Psychosocial Flashcards
When is an abortion allowed
when a medical practitioner and two others are of opinion that: its not passed the 24th week, injury to health/mental of mother or child. continuation poses greater risk. Child suffering.
consent in 16-17 yr olds
presumed to have capacity unless shown otherwise, so can give consent. If they refuse, parents can consent if in best interest.
Consent under 16 and Gillick competent
presumed not to have capacity unless shown otherwise, then can give consent. When can understand. Unlikely under 13 have capacity.
Children who are not Gillick competent
Parental responsibility give consent in childs best interest. Can involve courts. (specific issue order) In an emergency act to save the life.
confidentiality in minors
same as adult. only broken when health + safety at risk. share info about under 13s sexual activity as deemed not to give consent.
what is a health behaviour
aimed to prevent disease, eating healthily etc
what is illness behaviour
aimed to seek remedy, going to the doctor etc
what is sick role behaviour
activity aimed at getting well
Attribution theory
About causality. Internal vs external locus of control. stable vs unstable. global vs specific. control vs uncontrollable.
risk perception
not rational when lack of experience with the problem, belief its preventable, belief that its not appeared yet so wont. belief that its infrequent. leads to selective focus - ignore risk increasing behaviour.
risk compensation - behaviour can be neutralised by another
self affirmation theory
protect self integrity. if presented with info that threatens sense of self, behave defensively. but if can self affirm, threat to resist information is reduced.
HBM
perceived susceptibility, severity, benefits, barriers.
Pain
an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Subjective.
Predictors of pain and disability
Resilience model, reduction in pain. (acceptance, mindfulness, readiness for change, optimism, coping, self efficacy.) Vulnereability models, increase experience of pain. (anxiety, depression, fear, catastrophising, somatic attention)
three process model of pain
physiological (tissue damage, endorphins etc), cognitive (classical and operant conditioning, role of affect - anxiety, fear, role of cognition - catastrophising(rumination, magnification, helplessness)meaning, attention.) behavioural.
ABCDE system of CBT
Awareness. Beliefs. Challenge. Delete. Evaluate.
Fit note
an employer shouldnt ask for evidence before 7 days. you can get statutory sick pay for 28 weeks.
Perception
Oart if the memory and retrieval process, dependant on attention. bottom up processing -matches to excisting sets in the brain, then recognises it.
Top down - we see what we expect.
Attention
Selective - attend more to stimuli that are changing, meaningful. Divided or focused. Negativly effected by stress.
sensation
function of the low-level biochemical and neurological events that begin with the impinging of a stimulus upon the receptor cells of a sensory organ. It is the detection of the elementary properties of a stimulus.
goals of sensation and preception
P - create useful information of the surroundings. S - detection. Linked by transduction
principles of gestalt
adjacency/proximity principle: things closer together will be percieved as belonging together. Similarity principle: look similar percieved as part of the same form. Good continuation: refers to predictability or simplicity. Law of closure: visual system supplies missing info that closes the outline of an incomplete figure.
Model of memory
Perception, storage, retrieval
ICF
Impairment, activity limitation, participation limitation
Disability
physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day- to- day activities.
Individual model of disability
Personal tragedy, medical problem, individual adjustment
Social model
- community participation is hindered by inaccessible environments.
- those with disabilities are oppressed by medical and social service professionals.
- underestimation of needs, poverty and deprivation.
Psychological model of disability
motivated to engage in the activity because it results in things they like, because they believe that other people who are important to them would like them to do it and because they believe they can.
biographical disruption
The experience of chronic illness leads to a loss of confidence in the body, and from this follows a loss of confidence in social interaction or self-identity
crisis model
primarily though not exclusively associated with the consequences of labelling and stigma. Here, the onset of a chronic illness is seen to irreversibly change the social status of an individual
negotiation model
focuses upon the emergent nature of the chronic illness experience. Living with a chronic illness is seen as representing a potential loss of self, in which the individual struggles to maintain `normality’ over time, and in the face of the uncertainty associated with such degenerative and debilitating illnesses. Thus, the model emphasises ‘adaptation’ rather than the adoption of a ‘deviant identity’ as in the stigma and labelling model.
types of stigma
- Stigma –branding or making.
- Enacted Stigma – societal reaction produces discriminatory experiences.
- Felt Stigma – expected societal reactions can change self-identity.
Effects of deafness
development of speech, language and cognitive skills in children. Slow progress in school. Difficulties with jobs. Social isolation and stigma. Risk of depression. Anxiety, reduced motivation.
fast mapping
children first learn the names of things which they interact, this quick learning of new content words is fast mapping
overextension and underextention
overextension - says ball when looking at an orange. uses ball to only describe a small red ball in underextension.
sensory memory
representations of the physical features of a stimulus are stored for a very brief time, perhaps for a second or less. This form of memory is difficult to distinguish from the act of perception.
short term memory
immediate memory for stimuli that have just been perceived. Capacity 7. chunking. Acoustic engrams make it easier. similar words are lost. frontal and parietal lobes
working memory
like STM that only lasts a short time but it allows us to manupulate material in STM. Manipulation not just storage.
long term memory
info stored on a near permanent basis. semantic code, things that mean similar get lost. hippocampus and sleep is essential for consolidation.
Iconic and Echoic memory
visual and auditory
levels of processing
deep vs shallow. automatic vs effortful. encoding specificity.
types of memory
procedural (motor skills), declarative (conciously recalled), implicit, explicit (concious processing, attention).
multi store model
sense organs to sensory memory - attention paid STM - rehearsal transfers to long term memory, retrieval to STM
model of working memory
central executive controls the phonological loop and visuospatial sketchpad.
levels of processing model of memory
memory is what happens as a result of processing info. doesnt distinguish between short and long term. Compares superficial to deep processing. Superficial - structural and phonemic processing. maintanence rehersal. Deep processing - semantic, elaboration rehersal.
constructivist model
people who perform a memory task actively reconstruct what they remember. • Memories stored in several interconnected units in network.
• Strength of unit increases as a function of learning.
• Strength of unit increases number of connections with other units
Ebbinghau’s Forgetting Curve
initially info is lost quickly. factors like how its learnt and rehearsed play a role in how quickly its lost. levels off, so long term is stable.
theories of forgetting
decay of trace/engram. (forgetting from STM which naturally decays). Interference (forgetting from LTM. limitation to processing ability - lack of sleep). Motivated forgetting. Superficial processing.
Stroke and DVLA
you cant drive for at least 1 month. If had a few successive TIAs have to wait 3 months before returning.
coping
managing stressors that have been appraised as taxing or exceeding a person’s resources. Appraisal, reappraisal, evaluation and reevaluation. Approach v avoidance, problem v emotion.
Goals of coping
To reduce stressful environmental conditions and maximize the chance of recovery
To adjust or tolerate negative events
To maintain a positive self-image
To maintain emotional equilibrium
To continue satisfying relationships with others
mental capacity act
protect those who cant make decisions for themselves. Purpose: advance decisions, LPA,
advance decision
written, legally binding. in the presence of a witness. It has no sway when capacity present.
Lasting power of attorney
person over 21 (donor) can appoint a person (donee) to make decisions if capacity is lost. Can act in personal welfare and property and affairs.
Quality of life
o A broad ranging concept affected in a complex way by a person’s physical health, psychological state, level of independence, social relationships and relationship to salient features in their environment.
quality of life can be used to:
compare treatments. investigate reasons for poor adherence. Policy making and resource allocation.
QoL scales
Generic v Illness specific. Standardised v individualised (SEIQoL, select 5 most important domains). Uni dimentional v multidimentional.
Measures must be reliable valid and sensitive.
Mental health act
reception, care and treatment of mentally disordered persons, the management of their property and other related matters. legislation which people can be detained, assessed and treated against their wishes. Use reviewed by care quality commission.
Section 5(2) of MHA
allows a consultant to detain an inpatient for 72h until further assessment.
Section 2 MHA
2 doctors (trained or psychiatrist and Ps GP.) and an approved mental health professional can detain for 28 days for assessment if susspect a mental illness and are at risk of harming them or others. Must be seen in 14 days of making application. doctors must see you 5 days apart. care plan with care programme approach helps needs met on release.
Section 3 MHA
detain for 6 months for treatment.
community treatment order
you can be readmitted to section 3 if they dont obey specific conditions.
rights under MHA
appeal to a tribunal, once in the 6 months. Get help from an advocate. Can be treated against their will for 3 months, then seen by a second opinion. released by responcible clinician, MHA manager, relative, tribunal.
mental capacity act
can admit those without capacity to sustain life. Must document and show capacity is impaired. DOLS apply and must involve a IMCA.
regarding the MCA, what is coercion
coercion is forcing someone to act in an involuntary manner by intimidation or threats or force. its justified when have a mental disorder as this automatically entails lack of competence to make decisions.
adherence
following the advice of health care professionals. Pill counts, blood or urine samples can measure adherence. 50% non adherent.
non adherence includes
not taking enough or taking too much meds. Not taking the whole course, not leaving correct intervals. Taking aditional unprescribed meds. Not following advice. Not attending appointments.
Common reasons for non adherence
instructions difficult or forget them. disagree with plan. not understanding the treatment. not trusting the doctor. unwanted side effects. Most important predictors are beliefs about illness and treatment.
with SZ, non adherence is predicted by
not seeing a benifit, not knowing about relapse, not liking it, poor insight on their condition, poor relationship with the prescriber.
adherence is most likely to occur when
understand, remember, satisfied. Concordance in consultations.
when symptoms are felt, when dose isnt complex. Better mood and social support. Better doc patient relationship.
help seeking triggers
interpersonal crisis. Interference with social or personal relations. Sanctioning. Interference with vocation or physical activity. Temporalizing of symptomatology.
EIS
help return to normal life, reduce duration of untreated psychosis (DUP). Reduced hosp admissions, relapse rates, symptom severity. Other than meds involves CBT, fam intervention, psychotherapy (Milieu) join a support group. Cognitive remediation.
Non interactive theories of placebo
Individual characteristics - emotional dependency, extroversion, highly suggestible. Treatment characteristics - bigger treatment more effective.l Health professional characteristics - who administers it.
Interactive theories of placebo
interactions between Ps, treatment and HCP - experimenter bias. patient expectations - illness change, Ps link this change to the treatment. Reporting error - expect improvment, want to please dr, inaccurate report. Drs report errors if want to see improvement. Conditioning - the unconditioned treatment with conditioned stim(hosp) can get a conditioned responce. Anxiety reduction - gate control, reduce anxiety closes gate to pain.
Physiological theories of placebo
placebos increase endorphin release - brains natural pain killers, so dec pain.
Expectant theories of placebo
Ps and dr expect to work.
Cognitive dissonance theory
investment needed and individuals justify their behaviour, see themselves as rational and in control. Placebos activate unconscious regulating mechanisms.
Shared decision making continuum
Patient/agent driven - Physician shows options but gives no recommendation.
Physician recommentation decision.
SDM.
Informed non dissent - physician determines best course and fully informs.
Acupuncture
works by- release of endorphins, increase blood flow, dec inflamation and swelling, can be utilised after surgery.
Social support
esteem support, companionship, instrumental support.
Social inequalities in healthcare
black report provides 3 explanations.
Natural/social explanation - health influences social mobility.
Cultural/behavioural explanation - similar to above.
Materialistic explanation - housing, education diet effect health.
Artifact
drug abuse
substance used in a way that doesnt conform with social norms. Can abuse without being dependant.
Drug dependance
depends on drug for normal physiological function. withdrawl symprtoms. Can be dependant without being addicted.
drug addiction
behavioural syndrome, compulsive use.
behavioural activation therapy of depression
theory holds that not enough environmental reinforcement or too much environmental punishment can contribute to depression. The goal of the intervention is to increase environmental reinforcement and reduce punishment.
working memory
system responsible for the transient holding and processing of new and already-stored information, and is an important process for reasoning, comprehension, learning and memory updating.
episodic memory
memory of autobiographical events
ways of coping questionaire
asses coping processes
