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262 Cards in this Set
- Front
- Back
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Factors that influence symptoms -
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Individual differences/personality, cultural differences, situational factors, stress, mood
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Five distinct components of illness schemas -
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Identity/label, consequences, causes, duration, cure
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Most individuals have three models of illness:
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Acute (bacterial or viral, short duration), chronic (multi-factorial, long duration), cyclic (alternative periods of activity)
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Other factors that can influence interpretation of symptoms:
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Lay referral network (input from friends, family and peers), internet
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Canada's public health care system is ______. American health care system is ____ ____.
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Canada = funded. America = privately funded
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Factors that can predict the use of health services:
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Age (infant vs. late adulthood vs. elderly), gender (women > men) , socio-economic status (specialists vs. general care), culture, social psychological (individuals attitude and beliefs about symptoms and health care)
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Culture: Visible minorities more commonly visit a
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Physician, fewer visit specialists
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Social psychological: Health belief model states predictors include -
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1) perceived threat to health, 2) belief of efficacy of intervention
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Misuse oh health services can come with symptoms associate with
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Emotional disturbances, individuals report physical symptoms which are triggered by psychological drivers (university students' disease, inappropriate assessment by pt, limited access)
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Misuse of health services: Worried well -
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Individuals place over emphasis on symptoms due to heightened self-care
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Misuse of health services: Somaticizers -
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Express symptoms after personal emotional insult (depression, mood disorder)
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Misuse of health services: Secondary gains
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Includes downstream benefits arising from the illness (time off/rest, removal from responsibility, medical symptoms vs. psychological symptoms)
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Delay behaviour -
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Patients live with one or more potentially serious symptoms without proper care
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Delay is defined as
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The time between recognition and treatment
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Delay is composed of several time periods:
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Appraisal delay (symptom is serious), illness delay (symptom implies an illness), behavioural delay (time between recognition and treatment), medical delay (time between appointment and treatment)
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Delay behaviour - Predictors - Elderly appear to delay ____ than middle-aged
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Less
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Treatment delay occurs after primary visit due to:
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Curiosity satisfied by first visit, fear/alarm of symptoms and diagnosis
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Health care providers can include:
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Physician, physician assistant, nurse practitioner, nurse, health educators/nutritionists, psychologists/psychotherapist, physiotherapists, social workers
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Delivery of care can influence
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Perceived care
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Patient consumerism -
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Want to be involved, more active in decision making process
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The _____ has become a common resource
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Internet
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Primary health care providers are
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First point of entry
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Secondary providers are usually
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Specialists
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Primary health care providers are
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Gatekeepers
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Many individuals resort to
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Complementary and alternative medicine (CAM)
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CAM includes -
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Massage therapy, chiropractic care, acupuncture, homeopathy
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CAM users tend to be
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Female, middle-aged, highly educated with multiple chronic issues
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CAM appointments are
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Longer and more rigorous
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Changes in Philosophy:
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More women have entered the male dominated field, physicians are no longer "God", Eastern medicine has influenced Western practice (this includes holistic approach)
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Holistic approach:
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Health is a positive state, health is not simply disease-free, health education, self-help, self-healing
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Barriers to care -
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Poor communication (doctor's don't listen to the patient), use of jargon/special words hampers understanding and communication, baby talk or simplistic approach prevents understanding, elderspeak uses infant-like delivery by health care providers, stereotypes of patients can influence diagnosis and treatment (cultural stereotypes, sexism)
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Non-adherence -
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When a patient does not follow the prescribes treatment (average ~26%)
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Antibiotics non-adherence is estimated at
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1/3
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Lifestyle changes non-adherence is
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80%
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Creative non-adherence -
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When patients modify and/or supplement prescribed treatment
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Causes of non-adherence -
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Poor communication, perceived satisfaction, treatment regimen (complexity of treatment), type of treatment
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Type of treatment -
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High adherence for medical treatment (90%), lower adherence for vocational treatment (76%), lowest adherence for social/psych treatment (66%)
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Placebo -
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Any medical procedure/agent that produces an effect in a patient because of its therapeutic intent and not its specific nature, whether chemical or physical
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Placebo possibly releases
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Endogenous opioids (fMRI data)
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Other factors which influence placebo effect -
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Interaction with health care provider, patient characteristics, physical appearance and administration of the placebo
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Two types of pain -
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Acute and chronic
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Acute pain -
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Caused by soft tissue damage, infection, inflammation
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Chronic pain -
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Long-term illness or disease, may have no apparent cause, can trigger other issues, difficult to assess and diagnose
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Types of chronic pain -
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Chronic benign (6 months+, intractable to treatment), recurrent acute pain (series of intermittent episodes), chronic progressive (6 months+, increasing severity)
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Example of chronic benign -
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Lower back pain
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Example of recurrent acute pain -
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Migraine
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Example of chronic progressive -
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Rheumatoid arthritis
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Pain affects
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1 in 10 Canadians (1.5 million)
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Rates are higher in
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Those over 65 and women
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Costs in health care utilization and lost productivity are approximately
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10 billion annually
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Over _____ spent annually on OTC meds
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4 billions
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Factors that influence symptoms:
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Cultural differences, gender (women are more sensitive to pain)
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Measuring pain is difficult because
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Personal report of pain can be very subjective
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More commonly used assessment tools:
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Verbal reports
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Measuring pain: Pain behaviour =
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Observable behaviours that arise from pain
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Observable pain such as:
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Facial and audible expressions of distress, distortions in posture and gait, negative affect, avoidance of activity
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Pain is viewed as a complex
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Biopsychosocial event involving psychological, behavioural, physiological
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Nociception =
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System that carries signals of damage and pain to the brain
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Nociceptive neurons have cell bodies in the
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Dorsal root ganglia
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Nociceptive neurons can detect
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Mechanical, thermal, and chemical stimuli
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Polymodal nociception -
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We can experience some or all of these simultaneously
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Nociception transmission: Bidirectional axons synapse in
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Dorsal horn of the spinal cord
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Signal continues to
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Brain where its processed
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A-delta fibers -
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Small myelinated fibers, transmit first pain and sharp pain rapidly, fastest transmission, open gate
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C-fibers -
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Unmyelinated fibers, transmit secondary dull or aching pain, open gate
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A-beta fibers -
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Large diameter myelinated fibers, transmit info about vibration and position, close gate
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Theories of pain: traditional model -
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Pain resulted from transmission of pain signals to the brain. How deep the wound is determines the degree of pain
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Theories of pain: gate control theory -
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psychological state/factors contribute to pain experience. Pain gate: more open gate = feel it more. More closed = don't feel it as much
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Gate control theory: other factors can contribute to opening/closing the gate -
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Physical (extent of injury and inappropriate activity level, medication), emotional (anxiety or worry, positive emotions and relaxation), cognitive (focus on pain or boredom, distraction or concentration on other things)
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Weakness in gate control theory:
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Unable to explain phantom limb pain
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Neuromatrix theory:
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Brain has a blue print of your body
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Neurosignature:
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Original blue print of body, can give rise to pain
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Opioids -
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Compound that helps manage pain
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Endogenous opioids:
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Beta-endorphins (peptides that project to limbic system, brainstem), proenkephalin (peptides found in endocrine and CNS), prodynorphins (peptides in the gut, pituitary, brain)
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Acute-stress (SIA) and physical activity =
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Reduces sensitivity to pain
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Traditional pain-management techniques:
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Pharmacological (pain medications), surgical (lesions of pain fibers), sensory techniques (exercise)
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Psychologists pain-management techniques:
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Biofeedback (be in tune with your body, train yourself to deal with situations), relaxation, hypnosis, acupuncture, distraction
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Personality traits can influence the experience of
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Pain
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MMPI - Neurotic triad -
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Hypochondriasis, hysteria, depression
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Chronic pain is associated with -
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Depression, anxiety, and substance abuse
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OxyContin is a time release formulation of
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Oxycodone
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OxyContin is similar to
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Morphine
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OxyContin is used for
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Moderate to severe pain
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One of the most popular street drugs =
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OxyContin/OxyNeo
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Factors of chronic illness include -
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Genetics (alzheimer's), environmental (cancer, asthma), lifestyle (HIV), previous injury of prolonged strain (lower back pain)
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_____ of the pop has a chronic condition
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58%
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______ in the elderly subpopulation has a chronic condition
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81%
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Chronic conditions are more common in -
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Women, lower-income, seniors, certain ethnic subpopulations (aboriginal people)
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Diabetes =
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10 billion dollars
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Cancer =
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18 billion dollars
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Arthritis =
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20 billion dollars
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CVD/hypertension/stroke =
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26 billion dollars
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Quality of life impacts
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Chronic illness
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QOL has several components:
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Physical functioning, psychological status, social functioning, disease or treatment-related symptamology
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WHOQOL-BREF -
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Assessment tool, 26 items, physical health, psychological health, social relationships, and environment
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QOL may fluctuate:
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Characteristics of the illness, acute changes in symptoms, age-related changes over time, culture
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Why study QOL?
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History, identify trends between illness and QOL factors, comparative effectiveness between treatments
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Chronic illness requires long-term
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Dramatic change
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Emotional phases of chronic illness -
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Denial, anxiety, depression
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Self-concept -
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Stable set of beliefs about one's qualities and attributes
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Self-esteem -
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General evaluation of self-concept
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Self concept is a composite of -
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Physical self (body image), achieving self, social self, private self
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Avoidant coping may cause
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Psychological distress
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Active coping -
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Less psychological distress, better overall outcomes
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Social support can provide
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Positive reinforcement
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Multiple coping strategies are
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Most effective
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Physical rehabilitation goals -
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Use your body as much as possible, sense changes in the environment, learn new physical management skills
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Benefit finding -
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Acknowledgment of the positive effects of chronic illness
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Positive changes -
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Re-evaluation of priorities, strengthening of relationships, realization of one's abilities, lifestyle changes
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Psychological intervention for chronic illness:
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Individual therapy (medical vs. psychotherapy), brief psychotherapeutic therapy, patient education, relaxation, stress management, exercise, social support interventions, family support
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Death from infectious disease is much
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Lower today
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Average life span in Canada is
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81 years
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Infant mortality is -
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High, 5.1 per 1000
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Children have a poor understanding of death until age
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9-10
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Premature death: before age of
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79
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Continued treatment can cause
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Psychological distress
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Euthanasia -
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Ending the life of a person who is suffering from a painful terminal illness
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Patients request euthanasia or aid of dying when:
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They are experiencing distress and or fatigue, they are in pain or suffering, they feel they are a burden to their family
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Euthanasia is legalized in
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Netherlands, Belgium, and Luxemburg
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Kubler-Ross's five-stage theory -
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Denial, anger, bargaining, depression, acceptance
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Hospice care -
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End-of-life care, focus on improving quality of life not cure the illness, pain management, emotional support
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Home care -
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Psychological benefits for patients
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4 major chronic disorders -
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Heart disease and stroke (CVD), hypertension, diabetes (type I/II)
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Number two cause of mortality in Canada and accounts for 1/5 deaths in 2007 =
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Coronary heart disease
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Coronary heart disease is a disease of
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Modernization (diet/activity level)
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CHD deaths in women and men =
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Women: 22%, men 20%
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CHD is caused by
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Atherosclerosis (narrowing of the coronary arteries)
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CHD lowers oxygen supply to the
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Heart
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Temporary shortages cause
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Angina pectoris (severe pain caused by an inadequate blood supply to the heart
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Severe deprivation causes
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Myocardial infarction (heart attack)
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Proinflammatory cytokine IL-6 is involved, IL-6 stimulates a process that causes
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Atherosclerotic plaques (disease in which plaque builds up inside your arteries)
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Levels of _____ in the bloodstream is a strong predictor of CHD -
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C-reactive protein (CRP) (cause or indicator?)
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CRP is produces in the ___ and released in the ___
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Produced in the liver, released in the bloodstream
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Weight gain and low physical activity cause elevated
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CRP levels
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Other risk factors for CHD:
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High blood pressure, diabetes, smoking, obesity, low physical activity
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Metabolic syndrome =
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When an individual has three or more of: obesity centered around the waist, high blood pressure, high blood sugar level, low levels of HDL (high-density lipoprotein or good cholesterol), difficulty metabolizing blood sugar (pre-diabetes)
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____ has a genetic link, and is worsened by lower-socio-economic status
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CHD
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Cardiovascular reactivity contributes to CHD by damaging
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Endothelial cells, which facilitates the deposit of lipids, increases inflammation, and develops atherosclerotic lesions (artery wall will thicken)
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Acute stress can cause angina/heart attack by -
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Emotional stress, anger, extreme excitement, negative emotions, sudden bursts of activity
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CHD is more common with
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Low socio-economic status, males
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CHD is linked with -
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Higher rates of physical inactivity, smoking, elevated cholesterol, being overweight
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Why do we eat too much?
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Serving size, food access, social context, stress
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____ is a leading cause of mortality in women
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CHD
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Less is known about CHD in
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Women
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Occurs later in life for women but recovery rates are
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Lower
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Fewer women are referred to a
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Cardiologist
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Fewer women return to work after a
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Heart attack
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Younger women are protected by higher lecels of
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HDL
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After menopause CHD increases because of -
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Weight gain, increased blood pressure, increased cholesterol
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There's less media messaging and education for
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Women
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Less counseling about
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Lifestyle
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Less likely to use
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Pharmacotherapy
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Women are more likely to be
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Misdiagnosed
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Women tend to display a lower _____ after treatment
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QOL, and more likely to go to long-term care facilities
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Anger and hostility are risk factors for
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CHD
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Anger is also a predictor for
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Survival. Potential trigger for angina/heart attack
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Cynical hostility -
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Suspiciousness, resentment, antagonism, distrust of others (most dramatic hostility)
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Response to stress is heightened and lasts longer in
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Hostile individuals
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In some individuals stress causes:
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Vasoconstriction in peripheral areas of the heart, simultaneously increases heart rate
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Stress and anxiety linked to CHD via changes in:
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Blood coagulation (blood changes from a liquid to a gel), fibrinolytic activity (breakdown of blood clots)
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Strong link between depression and
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Metabolic syndrome
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Many patients delay before going for treatment -
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Denial of episode, interpret as mild symptoms, self-treatment
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_____ delay longer
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Elderly and those who have had initial symptoms checked by a doctor
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_____ or _____ increases delay
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Daytime attack or presence of family member
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Treatment for CHD -
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Coronary artery bypass graft (CABG), hospitalization with monitoring, assessment of anxiety, depression, PTSD, home-care with rehabilitation
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Cardiac rehabilitation -
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Education, lifestyle modification, produce relief from symptoms, reduce severity of the disease, limit progression, promote psychological and social adjustment, restore self-efficacy
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Pharmacotherapy -
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Antiplatelet agents (aspirin), beta-adrenergic blocking agents, statins-target LDL (lipitor)
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Diet and activity level -
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Lower cholesterol level, lose weight, reduce smoking and alcohol consumption, exercise, return to work
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Stress management -
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Stress is a proven trigger and contributor, treatment programs are lacking, patients show inability to lower stress
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Depression -
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An issue throughout all phases of CHD, may impact response to CHD treatment, improve QOL and perceived health
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Social support -
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Spouse or family significantly improves recovery, cardiac invalidism (pt. and spouses see abilities as lower than they actually are)
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Hypertension or high blood pressure occurs when -
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Supply of blood through vessels is high
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Hypertension puts pressure on
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Arterial walls
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Hypertension is assessed by level of
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Systolic (pressure) and diastolic (rest) blood pressure
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Systolic -
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Force generated by contraction of heart
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Diastolic -
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Pressure in the arteries when the heart is relaxed
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Mild hypertension -
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Systolic pressure between 140-159
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Moderate hypertension -
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Systolic pressure between 160-179
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Severe hypertension -
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Systolic pressure above 180
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5% of hypertension caused by failure og
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Kidneys to regulate bp
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Risk factors of hypertension -
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genetic link, >50 men are at greater risk, cultural differences, lower socio-economic status, dietary sodium intake (35% higher), emotional factors (anger, hostility, family environment), chronic stress (work, life, environment)
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Treatment of hypertension -
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Low-sodium diet, reduce alcohol consumption, reduce caffeine intake, weight reduction and exercise, anger-management
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Third leading cause of death =
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Stroke
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Stroke is a
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Disturbance in blood flow to the brain
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Ischemic =
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Disturbance of blood flow to a localized area of the brain
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Cerebral hemorrhage =
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Bleeding, blood leaks into brain tissue
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Recurrence rates for stroke is
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20% = high
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___ die from a stroke
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15%
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___ minor disability
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25%
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___ moderate-severe disability
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40%
|
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___ long-term care
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10%
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___ recover completely
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10%
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Warning sign for stroke =
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Weakness, trouble speaking, vision problems, headache, dizziness
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|
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Daily aspirin is very effective and prevents
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Coagulation
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After stroke, ___ require assistance with daily life
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71%
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Other consequences after stroke =
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Motor deficits, cognitive problems, emotional problems
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Diabetes =
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Insufficient secretion of insulin, or insulin resistance
|
|
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Glucose breakdown is used as
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Energy in cells
|
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Insulin is produced by the
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Beta cells of the pancreas
|
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With diabetes the glucose does not
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Enter the cells and remains in the blood
|
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Hypoglycemia =
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Low content of glucose in the blood
|
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Hyperglycemia =
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High blood glucose
|
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Type I diabetes =
|
Insufficient secretion of insulin, immune system attacks beta-cells, develops earlier in life, accounts for 10%, insulin-dependent
|
|
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Type II diabetes =
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Insulin resistance, develops later in life, related to obesity and diet, more common in men, preventable
|
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Results of diabetes =
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CHD, shorter life expectancy, depression, sexual dysfunction
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Deadly quartet =
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Diabetes, interabdominal body fat, hypertension, elevated lipids
|
|
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Psychoneuroimmunology -
|
Talk about the immune system. The study of the interaction between psychological processes and the nervous and immune system of the human body
|
|
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The immune system =
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surveillance system of the body (infection, allergies, cancer, autoimmune disorders)
|
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The immune system determines what is
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Self and foreign
|
|
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Natural immunity =
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Defence against a variety of pathogens (external things)
|
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Largest group of cells in natural immunity is
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Granulocytes (includes neutrophils and macrophages, which are phagocytes)
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GHranulocytes attack
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Pathogens
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Neutrophils and macrophages congregate at the
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Site on injury or infection and release toxic substances
|
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Cytokines lead to
|
Inflammation, fever, promote wound healing
|
|
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Macrophages release
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Cytokines (amino acids)
|
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Natural killer (NK) cells recognize
|
Viral infections or cancer cells, trained to rupture cells
|
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Specific immunity =
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Slower process but more specific, and divide
|
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Natural and specific =
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Work together, natural followed by specific
|
|
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Humoral immunity and B lymphocytes =
|
Target bacteria. Provide protection against bacteria, neutralize toxins produced by bacteria, prevent viral infections
|
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Humoral immunity is mediated by
|
B lymphocytes
|
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Cell-mediated immunity involved
|
T lymphocytes from the thymus gland
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Operates at the
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Cellular level
|
|
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Cytotoxic (Tc) cells response to
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Specific agents
|
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Helper T (Th) cell enhance functioning of
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Tc cells, B cells and macrophages
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Immune function cn be assessed by
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Studying distribution of immune cells in blood samples, examining the functioning of immune cells
|
|
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Blood examination counts numbers of
|
T, B, and NK cells
|
|
|
Immunocompetence =
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Immune system is working well
|
|
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4 things to assess the functioning of cells =
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Activation, proliferation (dividing), transformation (changes in cells), cytotoxicity of cells
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Latent virus =
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Flu shot/dead virus, how many antibodies are produces
|
|
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Antibodies fight
|
Bacteria
|
|
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Immunocompromised =
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Having an impaired immune system
|
|
|
Short-term stressors:
|
Fight-or-flight response, elicit immune response to potential injury or infection, increase in NK cells, also leads to down regulation of specific immunity
|
|
|
Long-term stressors:
|
Causes both cellular and humoral down regulation, stronger among elderly or those with other issues, can impact other co-morbid issues
|
|
|
Intense -
|
Short-term stressor, recruit cells that help defend against wounds/infection
|
|
|
Acute stressor -
|
Few days, up regulate immune function to combat threat from pathogens
|
|
|
Chronic stressor -
|
Few days, down regulation of immune functioning. More open to disease
|
|
|
AIDS =
|
Acquired immune deficiency syndrome
|
|
|
Estimated to have begun in
|
Central Africa (70's)
|
|
|
Factors that have contributed to AIDS =
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High rates of extramarital sex, low condom use, high rate of gonorrhea
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Human immunodeficiency virus (HIV) -
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Attacks the helper T cells, attacks macrophages of the immune system, exchanged by bodily fluids (blood and semen)
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A person who has HIV may not have
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AIDS
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Early symptoms of HIV:
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Swollen glands, mild-flu like symptoms
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Progressive symptoms include:
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Chronic diarrhea, skeletal pain, blindness
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Therapy = Highly active antiretroviral therapy -HAART -
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Combination of antiretroviral medications, must be taken religiously, treatments may be complex and disruptive, depression may contribute to non-adherence
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AIDS two major risk groups =
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Homosexual men, intravenous drug users (adolescents and young adults)
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Cancer -
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Dysfunction in DNA. Causes excessive rapid cell growth, provides no benefit to the body, drains the body of essential resources
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There is a familial link to
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Cancer (genetics, diet, lifestyle factors)
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Depression has been positively linked to cancer -
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Elevated endocrine response (cortisol, NE)
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Arthritis -
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Inflammation of a joint
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In Canada, ____ are affected
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1/6
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2/3 are
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Women
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3/5 are under the age of
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65
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Types of arthritis =
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Rheumatoid, lupus, osteoarthritis, gout
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Rheumatoid -
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3 times more common in women. 25-50 year olds. Targets small joints of the hands, feet, wrists, knees, ankles, and neck. In mild cases only targets one or two joints. Immune system targets the thin membrane surrounding the joints = inflammation, stiffness, pain
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Osteoarthritis -
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Most common, women and men equally affected, after age 45
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Changing health habits =
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Smoking, high-cholesterol foods, high-fat foods, exercise
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Social marketing -
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The application of marketing technologies developed in the commercial sector to the solution of social problems where the bottom line is behavioural change
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Focus on elder -
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Canada's elder pop is growing
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Focus on health promotion -
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Chronic illnesses are expensive, educational programs, long-term behavioural change
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Focus on socio-economic status SES -
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Education, income, social status
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Gender differences -
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Women - breast and ovarian cancer, longer life span, lower QOL, require long-term facilities
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Current social tendencies modulates rates of illness -
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Integration of technology, lower exercise, diet/environment
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