PCCP 3 Flashcards
Why is it hard to measure how stressful certain events are?
Vary person to person
Vary over lifetime
What is the major physiological problem with stress in modern life?
Its is adapted to cope with short term not long term problems
What is a model that maps how we deal with stress?
The transitional model of stress
- primary appraisal - is this a threat
- secondary appraisal - do i have the resources to cope
- stress greater than coping then stressful!
- reappraisal - given what happened last time can i cope now
What makes events more stressful?
Lack of control
Lack of support
How does stress effect physical health?
Raised cortisol means:
Suppressed immune system
Unhealthy behaviours (eating, drinking, smoking)
How does stress effect mental health?
More vulnerable to cognitive distortion (rumination, catastrophising, personalisation). Makes person feel helpless if event occurs again even if they have more control second time.
Symptoms of stress
Missing work Mood swings Anger Ibs Palpitations Chest pains Difficulty sleeping Alcoholism
Treatments of stress
Exercise
Counciling
Drugs
What do patients have to cope with?
Medical problems: Diagnosis Physical limitations Treatment Hospitalisation Loss of autonomy Biographical disruption Economic issues Social issues AND Normal stuff (bereavement, divorce, unemployment, etc)
What are the two main coping styles patients employ to deal with stress? Give some examples? Which is better in the long term?
Emotion focussed (humour, anger, prayer, discussion) Problem focussed (seeking advice, taking action)
Problem focussed better long term
How can clinicians help patients cope?
Help to direct/recognise support (social services, websites, charities, hospital visitors) Increase personal control (pain management, adjustable medications like variable insulin, treatment choices) Reduce uncertainty (communicate, peer contact (eg. Pairing pre op patients)) Stress management (councilling, behaviour training, relaxation stratergies, medications)
What is the effect of chronic illness on mental health?
Depression 2-3x more likely (1 in 5 chronically ill are depressed)
Anxiety more common too
Why might depression be hard for clinician to detect?
Onset on returning home
Pts think it is normal to be depressed
Symptoms attributed to illness (e.g. Lethargy)
Pt doesnt want to. Bother anyone
Pts dont want to be stigmatised
Clinician doesnt think it is their job (e.g. Surgeon)
Hcp steers pt back to physical problems
What are the types of psychological therapy?
Type A - treatment in normal consultation
Type B - eclectic (broad range of influences) psychological therapy
Type C - formal psychotherapy with identified therapist
What are the type c psychotherapies?
Cognitive behavioural therapy
Psychodynamic
Systemic
Humanistic
What is the structure of cognitive behavioural therapy?
Example
What does it require?
Change maladaptive thoughts, beliefs and behaviours
E.g. By gradual exposure to a stressor with enforced staying still to break the operant conditioned good feeling of fleeing
Requires input and work from the patient with a defined goal (i want to be able to do ‘x’)
What is the structure of psychodynamic therapy?
Example
What does it require?
Re-enactment of conflicts in early life between pt and therapist
Lots of therapist being quiet to see what pt says (transference)
Pt must be able to tolerate mental pain and be interested in self exploration
What are systematic and humanistic therapies? When are they useful?
Systematic - focuses on relationships and interactions - can be group/family based
Humanistic - being nice - useful short term post bereavement etc.
What is the cognitive model?
Situations don’t upset us but the view we take on them (e.g. Someone not waving is worse if you feel marginalised and therefore feel ignored rather than thinking that they may just have not seen you)
What is a stereotype?
A stereotype is a generalisation we make about a specific social groups and thus members of those groups
Why can stereotypes be useful?
Allows us to make predictions about how people will behave and adapt our behaviour accordingly
Why do stereotypes become engrained?
They reinforce themselves, we pick up. More on things that support our views more
What is. Prejudice?
An evaluation of a stereotype that determines your attitude (pre judging an individual based on a stereotype)
What is discrimination?
Acting on a prejudice treating someone differently because of their group membership
When are we more likely to discriminate?
When under pressure
When tired
When suffering info overload
How can we reduce discrimination?
Getting to know memebers of other groups
Reflective practice
Awareness of own stereotypes/prejudice
What mental health problems increase with old age?
Dementias
NOT depression etc
What are stereotypes of the old?
Grumpy Personal stagnation Intellectual deterioration Introverted Cant adapt
Why might iq drop from 20 to 90years old?
Better education now - need to do a cohort study!
Why might personality of the old be different from the young?
Cohort effect
Conforming to stereotypes
What are the activity and disengagement models of ageing?
Disengagement - its natural for the elderly to withdraw from the social system they belonged to
Activity - older people are happier if they maintain social interactions
How do families change for an old individual?
Empty nest syndrome
Grandparent hood
Importance of friendship as family disperses or spouse dies
What is the effect of retirement on the elderly?
Loss of latent rewards (satisfaction, friendship, social networks)
Financial worry
Is old age a period of stagnation?
No - it is a time of unanticipated change!
What are the ‘social norms’ regarding sexuality?
Men and women differ anatomically
Men act masculine
Women act feminine
Men like women and women like men
What are the different elements of sexual attraction?
Feelings
Identity
Behaviour
These may differ - e.g someone may sleep with the same sex (behaviour) but not identify as gay.
What is an emotion neutral way of phrasing questions about homosexual behaviour that doesn’t broach on identity or feelings?
Have you :
Men who have had sex with men (mwm)
Women who have had sex with women (www)
What is a transgender individual?
Gender identity or expression not matching anatomical sex
What is a transexual individual?
Wishes to swap gender
What is a transvestite individual?
Wears cloths of the opposite sex
What diseases and behaviours are more prevalent in lgbt communities?
Anxiety, depression, smoking, drug use
Stds - syphilis, hiv, hpv
Why is depression more common in lgbt?
When is it particually marked?
Discrimination and isolation
When it conflicts with other major groups in the patients life, eg religion
Why may lgbt be wary of healthcare providers?
Lg Mental illness until 1992
Bt still a mental illness
Lobotomy practiced until 1980s
What are health related behaviours?
Behaviours that promote good health or increase risk of bad health
What broad groups of theories can be applied to health related behaviour?
Learning theories
Social cognition models
Stages of change model
What are the learning theories?
Classical conditioning
Operant conditioning
Social learning theory
What are the social cognition models?
Health belief model
Theory of planned behaviour
Give some examples of classical conditioning applied to healthcare positively and negatively
Positive - disulfarim with alcohol
Negative - anticipatory nausea in chemo
Why might operant conditioning lead to unhealthy behaviours?
Unhealthy behaviours often have good immidiate rewards (unsafe sex, drinking, smoking etc.)
How might operant conditioning be beneficial in healthcare
Reward for good behaviour (e.g. Holiday with money that would have gone on smoking)
What is social learning theory? What class of models does it fall into? Good and bad examples
Learning theories
Watching others be punished / rewarded for a behaviour and mimicking
Peer taught safe sex, good behaviour and dedication from athletes
Peers smoking or drinking
What are the social cognition models?
Health beliefs model
Theory of planned behaviour
What theory do social cognition models rely on?
Cognitive dissonance theory - discomfort in individuals when beliefs don’t match reality
What is the health beliefs model?
What is its major error?
People make choices based on their beliefs about a threat (susceptabity and severity) and beliefs on how their behaviour will influence that threat (both costs and benefits)
It assumes all beliefs are made rationally with no emotions and there is no coercion
What is the theory of planned behaviour?
A combination of beliefs about outcomes, beliefs about normal behaviour and percieved control over behaviour are evaluated to form an intention and eventually a behaviour change
What is the major problem with the theory of planned behaviour
The intention behaviour gap - an intention wont necessarily cause a change in behaviour
What is the stages of change model?
Precontemplation Contemplation Preparation Action Maintenance
What happens during the stages of change model if someone drops back a stage or more?
Relapse - a normal phenomenon not failure!
Differentiate adherence and compliance
Compliance - pt following drs advice
Adherence - pts behaviours coinciding with medical advice via agreement and right to choose.
How prevalent is non-adherence to treatment? Which treatments are worst?
Some chronic disease treatments have 50 % non adherence
Worst are diet, behaviour change and exercise
Which conditions promote high adherence?
Hiv, cancer, arthritis
Which conditions have low adherence
Pulmonary disease, diabetes
What can count as non adherence?
Not taking/doing Wrong amount Wrong time Wrong duration Taking other meds that interact?
How can adherence be measured directly?
Advantages and disadvantages?
Urine/blood tests for drugs
Observed taking
Accurate, but expensive, impractical and not foolproof (eg just taking meds prior to blood test)
How can adherence be measured indirectly?
Problems?
Pill counts (lost pills) Mechanical record eg dispensing machine (doesnt confirm pills are taken) Self reporting (biased, tends to overreport) Second hand report (depends on familiarity with patient)
Why might you get poor adherence to medications?
Low symptoms
Low severity in less life threatening disease
More severity in more life threatening disease (giving up)
Treatment factors (ADRs, inconvenience, complexity)
Understanding of treatment
Recall
Lay beliefs (see health beliefs model risk v benefit)
Depression
Homelessness
Low social support
Low follow up care
Poor attitude from dr
How can we increase adherence?
Increase comprehension
Reduce practical barriers
Adherence over compliance (ie involve patient)
What is concordance?
A negotiation between dr and pt with the pts views respected
Why do people use drugs?
Pleasure Entertainment Peer pressure Boredom Stress Depression Spirituality
Why is it not as simple as classifying bad drugs as strong ones like heroin or mdma and mild ones like cannabis?
Consequence of drug use depends of drug, amount, mindset, setting
Eg 10x cannabis a day as depressed may be worse than occasional cocaine on a night out with friends
How can excessive drinking be subclassified?
Hazardous - over sensible limits but no adverse health problems yet
Harmful - as hazardous but with physical or mental harm
How can alcohol dependance be sub classified?
Moderate - do not need to drink to avoid withdrawal symptoms
Severe - withdrawal symptoms if stop drinking
What is a complex needs alcoholic?
Severely dependant drinker with other needs (e.g. Psychiatric, homeless)
Give an alcohol screening tool
C - ever felt the need to Cut down
A - Annoyed if others tell you you need to cut down
G - ever felt Guilty about your drinking
E - ever needed an Eye opener in the morning
What drugs are often administered to alcoholics?
Vit B
Thiamine
Disulfiram
Diazepam
What is the sexual response cycle?
Stimulation (tactile or psychological)
Activation of arousal reflex
Positive emotions and stimulation activate brain
Brain reinforces arousal reflex
Where can the sexual response cycle be broken?
Inappropriate stimulation (insufficient or painful) Inappropriate emotion (e.g. fear) Distraction of the brain (spectatoring - i.e. Concentrating on achieving arousal)
How can sexual arousal problems be treated?
Counselling Make patients aware of where things can go wrong in the cycle Psychosexual therapy (looking for hidden problems in relationship by making a parody of it between couple and councillor Behavioural - masturbation exercises Lubricants Meds Pumps Tension rings
What are the levels of attachment in a:
Newborn - 3m
3m - 8m
>8m
N-3 = preference for faces 3-8 = preference for non-stranger but happy for any nice contact >8 = specific to caregiver, wary of strangers, upset if key people leave
What are phases of separation from caregiver on a young child?
What is the big problem with this?
Protest - crying/searching
Despair - helpless/withdrawn
Detachment - loose interest but apathetic when carer returns
Detachment seems like improvement but isnt
Which age group suffer most from separation from caregiver?
6m to 3 yrs as unable to communicate effectively and lack understanding
Feel like they are being punished
What effect does separation of child and caregiver have on treatment?
Decrease adherence
Increases pain and stress
How can we decrease attachment problems?
More carer access Attachment objects Reassurance Home like environment Specialist staff with continuity
What are the four stages of piagets development model? What ages apply to each?
Sensorimotor 0-2
Preoperational 2-7
Concrete Operational 7-12
Formal operational >12
What occurs in the sensorimotor phase of development according to piaget?
Organising sensations
Developing body schema
Movement coordination
Object consistancy
What occurs in the preoperational phase of development according to piaget?
Egocentric speech
Centration
Overgeneralisation
What occurs in the concrete operational phase of development according to piaget?
Difficulty with abstract thought
Collecting shit about their favourite topic
What occurs in the formal operational phase of development according to piaget?
Abstract logic
Develop and test hypotheses
What are criticisms of piagets model of child development?
Focuses on cant do not can do
Suggests if a child is to young then not to try
Partial info can be damaging as most children will try to make sense of what they are given whatever stage they are at
What is an alternative to piagets theory of child development?
That children and adults share a journey from novice to expert and a child will learn as an apprentice?….. WHO THE FUCK GETS PAID FOR THIS SHIT
