Psychology Flashcards
0
Q
What are some features of the biopsychosocial model?
A
• The idea that the biological, psychological & social aspects are all linked:
- bio- physiology, genetics, pathogens
- psycho- cognition, emotion, behaviour
- social- social class, employment, social support etc.
• See patients as real people
• Causal influence of thoughts, feelings, motivation & behaviour on health and illness
o Diagnosis & treatment (adherence)
• Doctors have a role in changing health behaviour e.g. smoking cessation
• Doctors have to see people with mental health problems
• Important to understand feelings & emotions e.g. reactions to diagnosis & coping with illness
1
Q
What are some features of the biomedical model?
A
• Traditionally medicine is not interested in the psychological or social factors
• Biomedical model dominant in Western medicine:
o Illness understood in terms of biological & physiological processes
o Treatment involves physical intervention – drugs and surgery
2
Q
Define psychology
A
The science of how people think, feel and behave
3
Q
Define health psychology
A
Application of psychology (the science of how people think feel and behave) to health
4
Q
Explain what a stereotype is
A
THINK
How we store memories and organise knowledge- cognitive model of psychology
Knowledge stored as mental representations- organised in schemata
Generalisations we make about specific social groups and members of those groups
Overlooks individuality
Saves processing power; makes the environment more predictable, allows anticipation and avoids information overload
5
Q
What are some advantages of stereotyping?
A
Saves processing power
Makes the environment more predictable
Allows anticipation
Avoids information overload
6
Q
Explain what prejudice is
A
FEEL Attitudes Prejudgment based on NEGATIVE stereotypes Emotional response to a stereotype Evaluative and effective
7
Q
Explain what discrimination is
A
BEHAVE
Behaving differently with people from different groups because of their group membership
8
Q
When are we more likely to rely on stereotypes?
A
When we are under time pressure, fatigued, or suffering from information overload - to save processing power
9
Q
How do we overcome stereotyping?
A
Get to know members of other groups
Challenge negative stereotypes
Reflective practice
10
Q
What two aspects of a human are looked at when assessing ageing?
A
Intellect
Personality
11
Q
How is intellect measured?
A
IQ
12
Q
What is cross sectional intellect?
A
Emphasised gradual linear decline IQ thoughout adult life, accelerating after age 70
13
Q
What are some methodological issues in studying and comparing intellectual function over the human lifespan (as in with cross sectional studies)?
A
Comparing groups of different ages cross sectionally
Changes overtime within individuals
Cohort effects- numeracy and literacy skills
Validity of measures
14
Q
How are longitudinal studies regarding ageing better than cross sectional studies?
A
More valid
Less pessimistic
15
Q
Describe longitudinal studies of intellect
A
Following several groups over a period of time
Assessing verbal meaning, verbal fluency, inductive reasoning, numeracy and special orientation
Decline does not occur at the same rate in all areas
16
Q
What is the most age sensitive component of intelligence?
A
Processing speed and problem solving
I.e. Fluid intelligence
Myth that ALL old people suffer from fundamental intellectual decline
17
Q
What is crystallised intelligence?
A
Highly learnt skills
General knowledge
18
Q
What is fluid intelligence?
A
Problem solving without prior training or exposure
19
Q
What is the relevance of memory wrt ageing?
A
Gets worse with age
Different aspects if memory behave differently
Effects of diseases - Alzheimer’s, dementia
20
Q
Link personality to ageing
A
Families in old age- empty nest phenomenon, grandparenthood, changing patterns of family contact, importance of friendships
Work and retirement- historical perspective, loss of manifest and latent rewards of paid work, unemployment vs retirement, social networking
Death and bereavement- reluctance to acknowledge mortality, often more common or different
Does getting old change your personality or does gradual throughout life development in personality eventually correspond to the social construct of an old person?
21
Q
What are the three models related to personality and ageing? Expand on them
A
Developmental model
- different emotional conflicts are assessed at different stages in life
- -> young adult life - intimacy vs. isolation
- -> mid adult life - generation vs. stagnation
- -> old age - integrity vs. despair
Trait model
- personality described in terms of constituent traits
- cross sectional - different distribution of traits at different ages
- longitudinal - stability of traits within an individual over time
Social adjustment of ‘successful’ ageing
- disengagement model - disengagement from social involvements as an adaptive mechanism
- activity model - successful ageing require maximal engagement in aka areas of life
22
Q
What is health related behaviour?
A
Anything that may promote good health or lead to illness
23
Q
What are the learning theories and social cognition models associated with health related behaviour?
A
• Learning theories:
o Classical conditioning - association with other stimuli (behaviour becomes habit)
o Operant conditioning – behaviour reinforced by rewards and punishments
o Social learning theory – observe others’ behaviour and see what’s rewarded and punished
• Social Cognition Models:
o Health Belief model
o Theory of planned behaviour
24
Describe classical conditioning
Association with other stimuli- behaviour becomes habit
• Pavlovian Conditioning – force of habit
o ‘Pavlov’s Dogs’ example of this
• Many physical responses can become classically conditioned
o Anticipatory nausea in chemotherapy
o Phobias e.g. fear of hospitals
• Unconsciously paired with the environment or emotions
25
Describe operant conditioning
Behaviour reinforced by rewards or punishments
• People (or animals) act on the environment & behaviour is shaped by the consequences e.g. reward or punishment
o Behaviour reinforced (increased) if it is rewarded or punishment is removed
o Behaviour decreases if it is punished or the reward is removed
• Unhealthy behaviours are often immediately rewarding & driven by the short term
26
Describe the social learning theory
Observe others behaviours and see what is rewarded and punished
People can lean vicariously i.e. observation/modelling
• Behaviour is focused on desired goals/outcomes
• People are motivated to perform behaviours that are valued or they believe that they can re-enact
• Modelling is more effective if models are high status or “like us” (value/ability)
o Family or celebrities play important part here
27
What do social cognition models focus on?
Focus on cognitive factors in health-related behaviour – knowledge, beliefs, attitudes, expectations etc.
28
What is the health belief model?
Social cognitive model
Beliefs about health threat- perceived SUSCEPTIBILITY and SEVERITY
Beliefs about health related behaviour- perceived BENEFITS and ACTION
Cues to action
29
What are some limitations of the health belief model?
o Rationale and reasoning – often consequences are only thought about after the action
o Decisions – habit, conditioned behaviour, coercion
o Emotional factors – fear
o Incomplete – self-efficacy, broader social factors
30
What is the theory of planned behaviour?
Social cognitive model
Belief about outcomes/ evaluation of outcomes --> attitude towards behaviour --> intention --> behaviour
Normative beliefs/ motivation to comply --> subjective norm --> intention --> behaviour
Individual control barriers/ facilitators --> perceived control ---> intention --> behaviour (can bypass intention and go straight to behaviour)
31
What are some limitations of the theory of planned behaviour?
• TPB – good predictor of intentions, but poor predictor of behaviour
o Problem is translating the intentions into a behaviour; not a certainty to happen
o Concrete plans of action
32
How are changes in health related behaviour modelled?
Stages of change model (Transtheoretical model)
33
Describe the stages in change (Transtheoretical) model
Stages of Change (Transtheoretical) Model
• The way people think about health behaviours and willingness to change their behaviour – are not static
• Stages of change model – 5 stages which people may pass through over time in decision making/change
• Different cognitions may be important determinants of health behaviour at different times
1. Pre-contemplation – “I’m a smoker and not worried about it”
2. Contemplation – “Been coughing recently. Maybe it’s the smoking?”
3. Preparation – “I’ll try to cut down gradually until I quit”
4. Action – “I am smoking 1 cig per day less that the day before, until I get down to zero”
5. Maintenance – “I’ve not smoked for 3months”
6. Relapse – “Just having the off cigarette won’t hurt – ill cut back again (? cycle back to 3. Preparation stage)
Intervention must be appropriate to the stage the person is at
34
Why is relapse in the stages of change model not viewed as a bad thing?
• Relapse is not an end stage, but a natural part of the process of changing behaviour
o Not a reason to ‘give up giving up’
o Prevent ‘lapse’ becoming relapse
o Stages of Change is a cycle and relapse is normal
• Identify and avoid high risk situations
• Improve coping skills, ‘road map’, written instructions
35
What are some strategies of changing health related behaviour?
* Information – health education, health promotion
* Behavioural skills and resources e.g. smoking cessation programmes, exercise advice
* Incentives to change e.g. financial incentives
* Motivational interviewing
36
What is motivational interviewing?
• Motivational interviewing is a client-centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence
• Aims to elicit patient’s own arguments for change
• Increase internal motivation: shift towards being more ready/willing/able to change
• Particularly helpful with people who are ‘precontemplative’ or ‘contemplative’
• Set of tools to help you as practitioners work with patients to change health behaviour e.g. drinking, diet, smoking
1. Express empathy
2. Develop discrepancy
3. Roll with resistance
4. Support self-efficacy
37
What is compliance?
Extent to which the patient complies with medical advice
38
What is adherence?
Extent to which patient behaviour coincides with medical advice
Similar to compliance, normally used interchangeably
39
What is concordance?
Negotiation between the patient and doctor over treatment regimes
Implies the patient is active and in partnership with the doctor
Patient’s beliefs and priorities are respected and decisions are shared
Trying to be incorporated into clinical practice more and more
40
What is Leys model of compliance?
Understanding--> compliance
Understanding --> satisfaction --> compliance
Memory --> compliance
Memory --> satisfaction --> compliance
41
What is unintentional non adherence?
• Unintentional non-adherence
o Capacity and resource limitations e.g.
• Individual constraints – memory, understanding, dexterity
• Aspects of the environment – problems accessing prescriptions, competing demands, lack of social support
42
What is intentional non adherence?
o Beliefs, attitudes and expectations e.g.
• Beliefs about susceptibility/severity
• Costs/benefits e.g. side effects
• Other options e.g. complementary therapy
• Poor doctor-patient relationship/lack of trust
• Maintain a sense of control
• Stigma/avoid labelling as a ‘patient’
43
How may concordance lead to better adherence?
• Concordance may lead to better adherence because:
o Patient is involved in, and has shared ownership of, decisions about treatment
o Patients’ beliefs, expectations, lifestyle and priorities can be taken into account
o Barriers to adherence e.g. practical or informational can be addressed
o Promotes patient trust and satisfaction with care which makes adherence more likely
44
Expand on the multidimensional model of adherence
Contributing factors
- illness/ disease factors -symptoms and severity
- treatment factors- preparation, immediate character, administration, consequences
- patient factors- understanding and recall, beliefs
- psychosocial factors- social context, psychological health, social support
- healthcare factors- setting, doctor patient interaction
45
What are some tensions in concordance?
Between evidence based medicine and patient choice
Between individual rights (e.g. Patient autonomy) and responsibilities
Concordance does not address medicine taking
46
Describe the fight or flight response to a stressful event
Increased oxygen availability - breathing and haematocrit
Enhance mental functioning- sensory awareness and alertness
Increased fuel availability- liberation of glucose, protein breakdown and insulin resistance (increases blood sugar)
Conservation of energy resources- digestive system, sexual response
Preparation for tissue damage/ fatigue- fuel conservation, blood clotting, endogenous analgesia, immune and inflammatory response
Enhance physiological functioning- cardiac output, BP sweating, muscle responsiveness
47
What chemical usually triggers the fight or flight response?
Catecholamines (adrenaline and noradrenaline)
48
What does the general adaptation syndrome refer to wrt stress?
Long term stress response is damaging-
| Alarm- resistance- exhaustion
49
What is a stressor?
An objective measurement of stress
| Stressors include - stressful life events and daily hassles and uplifts
50
Describe the transactional model of stress
Subjectivity of stress- different things may be stressful for different people at different times
Process of interaction between a person and what is going on in the outside world
Stress is a result of how people appraise their events and their ability to cope with them
Demands (stressors) - life events, hassles, chronic stressors Resources - e.g. Personality, social support, coping skills
Demands / Resources --> appraisal --> STRESS response
51
What three things does the transactional model of stress account for?
Differences between individuals
Different impacts of different stressors
Stress response in absence of direct threat
52
What does primary appraisal include?
• Primary Appraisal
o Is this event a threat? How bad could it be?
o Benign, challenging, threatening
53
What does secondary appraisal include?
• Secondary Appraisal
| o Do I have the resources or skills to cope?
54
What does reappraisal include?
• Reappraisal
| Reconsider the situation once have tried to cope with it (may decide its more ot less stressful than thought
55
In what 4 ways can stress affect health?
Cox et al (1983) identified 4 ways that stress can influence health:
1. Physiological responses causes physical damage, especially when intense and/or prolonged
2. Effects on the immune system can increase vulnerability to infection
3. Coping efforts: increase in unhealthy behaviour- smoking, alcohol etc.
4. Negative impact on mental health (e.g. anxiety, depression) affecting coping and illness behaviour
56
What does stress management involve?
* Cognitive strategies - e.g. cognitive restructuring, hypothesis testing
* Behavioural strategies – skills training e.g. assertiveness, time-management
* Emotional strategies – counselling, emotional disclosure, social support
* Physical strategies – relaxation training, biofeedback, exercise
* Non-cognitive strategies – drugs
57
What is coping?
Coping is about finding ways to manage events/experiences that are appraised as threats or demands, and which tax or exceed a person’s available resources
Strategies to reduce or deal with the threat or, increase resources
58
Describe emotion focused coping
Changing the emotion
o Behavioural approaches; do something e.g. talking to friends, alcohol, finding a distraction
o Cognitive approaches: change how you think about the situation, e.g. denial, focus on positive aspect of problem – have to give up job you don’t like, chance to do something different
59
Describe problem focused coping
Change the problem or resources
o Reduce demands of a stressful situation e.g. find out how to cope with feelings of claustrophobia in mask for radiotherapy
o Expand resources to deal with it e.g. if mobility a problem, focus on physiotherapy exercises, but a motorised wheelchair etc
60
How can a doctor help with coping?
* Increase/mobilise social support- suggest formal services of support, help them contact family, relatives and friends for support
* Increase personal control- pain management, give patient many choices, take cognitive control (mss)
* Prepare patients for stressful events (reduce ambiguity)- effective communication, peer contact (painting pre op and post op patients)
* Stress management techniques- cognitive, behavioural, emotional, physical, non cognitive
61
Describe anxiety
Response to a threat-
-Threats to identity/ well being
-Threatening events- surgery treatment, test results, uncertainty, prognosis
Unpleasant emotional state - may include feelings of panic/ dread
Likely to occur at various stages of illness- diagnosis, awaiting results, discharge from hospital, illness progression
Sustained anxiety can be associated with unhelpful thinking patterns- increased vigilance for threats (e.g. Symptoms); interpret ambiguous info as threats; increased recall of threatening memories
Anxiety disorders- phobia, panic attacks, PTSD
62
Describe depression
Response to loss, failure or helplessness
-Loss of health, physical capacity
-Loss of identity, social status
-Reactions to symptoms, negative experiences of illness
-Physiological changes
-Medication side effects
Emotional state characterised by persistent, low mood, sadness, loss of interest, despair, feelings of worthlessness
Tends to be long term
Higher risk- severity of illness, pain and disability, other negative life events, lack of social support
Comorbid depression can- exacerbate pain and distress associated with physical health problems, adversely affect illness outcomes
63
What is pain?
```
• Acute vs. Chronic pain
o >3 months
o No on-going tissue damage
o Prolonged medication
o Rest is not useful
o Can arise from medical condition or from an unknown cause
```
64
Describe the control theory of pain
• Pain experienced in the brain though complex pathways between the brain and damage/disease source via nerve fibres
• Messages pass through two neural relays or ‘gates’ in the spine
• The extent that the ‘gates’ are open or closed affects the number of pain messages that are received
o Gates can be opened and closed by physiological events e.g. physical stimuli, tissue damage, nerve messages
o And/or psychological factors e.g.g thoughts, beliefs, interpretations, fear, anxiety
65
What is meant by open and closed gate wrt the control theory of pain?
```
Open Gate
• Injury
• Over/under active
• Sensitivity of NS
• Stress and tension
• Focusing on pain-expectation
• Negative beliefs
• Minimal involvement in life
```
```
Close Gate
• Medication
• Counter stimulation
• Exercise
• Relaxation
• Distraction
• Positive emotions
• Positive beliefs – control
• Active life
```
• Pyschological factors e.g. depression and anxiety may exacerbate; perception of pain influenced by expectations, beliefs and attributions about pain, stress
66
What are three examples of physiological therapies?
* Cognitive-behaviour Therapy (CBT)
* Psychoanalytic/psychodynamic therapies
* Humanistic therapy
67
Describe Cognitive- behaviour therapy
o Change maladaptive thoughts, beliefs and behaviour; focus on ‘there and now’
o Suitable for: depressions, anxiety, phobias, eating disorders, schizophrenia
o People need to be willing to engage actively/collaboratively and can articulate problems
68
Describe Psychoanalytic/psychodynamic therapies
o Address unconscious conflicts and resolve previous painful experiences
o Suitable for: interpersonal/personality problems
• People with the capacity to tolerate mental pain and interest in self-exploration
69
Describe Humanistic therapy
o Warmth, empathy, unconditional positive regard
| o Suitable for: life events, mild depression, anxiety and stress
70
What is psychotherapy?
Systematic use of relationship between a patient and a therapist - as opposed to physical and social methods - to produce changes in feelings cognition and behaviour
71
What is the attachement theory of child development?
Attachment theory (Bowlby)
• Separation leads to distress
o Protest, despair, detachment (in the past, this was mistaken for recovery, so restricted parental access to hospitalised child to reduce the visible distress
o But, negative psychological outcomes (less play, less sleep, depression, anxiety, aggression, detachment)
72
Describe how practice has improved with regard to children nowadays
Good practice now
o Parent/carer access, attachment objects (e.g. teddy), home-like environment, play, continuity in staff, trained staff (specialist paediatric nurses), reassure not punished/abandoned
o Social referencing – reassure parents
73
What is the Piaget theory?
```
• Childhood Cognitive Development (Piaget)
o Sensori-motor to 0-2yrs
o Pre-operational to 2-7yrs
o Concrete operational to 7-12yrs
o Formal operational to 12yrs+
```
74
Describe some implications of childhood development
• Implications
o Assess level of understanding, tailor communication
o Danger of metaphors with younger children
o Difficulty of expressing feelings
o Difficulty thinking about the future (abstract concept) even in adolescence: implications for adherence
75
Define culture
Culture is defined by each person in relationship to the group or groups with whom he or she identifies. An individuals cultural identity may be based on heritage as well as individual circumstances and personal choice. Cultural identity may be affected by such factors as race, ethnicity, age, language, country of origin, sexual orientation, gender, socio-economic status, religious/spiritual beliefs, physical abilities, occupation etc.
These factors may impact behaviours such as communication styles, diet preferences, health beliefs, family roles, lifestyle, ritual, and decision-making processes.
All of these beliefs and practices, in turn can influence how patients and healthcare professionals perceive health and illness and how they interact with one another.
76
Define diversity
This has imprecise and inconsistent uses.
May mean diversity of ethnicity for which the term multiculturalism is often used OR Much broader range of differences relating to individual characteristics beyond ethnicity
77
Why is diversity important in healthcare delivery?
Increasing albeit limited evidence that taking a patient centred approach improves outcomes.
Increasing diversity populations (patients and workforce)
Huge disparities in care accessed
Disparities beyond point of access
Differential outcomes
Legislative frameworks
78
How may misinformation of cultural diversity result in problems?
Lack of knowledge – resulting in inability to recognise differences
Self protection/denial – leading to an attitude that these differences are not significant or that our common humanity transcends our differences
Fear of unknown or the new – because this is challenging and perhaps intimidating to understand something new that does not fit into one's worldview
Feeling of pressure due to time constraints – which can lead to feeling rushed and unable to look in depth at an individual patients needs
In turn may lead to:
Patient provider relationships being affected when understanding of each other's expectations is missing
Miscommunication
Non-compliance and not understanding the patient's perspective
Rejection of health care provider
Conflict or isolation within staff groups
79
What are some potential cultural problems for young people?
Pressures to conform to practice their families religions or other practices that do not sit comfortably with the young person
Pressure to conform to expected gender roles/careers
Pressure to conform to social norms
Pressures to conform to family expectations that differ from what the young person wants
Sexual orientation
Impending forced marriages
Difficulty in reconciling the culture in the private and public domains
80
How as a clinician would you incorporate cultural diversity?
Provide a sensitive and respectful service nonaging cultural beliefs and
– By history taking, tick box checklist – sociocultural dynamics
Respect cultural individuality whilst maintaining patient centred curiosity
– Care planning and cultural information sharing without making assumptions and falling back on stereotypes
Being a reflective clinician
81
Describe the medical model of disability
Thinks that the person is the problem
Through the medical model, disability is understood as an individual problem. If somebody has an impairment – a visual, mobility or hearing impairment, for example – their inability to see, walk or hear is understood as their disability.
Impairment: Any loss or abnormality of psychological, physiological or anatomical structure or function.
Disability: Any restriction or lack, resulting from an impairment, of ability to perform any activity in the manner or within the range considered normal for a human being.
Handicap: a disadvantage for a given individual, resulting from an impairment or disability, that prevents the fulfilment of a role that is normal depending on age, sex, social and cultural factors for that individual.
82
Describe the social model of disability
Thinks that society is the problem
Unequal relationship within a society- needs of impaired people often given little/ no consideration
All about the barriers people face
The social model was created by disabled people themselves. It was primarily a result of society’s response to them but also of their experience of the health and welfare system which made them feel socially isolated and oppressed.
Impairment: lacking part or all of a limb, or having a defective limb, organ or mechanism of the body.
Disability: the disadvantage or restriction of activity caused by a contemporary social organisation which takes little or no account of people who have physical impairments and thus excludes them from participation in the mainstream of social activities.
83
What barriers do disabled people face?
People with impairments are disabled by the fact that they are excluded from participating within the mainstream of society as a result of physical, organisational and attitudinal barriers
- prevent them from gaining equal access to info, education, employment, public transport, housing and social and recreational opportunities
84
Why do people use and abuse drugs and alcohol?
```
Pleasure
Entertainment
Social lubricant
Enhance creativity
Enhance other experiences, music, dancing, sex
Peer influence
Relieve boredom
Relieve anxiety, depression, stress
Forget worries
Relief from pain
Spiritual quest
```
85
What are the different levels of dependence on alcohol?
Moderate- drinkers have a degree of dependence, have not reached stage of relief drinking
Severe- serious longstanding problems, chronic alcoholics, experienced significant alcohol withdrawal, may have formed habit of drinking to stop withdrawal symptoms, may require an inpatient alcoholic detox
Complex needs- extension of severe, psychiatric problems, poly drug dependence, multiple serious episodes, homelessness
86
What does harmful drinking refer to?
Drink at higher levels than hazardous drinkers
| Show clear evidence of some alcohol related harm
87
What does hazardous drinking refer to?
People who drink over the guidelines (regular excessive consumption and less frequent sessions of heavy drinking)
Increases risk of harmful consequences
88
What does low risk drinking refer to?
People who drink within guidelines
| Low risk of harmful effects
89
What does abstention refer to?
People who don't drink alcohol at all
90
What are the five levels of alcohol consumption?
```
Abstinence
Low risk drinking
Hazardous drinking
Harmful drinking
Dependence
```
91
What problems and behaviours is alcohol misuse generally associated with?
```
Cancer
Heart disease
Offending behaviours
Domestic violence
Suicide
Self harm
Child abuse
Child neglect
Mental health problems
Social problems- homelessness
```
92
What are 4 alcoholic screening tools?
CAGE- Cut down Annoyed Guilt Eye opener
AUDIK- Alcohol Use Disorders Identification Kit
FAST- Fast Alcohol Screening Test
PAT- Paddington Alcohol Test
93
How would you manage alcohol misuse?
Alcohol detoxification- treating patients with withdrawal symptoms during medically assisted alcohol withdrawal - chlordiazepoxide, diazepam (Valium)
Supportive treatment- nutritional supplements (Vit B and Vit B1) and dose parenteral thiamine
Relapse prevention- medications to prevent relapse and promote abstinence- Antabuse- disulfiram
Acute intoxication- monitoring vital signs, electrolytes (esp. K+), glucose levels, administer thiamine (B1), management of withdrawal
94
What is attachment?
Biologically based system that functions to maintain proximity to the infants caregiver
Infants are predisposed to exhibit: proximity seeking behaviours and contact maintaining behaviours
95
What are the Three stages of social development in infancy?
Critical period for first attachment during first year and problems may suit if separated during the first 4 years
Stages of social development in infancy:
- new borns show preference for human faces to inanimate objects - first social smile ~ 6 weeks
- ~ 3 months distinguish strangers from non strangers- show preference for none strangers (e.g. Smiling) will allow any adult to handle them without becoming upset
- 7-8 months specific attachments formed, child will miss key people and show signs of distress in their absence- wary of strangers picking them up, touching them, even with key people present
96
What are secure and insecure attachment styles?
Secure- secure attachment predicted by:
- carer sensitive to child signals (crying, smiling etc.)
- rapid, appropriate response emitted consistently
- interactive synchrony with carer
- carer accepts role of parent/ carer
- carer has higher self esteem
Insecure- avoidant, ambivalent, disorganised
97
What behavioural and physical changes are detected in children when an attachment figure is absent?
Behavioural changes- separation anxiety, increased aggression, clinging behaviour, bed wetting, detachment
98
What is the attachment theory?
Bowlby- described behaviour of children in residential nurseries and hospitals separated from their mothers
3 phases
PROTEST- distressed, look for mother, may cling to substitute, can last hours or even days
DESPAIR- signs of helplessness, withdrawn, cry only intermittently
DETACHMENT- more interested in surroundings, may smile and be sociable, but are remote and apathetic when carer returns
99
What are some effects of the attachment theory and some consequential implications as a result?
Most invert distress for children aged 6months to 3 years
Lack ability to keep image of carer in mind
Limited language- e.g. Tomorrow
Lack ability to understand abstract concepts
Often feel abandoned- may attribute it to their own failing- see being left as a punishment
Implications:
Adherence to treatment may be adversely affected and this in turn may impede recovery
Patients experience of pain may be worse if anxiety levels are high Patients may suffer from adverse effects of stress on health
100
What are some criticisms of the attachment theory?
Too simplistic
Overly focussed on mothers and fathers are marginalised
Multiple attachment figures may be formed - this was not explored initially
Quality of substitute care not considered
BUT despite criticisms - agreement that separation of children from carers is distressing for both and can have negative short and long term psychological and physical consequences
101
What is Piaget's theory of childhood cognitive development?
Child's mind develops through 4 different stages
1) sensorimotor (0-2)
2) preoperational (2–7)
3) concrete operational (7- 12)
4) formal operational ( 12+)
102
What is the sensorimotor stage of Piaget's theory?
Sensorimotor (0-2)
Babies experience world through senses
Develop motor coordination
No abstract concepts
Developed body schema – awareness of where they end and the world starts
Develop /understand permanence around eight months – understanding continuing existence of objects even when they are out of sight
103
What is the preoperational stage of Piaget's theory?
Preoperational (2-7)
Language development, symbolic thought able to imagine things
Egocentrism (difficulty seeing things from other points of view, believes everyone experiences the world the way they do)
Lack concept of conservation
Classification of single feature (e.h. all red objects, order by size)
104
What is the concrete operational stage of Piaget's theory?
Operational (7-12)
Think logically but concrete rather than abstract
Achieve conservation of number, mass and weight
Classification by multiple features
Able to see things from another's perspective
105
What is the formal operational stage of Piaget's theory?
Formal operational (12+)
Abstract logic
Hypothetical deductive reasoning
106
What are some criticisms of Piaget's theory?
Tend to focus on what a child can't do not what they can achieve
If a child is deemed to young to appreciate a given concept there is no point in trying to inform them
But partial information can be damaging, the child will try and make sense of the situation anyway
107
What is Vygotsky's theory of social development?
Cognitive development requires social interaction
Child as an apprentice learns through shared problem-solving
With 'able instruction' child can receive some increase in understanding (x+1)
Focus on zone of proximal development (+1 bit!)
108
What are some do's when communicating with a child?
Smile/look sad as appropriate
Stay calm – look more in control
Acknowledge and greet child- talk to parnet/ carer first – gives time for the child to relax
Observe wait listen (OWL)
Simple and clear information – don't hurry
Act out/imitate with a doll what you want the child to do
Give them choices – empowers them
Play, have fun with the children
Distraction – with interests
Give enthusiastic praise
Acknowledge feelings and congratulate on efforts
Stickers, certificates, special prizes- rewards
109
What are some don'ts when communicating with a child?
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Stand over the child
Use force
Promise things you can't deliver
Express frustration
Blame/criticise
Expect the same things at different ages
Rush
Ask too many questions
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110
Sexual diversity
-
110
What is sexual dysfunction?
The sexual dysfunctions are characterised by a disturbance in sexual desire and in the psychophysiological changes that characterise the sexual response cycle and cause marked distress and interpersonal difficulty
110
What are some common features of sexual dysfunction?
* Problems occur irrespective of sexual orientation
* More than one problem can co-exist in the same individual e.g. vaginismus and loss of libido, rapid ejaculation and erectile failure
* Problems are often in both partners, e.g. vaginismus and erectile failure
* Problems may be lifelong or acquired
* Problems may be generalised or situational
* Problems may be due to physical and/or psychological difficulties
111
What is the common presentation of someone with sexual dysfunction?
• Sexual problems may present overtly or covertly e.g.
o Repeated negative investigations for pain or discharge
o Never being happy with any offered method of contraception
• Reluctance to raise a sexual problem
• Increasing number of individuals seeking help – maybe due to media influence and reduced taboo and embarrassment
112
What are some points to consider when discussing sexual dysfunction with a patient?
* Empathy of reassurance
* Embarrassment
* Stigma
* Privacy and confidentiality
* Open and specific questions
* Avoid labels and value judgements – do not make assumptions
* Terminology
* Religious and cultural issues
* Interview partner
113
Describe a structured clinical interview of a patient with a suspected sexual dysfunction
• Detailed description of the problem, its onset and progression
o Include behavioural, affective and cognitive functioning
• Relationship with partner
• Relevant past relationships
• Medical history and drug use
• Mental health history
• Family and pychosexual history – with upbringing
• Significant life events – trauma, rape, child abuse
• Sexuality
• Cultural aspects
• Coping mechanisms and support networks
114
Why do people have sexual problems? 4 stages
Failure- Precipitating Factors- physical, psychological, life events, partners problems
Failure- Predisposing Factors- false beliefs and concepts, unrealistic expectations,poor communication skills, physical vulnerability, early sexual trauma
Fear of failure- Perpetuating factors (Partner)- breakdown in comms, pressure to perform, criticism and self blame
Fear of failure- Perpetuating factors (Self)- loss of confidence, spectating, guilts and shame, anger and frustration
115
Describe the 5 stage Grief Model (Death and dying)
• The 5 Stage Grief Model (Kϋbler-Ross)
1. Denial
• “It’s not true”, “It can’t be happening to me”
• Refusal to discuss the illness/the future
2. Anger
• “Why me?”, “the doctors don’t know what they are doing”
• Search for alternatives?
3. Bargaining
• “I’ll go to church every day if I can just live to see my grandchild”
4. Depression
• “Why should I try and do anything”, “I can’t fight it any longer”
5. Acceptance
• “It will be okay”, “I’m ready to make funeral arrangements”
116
What is denial?
* Can be a means of coping with overwhelming information and emotions in the early stage of getting the news
* Check that the patient understands, and how much information they want to know
* Respect desire ‘not to know’
* Offer written information to patients to look at with their family
* Check and review over time – ‘when ready’
117
What is bereavement?
• The grieving process
o Need to work through grief; disbelief and shock, developing awareness, resolution
o Common elements – anger, blame, depression
• Risk factors for poor outcomes
o Prior bereavements, mental health
o Type of loss – young person, mature of death, caring status
o Lack of social support, stress from other crises
o Expression of grief discouraged
o Ending of grief discouraged
• Importance of time to say goodbye, rituals in mourning, social support
118
If bad news is not broken well what can this had an effect on?
o Doctor-patient relationship
o Emotional well-being of patients e.g. distress and depression
o Adjustment to and ability to cope with the illness, for patients and their relatives
119
What is the general protocol for breaking bad news?
SPIKES
- S- Setting and listening skills
- P – Patient’s Perception
o What does the patient know already? Before you tell, ask
- I – Invitation from the patient to give information
o “How much information would you like me to give you about your diagnosis and treatment?”
- K – Knowledge
o Give a warning shot à flagging
o Information in small chunks and avoid jargon
- E - Empathy
o “How are you feeling?”
o Listen to the patient’s concerns
- S – Strategy and summary
o Summarise the main discussion topics and check understanding
o Discuss the strategy and agree on the next step
o Closure
120
Lgbt
A
