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SOBE II Mike Rose > Terms to Know > Flashcards

Terms to Know Flashcards

1
Q

Gender Identity

A

Internal sense of being male/female/not comforming to either

It is not the same as sexual orientation or the physical characteristics defining biological maleness or femaleness.

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2
Q

Sexual orientation

A

Individuals preferred sexual preference

Does not imply what sexual experiences that person has had

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3
Q

Transgender

A

Self identity and general sense of self doesn’t not conform to the physical gender

Gender identity is influenced by culture, race, class, etc. becasue norms differ in each group or society

Gender nonconforming in one setting may be conforming in another

Can imply a diverse blending of male and female roles/characteristics/expression rather than distinguishing between extremes of male and female

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4
Q

Transsexual

A

A person who has undergone treatment to become recognizable as a gender different from their birth or assigned gender

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5
Q

Gender non-conforming

A

Not corresponding to usual male/female identity of that culture

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6
Q

Gender dysphoria

A

Physical or assigned gender does not align w/ gender identity and causes distress.

The physical and psychological mismatch is not a pathology, but the stress that it causes is

Goal of treatment is to reduce distress.

Rx includes feminizing and masculizing hormones, sex reassignment surgery, counseling. Effective rx is unique to each person.

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7
Q

Gender conforming or cis-gender

A

Gender identity and assigned gender are the same

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8
Q

Prevalence of transgender/transsexual/gender nonconforming

A

Difficult to study

Male to female: 1:7000 - 1:20,000
Female to male: 1:33,000 - 1:500,000

Most frequently cited is 0.3%

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9
Q

Mental health issues of transgender individuals

A

High incidence of anxiety and depression

Not inherent to being transgender

Related to “minority stress”

90% face gender discrimination

26-54% of transgender youth have attempted suicide

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10
Q

Factors influencing

A

Interplay of biology, environment, culture

Awareness of gender identity develops in early childhood and is influenced by childhood experience

Sexual differentiation of the brain in the presence of androgens

Genetics

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11
Q

Disorders of sexual development

A

These patients have a discrepency between external genitalia and gonadal and chromosomal makeup

Typicall in the past a gender at birth based on apperance of genitalia

Ambigious genitalia - variation in urethral opening, clitoral or penile size, location of gonads, partial fusion of labia

Studying these individuals shows us that prenatal and postnatal androgen exposure influences gender identity.

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12
Q

Gender Identity Genetics

A

Studies of monzygotic twins shows 39% concordance of gender dysphoria

No specific gene

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13
Q

Pubertal suppression

A

Completely reversible delay of the development of secondary sex characteristics to provide time to explore gender identity before permanent changes.

Buys time

Male to female: GnRH or progesterone

Female to Male: GnRH

Early use may avert social and emotional consequences better than later use

Complications: decreased bone density, decreased attainment of height, insufficient development of penile tissue for vaginoplasty

Can be used for a few years and then oophorectopmy or orchiectomy can be performed.

Suppresses ovulation and sperm production

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14
Q

Hormone Therapy

A

50% use illegaly obtained hormones due to barriers to health care

Lack of insuarance, lack of providers willing to perscribe, lack of coverage of hormones, and surgery and mental health care

Patient must have diagnosis of gender dysphoria established by a qualified mental health provider

Informed consent

Other mental health issues should be addressed

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15
Q

Estrogen therapy

A

Contraindicated w/ history of DVT, estrogen dependent neoplasm, or cirrhosis

Increased risk for embolism, gall bladder disease, weight gain, hyperlipidemia, lft abnormalities

Possible increased risk for: CV disease, HTN, type II DM

No evidence for increased risk for breast cancer

Spironolactone allows for smaller dosages for the same effects.

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16
Q

Tolerance

A

A reduced sensitivity requiring higher quantities of alcohol to achieve the same effects

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17
Q

Withdrawal

A

A set of sx that occur when an individual reduces or stops alcoholic consumption after long periods of uses

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18
Q

Withdrawal Syndrome

A

Two of the following

Increased hand tremor
Insomnia
N/V
Transient hallucinations
Psychomotor agitation
Anxiety
Tonic-clonic seizures
Autonomic instability
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19
Q

Craving

A

Desire or urge to consume alcohol

Physical

Psychological

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20
Q

Patterns of Alcohol Use

A

Men drink more than women

Whites have the highest rates of alcohol use, Asians the lowest

The majority of AI people did not drink last month

Increasing education is associated w/ increased use

AI have highest binge rate

Trend = better off –> more social drinking but less binge; worse off –> less social drinking but more binge drinking

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21
Q

CAGE Assessment

A

Cut Down - have you ever felt you should cut down on drinking?
Annoyed - have people annoyed you by criticizing your drinking
Guilty - Have you ever felt bad about your drinking
Eye opener - have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover.

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22
Q

Asessment of alcohol abuse

A

AUDIT

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23
Q

Treatments

A 
Alcoholic Anonymous (AA)
Motivational Interviewing (MI)
Relapse Prevention (RP)
Harm Reduction
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24
Q

AA

A

Self-help approach

12 step program

Spiritual basis

Abstinence based

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25
Q

Motivational Interviewing

A

Person centered

GOAL ORIENTED

method of communication

enhancing intrinsic motivation to change

exploring and resolving ambivalence

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26
Q

Stages of Change

A 
Precontemplation
Contemplation
Determination/Preparation
Action
Maintenance

Goal is to move along path, not get to zero

A few simple non judgemental statements can make a huge difference

Ask, Assess, Advise, Assist

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27
Q

SPIKES

A 
Setting
Perception
Invitation
Knowledge
Emotions
Strategy

For breaking bad news

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28
Q

When can I decline to treat

A

Scope of practice (legal and ethical)
Clinical skills (legal and ethical)
Exposure of infection (legal; not ethical)
Torture/Execution (ethical?; legal?)
Referral (not legal or ethical)
Reproductive health (legal and ethical) *

*separates personal and professional ethical assessment –> conscience clauses

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29
Q

Conscience clauses

A

For reproductive health –> legally permit professionals to not provide certain medical services, based on MD’s personal beliefs (i.e. ocps, abortion, stem cell rx) in some cases also applies to refusing to provide info about referrals for these services

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30
Q

Substituted judgement

A

Decisions based on patient pregerences

Sources for guidance for SJ
-written documents; living wills (legal forms)
-Discussion
-Life story, life style
"biographic knowledge"
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31
Q

Bests Interests

A

Pt wishes unknown or never known

Decision on what is best for the patient

Sources for guidance:

  • pain and suffering
  • Functionality; prognosis

BI is only used if no info on patients thoughts

32
Q

When you don’t need informed consent

A

EMTALA (legal)
Children (legal age)
Good Samaritan
Best interests criteria vs default of full care (ethical)

33
Q

Futility

A

Aka non-beneficial care

Not obliged to provide care that you don’t believe to be scientifically beneficial

Limits pt autonomy –> pt can’t demand care

Assessed using: clinical prognosis (MD assessment); social, spiritual, perosnal, family goals (pt assessment), costs and benefits (societal assessment)

34
Q

When can we forego medical interventions

A

When it is likely to offer little benefit to patient (i.e. CPR, feeding tube, ventilation, dialysis).

But may be perceived as life extending – then not forego unless all agree

Facilitated by trusting Dr-Pt relationship

Ethics:

  1. ) first align autonomy & beneficence
  2. ) understand/explain non-maleficence
35
Q

Conflicting interest

A

Risk of use can compromise patient outcome

Financially: investment in drug under investigation; enrollment fees; inducements; prescribing to owned facilities

Legal and Ethical issue

Avoid conflicts, and when cannot –> disclose conflicts (clinically; giving talks; publishing etc.)

36
Q

Competing issue

A

Both have claim and must happen

Negotiate to accomplish both (i.e. kid at soccer game and clinic or have assistant do informed consent to avoid coercion)

Ethical not legal issue

37
Q

Privacy

A

Limited government role

Family decisions; family planning; abortion

Termination of life-sustaining treatment

38
Q

Confidentiality

A

Government involved

HIPAA : letter and spirit of the law

Key is to never open a chart w/o a legitimate reason

39
Q

Confidentiality exception issues

A

Public health reporting (infectious - epidemiology, containment, contacts, notificaiton, vaccination, quarantine-, firearms, elevated blood lead, cancer, birth defects)

Tarasoff - known risk factors to known persons

Impaired professionals

Emancipated minors

Patients/others at risk (think driving in elderly)

40
Q

Tarasoff v U of Cal

A

A case in which the Supreme Court of California held that mental health professionals have a duty to protect individuals who are being threatened with bodily harm by a patient. The original 1974 decision mandated warning the threatened individual, but a 1976 rehearing of the case by the California Supreme Court called for a “duty to protect” the intended victim. The professional may discharge the duty in several ways, including notifying police, warning the intended victim, and/or taking other reasonable steps to protect the threatened individual.

41
Q

Shiavo

A

The trial included testimony from eighteen witnesses regarding her medical condition and her end-of-life wishes. Michael Schiavo claimed that his wife would not want to be kept on a machine where her chance for recovery was minuscule. According to Abstract Appeal Trial Order, her parents “claimed that Terri was a devout Roman Catholic who would not wish to violate the Church’s teachings on euthanasia by refusing nutrition and hydration.” Judge Greer issued his order granting the petition for authorization to discontinue artificial life support for Terri Schiavo in February 2000. In this decision, the court found that Terri Schiavo was in a persistent vegetative state and that she had made reliable oral declarations that she would have wanted the feeding tube removed.[21] This decision was upheld by the Florida Second District Court of Appeal[24] (2nd DCA) and came to be known by the court as Schiavo I in its later rulings.[25]

42
Q

Tuskagee Syphilis Study

A

as an infamous clinical study conducted between 1932 and 1972 by the U.S. Public Health Service to study the natural progression of untreated syphilis in rural African-American men in Alabama. They were told that they were receiving free health care from the U.S. government.[1]

43
Q

Baby Jane Doe

A

The Baby Doe Law or Baby Doe Amendment is the name of an amendment to the Child Abuse Law passed in 1984 in the United States that sets forth specific criteria and guidelines for the treatment of seriously ill and/or disabled newborns, regardless of the wishes of the parents.

44
Q

Proxy

A

Decision maker picked by patient

45
Q

Surrogate

A

Decision maker picked by patient

46
Q

Guardian

A

Decision maker chosen by courts

47
Q

Conservator

A

Decision maker chosen by courts

48
Q

Basic Principles of Motivational Interviewing

A

Collaborate
Evoke
Encourage
Elicit values, fears, hopes, and expectations, feelings

49
Q

Barriers to Change

A

Social - norms, secondary gain
Spiritual - suffering/depressed
Psychological - depressed/anxious
Biology - exercise hurts

50
Q

Typical Day assessment

A

Good way to gather a lot of information
Develops rapport
Unhealthy behaviors tend to cluster in individuals

Chance to aks “how do you feel about … smoking, drinking, lack of exercise, etc.”

51
Q

Questions to elicit change talk

A

Desire: Do you want, like, hope…?

Ability: Is it possible, what could you do? How would you do that?

Reasons: What would the benefits be for you? Why would you make this change?

Need: What should/do you need to do.

Remember D.A.R.N. change is hard!

52
Q

Questions to initiate conversations about change

A

What are the benefits and drawbacks to the proposed plan for change?

It sounds like you don’t like… What would you like? Because? How would that feel?

What can the medication do for you?

What worries you the most about surgery?

What problems have you had with exercise in the past?

53
Q

Four productive questions to ask in MI?

A

How important is this change to you?

How confident are you that you can make this change?

How has this behavior kept you from moving forward?

Does it feel like there is a block?

54
Q

How to properly listen

A

Eye contact

Reflect what you’ve heard every 1-2 min

First part is most important

Silence is OK

I’m sorry- can be enough

Be honest w/ your time limitations

If you feel stuck, the patient probably does too. Listen for tone in voice.

REFLECTIVE LISTENING. SUMMARIZE EARLY AND OFTEN.

55
Q

Change talk that predicts action

A

Commitment: I am going to, I will, I intend to…

Taking steps: I actually went out and…

56
Q

Informing patient in motivational interview

A

Don’t overwhelm patient

Consider the priorities of the patient***

Offer choices

Talk about what others do

Deliver w/ care

Ask permission

Support home and optimism for change

57
Q

Reasons why a patient doesn’t hear you

A 
Bewildered
Overwhelmed
High emotion
Mood
Distractions
White coat syndrome
Want's to look good for you
58
Q

Motivators

A

Make it personal!

People change when they see change as relevant to something important to them (activities, identity, values)

Recreation
Relationship
Sex
Work
Family

Identities can motivate change (good parent, spiritual, good christian, good spouse/partner, responsible)

59
Q

Why people do not change

A

Ambivalence

Resistance

Personal struggles

60
Q

Ambivalent patient

A

Most people want to feel healthier and feel uncomfortable with change

Patients usually know good reasons for change and they enjoy the status quo too

Reason to change
Reason not to change
Stop thinking about change

Ask patient to tell you their pros and cons
Ask what’s next

61
Q

Resistant patients

A

Natural tendency

Pushing for adherence can decreases adherence!!!

Many reasons for resistance to change (money, lack of support, religious beliefs, etc)

Key is to ask about sources of resistance, avoid arguing/lecturing/reflect/offer empathy

Encourage the patient to come up w/ a new perspective/way to solve the problem

Ask what has worked in the past.

Use scale 1-10

62
Q

I can see what you mean but…

A

Offer patience and acceptance

Reflect both sides of patient’s ambivalence

63
Q

Just tell me what you think I should do

A

Ask how will this work for you?

64
Q

I really can’t cope at all…

A

Patient overwhelmed

Convey understanding

Point out patient strengths

65
Q

Chronic Pain Patients

A

Use more time

Furstrating - no concrete findings

Psych and Social problems exacerbate sx

Legal problems (litigation, rx for drug abuse, rx forgery

66
Q

Stages of Chronic Pain

A
  1. ) Injury
  2. ) Initial Distress
  3. ) exacerbation of pscyhological and social problems
  4. ) Acceptance of sick role - family patterns, disability
67
Q

How many severely suicide commiters have seen a pcp in last month? Psychotherapist?

A

45% PCP

20% therapist

68
Q

Referral issues w/ mental health

A

1/3 to 1/2 of primary care patients refuse referral to a mental health professional

69
Q

Being seen medically does what to depression prevalence

A

Goes up w/ more intense care

5% in general pop
10% in medical outpatient setting
15% in inpatient.

70
Q

Why integrate behavior health and physical care services

A

We don’t have enough time - 6 problems for 13 minutes

  1. ) compromised physical health is associated w/ behavioral health prblems
  2. ) Compromised behavioral health may lead to physical problems
  3. ) Stigma and underutilization/underavailability of mental health services
  4. ) Compartmentalized understanding of health
71
Q

Factors underlying link between heart disease and a/d

A
  1. ) Lack of self-care - poor diet, minimal exercise
  2. ) Sleep problems - insomnia triples heart risk
  3. ) Obesity –> depression –> heart dx
  4. ) Blood vessels changes - a/d have increased production of free radicals and fatty acids
  5. ) Stress - increased insulin and cholesterol levels, increased bp, effects on immune system

Anxiety doubled risk of death from any cause
D&A triple risk (70% were heart attacks)

72
Q

Core Components of Integrated Care

A
  1. )Biopsychosocial Spiritual model
  2. ) Collaboration - flattened hierarchy, mutual respect
  3. ) Three world view -financial clinical, and operational points of view in mind when treating patient
73
Q

Process of Coping

A

Environmental Event (i.e. test) –> Primary Appraisal (assessment of the situation i.e. must pass test) –> Secondary Appraisal (assessment of resources that are available i.e. notes, flaschcards, etc.) –> coping behaviors (i.e. studying, sleeping, eating well) –> coping outcome (biological, psychological, and behavioral)

Coping is adaptive if it decreases stress
Coping is maladaptive if it makes stress worse

74
Q

Coping techniques

A 
Relaxation
CBT
Stress inoculation
Exercise
Social Support
Pharmacologic interventions (B-blockers and benzos are first line for phsyiologic stress relief)
Biofeedback
75
Q

Learned helplessness

A

Repeated efforts to exert control in situations that fail to achieve an organism’s desired effects lead to a sense of helplessness or loss of sense of control.

SOBE II Mike Rose (1 decks)

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