Lecture 4: Psychological and Social Considerations of Pain + Death Flashcards
What are the 7 psychosocial consequences of pain and loss?
- fear and anxiety
- depression
- loneliness & anger
- caregiver burden
- bereavement
- financial and resource burden
- substance abuse
T/F: Anxiety is the unpleasant emotional response caused by anticipation or awareness of specific danger.
F: FEAR is the unpleasant emotional response caused by anticipation or awareness of specific danger
What does fear encourage?
Encourages avoidance from the threat
What is the result of the physiological response of “fight or flight”?
- dry mouth & “butterflies”
- palpitations & hyperventilation
- dizziness, tremor, sweating
- urinary urgency
What are two classifications of causes for Fear?
organic and non-organic
What are examples of organic causes for fear?
- pain
- steroids
- bronchodilators
- EtOH/hypnotic withdrawal
- cerebral irritation
- impending catastrophic event
What are examples of non-organic causes of fear?
Situation: -impending procedure -relapse -withdrawal -impending death -loss of autonomy Disease: -psychiatric -delirium -Generalized Anxiety Disorder -PTSD -Depression
T/F: Anxiety is prompted by generalized, non-specific threats to the ‘self’
True
T/F: anxiety motivates hypervigilance but does not motivate retention of proximity to the perceived threat
F: Anxiety motivates hypervigilance and retention of proximity to the perceived threat
What are 10 ways anxiety may manifest?
- Feeling, swamped, or overwhelmed
- Trouble thinking, solving problems, or making decisions (even about little things)
- Feeling agitated, irritable, restless, or panicked
- Feeling or looking tense
- Concern about “losing control”
- Uneasy sense that something bad is going to happen
- Trembling or shaking; headaches
- Being cranky or angry with others
- Trouble coping with tiredness, pain, nausea, and other symptoms
- Problems sleeping or restless sleep
What are three characteristics of a panic attack?
- discrete period of intense fear
- 4+ symptoms develop abruptly
- peaks within 10 minutes
Would it be considered a panic attack if it peaked over the course of an hour?
No, would peak within 10 minutes
T/F: terminal agitation is a distressing form of delirium in dying patients
True
What are the four physical causes of terminal agitation?
- opioid toxicity/withdrawal or drug interactions
- pain or raised ICP
- fever/sepsis/ hypercalcemia
- psychological elements
What are psychological and spiritual causes of terminal agitation?
- spiritual/emotional/physical restlessness
- anxiety/agitation/cognitive failure
T/F: Signs of terminal agitation as a cause of psychological, spiritual or emotional restlessness includes unintentional and purposeless motion without emotional distress?
FALSE: signs of spiritual, emotional, or psychological restlessness is signified by:
- unintentional and purposeless motion
- emotional distress and restlessness
T/F: Stress is not defined by mental or emotional strain, it is purely physically manifested?
False: stress is a state of mental or emotional strain or tension during demanding circumstances
What is Thanatophobia?
The fear of death
Why do patients develop PTSD?
PTSD as a result of fear of recurrence of illness
What are some examples of how you can remove reversible organic causes to manage fear and anxiety?
- drug reactions + withdrawal; providing coffee
- urinary tract infection: provide treatment to take away discomfort
- obstructive/central sleep apnea: sleep ap machine
- ‘sundowning’: providing medication/increased activity in the evening, encouraging elders to sleep earlier
- dehydration: reminders to drink water
T/F: cold water is a solution for management of acute fear and anxiety
True
What are 6 pharmaceutical solutions for different approaches for acute vs. chronic fear and anxiety?
- alcohol
- benzodiasepines
- beta-blockers
- barbiturates
- opioids
- antidepressants (SSRIs, TCA)
What are 7 different methods for non-pharmaceutical therapy and counseling to manage chronic fear and anxiety?
- Cognitive Behavioral Therapy
- Behavior Therapy
- Talk Therapy (individual or group, online forum)
- Psycho-Philosophical: Achieving Fearlessness
- Meditation, Yoga, Tai-Chi, Religious Observances, Music
- Hot Bath, Massage, Haircut/Shave, Grooming
- Foods & Herbal Remedies (chocolate, tryptophan, probiotics, folate & b vitamins)