Health Psyche Flashcard Quiz

'Behaviours that are related to the health status of the individual' (Ogden, 2007)

• Good health behaviours: Sleeping (7-8 hours), regular exercise, healthy eating, eating breakfast every day
• Health protective behaviours: Wearing a seatbelt, attending regular check-ups, health screening
• Health impaling habits: Smoking, eating a high fat diet, alcohol abuse

• Bio: Viruses, Genetics, Bacteria
• Psycho: Behaviour, emotions, beliefs, coping, stress
• Social: Class, employment, ethnicity

• Emotional dispositions (present - psychological processes involved in both the experience and expression)
• Generalised expectancies (future - psychological processes involved in formulating expectations in relation to future outcomes )
• Explanatory styles (past - psychological processes involved in explaining the causes of negative events)

• OCEAN
• O - Openness to new experiences - Intellect and interest in culture
• C - Conscientiousness - The will to achieve
• E - Extroversion - Outgoing
• A - Agreeableness - Loving, friendly and complaint
• N - Neuroticism - Experience more negative emotions

• Locus of Control - Expectations that future outcomes will be demonstrated by factors that are either internal (self - responsible for own health, illness can be avoided etc.) or external (powerful others, and chance)
• Self-Efficacy - Belief in one's own ability to organise and execute a course of action, and the expectation that the action will result in, or lead to, a desired outcome

• Perceived Susceptibility + Perceived Severity = Perceived Threat
• Percevied Benefits + Perceived Barriers = Perceived Efficacy
• Perceived Threat + Perceived Efficacy = Health Behaviour

• Behavioural Beliefs + Outcome Evaluation = Behavioural Attitude
• Normative Belief + Motivation to Comply = Subjective Norm
• Control Beliefs + Self-efficacy = Perceived Behavioural Control
• Behavioural Attutude + Subjective Norm + Perceived Behavioural Control = Behavioural Intentions = Behaviour

•  Pre-contemplation
•  Contemplation
•  Preparation
•  Action
•  Maintenance
• (Relapse can occur at any time)

•  Behaviour analysis
•  Coping skills training - cues, negative affect, peers
•  Cognitive restructuring - understanding relapse as both a process and as an event
•  Integration into social supportive networks

•  Identifying high risk situations
•  Develop coping strategies
•  Preventing lapse from slipping into relapse
•  How people respond to a lapse

•  Self - Efficacy ?
•  Temptations ?
•  Pros?
•  Cons?

• Background factors
• Stable factors
• Social factors
• Situational factors

• Context in which individuals live:
• Cultural norms; Social-Economic Status; Gender; Ethnicity; Genes; Chronic Health Status

• Relatively enduring and resistant to change:
• Emotional disposition (Present); Generalised expectancies (Future); Explanatory styles (Past)

• Resources available through social relations:
• Perceived support (family, friends, peers, etc); Subjective norm; Helping relationships

• Give meaning to salient events and respod to demands e.g. appraisal & coping:
• Situation-specific self-efficacy; Perceived risk; Emotional response; Intention (motivation); Outcome evaluation

• Health Belief Model
• Theory of Planned Behaviour
• Transtheoretical Model
• Protection Motivation Theory
• Theory of Reasoned Action

• Behaviours that patients engage in once they believe that they are ill. The belief can be objective or subjective; confirmed or suspected, self or other notified.
• Active process not passive e.g. help seeking, treatment adherence, behaviour change

A patient's implicit understanding of their health status based on common-sense beliefs about their illness e.g. beliefs about the cause, course and consequences of the illness

Clustering of related beliefs which provide a framework for an understanding, or picture, of illness that serves to direct coping responses and illness behaviour

•  Identity: What is it? (diagnostic)Label patients give to their illness, labels bias the interpretation and assimilation of illness related information
• Cause: What caused it? Patients develop ideas about the cause of their illness, causal beliefs influence treatment expectations, causal beliefs influence emotional response to illness
• Time: How long will it last? 3 main timelines for illness (Acute, chronis & cyclical), Mismatch in perceived time and natural illness course is not uncommon (Hypertension commonly believed to be cyclical, therefore patients negate the need to take meds)
• Consequence: How will it impact my life? Perceived effect of illness on the patient's life, perceived severity of consequence is prognostic (MI who thought more severe condition on admission spent longer in hospital, greater disability & increased risk cardio related morbidity)
• Control-cure: Can it be treated, controlled, managed etc. Beliefs about how an illness can be treated and the effectiveness of treatment, patients who believe its possible to control illness are more likely to adhere to treatment

Beliefs about illness can affect health status as people with chronic conditions both over-report of symptoms that relate to the condition and under-report of symptoms that, they believe, are unrelated to condition.

• Emotional disposition:
• - Ps with negative affect are more likely to notice symptoms, report more symptoms and do so more quickly, i.e. high false-positive
• - Ps with low expression block emotionally arousing stimuli and tend to report fewer symptoms, i.e. high false-negative
• Generalised expectancies  
• - Ps with favourable outcome expectancies (I-LoC; high Self-efficacy) report fewer symptoms ... But there might be a cost  
• - Lack of vigilance + control beliefs = delay & disease progression
• Explanatory style: 
• Pessimistic styles perceive more symptoms and symptoms of greater severity, but delay help seeking

• Illness information often from social cues
• - 'You look a bit pale' cues a search for confirmatory evidence
• - Lay referral network for advice, diagnosis and treatment
• Being a medical student
• - 'Medical Student Syndrome' - Symptom information leads to symptom searching; easier to confirm presence rather than confirm absence;
• Perceived social support
• - High: rate oneself as more healthy, recall fewer illness-related memories, and report fewer symptoms
• - Low: higher perceived vulnerability to illness, pessimistic about symptom relief, and report more symptoms

• Competition for cues (attention)
• - Attention for internal (bodily changes) vs. external (environmental) cues
• - If internal cue is strong (e.g. pain) we notice symptom, however if external distractions are stronger we may not notice symptoms e.g. running
• Stress (acute)
• - Often aggravate perception and reporting of physical symptoms
• - Increases perceived vulnerability to illness, and/or mis-attribution of physiological reactivity as symptoms of illness
• Symptom characteristics
• - Onset speed; Public visibility; Chronic illness-related complication

• See diagram but involves:-
• Representation of Illness
• Interpretation
• Coping
• Emotional response to illness
• Appraisal

• - Illness perception questionnaire
• - Develop appropriate management plan with patient

Health care initiatives aimed at maintaining or improving health among people who are currently free of symptoms. This includes the modification of risk factors (e.g. smoking, diet, alcohol intake) to avoid development of disease e.g. health promotion campaigns

Interventions aimed to detect disease early to delay or halt disease progression and developing symptoms e.g. screening

Rehabilitation or treatment interventions of already established disease/illness.

• Population Screening
• Services aimed at identifying specific health problems e.g. mammography and PAP smear
• Self-Screening
• Behaviours aimed at identifying health problems e.g. breast & testicular self-examination and H1N1 Flu
• Opportunistic Screening
• Adjunctive identification of (other) health problems e.g. hepB in pregnancy and depression in primary care

• Disease � Mammography 75%, HIV testing 6%
• Country � Mammography 78% England, 68% Wales, 38% Ireland
• Geographical region - Mammography 81% South-East, 62% North-East
• Sub-groups � Mammography <50% in low SES and minority groups

• Patient factors � Demographics, stable individual factors, social network
• Provider factors � Provider beliefs and behaviour
• Organisational factors � Invitation delivery & screening location

• True +ve Anxiety, fear, stress, guilt etc
• False +ve Unnecessary testing etc
• True -ve Maintain health damaging behaviours & ignore subsequent symptoms
• False -ve Untreated progression of disease
• Amended Loss of trust in service and provider, therefore less and delayed use of health care

• - During the past month have you often been bothered by feeling down, depressed or hopeless?
• - During the past month have you been bothered by having less interest or pleasure in doing things?

Alcohol dependence, Harmful Use, Hazardous Use

• CAGE
• - Have you ever felt the need to Cut down your drinking?
• - Have you ever felt Annoyed by criticism of your drinking?
• - Have you ever felt Guilty feelings about your drinking?
• - Did you ever need a morning Eye-opener?

• The 5 A's
• Ask the patient if they use tobacco
• Advise them to quit
• Assess willingness to make a quit attempt
• Assist them in making a quit attempt
• Arrange for follow-up to prevent relapse

• The 5 R's
• Relevance - Tailor advice & discussion to each patient
• Risks - Outline the risks of continuing smoking
• Rewards - Outline the benefits of quitting
• Roadblocks - Identify barriers to quitting
• Repetition - Repeat message at every visit

• - Do you want to stop smoking?
• - Are you interested in making a serious attempt to stop in the near future?
• - Are you interested in receiving help with your quit attempt?
• *Yes to all suggests high motivation to quit

• - How many cigarettes do you smoke a day? - 15+ = high dependence
• - How soon after you wake up do you smoke your first cigarette? - Within 30 min reflects high dependence

Guides choice of nicotine-based pharmacotherapy

• Depression is a disorder of emotion, can be subdivided into two types.
• Unipolar: depressive state
• Bipolar: involves (rapid) transition between depressive and manic phases ~25% of all depression cases

• Affect e.g. persistently lowered mood, dimished interest or pleasure in activities
• Behaviour e.g. not eating (appetite loss), sleep disturbance, lowered libido, social withdrawal
• Cognition e.g. depressive ideation (guilt), suicidal thoughts, fatalistic (hopelessness)

• Step 1 - Recognition in primary care and general hospital settings
• Step 2 - Treatment of mild depression in primary care
• Step 3 - Treatment of moderate to severe depression in primary care
• Step 4 - Treatment of depression by mental health specialists
• Step 5 - Inpatient treatment for depression

• Egan's 3 stage model
•  Cognitive Behavioural Therapy
•  Psychodynamic Therapy
•  Humanistic Approach
•  Systemic Approach
•  Transactional Analysis
•  Integrative Approach

• 1. Explore - What is the problem?
• 2. Understand - How has the problem arisen?
• 3. Action - How might change be achieved? What strengths and resources does the patient?
• Review and evaluate the outcomes of the strategies.

• Identify and change/correct negative thought patterns, beliefs and behaviours by combining:
• Behavioural techniques:
• Change unwanted behaviours e.g. activity scheduling, rewards, desensitisation, relaxation techniques, challenging irrational beliefs.
• Cognitive techniques:
• Change negative automatic thoughts e.g. overgeneralisation & personalisation, thought stopping, replacing irrational beliefs with rational thoughts

Depression, anxiety, addictions, OCD, eating disorders, phobias, Chronic fatigue syndrome

Aims are to help individuals to better understand themselves and modify internal perceptions of self and others.

Clarification of facts and exploration and reflection on significant issues can be used with those that suffer from depression, anxiety, panic disorders, PTSD, phobias, eating disorders, schizophrenia and addictive behaviour

Aim is to help the individual approach a stronger and more healthy sense of self

Explorations of self-evaluation of life experience can be used to help those with depression, anxiety and substance abuse

Aim is to address people not on an individual level, but as people in a relationship

This is done by exploration of individual identity and sense of purpose which can be used to help those with depression.

•  Less likely to adhere to medical regimes
•  Less likely to use health care services/seek professional medical help in future
•  Less likely to attend check-ups, screening or other forms of preventative health care
•  More likely to experience negative health outcomes
•  Quality of communication in consultation can, and should, be considered a risk factor for patient health

• Create a good interpersonal relationship �
• Social relationship (friendliness, conveying interest, making personal remarks), Therapeutic relationship (empathy, respect, genuineness and warmth), patient-centred communication (patient can express all their reasons, feelings, symptoms)
• Exchange information -
• Balance of information giving and information seeking
• Make treatment related decisions -
• Shared Decision Making (SDM), important for long term conditions

• Understand the problem:
• Dr�s perspective � Fear of increasing patient distress, limited time, unaware patients fail to disclose important information
• Patients perspective � Worry fears will be confirmed, belief that nothing can be done, desire not to seem ungrateful or critical, concern that it is not appropriate to disclose some problems
• Intervene in the process
• Evaluate the effects

•  Ethnic minorties
•  Low SES groups
•  Elderly
•  Females
•  Chronic illness
•  Psychological symptoms
• NB Could be a result of stereotypic knowledge

• Biological - Life sustaining activities are rewarded with dopamine, drugs and alcohol can release 2-10 times the amount of dopamine as a reward, brain interprets these drugs as essential for survival
• Social - Peer Pressure
• Psychological - Pleasure seeking, self-medication

• Affective - Shock, anxiety, fear, depression, anger, frustration, lowered self-esteem, guilt
• Behavioural - Smoking, alcohol, help seeking delay, poor adherence, relapse, social withdrawal, illicit drugs, sexual function
• Cognitive - Poor attention, errors in decision-making, hyper vigilance for threats, bias to interpret ambiguous events as threatening, memory loss and learning difficulties
• Physiological - Activation of nervous system, hormone production, metabolic function (fewer calories are burned), fatigue, disease and illness

Stress can cause a down-regulated immune response. This can be reversed with a psychological intervention which can enhance immunocompetence.

• On the ward:
• Slower wound healing, more post-surgery complications, longer in-patient stay, more staff time per day, more analgesia use, less satisfaction with treatment  associated with poor adherence
• After discharge:
• Longer recovery e.g. return to work, more service use e.g. related symptoms, less use of rehab services, increased risk of co-morbidity and early mortality

Problem-focused coping vs emotion-focused coping

• Stimulus - Focus on cause (stressor)
• Response - Focus on effect (outcome)
• Process - Focus on the person-environment interaction (transaction)

• Chronicity - Discrete sudden trauma to continuous chronic stressors, e.g. car accident and diabetes
• Magnitude - Life changing events to daily hassle e.g. getting married/divorced and car parking at WMS
• Inclusiveness - Individuals to societies e.g. driving test and September 11th

• Job
• Organisation
• Personal Factors
• Relationships
• Work-life Balance

•  Somatisation disorder (Briguet's syndrome)
•  Conversion disorder (Conversion hysteria)
•  Hypochondriacal disorder (hypochondriasis)
• Somatoform pain disorder (Psychogenic pain)
• Body dysmorphic disorder (dysmorphophobia)

• Visualisation/imagery
•  Progressive muscle relaxation
•  Passive muscle relaxation
•  Autogenic 'self-hypnosis'

• Pain - Different sites, specific bodily functions
• GI - Nausea/vomiting, bloating, food intolerances, diarrhoea
• Sexual - Erectile dysfunction, irregular menses
• Pseudoneurological - Voice loss, impaired vision, hallucination amnesia

• -Presence of physical symptoms not fully explained by presence of medical condition
• - Symptoms cause clinically significant distress and impairment
• - Psychological factors judged important in symptom onset and severity
• - Symptoms are chronic and not normally intentionally produced

• CRISP
• C � Context � Review recent history of current symptoms in context of life events
• R � Reaction � Ask questions about patients reactions and coping to symptoms
• I � Iatrogenic Harm � Be vigilant to IH
• S � Screen � Use screening questions for psychiatric morbidity
• P � Perceptions � Identify patients� concerns & beliefs

• PARADE
• P � Provide � Provide a framework
• A � Agree � Agree on a treatment plan tha includes a follow up and review
• R � Reassure � Reassure the patient
• A � Advise � Advise on how to cope with symptoms
• D � Discuss � Discuss patient concerns at the earliest opportunity
• E � Encourage � Encourage to return to normal activity as soon as possible
• S � Set Homework � Set Homework for next meeting

• CREEP
• C � Consistency � Consistency of care
• R � Relative � Co-opt a relative
• E � Expand � Expand agenda
• E � Expectation � Expectation management
• P � Proactive � Proactive not reactive

• ICE B/S
• I � Internalised � Has the �sick role� been internalised?
• C � Coping � Symptoms significantly affect ability to cope?
• E � Excessive � Excessive but unsatisfactory service use?
• B � Belief � Is there resistance to explanation & reassurance?
• S � Symptoms � Are symptoms beyond the norm?