WEEK 3: Psychological considerations in cardiac & respiratory diseases

Question 1

Nearly 20-25% of acute MI patients demonstrate severe psychological stress or major depression
Clinically significant depressive symptoms are found in 40-65% of patients after an MI

State the factors that negative feelings are associated with.

Answer 1

A reduction in well being.
Poorer quality of life
Higher risk of recurrence of a cardiac event

Question 2

Define Cardiac neurosis.

Answer 2

Ananxietyreactioncharacterized by
-quickfatigue
-shortnessof breath
-rapidheartbeat
-dizziness andothercardiacsymptoms
butnotcausedbydiseaseofthe heart

Question 3

State the other 4 names for cardiac neurosis.

Answer 3

effortsyndrome
Irritable heart
Neuro-circulatory asthenia
Soldier’s heart

Question 4

Describe the WHO classification of cardiac neurosis.

Answer 4

WHO classifies this condition as a somatoform dysfunction or type of psychosomatic disorder in their ICD10coding system?

Question 5

Outline the psychosocial risk factors in cardiovascular disease.

Answer 5

-Lack of social support
-Lack emotional support
-Work related stress
-Personality types
Type A
Type D
-Psychiatric history

Behavioral aspects
-Diet
-Physical activity
-Alcohol
-Smoking
-drugs

Question 6

Describe Grief reaction after death.

Answer 6

Denial: We use denial as a defense mechanism
Anger: Filled with anger and blame over the death of our loved ones.

Bargaining: We try to bargain with God or with a higher power about reversing what has happened to us.

Depression: grief, sadness, regret, fear, and sorrow

Acceptance: We become aware that it’s going to be OK

Question 7

Describe Grief reaction after MI.

Answer 7

Denial: I’m too young for an MI

Anger: How can this happen to me? I don’t have heart attacks. I am fitter than most

Bargaining: I will do more exercise, May be stop smoking, Give up red meat

Depression: What if it happens again and this time I die? I am actually going to die.

Acceptance: May be the pills will help and I will be ok

Question 8

What is Cardiac Rehabilitation?

Answer 8

A tertiary disease prevention method.

Question 9

What is the aim of Cardiac Rehabilitation?

Answer 9

Aims to reverse limitations experienced by patients who have suffered the adverse pathophysiologic and psychological consequences of cardiac events

A medically supervised program

Enhances physical, mental and social recovery of heart patients

Broad principles applied to other chronic diseases

Question 10

State the benefits of cardiac rehabilitation.

Answer 10

1. Is a professionally supervised exercise & education program
2. Helps patients recover from heart attacks, heart surgery and cardiac interventions
3. Provides education & counseling
4. Increases fitness levels, reduces cardiac symptoms, improves health & reduces the risk for future heart problems
5. Usually meets 2-3 times/week for up to 12 weeks in OPD setting

Question 11

State benefits of participating in Cardiac Rehabilitation.

Answer 11

-Improves quality of life

-Improves your ability to perform daily life activities

-Increases knowledge of heart disease

-Increases self-esteem and confidence

-Improves adherence to healthy lifestyle choices

-Reduces lifestyle related risk factors

-Reduces future complications

Question 12

State the specific benefits of the exercise training component.

Answer 12

-Improved functional capacity for the patient,

-Improved blood vessel function,

-Improvement in cardiovascular risk factors, -

-Improved coronary blood flow,

-Improved electrical stability of the heart muscle (thus reducing the risk of a fatal heart rhythm disturbance),

-Reduced risk of blood clots

-Reduced cardiac work and oxygen requirements.”

Question 13

Who needs Cardiac Rehab?

Answer 13

-Patients who have had a heart attack

-Patients with angina or known coronary artery disease

-Patients who have undergone open heart surgery (CABG), angioplasty or stent (PCI), valve repair or replacement

-Patients who have had a pacemaker or ICD implanted

-Heart failure patients

Question 14

Discuss the Typical Cardiac Rehab Program.

Answer 14

1. Psychological approach
2. Risk factor modification.
3. An exercise program.
4. Providing vocational guidance

Vocational guidance is a process designed to assist individuals in making informed decisions about their career paths and employment choices. It involves providing guidance, support, and resources to help individuals identify their interests, strengths, skills, values, and personal preferences related to work and career

Question 15

Describe Psychological approaches of Cardiac Rehab Program.

Answer 15

Counseling
-Living with chronic disease
-Nutritional aspects
-Appropriate use of prescribed medication
-Lending emotional support
-Supplying information on physical limitations

Cognitive behavior therapy
-Severe anxiety
-Post traumatic stress disorder

Stress and anxiety management

Psychiatric treatment

Question 16

Describe Risk factor modification approaches of Cardiac Rehab Program.

Answer 16

Hypertension
Smoking
Alcohol consumption
Physical activity
Diet
Obesity
Other co-morbid conditions

Question 17

Describe Exercise program approaches of Cardiac Rehab Program.

Answer 17

-Patient fitness for exercise assessment

-Gradual increase in intensity of exercise

-Tends to be physiotherapy and occupational therapy focus

-Gym based

-Minimum of 6 weeks

Question 18

Discuss Vocational Guidance approaches of Cardiac Rehab Program.

Answer 18

Occupational Health issues

-Occupational history
-Drug history
-Social history
-Physical examination
-Work place assessment (ideally)
-Advice to employer
-Review as required

Question 19

Who is Involved in Cardiac Rehab in Health Care Professionals?

Answer 19

Physicians
Counselors
psychologist
Physiotherapist
Dietician/nutritionist
Occupational therapist

Question 20

Who is Involved In Cardiac Rehab in Social setting?

Answer 20

Family
Friends
Work colleagues.
Social networking
Life insurance
Medical aid
Traditional healer
Faith healer
Church group

Question 21

Cardiac Rehab Attendance is generally poor.

Non-attendance reasons unclear but suggested include:

Answer 21

-Poor educational background
-Poor understanding of the disease
-Feeling of loss of control over disease
-Older age
-Unemployment

Question 22

Discuss Pulmonary Rehabilitation.

Answer 22

A multidimensional continuum of services directed to persons with pulmonary disease and their families

Focus on patients with Chronic Obstructive Pulmonary Disease

Similar principles to cardiac rehabilitation

Question 23

Outline the Principal Goals of Pulmonary Rehabilitation.

Answer 23

-Reduce symptoms

-Decrease disability

-Increase participation in physical and social activities

-Improve the overall quality of life (QOL) for patients with chronic respiratory disease

-Multi-disciplinary approach

Question 24

Discuss the different aspects included in Pulmonary Rehabilitation Program.

Answer 24

1. Patient and family education
2. Exercise training
   Physical aerobic exercise for 6 weeks
   Focus on lower extremities.
   Ideally 3 sessions per week
   60-70% max speed on shuttle walk test if possible
3. Psychosocial support
   Physical relationships
   End of life planning issues
   Smoking cessation
4. Advice on nutrition
5. Multidisciplinary

Question 25

Outline the Benefits of Pulmonary Rehabilitation.

Answer 25

-Improve exercise capacity

-Reduce breathlessness

-Improve health-related quality of life

-Decrease healthcare utilization

-Relieve fatigue

-Improve emotional function

-Enhance patients’ sense of control over their condition

Question 26

Contraindications to Pulmonary Rehabilitation.

Pulmonary rehabilitation is not suitable for:

Answer 26

-People who cannot walk

-Have unstable angina

-Who have had a recent myocardial infarction

Question 27

Discuss the Role of traditional AFRICAN healing.

Answer 27

Considered broader in some respects than that of a contemporary medical doctor.

The traditional healer advises their clients in all aspects of life, including physical, psychological, spiritual, moral, and sometimes legal matters. They also understand the significance of ancestral spirits and the concept of witches

African traditional healing is intertwined with cultural and religious beliefs and is holistic in nature. It does not focus only on the physical condition, but also on the psychological, spiritual and social aspects of individuals, families and communities.

Question 28

Discuss Good health in the African context.

Answer 28

Good health for the African consists of both proper functioning of bodily organs mental, physical, spiritual, and emotional stability [of oneself, family members, and community (Omonzejele 2008:120) this integrated view of health is based on the African unitary view of reality. Good health for the African is not a subjective affair.

Good health requires good relationship with one’s ancestors because it is of paramount importance that the ancestors stay healthy so that they can protect the living (Iroegbu 2005:81)

Good health also includes the viewing of an individual as a collective member of the community; as such, good health would also include good relations with ancestors and the community. Thus Mbiti (1990) rightly notes.

Question 29

Discuss Traditional beliefs on disease causation.

Answer 29

1. Many traditional African communities are of the view that certain illnesses which defy scientific treatment can be transmitted through witchcraft and unforeseen forces.

These include barrenness, infertility, attacks by dangerous animals, snake bites by dangerous snakes, persistent headaches and repeated miscarriages (Obinna 2012:137-139; Thorpe 1993:25).

2. Many traditional healers and practitioners are of the opinion that disobeying taboos openly or secretly is one of the ways people could become sick (Gyekye 1995:133).

The consequences always manifest either on the person(s) concerned or the entire community in the form of diseases, and possibly death.

Question 30

Discuss HEALING PRACTICES IN THE AFRICAN CONTEXT.

Answer 30

Spiritual issues

1. Spiritual protection: If the diviner or the traditional healer perceives the cause of the disease to be an attack from evil spirits, the person would be protected by the use of a talisman, charm, moto [spiritually prepared black powder] for body marks, amulets, and a spiritual bath to drive the evil spirits away.
2. Sacrifices: Sacrifices offered at the request of the spirits, gods, and ancestors
3. Spiritual cleansing: using herbs and blood of a slaughtered animal

Dogs and cats are used to replace the life of people, because they believe that the spirit of such animals is strong for that purpose.

There is also the view that, because they are domestic animals and are very close to people, sometimes when they see that someone very close to them is about to die, they offer their lives for that person to live.

In some cases herbs are prepared for the person to bathe with at specific times for a number of days. Sometimes an animal can be slaughtered and the blood would be poured on the head and foot of the sick person; the blood poured on the sick person serves as a way of cleansing.

Question 31

Discuss Appeasing the gods as a form of healing practice in african context.

Answer 31

For diseases that are caused by a curse or violation of taboos.

Done either sacrificing an animal or by pouring of libation.

Patient buys the ritual articles for the process as requested by the gods or the spirits.

Articles include spotless animals (dove, cat, dog, goat, and fowl), schnapps, akpeteshie [traditional liquor], calico (red, white or black) and sometimes eggs

After the rituals, these articles are sometimes left at the required place to rot, or they are sometimes thrown into a river as required by the god or spirits.

They are at times placed on a four-way junction or the outskirts of the community, depending on the purpose of the ritual (Insoll 2010:234–235).

Question 32

Discuss exorcism as a form of healing practice in African context.

Answer 32

Exorcism is practiced to deliver the person possessed by an evil spirit.

Involves singing, drumming, dancing, the spraying of powder to the sky and on the possessed, and the use of abodua [animal tail] to drive away the evil spirit

The possessed person is seen rolling on the floor like someone under bondage looking for freedom. Once the spirit has been released, the person would become stable, mostly with a deep sense of relief.

Question 33

Discuss Pouring of libation as a form of healing practice in African context.

Answer 33

Libation is a rite by which some liquid is poured on the ground or sometimes on objects followed by the chanting or reciting of words.

According to the practitioners, it is a form of prayer.

Question 34

Discuss physical treatments as a form of healing practice in African context.

Answer 34

Prescription of herbs: These prescriptions come with some specific instructions on how to prepare the herb, the dose and timeframe (Ayim-Aboagye 1993:109; Lartey 1986:75).

Clay and herbs application (skin diseases): In some of the healing processes, the traditional healer would prepare white clay with some herbs for the sick person to apply on his or her body for a number of days.

Counselling: Sometimes, the sick person is advised on how to live his or her life, especially the kind of food the person should or should not eat. This is mostly done when it is an issue of a violation of a taboo.

Question 35

Discuss divination as a form of healing practice in African context.

Answer 35

God is the healer but works through mediums such as spirits, herbs and deities with the assistance of diviners or traditional healers (Obinna 2012:135).

Diviners treat illnesses primarily through facilitating the direct intervention of the spiritual world to understand the cause of the illness and prescribe a cure (Obinna 2012:142).

If an illness is believed to be caused by patient inappropriate behavior a remedy or cure for the illness can only come through spiritual intervention.