Mind And Body In Medicine

Question 1

Health as an evaluative process:
1. Placebo effect
2. Angina pectoris and treatment

Answer 1

1. Positive effect produced by sham treatment due to patient’s belief/expectation that the treatment will relieve symptoms
2. chest pain and discomfort due to low BF to heart results in low tolerance to exercise showing as depressed ST seg; study treated with surgical intervention and sham surgery, for both interventions patients show no physiological change but most report feeling better and decreased nitroglycerin use for pain and increased tolerance to exercise

Question 2

biological basis for placebo effect:
1. Parkinson’s and dopamine
2. 11Craclopride
3. treatment interventions and placebo effect

Answer 2

1. reduced dopamine levels in presynaptic vessels in Parkinson’s causes motor dysfunction
2. dopamine receptors preferentially bind dopamine comp RAC, lvl of RAC detected by PET thus determine DA lvls by comp to RAC
3. treatment and sham showed similar DA levels, those that had expectations that treatment worked (placebo effect) had greater DA than no treatment and displayed decreased symptoms

Question 3

how PET scans work

Answer 3

1. patients injected with radiotracer, interact with neurons to emit positrons which annihilate when they collide with e- to release gamma rays, detected by PET
2. brighter scan indicates higher amounts of radiotracer compared to the studied substance

Question 4

neurotransmitters and homeostasis

Answer 4

1. neurotransmitter lvls exist in homeostasis
2. elevated lvls, decrease receptors to decrease affinity
3. depleted lvls, increase receptors to increase affintiy

Question 5

ambivalence and motivational interviewing

Answer 5

1. ambivalence (mixed feelings) towards health and wellbeing is normal
2. motivational interviewing is a collaborative, goal-oriented communication style that strengthens a person’s motivation and commitment to a goal with acceptance and compassion

Question 6

4 processes of motivational interviewing

Answer 6

1. engaging in mutual trust and respect
2. focusing on one thing
3. evoking another’s strengths, knowledge and ideas about themselves
4. planning is being with some while they form specific actions to task

Question 7

spirit of motivational interviewing in healthcare

Answer 7

1. compassion: caring and knowing what is important to another person and letting it become important to you
2. acceptance: respecting another’s choice to change or not through accurate empathy (understanding where they are coming from), affirmation, absolute/inherent worth (as a person), autonomy (support right to choose)
3. partnership: working together as equals
4. evocation: bring out another’s ideas, strengths, and knowledge of the situation and themselves

Question 8

motivational interviewing styles

Answer 8

1. directing: giving instructions/advice to do action and provide information
2. guiding: collaborate, assist, and encourage another in the process of change
3. following: seeking information, observing behaviour

Question 9

giving advice using ask tell ask:
1. reasons to ask
2. process
3. telling as professional or legal obligation

Answer 9

1. allows for autonomy, able to give options
2. ask for permission to give info/advice or what they know/want to know; tell info/advice clearly and in small amounts in plain language while emphasizing choice by offering a menu of choices; ask them what they thought or use teach-back to ensure understanding
3. establish a rule to highlight topics to discuss with the patients as a professional obligation or legal reporting requirement and to bring them up respectfully and in a compassionate and collaborative way

Question 10

Brief action planning:
1. overview
2. process
3. check in

Answer 10

1. highly struc self-management tool to build patient’s self-efficacy for healthy behavioural change with the spirit of MI
2. Anything that can be done for health in the next week or two: not now > check in, not sure > ask tell ask for ideas, idea > SMART planning > rate confidence lvl, lower than 7 rework plan using ask tell ask to increase confidence, higher than 7 re-state plan and set up check in for progress
3. not completed > reassure it is common, partially > recognize accomplishment, completed > affirmation; in all cases ask what to do next