Week 9: Health Disorders Flashcards
What is coronary heart disease?
A cluster of illnesses caused by ATHEROSCLEROSIS
What is atherosclerosis?
The narrowing of coronary arteries, due to plaque buildup on arterial walls
What are the consequences of coronary heart disease?
Obstruction of oxygen and nourishment to heart
What occurs when there is a temporary oxygen shortage to the heart?
Angina pectoris (i.e. pain in chest/arm)
What occurs when there is a prolonged or severe oxygen shortage to the heart?
Myocardial infarction (i.e. heart attack)
What is the factor that predicts coronary heart disease?
Metabolic syndrome helps to predict heart attacks
What are the factors for diagnosing metabolic syndrome?
- Central adiposity
- High BP (hypertension)
- Difficulty with metabolising blood sugar
- Low levels of HDL (good cholesterol)
- High level of triglycerides (fat)
What are the risk factors for coronary heart disease?
- Lifestyle of poor diet and little exercise
- Diagnosis of metabolic syndrome
- Risk “enhancers”: Acute and chronic stress reactivity, personality, depression
What is stress reactivity?
Degree of change (from baseline or average) in physiological response to stress
What are examples of acute stress reactivity?
- Negative emotions, particularly anger and hostility
- Extreme excitement
- Sudden bursts of activity
What are examples of chronic stress reactivity?
- Low SES
- Urban and industrialised societies
- Workplace stress (high demand + low control), job insecurity
Which type of personality is a CHD risk “enhancer”, and what are its characteristics?
Type A personality: Pervasive experience of anger and hostility
Which type of hostility is particularly potent?
Cynical hostility is particularly potent: frequent anger, antagonism, suspicion, distrust, resentment
In which case does greater anger/hostility not increase CHD risk?
Greater anger/hostility increases CHD risk for men, but this is less reliable for women
How does the relationship between anger expression and CHD risk differ across cultures?
Greater anger expression increases CHD risk in the US, but decreases CHD risk in Japan
What is the explanation for cultural differences in anger expression and CHD risk?
In US, lower SES people tend to express anger more
In Japan, high status ppl tend to express anger more, but high status BUFFERS -ve effects
What is the explanation for cultural differences in anger control?
Anger control is higher in Japan than in the US
Linked to decreased CHD in Japan, but not in the US
Hostile people tend to…
- Show exaggerated cardiovascular reactivity, longer stress episodes and slower recovery to both acute and chronic stressors
- Engage in health-compromising behaviours
- Have less social support due to having more interpersonal conflict
How does depression act as a CHD risk “enhancer”?
- Increases other risk factors of CHD (e.g. metabolic syndrome, health compromising behaviours)
- Increases inflammation, which elevates C-reactive protein (CRP) levels that can rupture arterial plaques, causing a blood clot
What happens when C-reactive protein (CRP) levels are elevated?
Can rupture arterial plaques, causing a blood clot
- i.e. atherosclerosis
What are ways to manage CHD?
Initial treatment
- Coronary balloon angioplasty
- Coronary artery bypass graft
- Medication: Beta-(adrenergic) blockers, statins
Cardiac rehabilitation
Psychosocial: Stress management, increase social support
Preventing delay in treatment-seeking
What is coronary balloon angioplasty?
Expand arteries by inserting stent and using a control to inflate arteries
How do beta-(adrenergic) blockers manage CHD?
Reduce sympathetic activation
What is cardiac rehabilitation?
The process of regaining normal or optimal level of physical and psychosocial functioning
Includes dietary and exercise programs, besides treatment and drugs
How does improving psychosocial factors manage CHD?
Enhance treatment effectiveness, reduce tendencies to get reactivity
How does preventing delay in treatment-seeking manage CHD?
Relapses are prevalent, patients and family members learn to notice symptoms
What is hypertension?
Occurs when the supply of blood through the vessels is too much
What are the characteristics of hypertension?
High CO and high TPR
How is hypertension diagnosed?
By BP readings measured by a sphygmomanometer (i.e. a BP cuff)
What are the 2 readings in BP measurements?
- Systolic: Maximum force when ventricles contract
- Diastolic: Pressure in arteries when heart is relaxed
What are the categories for systolic BP readings?
Ideal = 120 and below
Mild hypertension = 140-159
Moderate hypertension = 160-179
Severe hypertension = Above 180
What are the risk factors for hypertension?
- High negative emotionality and BP reactivity during childhood
- Chronic anger experience
- Males
- Low SES
- Stress
- Genes
What are the chances that an individual will develop hypertension if a) one parent has it, b) both parents have it?
a) One parent = 45% chance
b) Both parents = 95% chance
Hypertension itself is a risk factor for…
CHD and kidney failure
What are the ways to manage hypertension during the pre-hypertension stage?
- Lifestyle modification (improving diet, esp. lowering salt intake, and increasing physical activity)
What are the ways to manage hypertension once diagnosed?
- Lifestyle modification
- Drugs that lower cholesterol, beta-blockers
- CBT, with a focus on acquiring techniques for relaxation and anger management
When is CBT especially helpful?
For mild hypertensives, particularly if they do not respond well to drugs due to side effects
What is stroke?
Stroke results from a disturbance in blood flow to the brain
Caused by atherosclerosis or hypertension, when plaques form and damage the cerebral blood vessel (e.g. carotid artery)
What causes cerebral hemorrhage?
Rupture of a blood vessel in the brain
What are the impairments caused by stroke?
Motor impairments
Cognitive impairments
Emotional impairments
Where do motor impairments occur?
Commonly occur right after a stroke, on the opposite side to the stroke side
Typical areas affected: arm, leg, facial muscles
What types of cognitive impairments occur?
Cognitive impairments that are specific to regions of the brain that are damaged
What are the consequences of left-brain damage for cognitive impairments?
Impairments in short-term memory and aphasia (inability to understand others or express themselves)
What is aphasia?
Inability to understand others or express themselves
What are the consequences of left-brain damage for emotional impairments?
Elicit greater anxiety and likelihood of depression
What are the consequences of right-brain damage for emotional impairments?
Elicit alexithymia - inability to identify one’s own and others’ emotions
What is alexithymia?
Inability to identify one’s own and others’ emotions
What are the consequences of emotional impairment?
Affects general social functioning with others, particularly family and close friends
What are the ways to manage stroke?
- Medication
- Psychotherapy
- Cognitive remedial training
- Constraint-induced movement therapy
What are the types of medication used to manage stroke?
Aspirin, blood thinners, cholesterol drugs
How do blood thinners work?
Artificially lowers density of blood so it can flow more easily to brain
What is the function of psychotherapy to manage stroke?
Aimed at treating depression
What is the function of cognitive remedial training to manage stroke?
To restore cognitive skills and intellectual functioning
What is constraint-induced movement therapy?
A type of physical therapy that requires patients to use the more affected limb and avoid using the less affected limb for several hours each day
What is the aim of constraint-induced movement therapy?
To restore motor skills and functions
Why do stroke patients require a lot of social and emotional support from others?
B/c of impairments to basic daily functioning and depression
What is Type II diabetes?
Results from an imbalance between insulin production and responsiveness that causes insulin resistance
How does insulin resistance occur?
- Cells need energy in the form of glucose
- Insulin, a hormone produced by the pancreas, is produced when glucose levels rise in the blood
- Insulin is supposed to make cells take up glucose that is available in the blood
- However, cells can ignore insulin and not take up glucose, i.e. insulin resistance
- Glucose continues to stay in the blood. The pancreas detects that blood glucose levels are still high. To bring it to normal, it produces even more insulin to tell cells to take up the glucose
- Over time the increase production of insulin actually increases insulin resistance
- Pancreas can no longer keep up, insulin production falls, leaving blood glucose levels perpetually high
What is insulin?
A hormone produced by the pancreas, which is produced when glucose levels rise in the blood and supposed to make cells take up glucose available in the blood
What are the common symptoms of diabetes?
- Frequent urination
- Mouth dryness
- Impotence
- Irregular menstruation
- Loss of sensation
- Frequent infection (skin, gums, and urinary system)
- Pain or cramps in limbs
- Slow healing of cuts and bruises
- Intense itching
- Lethargy
What are the risk factors of diabetes?
- Overweight
- Little exercise
- High BP
- Sibling/parent with diabetes
- Had baby weighing >9 pounds at birth
- Member of a high-risk ethnic group
What are the health complications caused by diabetes?
- Heart: Increased risk of heart disease
- Eyes: Blindness due to damage of blood vessels, optic nerves
- Blood vessels: Damage blood vessels, leads to circulation problems
- Kidney: Kidney failure
- Diabetic neuropathy: Nerve damage, can evolve to gangrene and lead to amputation
What are the ways to manage Type II diabetes?
- Lifestyle modification
- Awareness of serious health implications of condition
- Increase sense of personal control through CBT, social support
- Therapeutic interventions
What are the aspects of lifestyle modification that help to manage Type II diabetes?
Low sugar/carbs diet
Regular exercise
Stress management
How does having awareness of serious health implications of their condition help to manage Type II diabetes?
Being unaware of serious health implcations -> undermine adherence to treatment
How does increasing personal control help to manage Type II diabetes?
Helps with adherence to treatment programs
Why are therapeutic interventions needed to help to manage Type II diabetes?
Depression and feelings of anger can interfere with glycemic (sugar) control in the body
So therapeutic interventions are needed to manage these emotional consequences
What is health?
A complete state of physical, mental, and social well-being, and not merely the absence of disease or infirmity
Why is it impt to understand the quality of life of people with chronic health disorders?
- Guide interventions to improve their well-being
- Pinpoint the likely problems to emerge in course of the disease
- Assess the impact of treatments and compare therapies
- Inform care that will maximise long-term health with the highest QoL possible
- High QoL can reduce the rate of illness progression and symptoms experienced
What are the processes involved in emotional response?
Denial -> Anxiety -> Depression
What are the characteristics of denial?
Avoiding implications of the disorder, especially if life-threatening
Protective initially
What are the characteristics of anxiety?
Awaiting diagnosis, invasive medical procedures, side effects of treatment
Mistaken to underlie the disease (complications due to anxiety)
What are the characteristics of depression?
Exacerbates the course of disease, especially CHD
Increases the use of health services for treatment
What are the different forms of the self?
- Physical self: Body image and perceived health
- Achieving self: Threats to self-concept and self-esteem
- Social self: Social support
- Private self: Unfulfilled dreams and goals
What is the best predictor of mortality?
Self-rated health predicts mortality strong (.70) beyond objective indicators
What are the other negative impacts of chronic disorders?
- Loss of income
- Discrimination
- Receiving negative responses from family and friends (-ve stereotypes)
- Strain family r/s, esp. caregivers, due to stresses of chronic disorders and need for constant care
What are silver linings of chronic disorders?
- Find more meaning in daily lives
- Learn to be more appreciative of their health and life
- Gain knowledge abt their health and learn to be healthier
- Learn to reorder their priorities in a more satisfying way
- Become more emphatic towards others
- Increase closeness with family and caregivers by going through challenges together
What are the types of coping?
- Avoidant coping
- Active coping
What is avoidant coping related to and what does it predict?
Tied to greatest psychological distress
Predicts worse responses to health disorders
What does active coping predict?
Predicts good adjustment
Increases sense of control
Which type of patients tend to have adherence problems?
Acute beliefs about their disorder
How is engaging in self-blame a double-edged sword?
Can motivate patients to assume responsibility and control over their condition
But it can also lead to guilt and depression
What are the predictors of well-adjustment, high treatment adherence, better treatment outcomes and longer life?
Believing that disorder is controllable (psychological control)
Having high self-efficacy
Who are the people that work with those with chronic health disorders?
Physical therapists
Dieticians
Occupational therapists
Social workers
What is the role of physical therapists?
Conduct treatment programs for patients physical impairment/disability to recover/manage disability
What is the role of dieticians?
Help with planning strict diets, especially for diabetics, as part of their lifestyle modification intervention
What are the roles of occupational therapists?
Evaluate the capacities of patients
Help plan therapy programs
Set goals, teach techniques and skills for rehabilitation
Help patients regain physical, mental, and emotional stability
What are the roles of social workers?
Help patients and their family access medication and social services
Find resources to solve their problems
