking bad news?

A
  1. Find out how much the patient knows and how much they want to know
  2. Allow the patient to answer in their own words
  3. Start broadly and then narrow the focus
  4. Listening is a difficult task for health professionals who are primarily inclined to act
  5. Be prepared to revisit - needs for information change over time
46
Q

What are 6 key techniques of breaking bad news?

A
  1. Repetition
  2. Summarising
  3. Non-verbal responses
  4. Acknowledgement of feelings
  5. Using language the patient can understand and checking for comprehension
    • “Can you repeat what I have said because sometimes I leave things out?”
    • DON’T SAY: “Do you understand?”
      • They will say yes because they don’t want to sounds stupid Arrangements for follow-up
  6. When in doubt act human!!
47
Q

There is a stigma in help seeking. Approximately 45% of people said they would be embarrassed to see a _____. furthermore, they believed that others would think less of them for seeing a psychiatrist.

A

psychiatrist

48
Q

What are 11 ways to improve communication?

A
  1. Be aware that stereotypes and stigma limit patients’ willingness to raise emotional concerns
  2. Challenge the notion that good communication is an inherent gift
  3. Communication skills can be learned
  4. Practice
  5. Get feedback
  6. Shamelessly steal the good lines of others!
  7. Be prepared to move outside your comfort zone
  8. Don’t underestimate the power of humour
  9. If you can find something interesting about the patient it will be harder to be critical or disengaged:
    • Respond to the humanity not just the disease
  10. Share the load with other team members
  11. Reflect on your personal values and goals and have realistic expectations of professional performance
49
Q

Out of

  • Antidepressants
  • Vitamins
  • Tranquillisers
  • Antipsychotics
  • ECT

What do patients believe is the most helpful for depression in the earlier days?

A

Vitamins

Then due to education it started to become anti-depressants. However, ECT (elctro convulsive therapy) is the most powerful treatment - but still seen as harmful

PHTY2230 (24 decks)

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