Sociocultural psychiatry Flashcards
Ethics
Sociocultural psychiatry
Three distinct ethical principles
Teleological systems focus on consequences. The rightness of an act is determined by it’s end. So the emphasis is on the consequence of an action. Aka consequentialism
Deontological ethics: place an emphasis on a person’s action rather than consequence. Morality of an action can be determined if a person has breached an obligation/rule of duty. Rule based ethics.
Virtue based ethics: Where emphasis is on moral character rather than the reasoning behind an action.
Virtue ethics and utilitarianism. Virtue is generally agreed to be a character trait, and the ethical principle emphasises the moral character of an individual as the driving force for an ethical behaviour.
Utilitarianism is a moral principle that holds that the morally right course of action in any situation is the one that produces the greatest balance of benefits over harms for everyone affected.
Global ethical policies
Decleration of Geneva (Physicians oath) declares a doctors dedication to humanitarian goals of medicine. Introduced following Nuremberg.
Declaration of Helsinki – Outlines ethical principles regarding human experimentation
Decleration of Tokyo – States that doctors should not participate or condone the act of torture or cruel treatment of prisoners.
Decleration of Lisbon – Outlines the principal rights of the patients that the medical professional endorses
Decleration of Orrawa – launched a series of actions among international organisations to acheieve the goal of health for all.
Human rights
Human rights act become law in 1998 and incorporated the rights contained in the european convention on human rights into UK law.
Models of illness
Impairment - structural or psychological damage to the person
Disability - inability to carry out ADL
Handicap- Social disadvantage resulting from the disability
Sick role described by American sociologist Talcott parsons.
Health belief model
They used the attitudes and experiences of individuals to help explain and predict health behaviours.
Model identifies several patient beliefs that might impact their treatment participation:
Core beliefs - Beliefs about severity of their illness
Belief about the susceptibility of acquiring the disease/complications
Belief about financial cost and of time and effort
Belief about benefit or success of treatment
Beliefs regarding the environment and social cues to accept the treatment.
The transtheoretical model (TTM)
Developed by James Proschaska and Carlo DiClemente (1982) this model aims to describe how a person can change their behaviour or acquire a new behaviour. 5 key modelts that encourage a person to change their behaviour:
Autonomy - increasing awareness of alternative treatments/behaviours
Increasing awareness - Of the problem and it’s consequences
Catharsis - emotional acknowledgment of the problem and the process of change.
Conditional stimuli - Involves counter conditioning: developing an alternative baheviour and avoidance of stimuli associated with behaviour
Positive reinforcement - from others and self reinforcement
Prochaska and DiClemente devloped 5 stages of change:
Precontemplation - the person has not yet considered changing their behaviour and does not see it as a problem.
Contemplation - Person starts to consider changing their behaviour and becomes more aware of the pros and cons of doing this.
Preparation - The person develops plans to change
Action- person carries out the behavioural change
Maintanence- person maintains the behavioural change
Family life
General systems model of families regards each family member as connected emotionally and each action of the family produces a reciprocail reaction in one of its member and vice versa.
Basis of family therapy.
Theodre lidz was an advocate for environmental causes of schizophrenia.
He researched family life in relation to schizophrenia and proposed two patterns
Marital skew and marital schism
Theory of expressed emotion
George brown and Michael rutter looked at family of a patient with schizophrenia and will talk spontaneously about the patient. Degree of expressed emotion
Degree of expressed emotion within a family is determined by the camberwell family interview:
Positive remarks
Criticial remarks
Emotional warmth
Hostility
Over involvement
Showed patients living in high EE families more likely to relapse.
Society and mental health
Society and mental health
George Engel’s Biopsychosocial model is widely used by psychiatrists in aetiological formulations.
Social causation theory – proposes that mental illness is caused by lower social class poverty. This theory does not hold true for conditions such as bipolar disorder and schizophrenia.
Social drift theory – recognises that whilst schizophrenic patients are over represented in social class V, their parents are not. Implies mental illness results in downward drift of economic status.
Social construction theory – Proposes that mental illness has been constructed by certain groups in society for their own personal interests.
Immigration and schizophrenia
Schizophrenia more frequently seen in migrant populations than native.
This is also observed in other mental disorders, but schizoprehnia is the most researched.
Change in environment rather than change in genetics play a significant role.
Stigma
Stigma is an attribute or trait considered to be shameful that sets a person apart as inferior or unacceptable.
Changing minds was a five year campaign in response to an early survey that showed most people with schizophrenia are violent and unpredictable.
Felt stigma - Persons fear of stigma
Enacted stigma - Persons experience of discrimination
Self stigma - Prejudice a person might hold about themselves. Internalised stigma develops as a result of societal views.
Public stigma - Negative reaction of the general population to a specific trait or attribute
Courtesy stigma - Stigma experienced by a person with a close association to a person who bears a stigma
Grief
Grief reaction
John Bowlby described the stages of grief. He observed that people can go back and forth between the stages and that there is no specific time frame to move from one to another.
Shock and disbelief - first few days
Yearning and anger - first few weeks
Despair and acceptance of loss - several months
Resolution - 1-2 years
Kubler Ross model can be remembered as DABDA
Denial, anger, bargaining, depression, acceptance.
Abnormal grief
Some people might experience a delayed grief reaction in which there is marked lack of grief symptoms in the first two weeks as they consciously or subconsciously make an effort to avoid painful emotions.
Others may experience a prolonged grief reaction and demonstrate grief related symptoms long after death (>6 months)
Features of abnormal grief
Generalised guilt
Suicidal thoughts
Hallucination
Feeling of worthlessness.
