Stigma onwards Flashcards
What is stigma?
A mark of disgrace associated with a particular circumstance, quality or person
What is social construction?
The enactment of stigma is about social interaction- it is about people’s responses to behaviour or physical appearance
What is the process of producing stigma?
Labelling- labelling human differences
Stereotyping- differences are linked to characteristics which form a stereotype
Othering- separating yourself (us and them)
Stigmatising- Devaluing people based on an attribute considered undesirable
Discrimination- acting differently towards people based on their attributes
What are the types of stigma?
Discreditable- keeping stigma hidden
Discrediting- stigma that can’t be hidden
Felt- shame you feel as a result of stigma
Enacted- discrimination by others
Courtesy- Felt by someone who is with someone who is stigmatised
What is the impact on individuals of stigma?
Internalising- absorbing the social views of others on you
Passing- passing ones self off as being normal but can still have felt stigma
Covering- not disclosing something which they could be stigmatised for- like a blind person wearing sunglasses
What is stress?
An imbalance between demands made on us and our personal resources for dealing with these demands
What are the primary and secondary appraisal of stress?
Primary- appraisal of event
Secondary- Appraisal of personal coping skills to deal with event
What are the 4 components of the stress response?
Emotional- feeling sad, on edge, irritable
Cognitive- can’t concentrate, difficulty switching off
Behavioural- change in appetite, smoking, drinking
Physiological- raised heart rate and resp rate
What is symptom amplification?
Misinterpretation and amplification of symptoms due to stress and other psychological factors
Who is more likely to misinterpret symptoms?
People with: A tendency to worry Mental illness Illness beliefs Previous serious illnesses
How do MUS arise during times of stress?
Misinterpretation of normal bodily sensation
Exaggeration of minor pathology due to stress
What is illness cognitions?
A patients own implicit common sense beliefs about their illness
What are Leventhal’s 5 dimensions to illness cognition?
Identity Consequences Cause Control/ cure Timeline
What are positive coping strategies to illness?
Problem-solving- controlling problem and reconstructing it as manageable, seeking information and support
Emotion focused- involves managing emotions and maintaining emotional equilibrium
What are negative coping strategies to illness?
Problem focused- focuses on problem, unlikely to help reduce stress
What are MUS?
Physical symptoms not explained by organic disease and causing or impairing function, and where there is positive evidence that symptoms are linked to psychological factors
What are the consequences of living with MUS?
Uncertainty- no diagnosis or prognosis
Lack of social support
Can’t enter sick role
Strained relationships with family/ friends
What are the keys to manage MUS?
Acknowledge symptoms genuine Avoid implying symptoms in the mind Provide clear explanations of investigations and results etc. Promote self efficacy Help symptom management Initiate depression treatment if needed
What does the patient want in regard to MUS?
Alliance with doctor over problems
Wants the doctor to recognise they are suffering and its not their fault
A convincing explanation that is plausible and credible
What is exculpation?
Recognise reality of patient suffering and confirm that they are not the patients fault or responsibility
What is addiction?
Continued repetition of behaviour despite negative consequences
What are the symptoms of dependence syndromes?
Salience Tolerance Compulsion Physiological withdrawal symptoms Relief of symptoms by further use Neglect of other interests
What factors make a drug addictive?
Pleasure producing potency
Rapid onset of action
Short duration of action
Tolerance and withdrawal
What maintains addiction?
Personality factors
Social factors
Withdrawal symptoms
What are the stages of the cycle of change?
Pre-contemplation Contemplation Determination Action Maintenance/ or relapse
What are the symptoms of end stage addiction?
Overwhelming desire to take drug
Almost automatic habit
Can be triggered by cues many years after abstinence
What type of conditioning causes addiction?
Operant-
Positive reinforcement- drink for high
Negative reinforcement- keep drinking to avoid hangover
What is the importance of causation?
Explains why things happen
Prevents disease by removing cause
Improve treatments through greater understanding of natural history of disease
How do you prove causation?
Find association
Consider cause of association
Use Bradford Hill criteria to inform decision
What is chance?
The effect of random chance in finding a significant result
What is bias?
Error in the collection and analysis of data
What is confounding?
Both factors not directly associated, but linked by a third factor
What is falsifiability?
We can rarely prove things are true but can easily prove things are false
What is statistical significance?
Strength of association gained by hypothesis testing
What is clinical significance?
Practical importance of treatment effect, whether it has a noticeable effect on everyday life
Name the Bradford Hill criteria?
Strength of association
Specificity- does A always only cause B?
Temporal association- effect has to come after cause
Theoretical plausibility
Consistency- do you always find the same relationship?
Coherence- does the data fit in with what we know now?
Dose-response relationship- does greater exposure lead to greater effect?
Experimental evidence
Analogy- if A causes B, does something similar to A cause something similar to B?
What is a chronic condition?
Long term illness expected to last 12 months or more
What are the positive consequences of being diagnosed with chronic condition?
Access to sick role Relief Employment rights/ welfare benefit Access to information Access to support groups Accepted as ill by friends and family
What are the negative consequences of being diagnosed with a chronic condition?
New set of uncertainties- prognosis etc. Stigma Possible limitations on work Many have to claim benefits Worry about fulfilling obligations Worry about complications
What are the typical grief reactions?
Affective- depression, distress, guilt
Cognitive- Denial, lowered self-esteem
Behavioural- fatigue, agitation, social withdrawal
Psychological- loss of appetite and weight loss
Which part of brain is involved in grief?
Nucleus accumbens
Describe the nature of grief?
Universal- crying
Culturally determined
Biological
Name Bowlby’s stages of grief?
Numbness
Yearning
Despair
Reorganisation
What is complicated grief?
Impaired by prolonged grief
Symptoms- depressive thoughts, anxious, painful memories
What does a child need when grieving?
To know they are going to be cared for To feel important and involved Continued routine Clear information about the death To know they did not cause the death Something to help remember the dead
Define health behaviour?
Activity people perform to maintain or improve health
Why study health behaviour?
Treatment protocols are behaviours
Rising medical costs
Aging population
What is social cognition theory?
Attitudes are developed and modified based on assessments about beliefs and values
Name the theories of predicting and changing health behaviours?
Transtheoretical model
Health belief model
Theory of planned behaviour
What are guidelines?
Systematically developed statements to assist practitioner and patient decisions about appropriate healthcare specific clinical circumstances
Why do we have guidelines?
To allow practice to be more evidence based and enable care to be more consistent across the country
How should a guideline be developed?
Systematically
Using a formal and explicit process
Address relevant clinical question
Use the best evidence to address each question
How do you determine the quality of a guideline?
Application
Clarity of representation
Rigor of development
What is a clinical protocol?
Plan to be followed in patient care
How do you identify all relevant studies in systematic reviewing?
Search relevant databases
Develop complex search strategy
Include unpublished data
Methods of quality assessment?
Randomisation
Allocation concealment
Blinding
Withdrawals and intention to treat analysis
What is heterogeneity?
Similarity of studies
What is publication bias?
Not all clinical studies get published
What is sensitive analysis?
Tests if results are sensitive to restrictions on data
