Lecture 1 Flashcards
BHC role
1) assist pt when habits, bx, stress, worry, emotional concerns re. physical or other life problems interfere with overall health
2) team member (PCP, etc.) to evaluate mind-body-behavior connection and to provide brief, solution-focused interventions
3) be a generalist
4) focus on pt self-care, symptom reduction and functional improvement
T.E.A.M.S
T: teamwork- clear, effective communication w/ pt, family, professionals
E: evidence-based approaches
A: attention to affect
M: mindfulness- promote pt and professionals
S: systemic perspective- look holistically
7-step problem-solving model
- ) Specifically define the problem
- ) Brainstorm possible solutions without being critical
- ) Critically evaluate each possible solution, discarding those that aren’t feasible using pro and con list
- ) Select the best option
- ) Implement the chosen solution
- ) Assess the outcome
- ) Fine tune the solution if necessary and monitor
5 A’s
“Can be applied to “any patient in any clinic with any problem”
Assess – gather info
Advise – specific personalized options
Agree – collaboratively select goals
Assist – provide info, teach, problem solve barriers
Arrange – specific plans for follow-up
5 A’s for initial consultation
- ) Intro to BHC service (1-2 minutes)
- ) Identifying/Clarifying consultation problem (10-60 seconds)
- ) Conducting a functional assessment of the problem (12-15 minutes)
- ) Summarizing your understanding of the problem (1-2 minutes)
- ) Listing possible change plan options (selling it: 1-2 minutes)
- ) Starting a change plan (5-10 minutes)
skills of primary care psychologist
- ) patient care skills (assessment, intervention, prevention, change, collaboration across team)
- ) promote well-being of other team members
functional assessment of the problem
1.) Nature of the Referral Problem
“Do you see depression as the main problem or is it something else?”
2.) Duration
“How long have you been feeling this way?” “Has it been longer than 2 weeks?” “How many months has it been?”
3.) Triggering Events
“Was there anything going on in your life at the time or was it out of the blue?”
4.) Frequency and Intensity of the Problem
“How often do you feel depressed?” “On a scale of 1-10, how intense or disruptive is your depression?”
overarching principles for primary care psychology
- ) agency (assumption that one can make effective, personal choices when necessary)
- ) communion (strengthening emotional and spiritual bonds that can be frayed by illness, disability, and family and social problems)
differences between BHC and MHC
BHC builds on PCP interventions, teaches PCP MH skills, holds a secondary role
benefits of integrated BHC
- ) immediate access
- ) improved recognition of behavioral health needs
- ) improved collaborative care and management of pts with psychosocial issues in primary care
- ) prevention of more serious MH disorders through early recognition/intervention
- ) easy transfer of treatments into PCP setting
Tobacco use strategies
- behavior change interventions (set a date to quit, talk about physical/psychological factors, prepare surroundings–tell someone, remove stimuli)
- pharmacological agents (patches, gum, nasal spray)
- establish pattern of use
- establish a history of prior cessation attempts
Overweight & obesity strategies
- self-monitoring (physical activity, food intake, weight)
- behavior change planning
Ex. slowing eating rate, eat on a schedule, do nothing else while eating, shop for food with a list and when satiated, accessibility of healthy vs. unhealthy food, - when eating out:
Ex. plan meal, share meal, don’t overindulge, don’t deprive - calorie education
Increasing physical activity
- check with PCP
- have fun w/ activity
- set goals
- start slow, work up
- track progress
- have a plan B for vacations, bad weather, holidays
- reward yourself
Diabetes types
type 1 - autoimmune destruction of beta cells (typical development in childhood, 5% of cases)
type 2 - develops based on lifestyle (managed through behavioral interventions
gestational - develops during pregnancy due to glucose intolerance
other type - genetics, surgery, meds
biopsychosocial model of type 2 diabetes
PHYSICAL
hypoglycemia (blood sugar lower than 60mg)
- symptoms: increased heart rate, headaches, hunger, shakiness, sweating, decreased concentration, mood changes, confusion
hyperglycemia (blood sugar higher than 140mg)
- symptoms: increased thirst, increased urine frequency, causes micro and microvascular problems (stroke, blindness, amputation, neuropathy, kidney issues)
EMOTIONAL
- bidirectional relationship between diabetes and depressions
BEHAVIORAL
-dietary habits, physical activity, med adherence
SOCIAL
-job, finances, friends
Assessment in Diabetes
PHYSICAL
-HTN, obesity, A1C levels less than 7%, frequency of hypo/hyperglycemic response
EMOTIONAL/COGNITIVE
- anxiety, depression, etc.
- How have these emotional experiences impacted your ability to care for yourself and diabetes?
- Do you find yourself avoiding checking your blood sugar?
BEHAVIORAL
- eating patterns (carbs, fats, time eating)
- physical activity
- med adherences
- foot/eye care
ENVIRONMENT
- quality of social, work
- understand PCP rec?
Assessment in COPD
PHYSICAL
- figure out cause (air, cigs, genetics)
- treat w/ meds (anti-inflammatory for short-term)
EMOTIONAL/COG
anxiety/depression associated w/ poorer COPD prognosis
BEHAVIORAL
smoking cessation-slows progression of the disease
-physical activity (must be gradual)
ENVIRONMENTAL
air pollutants, gases, fumes, dust
COPD important considerations
- do they have trouble breathing?
- what affects breathing the most?
- how has COPD changed ADLs/social functioning
- what kinds of situations tend to make people more down
Biopsychosocial factors to consider with Asthma
PHYSICAL
- airflow hindered by inflammation
- peak flow - how well pts exhale air
- medications for acute/chronic sxs
EMOTIONAL
-anxiety and depression are common
BEHAVIORAL
- warming up before exercise
- treatment and med adherence
ENVIRONMENTAL
-allergens, animals, pollen, cold air, dust, STRESS
biopsychosocial factors to consider with cardiovascular disease
PHYSICAL
-diabetes, HTN, high cholesterol
BEHAVIORAL
-dietary nutrients (salt!), alcohol consumption, med adherence
EMOTION/COG
- depression, anxiety, Type A personality
- how do you manage stress?
ENVIORNMENT
-social support, SES
assist steps in pain disorders
1) education and advice returning to daily activities
2) more intensive for patients who have experienced pain for 6-8 weeks
3) multidisciplinary chronic pain rehab
Assess
Risk factors, behaviors, symptoms, attitudes, preferences
Advise
Specify personalized options for treatment, how symptoms can be decreased and functioning and quality of life/health can be improved
Agree
Collaboratively select goals based on patient interest and motivation to change
Assist
Provide information, teach skills, and help problem solve barriers to reach goals
Arrange
Specify plans for follow-up (visits, phone calls, mail reminders)
Personal Action Plan
1) list goals in behavioral terms
2) list strategies to change health behaviors
3) specify follow-up plan
4) share the plan with health care team
Alcohol harm-reduction approaches
1) review ways to avoid or manage situations that are challenging for the individual to stay within their goals
2) review assertive communication skills to be able to refuse drinks when appropriate
3) review stress and anxiety management skills to take the place of drinking for relaxation
4 A’s for managing alcohol consumption
- Avoid triggering situations
- Alter (if you can’t avoid, alter in some way)
- Alternatives (choose a different alternative)
- Action (take a different action when you feel and urge to drink)
Assessing sexual problems
“Do you have naturally occurring erections in the morning?”
“Can you get an erection by yourself (masturbation)?”
“Was the onset gradual or sudden?”
“Are your problems specific to one partner or situational or generalized?”
“What medical problems do you have?”
“What medications do you take?”`
Advise sexual problems
- Inform the patient that it is not important to draw a sharp line between organic versus psychogenic ED
- Psychological effect even if it is organic may perpetuate or worsen the problem
- Inform the patient that having the partner involved in treatment is often helpful
- If there has been sexual abuse, a referral to a specialist might be necessary
Agree in sexual problems
- Many patients prefer to take medication over behavioral strategies
- Encourage patients to examine thoughts, feelings, behaviors that may worsen the condition and consider emotional factors while taking medications
Assist in sexual problems
- Education
- Support of Medical Intervention
- Sensate Focus
- Communication Training
- Cognitive Restructuring & Anxiety Management
- Changing Lifestyle Habits
premature ejaculation
biopsychosocial model
PHYSICAL
- genetic factors most likely, could also be acquired through psychological
EMOTIONAL/COG
- anxiety, low confidence, depression, poor body image
ENVIORNMENT
- history of sexual trauma
BEHAVIOR
- stop-start technique
5 A’s with PE
ASSESS
Questions:
“How much control do you feel you have when you ejaculate?”
“What thoughts go through your mind when you’re having sex?”
“What strategies have you used to prolong ejaculation?”
“How is this issue affecting your relationship?”
“How has your mood been lately?”
ADVISE
- Educating how to gain more control or exploring use of meds
AGREE
Remind patients of realistic outcome
ARRANGE
- Coordinate appropriate referral if necessary
ASSIST - Education - Stop-Start and squeeze technique - Relationship interventions - Gaining Control - Stop-Start Masturbation without Lubrication - Masturbation without Lubrication - Masturbation with Lubrication Intercourse with Partner
female orgasmic disorder biopsychosocial model
PHYSICAL
- can be caused by medical conditions or side effects of meds
- genetics
EMOTION/COG
- negative attitude about sex, high levels of guilt
- depression/anxiety
- inaccurate beliefs
BEHAVIORAL
- limited experience with masturbation
- lack of appropriate sexual stimulation/skill from partner
ENVIRONMENT
- sexual trauma
- low levels of comfort with sexual partner
- poor communication/conflict
5 A’s with female orgasmic disorder
ASSESS
“Have you ever experienced an orgasm?”
“Do you experience pain with intercourse?”
“Do you masturbate?”
“Are you aware of any thoughts getting in the way?”
ADVISE
Recommend appropriate steps depending on etiology of the problem
AGREE
Masturbation training
ASSIST Psychoeducation Sensate Focus Masturbation Training Sexual Communication
ARRANGE
Coordinate appropriate referral if necessary
5 A’s for Older Adults
ASSESS
- Need to determine whether there is significant cognitive impairment that would warrant further assessment by a neurologist (with screening tools such as MMSE)
ADVISE
- Not diagnosing but advising PCP and family when further assessment is necessary
- Advise on how to improve memory (e.g., reminder devices, memory exercises)
AGREE
- Coordinate appropriate referral if necessary
ASSIST
- Cognitive Interventions (e.g., memory cues and devices, A set place for keys and other important items, Daily to-do lists, Group numbers together
- Cognitive Exercises (Learning a new skill, Crossword puzzles,
- Physical Activity
- Relaxation
stress incontinence
results from physical exertion, sneezing, climbing stairs, running
urge incontinence
occurs when individual needs to void
mixed incontinence
stress and urge incontinence combined
overflow incontinence
Frequent urination, increased urgency, & constant dripping due to overdistended bladder
functional incontinence
Unable to get to the bathroom on time due to functional impairment (dementia, mobility limitations)
