Health Psych

Question 0

Describe and contrast the biomedical model and biopsychosocial model

Answer 0

Biomedical - fixed with physical inter, cause explained with physiology/biology

Vs combination of social, psychological and biological factors

Question 1

Define health psychology

Answer 1

The study of psychological and behavioural processes in health care

Question 2

How steriotypes?

Answer 2

Information stored in schemata to save processing power.
Individuals placed in certain schemata overlooking diversity.
Prone to negative traits.

Question 3

Define steriotype, prejudice and discrimination

Answer 3

Stereotype - overlooking individuality placing into schemata
Prejudice - negatively affects our attitudes based on stereotypes
Discrimination - affects behaviour

Question 4

Avoiding reliance on stereotypes

Answer 4

Getting to know individuals who challenge stereotypes

Reflection

Question 5

Changes in cognitive capacity with aging

Answer 5

Gradual linear decrease in IQ
Memory loss often linked to co-morbidities
Processing speed most affected. Fluid thinking vs crystalline.

Question 6

Relationship between personality and ageing including the 4 models

Answer 6

Developmental model- differnt stages have different conflicts - young adult intimacy vs isolation, generation vs stagnation, integrity vs despair.
Trait model - personality made up of different traits as ageing occurs.
Disengagement model - disengagement from different social activities as an adaptive mechanism.
Activity model- successful engagement requires engagement in all areas of life

Other factors:
Empty nest phenomenon
Grandparent hood
Friends
Contact with relatives 
Unemployment vs retirement.

Question 7

Define disability and their implications

Answer 7

Medical model
- problem created by impairment in physical or psychological factors (body is shaped and experienced) which restricts someone from the ‘norm’
Impairment - loss or abnormality of physical or psychological structure

Social model

• restriction or disadvantage created by a social organisation taking no account of physical impairments.
  Impairment - lacking part of a limb or organ.

Medical model- without cure it is given that they are disabled

Question 8

Identify barriers for people with disabilities in accessing healthcare

Answer 8

Physical/ environmental
Attitudinal/ behavioural - e.g. Staff not listening, different treatment
Institutional - training, policies.

Question 9

Define health rated behaviour

Answer 9

Anything someone does to negatively or postively affect health.

Question 10

Describe classical conditioning and how it can lead to a health related behaviour and how the behavior can be changed.

Answer 10

Pavlovs dog
Bahaviour linked to unrelated stimuli
E.g. Smoking on breaks (habit)
Elastic band to stop automatic reaction (break habit)

Question 11

Operant conditioning and how it can lead to a health related behaviour and how the behavior can be changed.

Answer 11

Behaviour driven by short term rewards or negative affects.
E.g. Smoking and feeling good/cool
Make own rewards for not smoking

Question 12

Social learning theory and how it can lead to a health related behaviour and how the behavior can be changed.

Answer 12

Bobo dolls.
How punishments and rewards in others lead to altering our behaviour.
Smokers do because others do
Use celebs and advertise negatives of smoking.

Question 13

Identify a tool for screening patients for levels of alcohol use

Answer 13

Cage audit pat fast
Cage- cutdown annoyed guilty eye-opener- four questions to ask. Eye-opener do they need a drink in the morning to study nerve?
Audit - alcohol use disorders identification kit and developed by who, more complex than cage.
Pat- padding alcohol test - from audit but takes 1/5 of the time.
Fast - fast alcohol screening test- two stage initial screening taken from audit.

Question 14

Describe the management of a patient with an alcohol problem

Answer 14

Alcohol detox _ give Vitamins B1 and B and parenteral (not GI) thymine (to prevent Wernickles Encephalopathy). Disulfiram (prevent relapse), Valium and chlordiazepoxide, chlormethaizole, Zopiclone.

Acutely - fluids, electrolytes, B1/thymine, glucose

Question 15

Describe the key features and techniques used in motivational interviewing

Answer 15

Roll with resistance, avoid argument, support self-efficacy, develop discrepancy (between their habit and personal goals), express empathy.

Gives patients ownership of decisions and removes barriers

Question 16

Define adherence compliance and concordance

Answer 16

Adherence - the extent to which a patient coincides with medical advice
Compliance - the extent to which a patient complies with medical advice
More patient centred as they have a right to choose.
Concordance- involvement of patient in decision making to try and improve adherence/ concordance.

Question 17

Explain the relationship between concordance and adherence

Answer 17

Concordance adresses the patients beliefs and priorities and give them ownership over decisions.
This is likely to improve adherence
May get patients views vs evidence based medicine. Rights vs responsibilities.

Question 18

Describe the extent of non-adherents across patient groups

Answer 18

Lowest in long term disorders which are asymptomatic or not severe e.g. Diabetes but also kidney transplants.
High in HIV, arthritis, GI, cancer.

Question 19

Describe techniques for measuring adherence in individual patient cases

Answer 19

Indirect:
Patient self report
Carer report
Pill counts
Mechanical measure of dose

Direct:
Urine or blood sample,
Direct observation

Question 20

Define intentional and unintentional adherents and identify potential reasons for both

Answer 20

Patient factors- memory, beliefs, symptoms, severity
Treatment factors - complex, side effects, preparation, duration, expense, administrations, labels, social stigma
Psychological factors- any point? Depression, social support, homelessness
Health care professional factors - relationship, trust, follow ups beliefs about prescriber.

Often a combination e.g. Theory’s of health related behaviour, health belief model and theory of planned behaviour.
Unintentional = memory, misunderstanding, limited resources
Intentional = beliefs, attitudes, expectation, motivation

Question 21

Describe the nature and effectiveness of and problems with interventions to improve adherence

Answer 21

Address barriers to adherence, address perceptual factors to motivation.

Better to combine not just address a single factor.

May lack theoretic input - why interventions work. Few are patient centered.

Concordance!

Question 22

Describe the physiological responses involved in stress

Answer 22

Fight or flight
Cortisol release
Increased heart rate 
Immune system up regulation
Clotting factors 
Ect

Question 23

Explain why stress can have positive and negative consequences

Answer 23

Short term - awareness, sharpness, faster thinking/ high performance, energised
Long term - tiredness, anxiety, high BO, low performance from alarm

Question 24

Define stressors and describe tools to measure stress based on stressors

Answer 24

Stressful events within Dailey life- Hassles and uplifts The transactional model of stress, measures stress on how individuals appraise stressors which accounts for subjectivity of stress

Question 25

Use the transactional model to explain stress as a process

Answer 25

``` Series of steps taken to analysis the threat/ stressor considering a number of factors e,g. Support, self efficacy, personality and coping. This leads to a stress response. Both resources (personality, social support and coping skills) and demands (stressors) affect each other and the appraisals. ```

Question 26

Define primary and secondary appraisal

Answer 26

Primary- is it a threat, how big? Secondary- can I cope? Reappraisal- is it easier harder to cope than I thought?

Question 27

Identify important factors which moderate the impact of stress

Answer 27

Social support | Control over a situation

Question 28

Describe the different ways stress can negatively impact health

Answer 28

CVS Long term immunosupression- cortisol (anti inflam) and decreased WBC. So more UTI, herpes, autoimmune disease Anxiety/ depression, thinking more rigid and extreme, overgeneralising, catastrophising, rumination. Low motivation. Substance abuse

Question 29

Outline strategies for managing stress

Answer 29

Cognitive - hypothesis testing, restructuring Behavioural- skills training, assertiveness and time management Emotional - counselling, emotional disclosure, social support Physical - exercise, meditation/ relaxation, biofeedback Drugs

Question 30

Define emotion focused coping

Answer 30

Change the emotion Behavioural- distract, relax, alcohol Cognitive - see positives/ change how you think about problem

Question 31

Describe problem focused coping

Answer 31

Changing the problem or resources Reduce demands of a situation e.g. Claustrophobia Expand resources e.g. Skills/ ways to improve

Question 32

Describe ways to aid patient' scoping and give relevant examples of useful approaches for individual patient cases

Answer 32

Increase social support Increase patient control- pain management, choices Prepare patients for stressful events to reduce ambiguity - peer contacts, effective communication Stress management - cognitive- non cognitive

Question 33

Explain why patients with chronic illness are at increased risk of mental health problems

Answer 33

Anxiety - response to threat, | Depression - response to loss, failure or helplessness

Question 34

Describe barriers to identifying psychological difficulties in patients

Answer 34

Symptoms attributed to disease or mental health? Psychological state may change over time Patient may not mention due to stigma, inevitability, judgement, adding burden, seen to be complaining HCP may not ask e.g. Not in job description

Question 35

Outline NICE guidelines for managing anxiety and depression

Answer 35

Depression- recognition, assessment and management Low intensity- self help, group CBT Severe- individual CBT, interpersonal therapy, other therapy, with drugs Anxiety- similar but SSRI often given in low intensity.

Question 36

Explain the limitations of a biomedical model for pain

Answer 36

Pain after symptoms/ treatment. Pain without symptoms. Phantom limb pain Different levels of pain

Question 37

Distinguish between acute and chronic pain

Answer 37

Chronic is over 3 months, rest does not help, often unknown cause, no ongoing tissue damage

Question 38

Outline the gate control theory of pain

Answer 38

Pain comes from complex pathways between brain and tissues. Goes through two neural relays or gates Different factors can open or close gates

Question 39

Discuss how biological, psychological and social factors affect the experience of pain

Answer 39

Injury, medication Depression, stress, distraction, exercise, positive outlook/ beliefs. Active life/ minimal involvement in life.

Question 40

Describe the principles and aims of pain management programs

Answer 40

``` PMP Aims to give patients control of pain. Graded exposure back into normal life. Work on fitness, motility and posture. Coping for stress, anxiety, depression Improve ability to relax Develop social skills ```

Question 41

Describe the key psychological therapies used within the NHS

Answer 41

``` Type A - psychological care integrated into mental health treatment Type B- eclectic (variety of sources) psychological therapy and counselling Type C (NHS) - psychodynamic, humanistic, family/systemic and CBT ```

Question 42

Describe psychodynamic therapies

Answer 42

Uses therapist - transference and countertransferance. Adresses underlying conflicts underneath symptoms. Id crisis from a young age, for interpersonal difficulties, personality problems, interest in self exploration, capacity to tolerate mental pain

Question 43

Describe systemic/ family therapies

Answer 43

In groups, look at patterns of interaction and their meaning, facilitate resources in system

Question 44

Describe humanistic therapies

Answer 44

No definition General counselling skills - empathy, warmth, unconditional personal regard Good immediately with motivation to move on

Question 45

Describe the behavioural aspects of CBT

Answer 45

Graded exposure to feared things Activity scheduling Reinforcement and reward Role play/ modelling

Question 46

Describe the cognitive aspect of CBT

Answer 46

Education of cognitive model Monitor thoughts and feelings - awareness of interrelationships Examine/ challenge negative thoughts Rehersal coping with situations Schema work - core beliefs, I'm unlovable ect worthless, freal

Question 47

Describe the rational for usinG CBT

Answer 47

We use cognition to make sense of the world Not a situation that upsets us but the view we take of it. Changes of mood are related to he way we make sense of events. Thoughts, physiology, emotions and behaviours all affect each other.

Question 48

Identify the mental health conditions that CBT is likely to be helpful for

Answer 48

Depression, sexual dysfunction, anxiety, PTSD, eating disorders, phobias, OCD Adjunctive treatment for psychotic symptoms - distracts with delusions but not good for withdrawal. Best for active patients

Question 49

Explain the concept of attachment in child development

Answer 49

Attachment- desire to be with Carer/ close proximity seeking behaviours and contact maintaining behaviours. Good attachments are important for social competence, self reliance ect. Critical period in first year but neccessary for 4 Begins at 3 months can recognise strangers. At 7-8 attachments form.

Question 50

Describe attachment styles

Answer 50

Secure Insecure- avoidant/independent, ambivalent or disorganised Can tell from how mother responds to child's signals, rapid appropriate responses, careers high Esteem.

Question 51

Describe the implications of separation for the hospitalised child

Answer 51

``` Behavioural- Depression Anxiety Aggression Bed wetting Clinging behaviour Detachment Physical- Lack of sleep Depression ``` 3 phases (Bowlby) Protest Despair Detachment- often mistaken for resolution May blame themselves May affect adherence, experience pain or suffer from stress.

Question 52

Give examples of good practice in the organisation of hospital care for children

Answer 52

``` Distractions Home like feel Visits encouraged Caring staff Explanation of not their fault Continuity of staff Allow attachment objects ```

Question 53

Describe Piaget's four stages of childhood cognitive model

Answer 53

0-2 sensorimotor- explore the world through touch. Develop Schema for where their body ends and world starts. At 8 months learn permanence. 2-7 pre operation categorise by 1 characteristic, egocentrism, cannot hold convocation 7-12 concrete operational - can categorise by more than one, can think logically but not abstract, conservation of number, mass and weight 12+ formal operational- abstract logic and hypothetical reasoning

Question 54

Describe Vygotsky's theory of social development

Answer 54

Affected by social interactions and shared problem solving so can increase understanding - zone of proximity

Question 55

Discuss Implications of theory about children cognitive development for communication with children about illness and treatment

Answer 55

``` Children have different zone of proximity so can't judge by age. Babies use motor, not verbal. Danger of metaphors Child may assume you know how they feel. Use faces pain scale ```

Question 56

Give examples of good practice in communication with children

Answer 56

``` Use Teddy's Pain scale Distract Ask parents to explain later Smile Use their language level to gage communication and assess level of understanding Babies- motor sensory Good body language Have stickers Congratulate child. ```

Question 57

Give a definition of cultural diversity

Answer 57

The idea of belonging to a social group with its own culture. Influenced by age, gender, ethnicity, language and is defined by the individuals relationships with people in the groups they associate with. It individually centred.

Question 58

Give examples of ways in which culture can impact on patients presentation to health services

Answer 58

People don't know services available to them Different stigma about mental health May not find treatment/ management acceptable The way they make sense of symptoms and behaviours Take into account pressure to conform to religion, gender roles, social norms, family expectations, sexual orientation, marriage

Question 59

Give reasons why organisation and delivery of healthcare need to take diversity into account

Answer 59

Steriotypes lead to different groups being given unequal treatment. Denial is a problem and people fear the unknown. Lack of time means doctors cannot understand culture identity/ patient needs - means they are less likely to adhere

Question 60

Describe the NATSAL survey

Answer 60

National survey of sexual attitudes and lifestyles on 3 occasions Asked in their home but a questioners a standard set of questions. Increase in opposite sex partners. Same sex increasing for women. Common for sexual problems

Question 61

Why is it difficult to get accurate info on sexual dysfunction

Answer 61

Embarrassed/ reluctant to admit to an interviewer May not recall their sexual encounters Not everyone sampled Some people declined.

Question 62

Explain the implications of diversity in sexual behaviour

Answer 62

No normal sexual behaviour | Comfortable and informed about discussing all forms of sexual behaviour

Question 63

Describe diversity in patterns of dying

Answer 63

``` Age 2/3 over 75 More babies than children Socioeconomic and geographic factors May be: Gradual Catastrophic Premature ```

Question 64

Describe the 5 stage grief model of adjusting to the idea of dying

Answer 64

``` Denial Anger- look for alternatives Bargaining- with doctor or religious figure Depression Acceptance ```

Question 65

Explain the potential positive and negative implications of denial in coming to terms with an illness

Answer 65

Denial is a form of coping and so needs to be respected | It can be a barrier to good care.- needs checking and reviewing over time

Question 66

Describe symptoms often experienced after bereavement.

Answer 66

Loss, grief, mourning Grief is a psychological and physical reaction to bereavement. Disbelief and shock early develop awReness with guilt, anger then eventually resolution Chronic Emotional - depression, anxiety, Anger, guilt, loneliness Cognitive- hallucinations, lack of concentration, memory loss, preoccupation, disturbance of identity Behavioural- irritability, insomnia, crying, social withdrawal Physical- immunosuppression, palpitations, fatigue, digestive symptoms

Question 67

Describe the aims of palliative care

Answer 67

``` Improve QOL Manage emotional and physical symptoms Support patients to live productively Give patients some control E.g. Hospices Follow Liverpool care pathway! ```

Question 68

Identify the risk factors for chronic grief following bereavement

Answer 68

Mentally disables, primary Carer, depression, spouse, social isolation, stress, if grief is discouraged, type of loss.

Question 69

Describe the sexual response cycle and give examples of dysfunctions that can arise at each stage

Answer 69

Desire- lack or loss Arousal- erectile dysfunction, sexual arousal disorder Organism- rapid ejaculation, inhibited orgasm or orgasmic dysfunction (can be sensitive too) Other- sexual aversion, lack of sexual enjoyment,vaginismus, dyspareunia, primary if never penetration or secondary from trauma, infection, pregnancy ect. Problems lifelong or acquired, generalised or situational. Often in both partners and a combo.

Question 70

Give examples of factors that can lead to sexual problems

Answer 70

Precipitating- physical, phycolgical, life events, partners problems Predisposing - false beliefs and concepts, unrealistic expectations, poor communication, physical vulnerability, early sexual trauma Perpetuating (fear of failure) self- loss of confidence, spectating, guilt, shame, anger and fustration Perpetuating partner- breakdown in communication, pressure to perform, criticism and hostility, guilt and self blame Rarely a single factor.

Question 71

Describe the main components of psychosexual theory

Answer 71

Find out relative contributions of physical dna psychological factors. Often now behavioural approach looking at cause instead of psychotherapy. Treat couples using co-therapists Facilitate communication Educative counselling individual or couple Modification of attitudes and beliefs Specific directions for sexual behaviour - sensation focus/ dilator therapy/ start stop

Question 72

What is the gender binary model?

Answer 72

Male and females distinguished by anatomy. Men should look and act masculine and vice versa.

Question 73

What is gender identity and gender role/ expression?

Answer 73

Gender identity- someone's internal perception and experience of their gender Gender role/ expression- the way the person acts in society and interacts with others

Question 74

What's the difference between transgender and transsexual?

Answer 74

Transgender- gender identity differs from birth sex | Transsexual- constant desire to live life as the opposite sex

Question 75

What does sexual attraction include?

Answer 75

Feelings, behaviour, identity

Question 76

Explain how experiences of discrimination can lead to poorer health for LGBT patients

Answer 76

``` Rejection from families Bullying at work More likely to live alone and access services when older. Half experience abuse at school Transgender: Depression, suicide, isolate, unemployment much higher Increased stress Social isolation Low self esteem Increased conflict Sub culture Distrust of authorities Discriminatory healthcare e.g. Lesbians refused smears Gps refuse to treat ```

Question 77

Define and give examples of heterosexism

Answer 77

Discrimination in favour of opposite sex sexuality and relationships. Presumption that people are in same sex relationships and it is the norm/ superior.

Question 78

Give examples of how stereotypes about LGBT patients can affect their healthcare

Answer 78

Lesbians don't have HPV/ haven't had sex. Butch men don't have anal sex. Lesbians don't want children. Same sex partner is not next of kin. Gay people don't need paternity/ maternity leave. Failure of organisations to tackle homophobia at work

Question 79

Describe the specific health needs that are present in the community

Answer 79

``` HIV incidence higher. Other stis Mental health particularly transgender and bisexual Cancer - smears LGBT people want Validate identity Confidentiality respect Knowledge of HCP ```

Question 80

Describe the specific health needs that are prevalent in the LGBT community

Answer 80

Illegal to discriminate

Question 81

Explain the ethical and legal requirements of doctors in providing good care for LGBT patients

Answer 81

Illegal to discriminate Do not let views prejudice treatment Challenge colleagues behaviour Respect patients and colleagues regardless of sexual expression

Question 82

Explain why it is important to tell patients when there is bad news

Answer 82

``` Maintains trust Easier to treat patients Patients want to know (often) Lack of info can cause distress, anxiety and dissatisfaction Promotes open communication Allows adjustment Prevents unrealistic expectations ```

Question 83

Explain implications for patients if bad news is not delivered well

Answer 83

Impact on doctor patient relationship Impact on emotional well-being e.g. Distress and depression Adjustment to and ability to cope affected for patients and relatives

Question 84

Describe blocking behaviours in breaking bad news

Answer 84

Changing subject Focusing on physical aspects Saying distress is normal Asking leading, closed or multiple questions Giving advice or info before concerns are addressed.

Question 85

Describe each step in the spikes model of breaking bad news

Answer 85

``` Setting Patient perception Invitation Knowledge Empathy Strategy and summary ```

Question 86

Setting

Answer 86

``` No more than 3 staff At patients level Sitting down Who the patient wants present Privacy Listening mode No physical barriers ```

Question 87

Patients perception

Answer 87

Ask what they know already

Question 88

Invitation

Answer 88

Does the patient want to know? How much? Denial can be used to cope

Question 89

Knowledge

Answer 89

``` Warning shot Small chunks Allow time for question Direct patient to diagnosis Check understanding Clear and simple explanation avoiding jargon ```

Question 90

Empathy

Answer 90

Empathetic response, Ask how they are feeling Acknowledge connection between news and emotion Validate/ normalise emotion Listen to concerns- ask what is concerning them the most

Question 91

Strategy and summary

Answer 91

Agree on next steps Summarise main topics Check understanding Be optimistic but avoid inappropriate reassurance Closure- give opportunity to ask questions, ask if they want someone called, left alone, someone to stay