Psychology Flashcards
1
Q
What is the biomedical model?
A
‘Traditional’ medicine is not interested in psychology or social factors, treatment only involves physical intervention
2
Q
List 5 stress management strategies
A
Cognitive, behavioural, emotional, physical, non-cognitive
3
Q
What does a cognitive stress management strategy involve?
A
Restructuring, hypothesis testing
4
Q
What does a behavioural stress management strategy involve?
A
Skills training, e.g. Time management, assertiveness
5
Q
What does a emotional stress management strategy involve?
A
Counselling, social support
6
Q
What does a physical stress management strategy involve?
A
Relaxation training, exercise
7
Q
What does a non-cognitive stress management strategy involve?
A
Drugs e.g. Alcohol, smoking
8
Q
State 3 ways to aid coping
A
Increase/mobilise social support
Increase personal control, e.g. Pain management
Prepare patients for stressful events - reduce ambiguity and uncertainty
9
Q
State 3 barriers to recognising psychological problems in patients
A
Symptoms may be inadvertently missed
Patients may not disclose symptoms
HCPs may avoid asking
10
Q
State 2 learning theories
A
Classical - same time association
Operant - delayed association
11
Q
What are the types of psychological therapies?
A
Type A: psychological treatment as an integral part of mental health care
Type B: Eclectic (range of sources) psychological therapy and counselling
Type C: Formal psychotherapists (by a ‘therapist’)
12
Q
What NHS psychological therapies are available?
A
Cognitive behaviour therapy CBT
Psychoanalytic/psychodynamic therapies
Systemic and family therapies
13
Q
How does cognitive behavioural therapy (CBT) work?
A
Relieves symptoms by changing maladaptive thoughts, beliefs and behaviour
Graded exposure to feared situations
Activity scheduling, reinforcement, education, monitoring
Examining and challenging negative thoughts. Behavioural experiments, rehearsal of difficult situations
14
Q
What sort of things is cognitive behavioural therapy (CBT) used for?
A
Depression, anxiety, eating disorders, sexual dysfunction
15
Q
What sort of patients are suitable for CBT?
A
Those keen to participate, who can engage collaboratively and accept a model emphasising their thoughts/feelings. Those seeking solutions.
16
Q
What are the limitations of cognitive behavioural therapy?
A
Has to be delivered by an expert practitioner (so is difficult for routine practice). Not so good where problems are complex and diffuse.
17
Q
What is systemic and family therapies?
A
Couples, families ect. Focus on relational context, addresses patterns of interaction and meaning. Suitable for mild to moderate difficulties with a recent onset.
18
Q
What are psychoanalytic/psychodynamic therapies?
A
Conflicts arising from early experience, that are re-enacted in adult life. Uses relationship with therapist to resolve such. Allows unconscious conflicts to be re-enacted and interpreted in relationship with therapist.
19
Q
What is psychoanalytic/psychodynamic therapies suitable for?
A
Interpersonal difficulties and personality problems. Requires a capacity to tolerate mental/emotional pain. Requires a patient with an interest in self exploration
20
Q
What is the negative cognitive triad?
A
Negative view of self
Negative view of surrounding world
Negative view of the future
21
Q
List types of anxiety disorder
A
Panic disorder (with or without agoraphobia) Social anxiety disorder Specific phobias Health anxiety OCD, body dystrophic disorder PTSD Generalised anxiety disorder
22
Q
How might CBT be used to treat anxiety?
A
Reduce avoidance
Cease safety-seeking behaviours
Exposure
Test beliefs
23
Q
What do you do if you have a conscientious objection to a particular procedure?
A
Explain this to patient and tell them of their right to see another doctor, ensuring they have sufficient information. You must not imply or express disapproval of patients lifestyle, choices or beliefs
24
Q
What are schemata?
A
How we store memories and organise knowledge - ‘sterotyping’. Helps avoid information overload. Unconscious.
25
Why is stereotyping good?
Avoids information overload, enables quick deductions
26
When can stereotyping be bad?
Shortcut overlooks diversity, prone to emphasise negative traits, and is resistant to change.
27
Why do people associate with groups?
Gives them a sense of elf identity and self esteem. People generally focus on the positives of their groups and negatives of others - prejudice.
28
What can help avoid negative stereotyping?
Reflective practise
29
What is the most age-sensitive component that declines?
Processing speed
30
List some diseases that have increased prevalence with age (70+)
Alzheimer, dementia, MCI
31
According to Erikson's 'life-stages', what effects personality/happiness in young adult life?
Intimacy Vs Isolation
32
According to Erikson's 'life-stages', what effects personality/happiness in mid adult life?
Generation Vs Stagnation
33
According to Erikson's 'life-stages', what effects personality/happiness in old age life?
Integrity Vs Despair
34
What does successful ageing require? What makes this difficult in western countries?
Maximal engagement in all areas of life. Family role adjustments.
Reluctance to acknowledge mortality in western culture makes this aspect of ageing difficult
35
What defines culture?
Each person in relationship to the group or groups with whom he or she identifies. Based on heritage as well as individual circumstances and personal choice
36
How may culture influence healthcare?
Influences how health and illness is perceived and how patients and healthcare professionals interact
37
How might culture negatively impact patient-provider relationships?
Miscommunication, non-compliance, not understanding (on both fronts). Isolation.
38
What is a consequence of minorities falling outside of social/cultural norms?
Marginalisation and discrimination
39
What is sexual orientation?
A term used to describe which gender you're attracted to. May be life-long from early age or vary over a lifetime. Includes feelings, behaviour and identity. These 3 things may or may not coincide.
40
What is MSM?
Men who have sex with men
41
What is WSW?
Women who have sex with women
42
What is gender identity?
Someone's INTERNAL perception and experience of their gender
43
What is gender role or expression?
The way a person lives in society and interacts with others
44
What is transgender?
Umbrella term for those whose gender identity and/or gender expression differs from their birth sex (transsexuals, transvestites, cross-dressers)
45
What is transexual?
Constant and overwhelming desire to transition and live as a member of the opposite sex
46
What do the LGBT have increased risk of?
Anxiety, depression, smoking...
47
How can discrimination lead to poorer health?
Increased stress, low self esteem, isolation, increased conflict, distrust of authorities/healthcare, 'bar-y' subculture - drink/drugs
48
What causes at lease 1/3 of all disease burden in the developed world?
Tobacco, alcohol, BP, cholesterol, obesity
49
Name 3 learning theories that can be used to help understand people's health-related behaviour
Classical conditioning
Operant conditioning
Social learning theory
50
Name 2 social cognition models that can help understand people's health-related behaviour
Health-belief model
| Theory of planned behaviour
51
What is classical conditioning?
Physical responses to associations e.g. Food/bell, smoking/environment .
Habit so difficult to change
52
How may classical conditioning be used to train desired behaviours?
Pair 'bad' behaviour with unpleasant response for therapy e.g. Alcohol and medication to induce nausea
53
What is operant conditioning?
Actions/behaviour shaped by consequences - increases if rewarded, decreases if punished.
Problem behaviours e.g. Smoking, are immediately rewarding
54
Why is operant conditioning a problem with problem behaviours?
Problem behaviours e.g. Smoking, are immediately rewarding
55
What are the limitations of learning theories?
They're based on stimulus - response associations, no account of cognitive processes, knowledge, beliefs, attitudes ect. No account of social context.
56
How are social learning theories formed?
By observation of others
57
Describe the social learning theory
Behaviour is goal-directed. We learn what behaviours are rewarded and how likely it is we can perform such from observing others. Modelling more effective if model is high status, or 'like us'
58
Describe the cognitive dissonance theory
Discomfort when inconsistent beliefs or actions/events don't match beliefs. Reduce discomfort by changing beliefs or behaviour.
59
How is the cognitive dissonance theory implemented in western society?
Health promotion on smoking boxes
| Creates mental discomfort, although information alone is not effective
60
Describe the health belief model
Beliefs about health threat and beliefs about health related behaviour combine to enable/or not action
BUT is incomplete, emotional factors not considered so not entirely rational/reasoned.
61
Describe the theory of planned behaviour
```
Following all contribute to intention, and therefore behaviour:
Attitude toward behaviour (beliefs about outcomes/evaluation of such)
Subjective norm (normative beliefs, motivation to comply)
Perceived control (individual, barriers and facilatators)
```
62
What is key about the theory of planned behaviour?
Intention doesn't always translate to reality
63
Describe the stages of change (transtheoretical) model?
The way people think about health behaviours and willingness to change behaviour is not static. 5 model stages (precontemplation, contemplation, preparation, action, maintenance, relapse)
64
What are the 5 model stages of the stages of change/transtheoretical model?
Precontemplation, contemplation, preparation, action, maintenance, relapse
Relapse is entirely normal - prepare for such!
65
What does the term 'compliance' mean?
An old term
The extent to which patient 'does what they're told'
Paternalistic, passive patient
66
What does the term 'adherence' mean?
The extent to which patient behaviour coincides with medical advice (patient centred, patients right to choose)
67
What is the general rate of non-adherence? What is a consequence of this?
50%
| 10-20% of all hospital admissions are due to non-adherence
68
What forms of non-adherence have particularly high rates?
Lifestyle changes
| Common in severe disease, HIV, arthritis, GI disorders, cancer, pulmonary disease, sleep disorders, diabetes
69
What complications does non-adherence have on the NHS?
Financial! Much medication given out thats not used
70
Why is non-adherence difficult to analyse?
Difficult to measure
Different types - not taking enough/at correct time/correct duration ect.
Difficult to compare studies of different treatments
71
What are 6 different strategies for measuring compliance?
```
Urine or blood test
Observation of consumption
Pill count
Mechanical/electrical measuring of when dose is taken
Patient self-report
Second hand report
```
72
What are the benefits/drawbacks of using urine/blood tests to measure compliance?
Good - most direct measure of compliance
Bad - expensive, limited use clinically
Bad - can still be masked e.g. Take melds just before test
73
What are the benefits/drawbacks of measuring adherence by patient self-report?
Good - easy, inexpensive
| Bad - prone to inaccuracies/bias
74
List some factors that might contribute to why a patient doesn't comply
```
Illness factors
Treatment
Understanding
Beliefs
Psychological health
Social support
Social context
Healthcare setting
Prescriber
```
75
How might illness factors contribute to a patients adherence to treatment?
Better when patients understand the treatment. Difficult for asymptomatic conditions e.g. Hypertension.
Severity of illness - if not severe, or very severe less likely to comply
76
How might treatment factors influence patient adherence?
Preparation (setting, waiting time ect)
Immediate character (complex regime? Long time? Inconvenient? Expensive? Behavioural changes?)
Administration - overseen by someone?
Consequences - physical/social side effects, stigma
77
How might understanding influence patient adherence?
Information given often not remembered, due to stress at time, anxiety.
Understanding of how/when to take drug
78
How might beliefs influence patient adherence?
Health belief model, depends on:
- Perceived severity of disease
- Perceived susceptibility
- Beliefs of treatment recommended
- Barriers to following treatment
- Beliefs about illness (lack of understanding)
- Beliefs about medication (tolerance, symptoms, side effects, stigma)
79
Describe the health belief model, as it applies to patient adherence
Health belief model, depends on:
- Perceived severity of disease
- Perceived susceptibility
- Beliefs of treatment recommended
- Barriers to following treatment
- Beliefs about illness (lack of understanding)
- Beliefs about medication (tolerance, symptoms, side effects, stigma)
80
How might psychological health may influence patient adherence?
'Non-compliant personality'
| Depressed patients 3 x less likely to comply
81
How might social support influence patient adherence ?
Socially isolated patients less likely to adhere. Family support is best
82
How might social context influence patient adherence?
Homelessness - less likely to be compliant
83
How might healthcare setting influence patient adherence?
Primary Vs Secondary care
Initial Vs Follow up care - if monitored then more compliant
Accessibility of venue and waiting times
84
How might the prescriber influence patient adherence?
Does patient trust them? Prescribers beliefs/enthusiasm in treatment. Good communication/manner improves compliance
85
What might cause unintentional adherence?
Capacity and resource limitations preventing adherence. Could be associated with individual constraints (e.g. Memory/dexterity), or aspects of their environment (e.g. Problems accessing prescriptions/affording them)
86
What does intentional non-compliance arise from?
Beliefs, attitudes and expectations
| Rational decisions from patients perspective
87
What possible interventions can you perform to help improve adherence?
Address practical barriers. Influence motivation. Comprehensive interventions (combining approaches) rather than focusing on a single cause.
88
What are issues making it difficult to improve patient adherence?
Difficult to tell why interventions work and some don't. Difficult to make truly 'patient centred'
89
What is concordance?
Negotiation between patient and doctor over treatment.
| Need to understand patient beliefs and priorities. Both are active!
90
Why does achieving concordance improve patient adherence?
Patient is involved
Beliefs/priorities/expectations are taken into account
Barriers to adherence are addressed
Promotes patient trust
91
What is the Elwyn et Al guide towards concordance in prescribing?
Define problem - clearly state issue, taking into account both yours and the patients views
Convey equipoise - make for there may not be set opinions about what's best
Describe treatment options, and consequences of none - provide this info in preferred format (e.g. Writing)
Check patient understanding
Elicit patients concerns and expectations about condition and possible treatments and outcomes
Ascertain patients preferred role in decision making
Defer is necessary - review needs and preferences
Review decisions after specified time period
92
What is the attachment theory (by John Bowlby)
Attachment is a biologically based system that functions to maintain proximity to the infants care-giver
Infants are predisposed to exhibit proximity seeking/contact maintaining behaviours (e.g. Crying) to keep them safe
93
What the stages of social development up to 8mths (Scaffer)?
Newborns show preference for human faces
~6wks first 'social smile'
~3mths. Distinguish strangers from non-strangers. Show preference for non-strangers (e.g. Smiling). Will allow any caring adult to handle them without becoming unduly upset
7-8mths. 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
94
What predicts a secure attachment for child and caregiver?
Predicted by having a carer who is sensitive to childs signals and is constantly emitting rapid appropriate responses back. Accepts role of carer, high self esteem.
95
Why is role of primary care-giver so important in the development of child?
Infant forms first 'mental model' of relationship based on interactions with their primary care giver.
Secure attachment - worthy of love and care, others will be available when needed.
Influences brain development better social competence, peer relations and physical/emotional health.
Critical period over first 4yrs for 1st attachment - problems may arise if separated over 1st 4 yrs ('window of opertunity')
96
What is the predictable pattern of behaviour following separation of an infant from their primary care giver? (Bowlby)
1 - Protest: distressed, look for carer, may cling to substitute. Hrs or days
2 - Despair: Signs of helplessness, withdrawn, cry only intermittently
3 - Detachment: More interested in surroundings, may smile and be sociable, but when carer returns they are remote and apathetic.
Often mistaken for recovery, masking damage to relationship
97
What physical changes might occur in an infant separated from their primary care giver?
Depression, slower movements, less play, less sleep, changes in heart rate and body temperature
98
At what age is separation from primary care giver most distressing for children? Why?
6mths - 3yrs
Lack the ability to keep image of caregiver in mind. Limited language (e.g. 'Tomorrow').
Often feel abandoned, may attribute it to their own feeling
99
What might be medical implications of being separated from primary care giver?
Adherence to treatment might be adversely effected, may impede recovery. Pain may worsen with anxiety. Stress effects.
100
What improvements have occurred in paediatric units now to help minimise stress as a result of removal of child from primary care giver?
Carer access enabled, attachment objects allowed, reassurance of child, more homely environment, continuity of staff so relationship can be established
101
What are the 4 stages of childhood cognitive development?
1 - Sensorimotor 0-2yrs
2 - Preoperational 2-7yrs
3 - Concrete operational 7-12yrs
4 - Formal operational 12+yrs
102
Describe the first, sensorimotor, stage of childhood cognitive development
Developing motor coordination, no abstract concepts.
Develop body scheme - awareness where body 'ends' and the world starts.
Develop object permanence at ~8mths (understand the continued existence of objects even when they are out of sight)
103
At what age is a child going through the sensorimotor stage of cognitive development?
0-2yrs
104
At what age is a child going through the preoperational stage of cognitive development?
2-7yrs
105
At what age is a child going through the concrete operational stage of cognitive development?
7-12yrs
106
At what age is a child going through the formal operational stage of cognitive development?
12+yrs
107
At approximately what age does an infant develop object permanence?
~8mths
108
Describe the pre-operational stage of childhood cognitive development
Language development, symbolic thought - able to imagine things.
Egocentrism - difficulty seeing things from others point of view, believe everyone experiences the world as they do.
Lack of concept of conversation
Classification by a single feature - proportion remains the same despite new setting e.g. 'More' fluid in taller, thinner container.
109
Describe the concrete operational stage of childhood cognitive development
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
Struggle with hypothetical/metaphors (e.g. Could be scary in a medical setting - 'balloon' lungs may pop)
110
Describe the formal operational stage of childhood cognitive development
Abstract logic
Hypothetical deductive reasoning
Often teenagers struggle to consider the future
111
What is Vygotskys theory of congenital development?
Cognitive development requires social interaction. Child is an 'apprentice' - learns through shared problem solving. Focus on 'zone of proximal development' - at a child can achieved with help and support
112
Give some general rules of thumb for when interacting with children
Don't assume 'average' ability, must be at individuals level
Young children lack theory of mind - may think others know how they feel
Difficult to articulate feelings/think about the future
Danger of using metaphors!
113
If access to primary care giver is limited (e.g. In hospital), what might help?
```
Good quality care, e.g.:
Play specialists
Homely stimulating environment
Familiar toys
Continuity of contacts
```
114
What can be critical in a consultation with a child?
Must get parents trust, as child goes off parents cues.
The context of the child within the family as a whole
Be truthful
115
What is social referencing?
Child looking at e.g. Parent to know how to react
116
What are the 3 main patterns of dying?
Gradual death - with a slow decline in ability and health
Catastrophic death - through sudden and unexpected events
Premature death - in children and young adults through accidents or illness
117
What might be in a patients perspective of terminal illness?
```
Fear of what lies ahead
Changes in responsibilities
Feeling like an outsider
Loss of identity
Losing the future
Worries about impact on family
```
118
What are the 5 stages of the grief model?
```
Denial
Anger
Bargaining
Depression
Acceptance
```
119
What is 'bad news' medically?
Any information that drastically alters a patients perspective of their future for the worse
120
You should tailor discussions about terminal illness to the patient, according to what?
Their needs, wishes and priorities
Their level of knowledge about, and understanding of, their condition, prognosis and treatment to be done
The nature of their condition
The complexity of the treatment
The nature and level of risk associated with the investigation or treatment
121
Describe the model for breaking bad news
```
Setting and listening skills
Perception of patient
Invitation from patient
Knowledge
Empathy
Strategy and summary
```
122
What should the setting for breaking bad news be like?
Face to face
| Ensure privacy, no interruptions. Tissues available
123
What is patient perception with regards to breaking bad news?
What does the patient already know?
124
What is invertation with regards to breaking bad news?
Invitation from patient to give information - don't assume they'll want to know everything
125
What is knowledge with regards to breaking bad news?
```
Give a warning shot
Give info in small chunks
Direct patient towards diagnosis
Check understanding
Avoid jargon!
```
126
What is strategy and summary with regards to breaking bad news?
Agree the next step
Be optimistic
Offer opportunity to ask questions
