S3 Health Psych

Question 1

Biomedical model

Answer 1

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

Question 2

Biophychosocial model

Answer 2

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

Question 3

Physiological response of stress

Answer 3

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

Question 4

Three steps of long term stress response

Answer 4

ARE
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

Question 5

Transactional model of stress

Answer 5

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?

Question 6

Two main factors that influence effect of stress on a person

Answer 6

• If they feel they are in control

- Social support that they have

Question 7

Four main impacts of stress

Answer 7

• 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

Question 8

Two types of coping styles

Answer 8

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

Question 9

What is depression

Answer 9

Negative cognitive triad

- negative view of self, world and future

Question 10

Barriers to recognising psychological problems

Answer 10

• 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

Question 11

Psychoanalytic / psychodynamic therapy

Answer 11

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

Question 12

Systemic and family therapy

Answer 12

Addresses patterns of interaction and the meaning

Focuses on relational context

Question 13

Humanist / client centered therapy

Answer 13

General counselling skills to help cope with immediate crises

Question 14

Cognitive behavioural therapy

Answer 14

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

Question 15

Define stereotype

Answer 15

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

Question 16

Define prejudice

Answer 16

Stereotypes can lead to prejudice

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

Question 17

Define discrimination

Answer 17

Stereotypes lead to prejudice
Prejudice can lead to discrimination

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

Question 18

Under what conditions are we likely to rely on stereotypes?

How can we avoid reliance on stereotypes?

Answer 18

Under time pressure, fatigue, information overload

Interact with members of other groups, reflective practice

Question 19

Two types of intelligence when ageing

Answer 19

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.

Question 20

Two types of models between personality and ageing

Answer 20

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

Question 21

Three models for social adjustment

Answer 21

Disengagement model - disengagement from social involvement as an adaptive mechanism

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

Continuity model

Question 22

Define disability

Answer 22

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

Question 23

Define impairment

Answer 23

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

Question 24

Barriers for people with disabilities in accessing healthcare

Answer 24

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

Question 25

Social model of disability

Answer 25

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

Question 26

Define cultural diversity

Answer 26

Culture is defined by the relationship a person has with the groups they identify themselves with Relates to persons circumstances and personal choice

Question 27

Define sexual orientation

Answer 27

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

Question 28

Define heterosexism

Answer 28

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

Question 29

What specific health needs are prevalent in the LGBT community?

Answer 29

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

Question 30

Challenges faced when providing healthcare to culturally diverse population

Answer 30

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

Question 31

What is the NATSAL survey?

Answer 31

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

Question 32

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

Answer 32

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

Question 33

Define compliance

Answer 33

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

Question 34

Define adherence

Answer 34

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

Question 35

Define concordance

Answer 35

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

Question 36

What is the relationship between concordance and adherence

Answer 36

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

Question 37

Techniques to measure adherence

Answer 37

Direct measures - urine/ blood test - observation Indirect measures - pill counts - patient self report - second hand reports - mechanical or electrical measures of dose

Question 38

Factors influencing adherence

Answer 38

- 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

Question 39

Types of non adherence

Answer 39

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

Question 40

Define health related behaviour

Answer 40

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

Question 41

What are the three learning theories

Answer 41

Classical conditioning Operating conditioning Social learning theory SOC

Question 42

Classical conditioning theory

Answer 42

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

Question 43

Operant conditioning theory

Answer 43

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

Question 44

Social learning theory

Answer 44

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

Question 45

Social cognition models

Answer 45

Cognitive dissonance theory Health belief model Theory of planned behaviour

Question 46

Cognitive dissonance theory

Answer 46

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

Question 47

Health belief model

Answer 47

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

Question 48

Theory of planned behaviour

Answer 48

Attitude towards behaviour Subjective norm Perceived control Leads to intention Leads to behaviour

Question 49

Stages of change model

Answer 49

``` Precontemplation Contemplation Preparation Action Maintainence Relapse ```

Question 50

Levels of drinking behaviour

Answer 50

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

Question 51

Tools for screening patients for levels of alcohol use

Answer 51

CAGE Cut down, Annoyed (about being criticised about drinking), Guilt, Eye opener AUDIT FAST - Same sorts of Qs as CAGE PAT - Paddington alcohol test

Question 52

Management of patients with alcohol problems

Answer 52

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

Question 53

Concept of attachment in child development

Answer 53

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

Question 54

Social development theory in infancy

Answer 54

- 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

Question 55

Secure attachment

Answer 55

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.

Question 56

When is critical period for first attachment?

Answer 56

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.

Question 57

Insecure attachment

Answer 57

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

Question 58

Stages in separation for hospitalised child

Answer 58

P DD 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

Question 59

Behavioural changes/ physical impact of separation from child

Answer 59

Behavioural - anxiety/ aggression - bed wetting - detachment Physical impact - depression - slower movement - less sleep and play - changes in heart rate and body temperature

Question 60

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

Answer 60

- 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

Question 61

Criticisms of attachment theory

Answer 61

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

Question 62

Good practice in hospital care for children to be comfortable

Answer 62

- 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

Question 63

Piaget's four stages of childhood cognitive development

Answer 63

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

Question 64

Vygotsky's theory of social development

Answer 64

Cognitive development needs social interaction - do not learn on our on X+1 X is what the child achieves on their own +1 is son of proximal development so bit extra child can achieve with support

Question 65

Things to bear in mind when communicating with children

Answer 65

- 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)

Question 66

Motivational interviewing

Answer 66

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

Question 67

Acute v chronic pain

Answer 67

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

Question 68

Gate control theory of pain

Answer 68

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

Question 69

Define - pain threshold - pain tolerance

Answer 69

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

Question 70

Aims of pain management programmes

Answer 70

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

Question 71

Bad news for patients is hard as

Answer 71

- 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

Question 72

5 stages of grief model

Answer 72

``` DABDA Denial Anger Bargaining Depression Acceptance ```

Question 73

Why is it difficult for Drs to break bad news?

Answer 73

- 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

Question 74

Breaking bad news model

Answer 74

SPIKES 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