Psykologi och hälsa Flashcards
1
Q
General paresis
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Mental deterioration, bizarre behavior result from massive brain deterioration from syphilis.
2
Q
Abnormality
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Defined in different ways:
- One is if the person is severely distressed. Then their condition is considered abnormal.
- Dysfunctional for either the person or society and other’s in the person’s vicinity. Lack of control plays a big role here.
- Societal judgement guided by norms concerning deviance.
Abnormal behavior is distressing for individual, dysfunctional for individual and/or so culturally deviant that other’s deem it maladaptive or inappropriate.
3
Q
Diagnostic reliability
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Clinicians using the system show high level of agreement in their diagnostic decisions.
4
Q
Diagnostic validity
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The diagnostic categories should effectively capture the essential features of the various disorders.
5
Q
DSM-IV-TR(Diagnostic and statistical manual of Mental disorders, Fourth Edition, Text Revision) has five axes based on five dimensions.
A
Axis 1: Primary diagnosis. Represents the patients primary clinical symptoms, the deviant behavior or thought processes that are happening at that time.
6
Q
Axis 2:
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Reflects longstanding personality disorders or mental retardation which may influence thoughts, behavior and response to clinical intervention.
7
Q
Axis 3:
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Represents present medical conditions such as blood pressure, recent concussions etc.
8
Q
Axis 4
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According to the vulnerability-stressor model, a diagnosis of the person’s psychosocial and environmental problems recently, is made.
9
Q
Axis 5
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An evaluation of the person’s coping abilities, reflected in recent adaptive functioning.
10
Q
Functional perspective
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The perspective we create when we try to accumulate knowledge of people.
11
Q
Contexual functionalism
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Finding the functions of behavior in the context in which they’re exhibited. Is often supplemented to a topographic analysis.
12
Q
Functionally equivalent behaviors
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Different behavior that perform the same function.
13
Q
Pragmatic truth perspective
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What is true is dependent on what we are trying to accomplish. Pragmatics drives the formulation of the answer as to what is true.
14
Q
BAT(Behavioral avoidance/approach test)
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A test designed to measure how far a patient is able to carry out an activity before it becomes unbearable, then you can record thoughts and emotions that arise when that point is reached, and even before it is reached.
15
Q
Topographic analysis
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Only describes behavior but does not explain it causally. Looks at excess, deficiency in the behavior. Aswell as duration and intensity.
- Sammanhanget
- Frekvens.
- Intensitet
- Duration
Important to use verbs instead of nouns. Concretisize. Positive terms, no negations. Inner, outer behavior? Voluntary, involuntary?
What does the patient want, which behavior?
16
Q
Contingency/Sequence analysis
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Contingency means a context in which an event has a specific probablity of occuring dependent on another event.
17
Q
ABC-
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Antecedent, Behavior, Consequence.
Three levels of explanation that allows a therapist to understand what happens, when/why and what follows as a result of the behavior.
18
Q
Establishing condition
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The fourth factor that sets the scene for the ABC sequence. It’s basically in which condition or context is all of this happening? It is like A and C susceptible to external influence.
The establishing conditioning enhances the reinforcer. Being hungry increases the reward from the reinforcer of eating.
19
Q
Positive reinforcement
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Adding a consequence increases the probability of a behavior being repeated.
20
Q
Negative reinforcement
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Removing a consequence increases the probability of a behavior being repeated.
21
Q
Positive punishment
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Adding a consequence decreases the probability of a behavior being repeated.
22
Q
Negative punishment
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Removing a consequence decreases the probability of a behavior being repeated.
23
Q
Aversive
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Associated with negative affect.
24
Q
Appetitive
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Associated with positive affect.
25
Generalized reinforcer
A reinforcer that brings about various benefits. It is a reinforcer which value must be learned or conditioned. It has no biological value for the person, instead it is a medium to other reinforcers. Money is a generalized reinforcer that opens up the possibility of acquiring a primary reinforcer such as food.
26
Primary reinforcer
Unconditioned reinforcer that has biological value to us. Needs no external reinforcer to drive behavior, the behavior has an internal reinforcer built in.
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Utsläckningskrevad
Behavior's intensity or frequency briefly increases to try to obtain the reinforcer that used to accompany behavior, but after seeing that this does not occur, behavior is extinguished.
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Cardinal symptom
The most important symptom for a diagnosis.
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Life event scales
Self-reports that quanitfy the amount of stress a person has suffered over a period of time.
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Strong stressors
The most stressful stressors are unpredictable, uncontrollable and that last a long duration.
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Cognitive appraisal of stressor
Four aspects.
Primary appraisal: Of the demands and nature of the situation.
Secondary appraisal: The resources available to cope with it.
Judgements of the possible consequences of the situation.
Appraisal of the possible personal meaning of the situation, what could it imply about us?
32
General adaptation syndrome (GAS)
Consists of three phases, alarm, resistance and exhaustion.
Sudden activation of the sympathetic nervous system triggers the alarm phase.
Resistance is when the body's resources are mobilized during a prolonged time. Stress hormones are continually secreted. There is a limit to how long this can be sustained.
Exhaustion occurs when the body's immune system is too weak, and vulnerability to disease is very high. Can lead to collapse, sickness or death.
Critique against GAS theory:
Unspecific and general.
Are rats and humans really able to be compared when rats were tortured?
What is stress? The stimulus or response?
Is it the emotional interpretation of signals?
Everything threathens homeostasis, is everything a stressor?
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Biphasic model of stress
Short term acute stress enhances immune response.
Long term chronic stress supresses it.
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Vulnerability factors
Things that increase our susceptibility to stressful events.
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Protective factors
Environmental or personal factors that facilitate good response to stressful events.
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Coping self-efficacy
The belief that we are capable of coping with a stressful event. Previous success builds it, failures undermine it.
Seeing others cope helps us feel that we too are able. Aswell as social persuasion increases coping self-efficacy.
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Type A behavior pattern
Being agitated, hostile, competetive, and having fast speech.
Type A behavior is defined in terms of an extreme sense of time urgency, impatience, competitiveness, and aggression/hostility.
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Problem-focused coping
Strategies that confront the problematic situation or that change it so that it is no longer deemed stressful.
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Emotion-focused coping
Strategies that manage the emotional responses resulting from the stressful event.
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Seeking social support
Turnings for others for emotional support and assistance, either emotionally or in the form of tangible aid, such as money.
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Seeking social support
Turnings for others for emotional support and assistance, either emotionally or in the form of tangible aid, such as money.
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Discriminative stimulus
A stimulus that indicates what behavior is appropriate in order to be rewarded or avoid a punishment.
42
Extinction
Respondent conditioning: When conditioned stimulus and unconditioned stimulus no longer occur simutaneously. That leads to the conditioned stimulus not leading to a conditioned response. This is because the unconditioned stimulus is no longer present, thus the predictor which is the conditioned stimulus does not work as it should.
Operant conditioning: When a consequence that was reinforcing the behavior no longer follows the behavior.
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Learning
The process in which an experience produces a relatively enduring and adaptive change in an organism's capacity for behavior.
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Interoceptive conditioning
An internal stimulus that triggers a respondent conditioned response. An increase in pulse may lead to a conditioned response of panic because a higher pulse has been conditioned in relation to panic attacks.
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Intermittent reinforcer
When the reinforcer is only occasionally applied to the behavior. It is a potent reinforcer.
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Generalization
Things similar to the conditioned stimulus will also elicit a similar response to the conditioned one.
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Schedules of reinforcement
A reinforcement schedule states when a reinforcer will be applied, if at all.
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Temporal relation, kontiguitet
Förstärkningen/Bestraffningen bör ske nära i tid till beteendet.
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Causal relation, response-reinforcer contingency
Is the reinforcer necessary and strong enough?
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Variable-ratio schedule
Reinforcer is varied and irregular, this is a strong reinforcer and creates a stable and steady flow of responses in search of reinforcer.
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Self-instruction training
Talking to oneself to better guide effective coping mechanisms.
There are four stages in which this process unfolds.
1. Preparing for the stressor.
2. Confronting the stressor.
3. Dealing with the feeling of being overwhelmed.
4. Cognitively appraising the efforts used for coping.
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Gate control theory
Experience of pain comes from the opening and closing of gating mechanisms n the nervous system.
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Transtheoretical model - six stages of change
1. Precontemplation: Person does not perceive a health-related problem, denies that something is unhealthy or feels powerless to change.
2. Contemplation: Perceiving a problem or a desireability to change but have not acted upon it. Until the perceived benefits of the behavior change outweighs the effort costs of changing, contemplators will not change.
3. Preparation: The person has decided to change, is preparing to do so, taking preliminary steps to change - such as cutting down on the number of cigarettes that they smoke daily.
4. Action: The person changes their behavior. High effort is involved here. Dependent on behavior-controll skills.
5. Maintenance: Successful at avoiding relapse for at least 6 months. May still relapse at a later stage, but then they reinstate their change efforts. Smokers typically pass through 3-5 cycles of this before kicking the habit.
6. The change in behavior is so ingrained and under personal control that the problematic behavior never returns.
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Allostatic load
The stressful load that repeated and prolonged stress reactions have on the body as the allostatic system tries to prepare and adjust for. It is the activation of the stress response and the upholding of this response that damages the body and mind. Long term stress reaction.
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ISO-strain
Low grade of control, high demands and low social support. Worst type of strain.
56
Occupational burnout
A state of exhaustion accompanied by a lack of professional efficacy and cynicism towards the value of one’s occupation.
57
Conservation of resources theory
Burnout is expected to occur when objects, conditions, people, energies that we value and are motivated to obtain, maintain and protect are threathened or lost OR when a person invests resources but fails to regain them.
58
Health
The state of complete physical, psychosocial, economical and spiritual well-being, not simply the absence of illness.
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Psychological factors
Emotions, thoughts, behavior, learning, attitudes and assumptions, motivation.
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Biological factors of biopsychosocial model
Inherited vulnerability and previous medical history affects how future pathology develops.
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Social factors of biopsychosocial model
Socioeconomical, socioemotional and sociocultural factors: Workplace, family, ethnicity, economy, culture, religion, social status and roles.
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Illness cognitions
Subjective experience of illness. Factors that affect: interpretation of symptoms(catastrophizing), emotional response and coping
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Motivational interviewing
Guiding a person through interviewing them about their current self and their ideal self.
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Multimodal treatment approaches
Aversion therapy: creating an aversive link to the behavior.
Relaxation and stress management training.
Self-monitoring
Coping and social-skills training
Positive reinforcement procedures to strengthen change
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Relapse prevention
Reduces the risk of relapse. This is done through preparing in advance for risky situations that might trigger relapse. Slipping is okay, relapsing should however be prevented. To do this, the behavioral changes need to be maintained. This can be done through exposure therapy.
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Abstinence violation effect
The person becomes upset and self-blaming over the lapse and convinces themselves they will never be able to resist temptation.
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Stress induced analgesics
Stress induced painkillers: If I hit my shin and it hurts and I then see a mountain lion I might not feel the pain because a more stressful stimulus has revealed itself.
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preventions
primary: for all people
secondary: for people at risk
tertiary: people who are feeling bad.
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Diagnosis
Helpful for three reasons
1. Knowing we are talking about the same thing.
2. Treatment plans.
3. Investigating ethiology, the causes of the condition.
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Psychodynamic psychotherapy
Exploring subconscious conflicts aswell as cognitions and emotions that create problems in the daily life.
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Cognitive behavioral therapy
Focuses on conditioned behavior and changing the responses to conditoned stimulus.
Focus on information processing and filtering and interpreting information and how to use that to our advantage.
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Interpersonal psychotherapy
Emphasizes interpersonal issues and psychological issues. No assumptions of ethiology but focuses on importance of interpersonal relationships in the present moment.
Four interpersonal themes:
Role conflicts
Grief
Role changes
Interpersonal competency flaws
Originally meant for depression but is also used for other diagnoses.
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Functional behavior classes
Topographically distinct behaviors that fill the same purpose and have the same function.
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Behavior observation
Antecedents, Context, Establishing circumstances, Behavior, Consequences.
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Habituation
We become less and less responsive to stimulus that is non-threathening, ultimately not consciously experiencing it.
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Sensitization
Becoming more and more responsive to aversive or threathening stimulus, experiencing it more intensely.
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Respondent learning
Coupling a neutral stimulus to a biologically inherent one, ultimately conditioning the neutral one to become conditioned and eliciting a similar response as the unconditioned one. Albeit less intense.
Good neutral stimulus that can be CS:
Clear stimulus.
Unprecedented, thus not conditioned to any other experience.
Typically of the same modality as the unconditioned stimulus.
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Reinstatement
The conditioned behavior is reinstated after exposure to US(Unconditioned stimulus). A person might use earbuds, gets a headache, stops usage then starts again, does not suffer headache, but once again after a while suffers it again, the conditioned response, in this case aversion to earbuds comes back.
78
Renewal
The conditioned behavior is reinstated after a change in context when the extinction occured in a previous context.
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Model learning
4 steps.
1. Attention to what is done.
2. Retention of observed behavior.
3. Reproduction - being capable of repeating the behavior.
4. Motivation - wanting to perform the behavior for a reward or avoiding punishment.
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Prevention
1. Primary Prevention(PP): Modifying risk factors before disease arises. Stopping smoking, dieting better, exercising.
2. SP : Actions to discover disease before it manifests itself. Screening and self-assessment. Such as checking testicles when showering.
3. TP: Treatment and intervention of manifested disease. Physiotherapy, medicine, psychotherapy.
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3 types of stressors
1. Daily Hassles - Losing keys
2. Negative events - Death of loved one.
3. Catastrophies - Natural disasters
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Fight or flight response
Prolonged stressors lead to biological decay. Physics-inspired explanation. A cortex that can take some strains but overstraining it leads to decreased endurance and ultimately exhausted cortex.
83
Acute stress reaction
Signal reaches brain, amygdala, emotional response generated. Leads to activation of sympathetic nervous system. As well as the HPA-axis: Hypothalamus, Pituitary Gland and Adrenal gland.
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Acute stress reaction
Signal reaches brain, amygdala, emotional response generated. Leads to activation of sympathetic nervous system. As well as the HPA-axis: Hypothalamus, Pituitary Gland and Adrenal gland.
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Allostasis
Homeostasis is upheld by allostasis which is the body's secondary cognitive system that predicts future needs thus prepares for them in order to minimize uncertainty.
85
Demand-control model
Job demand and job control influences how stressed we are. If we have high demands and low control we are bound to be very stressed as well as low social support is a strong moderator for stress.
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Effort-reward imbalance
Exerting high effort for low reward might take a toll on us. Whether the reward is monetary or social is irrelevant for the stressful response.
Reward can be both intrinsic and extrinsic.
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JD-R model
Job-demand-resource model. High demands and low resources both personally as well as professionaly leads to a stressed response.
Social support is essential for employee well-being
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Stress-management
In the chain reaction of:
Stressor --> Coping --> Stress response --> Overload
Treatment is typically focused on stressor and coping. Such as effective communication skills, time management, emotional intelligence. Coping can refer to relaxation exercises.
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Appraisal theory
1. Primary appraisal: Interpretation of the demands and stressor.
2. Secondary appraisal: Interpretation of available resources to cope.
3. Stressful response.
4. Coping mechanisms.
5. Reappraisal: Pacing and learning. Reframing ideas and assumptions of one self in relation to events, may modulate emotional responses in the future.
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Risks of shallow theories
Mislabeling central human activities as harmful because they may be stressful.
Risk of stress-phobia.
Unspecific interventions due to unspecific definition of stress, leads to high variability in healthcare quality.
Simplified theories leads to missing central aspects of how exhaustion develops and is sustained.
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Behavior-medicinal take on stress
What is a considered suffering depends on the needs and goals that each patient expresses. It is only a problem if it interferes with how we want to live our life.
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Alternatives to biomedicinal model
Psychosomatics: Psychological illness manifests as somatic distress in the body.
Health education: Information and it's effects in improving health and life style choices.
Behavioral medicine: Health improved through usage of learning psychology.
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Biopsychosocial model
All three aspects affect health and give rise to disease. Improving all dimensions is essential to ensure improved health.
Health behavior and sickness behavior comes from biological factors such as genetics, metabolism etc, behavior such as diet and exercise, social such as ethnicity, social status, role etc.
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Chronical illness
How one is affected is influenced by a number of factors:
Sense of control over situation
Acceptance of condition
Perception of condition
Interpretation of condition
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Key components of biopsychosocial perception of pain from stress perspective
Multidimensional perception of pain.
Prior vulnerabilities.
Stress and challenges.
Vulnerabilites from before(diathesis) interact with stress.
Social context, model learning. If your mother never complained about pain you are less likely to do so aswell.
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Assumptions of biopsychosocial model
1. Individual is responsible in part for her health.
2. A holistic approach to the situation, not just segmented and compartamentalized. Not just biomedicinal or physical assessment.
3. Focus on the individual's involvement, integrity and overall well-being.
4. Focus on interactional process between physiological and psychological factors in a sociocultural context.
5. Psychological factors are not just a consequence of the illness but also a causing factor.
6. Health and illness is on a spectrum, not quantitive stages.
7. Body and spirit interact and influence each other.
8. Psychological influences:
Direct: Stress --> Sickness
Indirect: Stress --> Cognitions --> Behavioral changes --> Sickness
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Strengths of biopsychosocial model
1. Higher patient satisfaction.
2. Development for treatments to reduce risk behavior that contributes to health dangers.
3. Increased comptency and understanding of one's own situation, not just a passive recipient of healthcare.
4. Predicts disease, allows for preventive measures. If we know of risk factors socially or psychologically we can prevent biological factors worsening aswell by treating the other dimensions.
5. Remarkeable improvement in quality of life in patients with chronic illness.
6. Increased psychosocial support for chronically ill patients.
7. Physiotherapy and behavioral medicine.
98
Setbacks with biopsychosocial model
1. More expensive, time consuming
2. Complex assessment, many factors.
3. Theoretical base needs to be evaluated and developed.
4. Etymological factors harder to determine, causality is not clear-cut.
99
Behavioral medicine
Applying techniques from behavioristic principles to treat behavioral problems that arise as a result of physical disease.
BUT ALSO treating physical illness with behavoristic principles of conditioned behavior and model learning etc.
Consequences of diagnosis are differentiated from diagnosis. Allows for prioritization of goals. Different professionals may treat different consequences of the same diagnose.
100
Perceived behavioral control
Self-efficacy important here. It is a moderator for how well we will perceive our ability to cope with a situation.
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Physiological moderators
Social support and recovery ability.
102
Factors of adjustment
Explaining model: Why did this happen? Satisfactory explanatory model leads to higher grade of acceptance.
Effects: Both perceived and real ones.
Self-efficacy: Will I be able to handle this?
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Bedömning av funktionsnivå
Hur patients psykiska symptom inverkar på vardagen och i vilken utsträckning.
Man gör en funktionsnivåbedömning för att avgöra huruvida pat. uppfyller konsekvenskriteriet i DSM-5, inverkar symptomen på patientens funktion? Kan även underlätta diagnostiken, om man ser hur funktionsnivån är nu och hur den varit tidigare kan man få ledtrådar om vad det kan handla om.
Avgör vårdbehovet - om man har låg funktionsnivå behövs starkare insatser
Allokering av resurser: Den som har det värst behöver mest vård och då behövs resurser.
Relevant för utvärdering av utfallet av insatser, lyckades vi ge patienten en bättre funktionsnivå för att leva sitt liv som den vill?
Mycket underlag för att bedöma funktionsnivån får vi från det anamnestiska samtalet.
Dock svårt att bedöma vad som är nedsatt funktion - relativt till personen tidigare eller andra personer i liknande kontext och som är i samma utvecklingsnivå eller livsstadie. Standardiserade instrument är till hjälp
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WHODAS 2.0
WSAS
Standardiserade instrument för att bedöma funktionsnivå. Ställer frågor om olika aspekter av funktion. Självskattningsformulär.
105
ABAS-2, Vineland
Standardiserade anhörighetsanamnesverktyg för att bedöma funktionsnivån på en patient.
106
Syfte med kartläggning under anamnestagning
1. Visa intresse, skapa förtroende och ge utrymme för att berätta
2. Få info om sårbarhet, riskfaktorer, utlösande händelser, stressorer, vidmakthållande faktorer, skyddsfaktorer och livssituation
3. Få information om funktion och relatera det till diagnostik.
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