HPsyHD S8 (Done) Flashcards Preview

ESA 3 Callum's Cards > HPsyHD S8 (Done) > Flashcards

Flashcards in HPsyHD S8 (Done) Deck (27):
1

How does death vary by age, gender and socioeconomic status?

Age:

Highest deah rates in older groups

67% of death in 75+

Gender:

Women on average live about 5 years longer

Socioeconomic:

Less wealthy experience greater disease and earlier death

2

What are the 3 main patterns of dying?

Gradual:

Slow decline due to progressive disease

Catastrophic:

Death due to a sudden and unexpected event

Premature death:

Death in children and young adults due to accidents or illness

3

What is the typical initial reaction to news that you have a terminal illness?

Shock, numbness, disbelief and confusion

Hard to take in what is said

4

What are Kubler and Ross's stages of grief?

Give a brief description of each

Denial:

"It's not true/Can't be happening to me"

Refusal to discuss illness/future

Anger:

"Why me!" - Anger at illness

"The doctors are to blame!" - Anger at others

Search for alternative treatment?

Bargaining:

"I'll go to church every day!" - Bargaining with god

"I'll do anything if you enter me into this clinicl trial" - Bargaining with doctors

Depression:

Depression and hopelessness arise

Could be in response to reality finally sinking in

Acceptance:

Patient accepts condition and plans for the future/moves on with the rest of their life

5

How must doctors respond to those in the Denial phase of grief?

Can be a coping mechanism

Must respect desire "Not to know"

Offer written information for patient to look at with family

Denial may be a barrier to care, make sure to review at a later time 'when ready'

6

Define 'Grief'

A set of psychological and physical rections to bereavement

A normal reaction of overwhelming loss in which normal functioning ceases

7

Define 'Mourning'

Process of adapting to loss

E.g. Funeral rituals

8

Describe the grieving process

Stages:

Disbeleif and shock

Developing awareness

Resolution

Additionally:

Everyone experiences this differently

Reassuring to know it is a normal thing and will pass

Common elements include Anger and blaming others

9

What are the effects of bereavement?

Older persons:

Particularly loss of spouse may increase risk of illness and mortality

General:

Physical symptoms (SOB, palpitations, GI dysfunction, reduced immune function)

Behavioural symptoms (Insomnia, irritability, withdrawal)

Emotional symptoms (Depression, anxiety, anger, guilt)

Cognitive symptoms (Lack of concentration, memory loss, preoccupation, hopelessness, hallucinations)

10

Describe the resolution of grief

85% adjust to bereavement and experience minimal grief after 2 yrs

15% experience Chronic grief, Anxiety, depression, PTSD after 2 years

11

What are the risk factors for chronic grief?

Prior bereavement

Poor mental health

Type of loss (young person, nature of death, caring status)

Lack of social support, stress from other sources

Expression of grief discouraged

Ending of grief discouraged

12

How is medical practice often inconsistent with patient wishes regarding death?

Most people want to die at home, but instead die in hospitals

56% to 67% express wnating to die at home, but only 35% die at home or in a care home

Relatives are often unable to provide home care as they ack support and advice

13

What are the aims of palliative care?

Improve quality of life

Manage emotional and physical symptoms

Support patients to live productively

Give patients some control

 

14

How do physicians react to death?

How is coping with death best achieved by a physician?

Can have a serious impact:

- Feelings of failure, guilt, sadness, anger, reminder of mortality

- Risk of burnout

- Unsure how to express emotions

Coping:

- Death not always a defeat

- Aknowledge loss with relatives, talk to colleagues/family

 

 

15

What are the stges of the sexual response cycle?

Desire

Arousal

Orgasm

Rest

16

What are the sexual dysfunctions affecting men, women and both?

Both:

Lack/loss of sexual desire

Sexual aversion or lack of enjoyment

Dyspareunia (pain upon sexual intercourse)

Male:

Erectile dysfunction

Rapid ejeculation

Inhibited orgasm

Women:

Sexual arousal disorder

Orgasmic dysfunction

Vaginismus (tightening of outer vaginal muscles upon attempt to penetrate)

17

How does sexual dysfunction vary across individuals, couples and time/situation and cause?

Problems occur regardless of orientation

More than one problem can present in one person

Couples often both experience sexual dysfunction

Problems may be lifelong or acquired

May be generalised or situational

Due to physical or psychological difficulties

18

What are the overall prevalances of sexual dysfunction in men and women?

Men - 22%

Women - 40%

Likely to be underestimates

19

How does sexual dysfunction present?

Overtly:

Patient is direct about the problem

Covertly:

Patient only hints at dysfunction through speech or behaviour

E.g. Repeated negative investigations for pain or dyscharge or never being happy with offered methods of contraception

Stems from reluctance to raise the issue

20

Where might you refer a patient presenting with sexual dysfunction?

GUM clinic

Gynaecological unit

Ante or Post natal services

Family planning

Urology

ONcolgy

Psychiatry

Pelvic pain clinic

Voluntary sector

21

What must be considered when discussing sexual issue with a patient?

Empathy and reassurance must be priority

Awareness of potential for embarrassment

Empathy for stigma and reassurance that it's ok to talk about

Privacy and confidentiality

Open and specific questions

Avoid labels and judgements

Terminology must be correct/understandable by all

Religious and cultural issues

Interview of partner (ask if you can)

22

What are the features of a structured clinical interview for sexual problems?

Detailed description of behavioural, cognitive and affective functioning

Relationship with partner

Releavant past relationships

Medical history and drug use

Mental health history

Family and psychosexual history (Repression, no intimacy as child)

Significant life events (Rape, sexual abuse)

Sexuality

Cultural aspects

Coping mechanisms and support networks

23

Why do people have sexual problems?

Cycle of failure and faer of failure enforcing further failure and problems

Predisposing factors to sexual 'failure':

False beliefs and concepts

UNrealistic expectations

Poor communication

Physical vunerability

Early sexual trauma

Precipitating factors for sexual 'failure':

Physical/psychological

Life events

Partner problems

Perpetuating factors (self):

Loss of confidence

Spectating (Hyper-selfconcious during sex)

Guilt and shame

Perpetuating factors (Partner):

Breakdown of communication

Pressure to perform

Critisism and blame

Guilt and self blame

 

Overall, Rarely a single factor

 

 

24

How were sexual problems historically viewed/treated?

Traditionally viewed as manifestations of deep seated psychological problems

Treated with long term psychotherapy

Masters & Johnson (1970s):

Introduced a behavioural approach to treatment focusing on immediate causes of dysfunction with short term target directed therapy

Basic assumption was that attitudes, ignorance and anxiety cause most sexual problems

25

What are the current main componenets of treatment of sexual dysfunction?

Educative counselling (Individual, couples)

Modification of attitudes/beliefs

Facilitation of communication/assertiveness

Specific directions for behaiour:

- Sensate focus - Focus on sensations not self

- Dilator therapy - Vaginismus

- Stop start - Erectile dysfunction

26

What physical treatments are available for males?

Oral therapy (Viagra, Cialis for ED)

Local therapy (EMLA cream)

Self injection therapy

Mechanical therapy (Pumps, rings to achieve erection)

Surgery (E.g. Inflatable penile implants)

27

What physical treatments for sexual dysfunction are available to women?

Testoserone (sexual drive increase)

Oestrogen

Clitoral therapy device (increase arousal)

Zestra gel (improve sensation)