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79 Cards in this Set
- Front
- Back
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Pt unconsciously refuses to admit to being ill or to acknowledge the severity of the illness
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Denial
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Ill pt reverts to childlike pattern of behavior that may involve a desire for more attention and time
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Regression
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Most important tool a physician has for obtaining info from a pt
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Clinical interview
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An effective interview starts with?
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Building rapport and trust
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Requirements for informed consent
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Physician must explain:
The benefits The risks The alternatives The consequences of no txmt The pt may opt out of txmt at any time |
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Health Literacy
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Do pts have the background knowledge, medical vocabulary, and experience to understand their medical problems and the options available to them
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Type of questions used during an emergency, or when the pt is overly talkative or sexually provocative
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Leading questions
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Are open-ended questions appropriate for young children?
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No
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"Tell me more"
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Facilitation
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"You said that your pain increased during the ambulance trip?"
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Reflection
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"Many people would have been scared if they had been injured as you were"
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Validation
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"That fall must have been a frightening experience for you"
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Empathy and Support
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Use of what interview technique will help a pt gather their thoughts and composure to continue the interview?
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Silence
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Final step in the interview process, in which the Dr. summarizes what the pt has said
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Recapitulation
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Methods for interviewing children
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Use the 3rd person, ask the child to draw a picture, use direct questions, have the child use their imagination.
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In the United States, how should the Dr. relay information about an illness to the pt?
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It is customary for adult pts to be told the complete truth about the diagnosis and prognosis of their illness.
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Should info about a pts illness be relayed to relatives?
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NO! Only with the pts permission may info be relayed after the pt has already been told.
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With ill children, how must the child be told of his illness?
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It is the parents responsibility to tell the child.
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Protocol for giving pts bad news
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Setting up the interview
Perception of the pt Invitation Knowledge Empathy Strategy/Summary |
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Pts two main health related fears
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That they will become dependent and lose bodily integrity
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3 types of transactions
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Parent: Condescending, critical
Adult: Logical, factual, no emotion Child: Resistive, self-centered |
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Two types of problem transactions
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Parent to Parent: Critical statements during arguements
Parent to child: Critical Dr and rebellious pt |
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Type of transaction that is best for clear and open communication
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Adult-Adult
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Is it inappropiate to refer pts to other drs because the pt is annoying, seductive, or angry
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Yes
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Cluster A personality disorders
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Schizoid, paranoid, schizotypal
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Cluster B personality disorders
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Borderline, anti-social, histrionic, narcissistic
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Cluster C personality disorders
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Avoidant, OCD, dependent
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3 major personality traits that make a good doctor
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Empathy, warmth, and genuineness
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The ability to identify with and understand another persons feelings or difficulties
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Empathy
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The expression of pity or sorrow for the pain or distress of another person
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Sympathy
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Steps of readiness to change
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Precontemplation: No problem
Contemplation: There is a problem Preparation: Must do something about problem Action: Take action Maintenance: Maintain awareness and involvement |
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Antisocial personality disorder before age 18
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conduct disorder
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The sexually provocative pt
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histrionic
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The pompous pt with a perfect self-image, who feels superior to others
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Narcissistic
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Pt with a pattern of voluntary social withdrawal without psychosis. Often without emotion. becomes more withdrawn during illness
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Schizoid
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Distrustful, suspicious pt, who may blame the dr and others for problems. Feels the motives of others are malevolent
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Paranoid
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Pt. with odd appearance, and thought patterns, but without psychosis
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Schizotypal
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Psychopaths and sociopaths
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Antisocial
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Erratic unstable behavior, with self-mutalation, and brief psychosis. Comorbid with mood and eating disorders.
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Borderline
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Pt who uses "splitting" as a defense mechanism
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Borderline
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Pt who is timid, socially withdrawn, and fears rejection
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Avoidant
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Pt with poor self-confidence, and allows others to make decisions for them
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dependent
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Strongest factor for pt compliance.
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Good physician-pt relationship. The pt likes the dr.
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Factors that increase compliance
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Feeling ill
Limitation of activity Written instructions Simple txmt schdule Acute illness Short time spent in waiting room Benifits greater than costs Peer support |
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Dynamic unconsciousness
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Behavior is influenced by forces derived from processes of which indviduals are not aware. While, these unconscious forces keep thoughts and emotions out of consciousness, they are at the same time dynamic affect peoples choices
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Controls id impulses and represents moral values and conscience
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Supergo
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Present at birth, contains instinctive sexual and aggressive drives. What type of thinking controls this?
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Id
Primary process |
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Controls the expression of the id and adapts to the requirements of the external world primarily through defense mechanisms
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Ego
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When does conflict arise within oneself according to freud
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When the drives of the id threaten to overwhelm the control of the ego and superego
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Contains repressed thoughts and feelings that are not available to the conscious mind. What type of thinking controls this?
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Unconscious mind
Primary process |
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A type of thinking associated with primitive drives, wish fulfillment, immediate gratification, and pleasure seeking
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Primary process
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Contains memories that are not immediately available but can be accessed easily
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Preconscious mind
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Contains thoughts that a person is currently aware of
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Conscious mind
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Thinking used by the conscious mind
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Secondary process thinking
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Presence of this represents gratification of unconscious instinctive impluses and wish fulfillment
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Dreams
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Errors of speech that reveal one's unconscious feelings
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Parapraxes: Freudian slips
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Major concepts of pyschoanalytic theory
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1. Behavior is motivated by unconscious biological instincts
2. Behavior is influenced by unconscious memories that are kept from awareness by defense mechanisms. 3. Psychic energy is channeled through the Id, Ego, and Superego |
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The adult in transactional analysis uses what part of the mind? the child? Parent?
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Ego
Id Superego |
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Freud's 1st stage of development
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Oral:
Sucking, biting, chewing, crying Obective: Establish a trusting dependence on others |
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Freudian Stage at which the child attempts to develop autonomy and independence without shame or self-doubt with loss of control
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Anal: 1-3 yrs
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Freudian stage at which their is a primary focus of sexual interest and stimulation. Pt at which the oedipal and elektra stages are consolidated
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Phallic: 3-5 yrs
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Freudian stage in which the person becomes independent, with self-realization and meaningful particpation in life
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Genital stage 11-13 to adulthood
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Mature defense mechanisms
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Altruism: Assisting others to avoid negative personal feelings
Humor: Express feeling w/o causing discomfort Sublimation: Rerouting an unacceptable drive in a socially acceptable way Suppression: Consciously putting aside but not repressing unwanted feelings |
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Transfer of emotions from an unacceptable to acceptable person
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Displacement
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Example of identification
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A man whose father was abusive, abuses his own son
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A person deliberately pushes emotions out of conscious awareness
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Supression
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Pt who continues to use drugs because he does not believe their is a problem
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Denial
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A teenager with a terminally ill younger sibling begins to do badly at school and argues with her parents at home
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Acting out
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A pt who who unconsciously refuses to believe an aspect of internal reality
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repression
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Person unconsciouscly deals with negative emotions by experiencing and expressing physical symptoms
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Somatization
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A woman who is termianlly with AIDS caused by IV drug abuse decides to stop using the drug and start an exercise and healthful diet program
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Undoing
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Believing people or events are either all bad or all good
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Splitting
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Appearance of childlike behavior during stressful situations
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Regression
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A man who has sexual feelings for his brother's wife begins to believe that his wife is cheating on him
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Projection
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A man who has no memory of a car accident in which he was driving and his girlfriend was killed
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dissociative amnesia
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Separation of function of memory processes in order to forget that events occurred
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dissociation
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A physician who has received a diagnosis of cancer excessively discusses the stats with his family
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Intellectualization
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Occurs when a pt reminds the doctor of a close friend or relative, or when the doctor is treating a colleague or close friend/relative. Why is this not good?
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Contertransferrence
Can cloud medical judgement and cause inappropriate rxn to a pt. |
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The relationships and attitudes that individuals form as adults are unconsciously modeled on relationships that they had with important people. This modeling is called?
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Transference
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