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Flashcards in S3 Health Psych Deck (74):

Biomedical model

All illnesses can be understood in terms of biological and physiological processes. Treatment includes physical intervention


Biophychosocial model

Health is an interplay or biological, psychological and social care factors.
So should treat whole person as psychological factors can influence health.


Physiological response of stress

Catecholamines are released from adrenal medulla e.g. Adrenaline and noradrenaline
Cortisol released from adrenal cortex - immunosuppressant
- increased resp rate
- more alert
- increased fuel availability as protein breakdown, insulin resistance
- digestive system and sexual response shut down to conserve energy


Three steps of long term stress response

Alarm - immediate physical response to stress that prepares us for fight or flight
Resistance - body attempts to resolve stress but if stressor continues then we remain in physiologically active state
Exhaustion - if stressor continues indefinitely then physical strain on body leads to exhaustion, illness or death


Transactional model of stress

Weighs up demands and resources - stress response?

Primary appraisal - what is the threat
Secondary appraisal - do I have resources to deal with threat
Reappraisal - reconsider the situation when you have tried to cope with it, was it has stressful as you first thought?


Two main factors that influence effect of stress on a person

- If they feel they are in control
- Social support that they have


Four main impacts of stress

- Physical damage (CVS)
- Immune related conditions (upregulated immune system in short term so prepared to fight off infections and in long term immune system depressed and inflammation occurs due to cortisol)
- Unhealthy behaviours - snacks, alcohol
- Mental health - overgeneralisation, catastrophising, personalisation


Two types of coping styles

Emotion focused coping
- changing the emotion via behavioural (doing something like taking to friends) or cognitive (changing how you think about situation) approaches

Problem focused coping
- change the problem or resources so reduce demands of the situation e.g. Find out how to cope or expand resources to help deal with the situation e.g. More exercise physio


What is depression

Negative cognitive triad
- negative view of self, world and future


Barriers to recognising psychological problems

- symptoms missed
- patients not disclosing symptoms e.g. Stigma, scared, thinks it's normal
- HCPs do not think it is their job to ask
- stigma attachment
- no time


Psychoanalytic / psychodynamic therapy

Use relationship with therapist to resolve issues
Aims to resolve unconscious conflicts that underlie symptoms
Therapist interprets patients behaviours and thoughts and helps patient express themself
Focuses on childhood and past
Focuses on interprofessional relationships


Systemic and family therapy

Addresses patterns of interaction and the meaning
Focuses on relational context


Humanist / client centered therapy

General counselling skills to help cope with immediate crises


Cognitive behavioural therapy

Relieves symptoms by changing maladaptive thoughts, beliefs and behaviour
Based on fact that it is not the situation that upsets us, but the view we take

Behaviours therapy e.g. Graded exposure to feared situations, active scheduling
Cognitive therapy e.g. Education, monitor thoughts, challenging negative thoughts

Used for depression, anxiety, eating disorders, sexual dysfunction

Has to be delivered by experts


Define stereotype

Generalisations made about specific social groups and members of those groups
- basis of stereotypes is about how we store memories and organise knowledge which is organised in schemata (groups of related information)
- stereotypes help save processing power
- overlooks diversity and prone to emphasise on negative traits of other groups and positive attributes of own social group


Define prejudice

Stereotypes can lead to prejudice

Making an assumption about someone based on a characteristic that they have


Define discrimination

Stereotypes lead to prejudice
Prejudice can lead to discrimination

Acting on an assumption made about someone due to a characteristic they have


Under what conditions are we likely to rely on stereotypes?

How can we avoid reliance on stereotypes?

Under time pressure, fatigue, information overload

Interact with members of other groups, reflective practice


Two types of intelligence when ageing

Crystallised intelligence
- dependent on the skills we learnt and general knowledge so reflects experience and long term therapy

Fluid intelligence
- problem solving in new situations so reflects processing speed and short term memory

As we age, crystallised intelligence stable but processing speeds decreases.


Two types of models between personality and ageing

Developmental model of personality ageing
- theory of eight stages of personality development each with its own characteristic crisis
- successful resolution of each crises leads to developmental strength

Trait model of personality ageing
- personality described in terms of constituent traits
- mode suggests people stay much the same and show stability in personality


Three models for social adjustment

Disengagement model - disengagement from social involvement as an adaptive mechanism

Activity model - successful ageing needs maximal engagement in all areas of life

Continuity model


Define disability

Physical or mental impairment that has a substantial and long term negative effect on your ability to do normal daily activities


Define impairment

Loss or abnormality or psychological, physiological or anatomical structure or function


Barriers for people with disabilities in accessing healthcare

Staff not trained
No wheelchair access
Size of test
Waiting room space in waiting rooms


Social model of disability

Disability is caused by the way society is organised and not the persons impairment or difference
Looks at ways of removing barriers that restrict life of disabled people


Define cultural diversity

Culture is defined by the relationship a person has with the groups they identify themselves with

Relates to persons circumstances and personal choice


Define sexual orientation

Used to describe the gender you are attracted to - this can change but you cannot change it


Define heterosexism

Assumption that heterosexuality is the social and cultural norm and superior to LGBT people


What specific health needs are prevalent in the LGBT community?

Mental health
Substance use
Cancer (HPV can be transmitted between women, MSM more likely to get anal cancer)
STIs (syphyllis is common between MSM)


Challenges faced when providing healthcare to culturally diverse population

Issues of generations
Language barrier
Not of same religion/ culture
Doctor patient relationships can be difficult e.g. Gender differences, imbalance of power


What is the NATSAL survey?

National survey of Sexual Attitudes of Lifestyles
- so far has been conducted on three occasions and asks questions about sexual behaviour


Why is it difficult to get accurate information on sexual behaviour?

- embarrassment or reluctance
- people may not be able to recounted to recall sexual encounters
- sampling problems


Define compliance

Extent to which patient follows medical advice
Implies doctor knows best, so power doctor and passive patient


Define adherence

Extent to which patient coincides with medical advice
Attempts to be more patient centred, need for agreement, shared decision


Define concordance

Negotiation between the patient and doctor over the treatment regimes
Patient is respected and active in making decisions
About the nature of interaction between a patient and clinician, not about patients medication taking behaviour


What is the relationship between concordance and adherence

Concordance is thought to lead to better adherence as
- patient involves and makes decisions in treatment
- barriers to adherence addressed
- promotes patient trust and satisfaction with care
- patients beliefs and expectations taken into account

Tensions in concordance
- between evidence based medicine and patient choice


Techniques to measure adherence

Direct measures
- urine/ blood test
- observation

Indirect measures
- pill counts
- patient self report
- second hand reports
- mechanical or electrical measures of dose


Factors influencing adherence

- Illness factors - seriousness
- Treatment factors - side effects
- Patient factors - beliefs about illness, medication etc
- Healthcare factors - patient doctor interaction
- Psychosocial factors - social support and social context


Types of non adherence

Unintentional non-adherence
- Capacity and resource limitations that prevents patients from following treatment e.g. Money, dementia

Intentional non-adherence
- Due to patients beliefs, attitudes and expectations that influence patient's motivation to take treatment


Define health related behaviour

Anything that may promote good health or lead to illness
E.g. Smoking drinking drugs exercise


What are the three learning theories

Classical conditioning
Operating conditioning
Social learning theory



Classical conditioning theory

Making unconscious associations with stimuli and other things that occur at the same time
E.g. Bell, food, salivation
Conditioned behaviours become habits which are hard to break

Based on single stimulus response association, no account of social context etc


Operant conditioning theory

Learning through association between actions and consequences
Behaviour reinforced if rewarded and vice versa

Based on single stimulus response association, no account of social context etc


Social learning theory

Looking at other people's behaviours and whether they are being rewarded or punished for what they are doing and then applying this to ourselves
Likely to look at behaviour of those like us or of higher status

Does not take into account how people reason


Social cognition models

Cognitive dissonance theory
Health belief model
Theory of planned behaviour


Cognitive dissonance theory

Discomfort when you hold inconsistent beliefs or actions/events do not match beliefs
This is uncomfortable so change beliefs or behaviours
E.g. Health information uncomfortable so promotes change in behaviour but information alone not effective as fear may cause avoidance


Health belief model

Beliefs about health threat (perceived susceptibility and severity)
Beliefs about health related behaviour (perceived benefits and barriers)

Leads to action


Theory of planned behaviour

Attitude towards behaviour
Subjective norm
Perceived control

Leads to intention

Leads to behaviour


Stages of change model



Levels of drinking behaviour

Low risk - abstention or low risk drinking
Hazardous drinking - over limits but avoided significant health problems
Harmful drinking - over limits and evidence of health related harm
Moderate dependence - degree of dependence but not reached relief drinking (so not drinking to avoid physical discomfort from withdrawal symptoms)
Severe dependence - serious and longstanding problems, relief drinking


Tools for screening patients for levels of alcohol use

Cut down, Annoyed (about being criticised about drinking), Guilt, Eye opener

- Same sorts of Qs as CAGE

PAT - Paddington alcohol test


Management of patients with alcohol problems

- counselling
- vitamin supplements
- relapse prevention e.g. Disulfarim


Concept of attachment in child development

Attachment theory was developed to understand relationship between infants and primary care givers

Attachment is to maintain proximity to infants care giver
- proximity seeking behaviours
- contact maintaining behaviours


Social development theory in infancy

- Newborns: preference for human faces over innate objects
- 3 months: distinguish strangers from non strangers, preference for non-strangers
- 7-8 months: special attachments are formed, child will miss key people and show signs of distress in their absence


Secure attachment

Carer is sensitive to child's signals and carries out rapid responses e.g. When crying

Infant forms first 'mental model' of relationship based on interactions with primary care giver.
Secure attachment shows child is worthy of love and care, influences brain development, self reliance, better social competence etc.


When is critical period for first attachment?

During the first year
However if disrupted early life they can still form positive relationships later on however problems may occur if separated in first 4 years.


Insecure attachment

Children do not have expectation that they are worthy of love and care. Results from neglect and lack of stimulation.

Can lead to serious underdevelopment in brain, especially region involving emotional regulation


Stages in separation for hospitalised child


Protest - distressed, looking for mother
Despair - signs of helplessness, withdrawn, intermittently crying
Detachment - more interested in surroundings, may smile and be sociable bit when carer returns they are remote


Behavioural changes/ physical impact of separation from child

- anxiety/ aggression
- bed wetting
- detachment

Physical impact
- depression
- slower movement
- less sleep and play
- changes in heart rate and body temperature


Why are child 6 months - 3 years most distressed when separated from caregivers?

- Lack of ability to keep an image of carer in mind
- Limited language e.g. Do not know what tomorrow means
- Lack of ability to understand abstract concepts
- Feel abandoned - being punished as naughty


Criticisms of attachment theory

- Overly focused on mothers
- Multiple attachment figures may be formed which is not explored
- Quality of substitute care not explored


Good practice in hospital care for children to be comfortable

- Parent access
- Attachment objects allowed e.g. Teddy
- Reassure child not abandoned or punished
- Environment like home
- Continuity of staff to develop relationships with them
- Stimulating toys and activity


Piaget's four stages of childhood cognitive development

Sensorimotor (0-2)
- experience world through senses, develop body schemata, permanence understanding at 8 months
Pre operational (2-7)
- egocentrism, lack of conservation, classification by single feature, language development, symbolic thought, able to imagine things
Concrete operational (7-12)
- achieved conservation, classification by multiple features, see things from other perspectives, think logically but concrete rather than abstract
Formal operational (12+)
- abstract logic, hypothetical deductive reasoning, can struggle with concept of future

Focuses on what child cannot do - bad


Vygotsky's theory of social development

Cognitive development needs social interaction - do not learn on our on

X is what the child achieves on their own
+1 is son of proximal development so bit extra child can achieve with support


Things to bear in mind when communicating with children

- danger of using metaphors
- do not assume 'average' ability of child
- social referencing (children look at closest bonded family member as a child to get a clue about what to be feeling and doing so draw in patients and confidence in them to draw in child)


Motivational interviewing

Technique to help patients move onto thinking about changing their behaviour
- understand perspective of patient
- let patient decide what to do
- aims to draw out patient's own arguments for change
- particularly helpful for people at precontemplative and contemplative change
- increases internal motivation


Acute v chronic pain

Acute pain protects us from damage or infection
Chronic pain usually signals part of the body is damaging or healing but if pain is for more than 3 months it is possible original physical pain has healed but pain pathways are over sensitised or dysregulated so pain felt when no injury present


Gate control theory of pain

Pain is experienced in brain through complex pathways in the body from damage/ disease
Gate control theory says pain is a result of a 2 way process or communication between the brain and tissue damage
The extent to which the gate is opened or closed affects the number of pain messages received
Factors that influence gate can be physical or psychological

Open gate - injury, negative beliefs, stress
Close gate - medication, exercise, relaxation, active life


- pain threshold
- pain tolerance

Pain threshold
- point at which stimulus becomes painful (similar for most people)

Pain tolerance
- degree to which painful stimulus is tolerated - varies widely between individuals e.g. Humour increases pain tolerance


Aims of pain management programmes

Help people manage pain to lead functional and positive life
Programmes are very effective
Educate people about dimensions of pain and how viscous cycles can arise
Patients encouraged to take control of their life though empowerment and activity


Bad news for patients is hard as

- fear of what lies ahead
- changes in responsibility
- feeling like an outsider
- losing the future
- wanting to maintain identity but being treated differently
- worry about impact on family


5 stages of grief model



Why is it difficult for Drs to break bad news?

- fear of how patient will react
- reminders of own mortality/ family and friends
- feel they are failing as a Dr by telling people they are going to die
- lack of time


Breaking bad news model


S- setting and listening skills
P - patient's perception
I - invitations from patient to give information
K - knowledge (warning shot, clear and simple explanations)
E - empathy
S - strategy and summary