PPD Flashcards
Give three examples of fertility treatment covered by the Human Fertilization and Embryology Act. (3 marks)
For three marks three examples would be given, examples include cyropreservation, in vitro fertilization, gamete intrafallopian transfer, intracytoplasmic sperm injection and donor insemination.
Outline some of the amendments made to the HFE Act in 2008. (3 marks)
For three marks three amendments would be given, amendments include:
* Creation and use of all human embryos outside the body are subject to regulation
* Ban on sex selection of offspring
* Removal of requirement for clinics to account of the child’s “need for a father”
* Added requirement for clinics to take account of “the welfare of the child”
* Legal recognition of both partners in a same-sex relationship as legal parents of children conceived through the use of donated sperm, eggs or embryos
Summary:
* They now recognise same sex relationships as legal guardians of a child
* Removal of requirement for clinics to account of the child’s ‘need for a father’, so a single woman can have a child on her own with donated sperm.
* Creation and use of all human embryos outside the body is subject to regulation
* Ban on sex selection
* There can’t be multiple legal fathers and mothers
Miss Jones and Mr Smith are found to be infertile and undergo fertilization therapy. Miss Jones is found to have blocked fallopian tubes and Mr Smith is found to not be producing sperm. Miss Jones and Mr Smith have a baby using an embryo created from donated sperm and a donated oocyte, Miss Jones then carries this baby to term. Discuss the parentage of the baby. (4 marks)
Miss Jones is the mother (1 mark) and Mr Smith is the father (1 mark). Miss Jones is the mother because she gave birth to the child (1 mark). Mr Smith is the father because he is in a relationship with Miss Jones and consented to treatment (1 mark). The donor of the oocyte is not the mother (1 mark). The donor of sperm is not the father (1 mark).
How is capacity assessed? (4 marks)
For four marks each of the following points should be included: comprehension of information, retention of information, ability to weigh up information to form a decision and an ability to communicate that decision.
Mr James is a 83 year old gentleman who came in via ambulance following a fall and is now on a general medical ward for observations. He is very agitated and is refusing all treatment. How could you maximise capacity? (2 marks)
For two marks two examples of techniques would be given, these include things such as; allowing adequate time, using translator or interpreter, using diagrams, assessing capacity at different times of the day, using video or audio.
Mr James is found to not be capacitous, what are the next steps? (4 marks)
Answers could include any of the following for a total of 4 marks: Mr James should be treated according to his best interests (1 mark) although this should take into account all aspects of Mr James and should not focus on his best medical interests (1 mark). A person holding lasting power of attorney for Mr James should be looked for (1 mark). An independent mental capacity advocate (IMCA) could be put in place for Mr James (1 mark). All treatment decisions and their rationale and assessment findings should be documented clearly in the notes (1 mark).
Discuss the different aspects of the Mental Health Act which legislate non-voluntary admission. (10 marks)
Answers should include any of the following for a total of 10 marks:
* Section 2 (1 mark) allows for 28 day detention (1 mark) and is made by two doctors, one of which must be a specialist (1 mark).
* Section 3 (1 mark) allows for 6 month detention (1 mark) and is made by two doctors (1 mark).
* Section 4 (1 mark) allows for emergency detention for 72 hours (1 mark) and is made by one doctor (1 mark).
* No admission should be made where drink or drugs is thought to be the sole cause of behaviour (1 mark).
* “Sexual deviancy” is covered by MHA 2007 but was not by MHA 1983. (1 mark).
* Decisions to made under MHA can be challenged under Section 139 (1 mark) or by a judicial review (1 mark). If doctor or doctors have acted in good faith there is no right to damages (1 mark) unless the challenge is made to a judicial review (1 mark).
Outline the key ethical principles which surround any research involving humans. (5 marks)
For 5 marks an answer would include the following:
* Scientific validity - with an example of validity e.g. “Appropriate methodology” (1 mark)
* Consent - should be voluntary from an informed and capacitous individual (1 mark)
* Confidentiality - adequate measures should be taken to protect any data collected (1 mark)
* Risks v benefits - risk of injury to participant should be outweighed by the potential benefit to participant (1 mark)
Discuss situations where the voluntariness of a person might be weakened (3 marks)
For 3 marks an answer could include any of the following for a total of 3 marks:
* Payment creates an incentive to join research (1 mark)
* Patients may misunderstand that participating in research is the standard care - “Therapeutic misconception” (1 mark)
* Patients may feel grateful to a clinician and feel obligated to join research (1 mark)
* Patient may be afraid of rejection or withdrawal of care if they decline to join (1 mark)
Outline practices of ethical animal experimentation (2 marks)
For 2 marks an answer could include any of the following for a total of 2 marks:
* Replacement - where possible use non-animal methods (1 mark)
* Reduction - number of animals used kept to minimum (1 mark)
* Refinement - smallest amount of pain and distress should be caused to animals (1 mark)
Describe in what ways having a child with an intellectual disability impacts on the family cycle.
- 60% parents spent 10 hrs or more per day on basic physical care
- 1/3 of parents said their caring role was continuous
- Parents woken up 3 times per night on average
- 48% no support from outside family
- 78% no support or <2 hrs a week with caring tasks
Characteristics of chronic illness which are important when considering psych impact.
- Long duration (usually for life) e.g. after CVD, lifelong preventative measures are needed.
- Slow progression – Chronic diseases e.g. MS/dementia/arthritis are insidious, which are well controlled for a certain time, but then may interfere with daily life. Patients often can experience uncertainty, denial, depression throughout the progression.
- Systemic – affects a range of systems. E.g. Chronically high blood sugar affects the heart, circulation, kidneys and CNS. In infection, others symptoms may occur e.g. weakness, fatigue, concentration problems or depressed mood. Therefore, patients must cope with both the emotional and psychological symptoms.
- Quiet tonic phases and severe episodic flare ups – For example, asthma may be well controlled, but a flare up may be a medical emergency, which requires admission and urgent treatment.
- Lifespan problem – the timing of diagnosis can impact individuals differently as perception changes with age. E.g. Children often will not understand nature of illness, but may be affected by disease in terms of separation from friends/family and frightening procedures. For Adolescents, peer acceptance may be a problem and for adults, education/work/relationships are important.
- Control (to increase QOL) rather than cure – Chronic illness can rarely be cured, but rather controlled in terms of negative impact on wellbeing. Good self-management is critical.
- Impact on QOL – work/social life/family/independence.
Crisis theory
- ‘Crisis’ model: after being diagnosed with a chronic illness, individual loses their social status (can’t work etc.). This can lead to ‘biographical disruption’ (bad) or ‘negotiation’ (good)
- Biographical disruption
o Enacted stigma: occurs when a person experiences actual abuse and/or discrimination (finger pointing)
o Felt stigma: When a person feels he is being discriminated against when actually he is not.
- Biographical disruption
- Different conditions have different social meanings, e.g. cirrhosis implies alcoholic. Therefore, these conditions hold stereotypes.
- Impairment or disability (e.g. HIV) leads to restriction in activities and social roles (due to recurrent infections). This then leads to negative labelling, which is enforced by negative social stereotypes transmitted in everyday life or media, e.g. drug users (for HIV). This will diminish patients’ self-esteem and cause felt stigma, leading to isolation and withdrawal from social life, eventually causing lack of confidence and loss of skill.
- Negotiation
- Person has difficulty maintaining ‘normality’ with time
- BUT they refuse to accept labelling and stigmatization; they preserve their identity
- Crisis theory has 3 main factors:
- Illness-related factors: e.g. Greater threat (some illnesses pose greater threat to some than others, the greater the threat, the more difficult coping), Embarrassing problems (e.g. disfigurement – embarrassing, lack of body function, loss of self-esteem.), Visible conditions (e.g. Keloid scars), pain (e.g. treatment may be painful or disease), time commitment for treatment (e.g. treatment schedules) and life style changes.
- Background and personal factors: e.g. Social class (higher classes can get cleaners, shopping delivered, counsellors etc), financial position (afford private care, treatments not under NHS etc), ethnicity (Asians have more support outside nuclear family), gender (men find it more difficult to adapt to illness – esp if it effects physical abilities. Men also find it difficult to seek social support, while females often report higher levels of pain and tend to acknowledge their need for support quicker. Different personalities may also influence adjustment:
o Open-mindedness (curious, imaginative) – more likely to adapt to illness
o Conscientiousness (self-disciplined, goal orientated) – more likely to adhere to treatment
o Exterversion (sociable) – more likely to receive social support as networks well built
o Agreeableness (cooperative) – accepting of treatment
o Neuroticism – Easily experience unpleasant emotions – depression?
o Optimism – associated with lower CVD mortality – likely to have active coping style, more use of problem-focused coping, seek social support.
o Resilience also leads to better psych adjustment – involves commitment, control and challenge.
o After illness, there is some positive effect e.g. better relationships (more compassion), change views of themselves (more stronger), and changed life philosophy (inspired) - Physical and social environment factors:
o Hospital/home care can be depressing – social support can enhance coping
o Financial support may provide relief e.g. cleaners
o Practical support 🡪 e.g. cooking/shopping may help, e.g. breast cancer survival increased by social support e.g. marital status, working, contact with friends.
- Eventually, chronic illness requires 7 areas of adjustment:
- Cope with symptoms and disabilities
- Adjust to hospital environment and treatment
- Maintain relationships with HCP, family, friends
- Maintain a reasonable emotional balance
- Maintain a good self-image
- Prepare for a uncertain future.
- RECALL transactional model of stress e.g. stress is a balance of perceived demands vs resources, leading to a psychobiological stress response.
- Psychological interventions in chronic illness include CBT (goal setting, self-monitoring), stress management (CBT, relaxation, bio-feedback), treat depression (exercise, medication), social support, emotional expression (via habituation, reappraisal and social support), prepare for death.
What 2 dimensions of Big 5 personality theory comprise antisocial personality? List 2 ways in which an antisocial personality may be disadvantageous for health and 1 way in which it may be advantageous.
- 2 dimensions = agreeableness and conscientiousness
- 2 disadvantages = harmful health behaviours and lack of social support
- 1 advantage = easy going
Definition of dependence:
- Loss of control over behaviour
- Criteria to measure dependence to cigs: Persistant desire or inability to stop, use despite harmful effects, building tolerance, higher level of use, withdraw syndrome, time spent using/recovering and activities of normal life given up.
- Smoking on waking is the main indication of dependence
- Basic mechanism of dependence is operant conditioning. Behaviour becomes embedded due to repeated positive reinforcement (this is seen in early smoking, where a puff of smoking, leads to a nicotine-induced dopamine release (reward), leading to more smoking) and negative reinforcement (Based on withdrawal syndrome as a punishment, then puffing on cigarettes provides relief, leading to more puffs).
- Dependence may also occur via classical conditioning. E.g. smoking increases with objects/sensations are associated with smoking (e.g. if you drink alcohol with smoking, alcohol acts as a secondary reinforcer). If you are in situations where you normally smoke (e.g. after work), then this can act as a cue to smoke. Therefore, change individual’s normal routines to avoid effects of classical conditioning. E.g. change alcohol type.
- In summary, cigarettes fulfil criteria for dependence. Nicotine acts as a positive reinforcer, withdrawal acts as negative reinforcer. Conditioning leads to liking for cigarette related stimuli, and situations paired with smoking trigger smoking.
