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ESA 3 > HPsych 4 > Flashcards

HPsych 4 Flashcards

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1
Q

Describe the physiological response to stress

A

Fight of flight

Short term changes to mobilise for activity

Mainly triggered by catecholamines (Adrenaline + Noradrenaline)

Results in:

Inc. O2 availability

Enhanced cognitive functioning

Liberation of glucose, proteolysis, insulin resistance

Reduced blood flow to digestive/reproductive systems

Inc. Cardiac output, muscle response and sweating

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2
Q

What is the stress performance connection?

A

Performance is optimal at a medium/normal level of stress (eustress)

Performance can dip and you become disorganised under high stress

Performance can dip if not sufficinetly stressed

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3
Q

List some of the effects of long term stress

A

Long term stress can lead to:

Exhaustion

Cardiovascular problems (Hypertension, athersclerosis)

Diabetes

Negative health behaviour (Smoking, overeating, drinking)

Muscle pains

Increased susceptibilty to infections, E.g. Peptic ulcers, Colds (Downregulation of immune system)

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4
Q

Compare the hunter-gatherer model of society with modern life in terms of stress response

A

Hunter-gatherer:

Acute stressors give acute response

Provides survival advantage

Modern life:

Frequent daily hassles lead to chronic stress

Physiological response poorly suited to chronic stress

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5
Q

What is a stressor?

Give examples

A

An event which causes stress

E.g.

Death of a spouse

Christmas

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6
Q

Define stress

A

A condition or feeling experienced when a person perceives thats demands exceed the personal and social resources the individual is able to mobilize

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7
Q

What is the Holmes and Rahe stress scale?

Give examples of stressors on the scale

A

1-100 Scale quantifying the level of stress caused by life events

E.g.

Death of a spouse - 100

Christmas - 13

Marriage - 50

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8
Q

What is Kaneer et al’s ‘Daily hassles and uplifts’ study?

Why is it useful?

A

Participants ranked daily stressors and uplifting events on a scale of 1-3

1 = Somewhat severe

2 = Moderately severe

3 = Extremely severe

Over a course of 9 months, then assessed their physiological measurements of stress

Use:

Found that daily stressors rather than large event stressors where useful in predicting stress as small stressors on a daily basis can build up to form a bigger stressor

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9
Q

What is the major problem with creating a model of stress?

A

Accounting for Individual variation / Subjectivity of stress

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10
Q

What is the transactional model of stress?

A

Theorieses that stress is a result of how people appraise events and their ability to cope with them

Stressors and resources are appraised and a stress reponse is generated based on that appraisal

Stressors = Events, Hassles, Chronic stressors

Resources = Personality, Social support, Coping skills, Control

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11
Q

Describe the process of appraisal according to the transactional model of stress

A

3 Stages:

Primary appraisal:

Is this event a threat? How bad could it be?

We classify event as benign, challenging or threatening

Secondary appraisal:

We appraise our resourses and skills to cope and decide if we are able to deal with stressor

Reappraisal:

Reconsideration after attempting to cope (may decide it’s more or less stressful than initially thought)

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12
Q

How does control affect our reaction to stressors?

A

High control over stressor is more likely to produce a lower stress state than little/no control over stressor

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13
Q

Demonstrate how social support is important to our stress reaction

A

Death of a spouse

Common for living spouse to die shortly after

Response to stressor + Loss of resource (social support)?

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14
Q

How can long term stress affect the cardiovascular system?

What is the other major condition that stress can contribute to? By what mechanisms?

A

Cardiovascular:

Hypertension

Cholesterol increase (athersclerosis)

Smoking

Physical inactivity

Overeating

Other:

Diabetes due to increased insulin resistance and blood glucose

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15
Q

Demonstrate how short term intense stressors can affect the cardiovascular system

A

Increase in sudden cardiac death triggered by earthquakes

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16
Q

How are stress and the common cold linked?

A

Increased stress is associated with increased prediposition to colds

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17
Q

Describe the response of the immune system to short and longer term stress

A

Short/Medium term stress:

Immune system upregulated

Prepares to repair damage and resist infection (increased lymphocytes)

Prepares to fight off pathogens (Increase in antibodies, B-Cells)

Long term stress:

Depressed immune function (Cortisol)

Inflammation

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18
Q

How can stress distort our cognitive function?

A

Thinking tends to be more rigid and extreme under stress

Congnitive distortions:

Overgeneralisation

Catastrophising

Personalisation

Rumination

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19
Q

How is the concept of ‘learned helplessness’ demonstrated?

A

Electrical shocks administered to dogs in a situation they cannot escape

Then when put in a situation where they can escape persistent shocking, they do not even attempt to escape

Dogs that have not ‘learned helplessness’ escape as expected

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20
Q

How do we apply the idea of ‘learned helplessness’ to stress?

A

Chronic stressors may lead to a state where someone loses motivation to deal with stressors

Concequences include:

Anxiety

Depression

Downward spiral of illness

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21
Q

Describe a cognitive techniques used to reduce stress

A

Congnitive restructuring:

Identification of negative emotional

Idnetification of negative/irrational thoughts

Attempt to rationally analyze the situation

Monitor mood

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22
Q

Give an example of a behavioural strategy for stress management

A

Skills training in assertiveness/time management

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23
Q

Give examples of emotional strategies for stress management

A

Councelling

Emotional disclosure

Social support (Family, Friends, Groups)

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24
Q

What are 2 physical strategies for stress management?

A

Exercise

Relaxation training

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25
Give a non-cognitive, clinical stress management technique
Drugs
26
What things might a patient have to cope with related to their diagnoses?
Emotion (Shock, anger, anxiety, depression, denial, fear)
27
What things might a patient have to cope with related to the physical impact of their disease?
Pain Limited mobility Oher symptoms
28
What things might a patient have to cope with related to their treatment?
Anxiety Discomfort Impact on body image
29
What things might a patient have to cope with related to hospitalisation?
Loss of autonomy, privacy, status Removal from usual support network
30
What things might a patient have to cope with related to adjustment to a condition?
Biographical disruption Change in identify (sick-role, stigma) Chronicity (indefinite change) Acknowledgement of mortality
31
What are the socioeconomic factors affecting patient response to disease?
**Social:** Bereavement, divorce marriage etc Improsonment Personal achievement Change of habits **Financial:** Dissmisal Retirement Job change Change in financial status
32
Give some examples of emotional focussed coping styles/activities
**Behavioural:** Talking to friends Alcohol/drugs Distraction **Cognitive:** Denail Focus on positive (E.g. Quitting unliked job)
33
Give examples of problem focussed coping styles/activities
**Reduce demands of stressful situations:** Coping mechanisms for disease stressors **Expand resources to deal with it:** Physiotherapy or motorised scooter to deal with immobility
34
What is the importance of coping mechanisms both to the patient and physician?
**Patient:** Active coping associated with better adjustment Passive coping also useful (particularly in chronically ill) **Physician:** Consideration must be given to patient's coping mechanisms when giving information
35
What are the 4 ways to aid coping in a patient?
Increase social support Increase personal control Prepare for stressful events Stress management techniques
36
In what ways can we increase a patient's social support? In what demographic is this particularly important?
Help patient recognise and mobilise support Suggestions for sources of support (Socail services, community resources, hospital visitors/chaplain etc) Particularly important in the elderly who frequently have impoverished social support networks
37
How can we increase pateint control with a view to aid coping?
Self managed pain medication Self management of disease (Diabetes management regimes) Give patients choices of treatments Aid congnitive control (Emotional management)
38
How can preparing patients for stressful events aid coping? Give two examples of how stress reduction techniques may aid coping
Reduces ambiguity and uncertainty Effective communication: *- Reduces anxiety, pain, length of hospital stay* Peer contact: *- Pairing of pre-op and post-op patients to reduce pre-op anxiety and recovery time*
39
What are the outcomes of successful coping?
Tolerating or adjusting to negative events/realities Reducing threats and enhancing prospect of recovery Maintaining positive self image Maintaining emotional balance Continue satisfying relationships with others
40
Give examples of the emotional effects of chronic and severe illness
Depression 2-3x more common in people with chronic disease Anxiety more common in people with heart attach, stroke and cancer
41
Give a basic description of anxiety in patients
Response to threat (Surgery, test results, uncertain prognosis) Unpleasant emotional state, may include feelings of panic of dread Likely to occur at various stages of illness: * - Diagnoses* * - Awaiting test results* * - Discharge from hospital* * - Making lifestyle changes*
42
Outline how anxiety affects patients
**Sustained anxiety associated with unhelpful thinking patterns:** - Increased threat vigilance - Interpretting ambigous information as threatening - Increased recall of threatening memories **Anxiety disorders (Phobia, Panic attacks etc)**
43
Give a description of depression in patients What is it a response to? (in patients)
Emotional state characterised by persistent low mood, sadness, loss of interst, despair, feeling worthless Tends to be long term **Response to loss/failure/helplessness:** - Loss of health/physical capacity/identity - Reaction to symptoms - Medication side effects
44
What factors raise risk of depression in patients? What can be the effect of depression on patients?
Severity of illness Pain and disability Negative life events Lack of social support **Effects:** Exacerbate pain and distress Adversely effect outcomes of illness
45
What are the direct and indirect pathways of psychological distress on health?
**Direct:** See flashcards related to impact of stress on health (Cardiovascular, diabetes etc) **Indirect:** Negative health related behaviour (smoking, drinking, overeating) Compromised quality of life Negative impact on coping with treatment Poorer self management of disease (reduced adherence)
46
What factors related to treatments and illnesses prevent recognition of psychological problems in patients?
Psychological response changes over time (Depression may set in after discharge) Symptoms may be attributed to illness or treatment
47
What patient factors prevent recognition of psychological problems in patients?
Belief it can't be alleviated Wish to avoid complaining/being a burden Avoidance of judgement/stigma
48
What factors relating to HCPs prevent recognition of psychological problems in patients?
Outside psychiatric setting HCPs may believe it's not in their role or fear overwhelming distress of patient Tendency to ignore Reluctance to label patients as psychiatric
49
What is the importance of recognising psychiatric difficulty in pateints?
Clear links between mental and physical health
50
What are the 3 main types of psychiatric intervention for patients?
Aid in coping (prevention of psychiatric difficulty) Counselling and psychological therapy Medication (Antidepressants)
51
What are the NICE guidelines for treatment of depression (mild to moderate and moderate to severe)
**Mild to moderate:** Individual guided self help Structures group physical activity Group based Cognitive behavioural training + Group peer support for chronic illness sufferers **Moderate to severe:** Combine above with anti-depressants High intensity psychosocial intervention (Individual CBT, interpersonal therapy etc)
52
What are the NICE guidelines on mild to severe/persistent stress?
**Mild:** Individual self help, psychoeducational group Medication (SSRIs) **Severe/persistent:** + High intensity psychosocial intervention (individual CBT, applied relaxation)
53
Describe the early bio-medical theory of pain How does psychology relate to this model?
Tissue damage (E.g. Cut knee) = Pain receptors triggered and messages sent to the brain, resulting in the pain sensation Physical damage is the sole cause of 'real' pain and explains all pains Only role of psychology is in the aftermath of pain (E.g. fear, anxiety, depression)
54
What phenomena challenge the early biomedical theory of pain? \*Exhaustive list given, Probably not necessary to memorise them all\*
Continued pain after damage heals Experience of pain in absense of physical harm Low pain experience upon severe injury Phantom pain in amputees Placebo effect Variation of pain in people with similar injuries
55
What is the WHO definition of pain?
Unpleasant sensory and emotional experience which is associated with actual or potential tissue damage or is described in terms of such damage
56
What are the common features of acute pain
Short term Attracts our attention Pain lasts as long as there is healing Action can be taken (Medication, Rest, Seeing Dr)
57
What are the common features of chronic pain?
Pain for \>12 wks Debilitating Not useful (Doesn't indicate ongoing tissue damage) Prolonged rest, medication not useful Arises from a variety of conditions/diseases or idiopathic
58
What are some ways we can assess pain Why is assessment of pain difficult?
**Assessment types:** Self-report Assess behaviour Psychophysiological measures Measuring effect of pain on other areas of life **Difficulty:** Direct objective assessment is almost impossible to obtain, pain is extremely subjective
59
Describe the physiological theory behind 'Gate Control Theory'
Pain is experienced in the brain through complex pathways in the body from damage/disease source Important neural relays (gates) for messages to pass through are located in the dorsal horn of the spinal cord Extent of pain messages recieved is determined by how open or closed the 'gates' are (open gate = more pain).
60
How does Gate Control Theory account for the subjectivity of pain?
Pain is a result of two way communication between brain and tissues/nerves Psychological and physiological factors can open/close the gate
61
Give examples of factors which may open the 'pain gate'
**Biopsychosocial factors:** Injury Sensitivity of the NS Stress and tension Focus on pain, Expectation of pain Negative emotions and beliefs Minimal involvement in life
62
Give examples of factors which may close the 'pain gate'
**Biopsychosocial factors:** Medication Counter-stimulation Exercise Distraction Positive emotions and beliefs Active lifestyle
63
What are the psychological factors contributing to pain? \*List of buzzwords from earlier in course\*
Operant and classical conditioning Anxiety, fear Secondary gains Pain behaviour Catastrophising Attention Self-efficacy Meaning
64
What are the limitations of the Gate Control Theory?
No physical structure identified Still assumption of biological basis of all pain Assumes physiological and psychological processes interact but still sees them as separate (Duallistic thinking) \*Side note: Last one is probably the lamest excuse for a limitation I've ever seen, please don't ever use it\*
65
Give a brief description of the 'Neuromatrix theory of pain' and how it relates to pain Avoid the urge to giggle at the ridiculously Sci-Fi name
Widespread distribution of neurons in our brain that imprint a 'neurosignature' upon patterns of impulse that pass through them We have an overall neurosignature for our sense of self created by subsets of patterns that give us particular sensations (Warmth, pain etc) Pain can be caused by multiple physiological and psychological process due to the fact that neurones of the pain neurosignature are also involved in other neurosignatures
66
What is the overall aim of 'Pain Management Programmes' How does it differ from bomedical management of pain?
Aims to improve the physical, psychological, emotional and social dimensions of quality of life in people ith persistent pain using a multidisciplinary team working according to behavioural and cognitive principles Doesn't focus on pain as a result of disease or damage or deficits in personality or mental health
67
What is the central message of PMPs?
Helping patients control pain, rather than pain be in control of them, not focusing on a cure, just management
68
What are the specific aims of a PMP related to change in behaviour/cognition?
Reinforce acceptance of chronic pain Improve fitness, mobility, posture Address fear of concequence of movement Learn to cope with stress, anxiety, depression, anger Learn to relax Graded return to normal daily activity Facilitate appropriate medication use Improve communication skills Reduce use of unhelpful aids and equipment
69
What are the 4 main 'prongs/topics' of PMP
Management of thoughts and feelings (CBT/Mindfulness) Active, paced activity (Understanding posture and biomechanics, building achievements) Goal setting Relaxation
70
Give some examples of topics adressed by PMPs other than the 4 main prongs
Communication (Assertivness and anger managment) Stress management Maintaining change and planning for 'bad days' Relationships
71
How does CBT and the concept of Mindfulness factor into PMPs?
Learning to focus on present moment without negative rumination on past or worrying about future Fighting negative thoughts/accepting them as 'just thoughts' and moving back to focusing on present moment Taking a stance of self-compassion, act with kindness towards self Can help in managment of stress, which in turn helps pain Encourages learning to tolerate a focus on pain but to detach negative thoughts and emotions from the experience
72
What are some other imprtant aspects of PMPs other than active treatment/education?
Being believed that pain is real Being part of a group (Shared experiences, social support) Social comparision (Can see others as worse off, feel better as a result)
73
Why might we refer patients to PMPs?
**When pain is causing:** Distress Disability Negative impact on QoL
74
What is a profile of someone typically referred to PMPs?
Average of 5yrs of pain Exhausted medical methods of relief Often angry, depressed, anxious, disabled, out of work, family difficulties, withdrawn socially
75
What patient factors might we need to consider when considering a referral to PMPs?
Communication Mental health Cognitive ability Willing to work in a group Level of physical function Social/psychological factors that might need addressing first
76
What are the issues/limitations of PMPs?
Not all patients can work in groups We know they are effective, but don't know what key aspects in particular make it effective Practicalities of follow up make it difficult to assess whether long term change is made PMP ideally needs to begin at onset of pain Staff needs specific training

ESA 3 (54 decks)

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