Notes test 3 Health Psychology (Psy 426)
Notes test 3 Health Psychology (Psy 426) PSY 426
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This 23 page Study Guide was uploaded by Puck Reeders on Tuesday February 3, 2015. The Study Guide belongs to PSY 426 at Geneeskunde Universiteit Utrecht taught by Gail Ironson PhD. M.D. in Fall2015. Since its upload, it has received 142 views. For similar materials see Health Psychology in Psychlogy at Geneeskunde Universiteit Utrecht.
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Test 3 Notes Chapter 9 Using Health Care Services November 11 2014 Using health care services The American healthcare system O 0000 Employers provide insurance for most working people Also private insurance and governmental insurance for some Medicare for all elderly people age 65 Medicaid for low income people Book says about 15 46 million had no health insurance but this number expected to go down to 5 when Obama care is fully implemented as April 2014 8 million had signed up 0 Obama Care has made a dent but not a big denkt 0 More blacks and Hispanics are uninsured 0 Part time workers do not get insurance 0 We get to go under our parents insurance Type of plans 0 Medicaid plan pays very little to doctors so member have a hard time finding doctors 0 Medicare pays does more generally 80 and you can choose fee for service or managed care 0 O O O 0 plan all expenses are covered Medicare is useful for ppl who have a preexisting condition I More blacks and Hispanics are uninsured Over 70 of employees are in managed care plans Fee for service Traditional can choose doc insurance pays about 80 Managed care programs place restrictions on members choices and services e g HMO few charger if you stay within HMO need preapproval for specialist PPO wider network network discounted fees no approval needed costs more but more freedom in who you see Lot of bankruptcy s is because of medical expenses even if they are insured Friend of Ironson Nurse fell went to ER and had to sell her house These have been around since the 1960 s Health Care systems in other countries 0 O 0 Many countries have universal health care e g Canada Germany Italy Sweden Britain Netherlands Australia Care is excellent less complicated to use and less expensive cost per citizen vs US They all rank above US is OSHP overall health system performance rankings US is 37th book table 91 and WHO ranking accessed 102012 0 However funding problems have led to long waits for diagnostic tests and elective surgery 0 The US spends the most money but is on 3 7quot Tax dollar 40 C Military 23C Health care 16 C poverty programs 00000 110 general gov t 6 C community and economic development O 0 3c energy science environment 2c diplomacy war prevention Who uses health Care 0 O O O 0 Americans visit docs 336 visits a year vs Europeans 686 visits a year Women use health services more I why Pregnancy related concerns they may get sicker more often or men may be more hesitant to visit docs Even when controlling for pregnancy and childbirth women use health care more often More utilization also from young children elderly and higher SES But gap between higher and lower SES in medical care usage has narrowed since the 1960 s since introduction of Medicaid and Medicare Heart attack victims 0 O O O 13 delay getting treatment for 3gt hours I cloths can be dissolved within 3 hours Important not to delay Men are more likely to seek treatment than women MI myocardia infarct more likely to be missed in women Symptoms Chest pain may feel like pressure or pain down left arm or indigestion SOB sweating symptoms harder to fit into specific pattern in women e g pain up in jaw Case history Mr Glover p 231 I Suffered 2rld heart attach 6 months after first I He experienced general discomfort pressure over his chest and pain down his left arm I The symptoms were similar to those of the first heart attack but he dismissed it because of fatigue gas muscle strain and emotional tension I But the negation itself not another heart attack was very much in his mind despite his denial I Behaviorally he alternated between sitting quietly to let it pass and pacing around the office to work it off Social and Emotional Factors and seeking care 0 O 0 Very depressed people delay getting care for symptoms Fear can either speed up getting treatment ie Cancer symptoms but if people expect pain from disease or treatment they may delay care dentist Social in uence men may think they have to be strong sanctioning wife may prod husband to go to doc to check out a symptom Symptom perceptionplacebo p231 0 O O O O O Box in book Symptoms by perception I Shows the role of expectation etch Participant and confederate Participant either got an inert nasal spray or not and told that substance produces in some people 4 sx itchy skin drowsiness headache and nausea Confederate either got a spray or not Confederate displayed behaviors related to symptoms e g scratching and yawning Ratings of known Sx greater if students received spray and confederate received spray P 238 Complimentary and Alternative medicine READ O 5 types I Manipulative and body based methods 0 They maneuver or move parts of the body as occurs in chiropractic and massage procedures O O I Biologically based methods most funding because it is easiest to design a randomized control trial 0 Apply materials found in nature such as herbal products and eitary supplements I Energy therapies rikie 0 Employ hypothesized or known physical energy fields such as biofields believed to exist and surround the body and electric or magnetic fields I Mind body interventions I Use techniques for enhancing the mind s ability to manage body function and symptoms as in progressice muscle relaxation and meditation I Traditional Chinese medicine and homeopathy 0 Complex theoretical approaches for treating illness that differ from and often preceded the development of the system of medicine practiced by professionals with MD degrees There systems often use one or more of the preceding 4 methods see p 237238 CAM website nccamnih gov I Nashville complementary and alternative medicine 0 Some investigators funded by CAM 0000000000 0 0 People who use CAM are generally well educated Over a 3rd of Americans use CAM Patients rarely tell their doctors they are using CAM First do what the doctor says and then try CAM Glucosamine to prevent and treat joints Folic Acid to prevent birth defects Chiropractic useful for treating backs Biofeedback for treating pain Dietary supplements for IBS irritable bowel syndrome Negative studies smelling lavender does not decrease stress or pain soy supplements do not help with osteoporosis For every dollar for tax I 3 I First chunk military second chunk healthcare I NCI cancer and NHLBI heart lunch and blood get the most funding Patients rarely tell their doctors that they are using CAM 0 Intercessory Prayer IP 0 00 Given picture or name of patient and you are asked to pray for them I They had a regimen Prayer is the most used CAM that people would do It is not on the ist anymore for funsing because so many people do it Back in 1898 study by berd southern medical journal I They had people praying for other people and they had a control group I They had all kinds of benefits I Shorter hospital stays fewer complications fewer meds for pain I Took another 10 years for another study to be published about this I The 3rd definitive study Funding 2 million I 3 groups 0 Intercessory Prayer IP benson O 0 Patients randomly assigned to 3 groups one group told they would be prayed for and they were n601 O O 2 groups were told you may or may not be prayed for I 1 group got IP 604 I 1 group did not get IP n597 I No difference in outcomes between these two groups The group that was prayed for and knew that they were prayed for gp 1 did the worst I Were they religious Problematic health care uses 0 O O O O O 0 Some people use system a lot such as hypochondriac Their symptoms are real they interpret real but benign bodily symptoms of an illness p 238 Hypochondriacs Tendency of people to worry excessively about their health monitor it very closely They interpret real but benign bodily symptoms as symptoms of Illness see also book def p238 related to neuroticism Neuroticism and hypochondriac it is linked Neuroticism It involves a high degree of self consciousness and vulnerability to stress as well as the tendency to experience anxiety hostility and depression Neuroticism is linked to the future development of a variety of illnesses Cardio vascular disease arthritis and IBS irritable bowel syndrome Patient practitioner relationship p 239 no slides Patients involvement in the medical care 0 00000 Generally women want more info more participation Younger adults more participation White people more participation then blacks and Hispanics As a doctor you need to find out how much participation the patient wants You are a doctor you will be in charge of deciding which of 1300 diseases does the person have Patients will have more stress if there is a mismatch or switch doctors between how much info they want vs how much info they are getting If mismatch I Less satisfaction with medical treatment I More stress during unpleasant medical procedures I Less adherence to doc s advice I More likely to switch docs PractitionerPatient Relationship Practitioners behavior and style 0 O O 0 Doctor centered style doc asks questions patient answers Patient Centered Style Docs ask open ended questions and avoid using medical jargon Female docs more likely to be patients centered and spend 10 more time with patients McKinlay only 39 of lower class women patients on maternity ward understood each of 13 medical words used Docs expected even less comprehension First complaint the client gives is often not the most significant Doc should probe for more Study page 241 O Assessed lower class women Physicians expected comprehension then the clients showed yet they used these terms with these women On average the words the doctor was using was understood by 39 of the patients Why were they using these words I Elevated the doctors status I Trying to keep from scaring the patient I Patronize the patient they don t need to know People that have more satisfaction with docs and are more likely to follow their advise 0 Women docs spend 10 more time with patients then male doctors do I Often doctors listen only to the first complaint that comes in And this is often not the most important 0 Tax 40 cnts to military 20 cents to healthcare 3 cents to science USA spends the most on health care but is number 37 on the list 0000 Nov 13 2014 Last part of chapter 9 0 Compliance and adherence The degree to which patients carry out the behaviors or treatments that the practitioners recommend 0 Compliance is the older term giving into a request makes it sounds more forced 0 Adherence Newer term More collaborative 0 Overall adherence O is around 60 0 Non adherence rate is 40 0 It is higher for acute illnesses with short term treatment I Flu etc even then 67 0 Lower for chronic illnesses with long term regimens I 5055 0 Adherence to recommendations about lifestyle are very low I Problem relapse How do u assess adherence 0 Doctors think they have in uence 0 Patients font want to make their doctors feel bad How to promote adherence 0 Asking non judgmentally will higher the adherence rate 0 Ask family members Adjective ways of assessing this 0 Pill count 0 Keep in touch with the pharmacy O Mems caps tell when the bottles have been opened I Flaw U can just open the bottle and not take the pill 0 Biochemical tests 0 Average nonadherence to medical advice is about 40 Why do patients not adhere 0 Characteristics of the illness or regimen I If the illness is something where you have to change your lifestyle you will have less compliance then if u ask someone to take less pills I The more pills u have to take and the more complex the treatment regimen the less compliance u have I Pills in the evening and in the morning are easier to take then the pills u have to take during the day 0 Side effects I The more side effects the less they are going to take it I Cost of treatment O I Duration for treatment compliance will go down over time I If u have a serious illness does not mean that the compliance goes up I If a patient believes that it is a serious illness the compliance will go up Interaction with patient doctor 0 Examples of complicated treatment regimen O O Dialysis 3 hours 4 times a week 23s of patient that need kidney transplant get them Others need to go on dialysis 75000 I 25000 Little and no associated with each other with Adherence Only the combination predicts adherence I Social class I Race I Religion I Gender I Age 0 Combine factors Adherence O O 0000 o O O o O O O o o O O O o O O Adolescents are less adherent when they have diabetes then children elder arthritis558447 have double the adherence compared to middle aged people with arthritis 20 3454 Diabetes you need to Minority groups if they low literacy American Indians do not want to take something every time AA has a very negative view that u take psych meds I They are afraid u are not handling your problems Diabetes is really effected by Exercise Having a piece of cake or not Psychosocial aspect of the patient related to adherence p They receive cost and benefit Health belief model Beliefs make a big difference in whether u are adherent or not Rational reasons why people don t want to do something I Side effects cost self efficacy You don t know how to take it you want to keep things private you see the illness is still there when u stop taking the meds Biggest reason for adherence is because people forget Side factors Depression I low adherence Social support will help with adherence Self efficacy if u feel like u can do it you are more likely to do it Box page 247 On test Doctor tells a patient what they need to do I More intelligent ppt do not remember more then less intelligent patient 0 There are emotional factors that go into it U remember the most important thing I If you are moderately anxious you will recall the most I The more medical knowledge the more u will remember 0 Understanding conceptual framework words are not new Cognitive and emotional factors in patients recall of info from physicians I Ppt forgets much what the doctor tells them I Instructions and advice more likely to be forgotten then other info I The more the patient is told the greater the proportion is they will forget I Ppts will remember what they are told first and what they consider most important I More intelligent ppts will not remember more than less intelligent ppts I Older ppts remember as much as younger ppts I Moderately anxious ppts recall more of what they are told than higly anxious ppts or ppts who are not anxious I The more medical knowledge a ppts has the more he or she will recall Where does the word doctor come from 0 It means to teach 0 Doctors need to explain info and asses whether the patient understands it Study p248 communicating with patient 0 Interviewed patients Recorded interaction with doctor Interviewed patients They did pill counts at the patients home Half of the patients did not know for how long to keep taking the meds 20 did not know the purpose of or did not know how often to take the drugs problem Poor knowledge because doctors did not provide important info and patients did not ask questions Other Studies 0 Average visit 20 minutes During this visit the docs gave 2minute advice OOOOOO Patient practitioner relationship 0 Satisfaction with doctors 3 times more likely to adhere O The more questions the patient asks the longer AID patients will survive P 248 Increasing patient adherence O For people with more serious illnesses you are more likely to die if u adhere I Kidney disease etc HIV 95 0 What adherence do u need depends on the illness P 250 how to present medical information 0 You want to give concrete specific recommendations I Don t just tell them to just do exercise Tell them exactly what to do Improving communication skills 0 Hypertensive people They gave the docs info to why they were not adhering And the doctors could do a better job Interventions for patientsp249 O motivational interviewing I How ready they are to do it I ID problems and benefits I Help patient recruit social support P 250 O Behavioral methods for patients to adhere I Tailor the regimen I Providing prompts and reminders I Self monitoring I Build I rewards behavioral rontracting Studies 0 To take or not to take O I Side effects was the nr 1 reason for patients not to take their meds I Preference to alternative medicine I You belief of the in uence of your mind on health To tell or not to tell I 50 of people that don t take their meds don t tell the docs 18 November 2014 Chapter 6 14 0 Intro to HIV 0 0 Someone With the HIV does not have aids HIV causes aids AIDS is not HIV Attacks the immune system specifically the CD4 thelper cell I When an antigen gets in it is presented by the CD4 cell It sends out factors for the transformation of Dcells it is involved in in cell mediated immunity CD4 does a lot of things to help out the rest of the immune system including sending out factors for the transformation of B cells cell mediated immunity I If they are knocked out then your immune system is not able to fight off things I Adaptive immunity not innate The virus is spread by exchange of bodily uids By intercourse sharing needles blood blood product hemophiliacs Risk groups risky sex and needle sharing I In the US African Americans gay men prostitutes drug addicts I Worldwide predominantly by hetero sexual 50 women 50 men I Miami is in the top 5 of the country of having HIV There is no cure but good antiretroviral treatment Requires strict compliance 95 I Came out in 1996 Also When Ironson study started I Disease replicates at such high rate if you miss a dose it is very detrimental If you think you have been exposed treatment can be undertaken immediately to minimize the probability of infection I For example if you have been raped No vaccine prevents HIV I But PrEP pre exposure profilaxis truvada You can take it before u have sex Cuts down the transmission rate to 30 I Cuts down transmission rate to 20 so don t do it have safe sex 20 or 30 Problems With using condoms don t want to use Vaseline or oil base lubricants be it erodes the rubber use water based I Use them correctly Leave a little at the top Safe sex use of condoms I No Vaseline or oil based lubricants only water based lubricants because it erodes the rubber I Use condoms correctly leave a little bit at the top and squeeze out the air 0 Typical Disease Course in HIV 0 First you are exposed to virus goes all the way up and peaks then drops and then goes back up depending on your treatment goes up when someone is really sick The danger point is the before the peak ppl report having u like symptoms Follow CD4 number and virus 0 Know the pattern spikes in the beginning and the end I First couple weeks I CD4 cells high in beginning and go down I Virus takes longer to go up I Normal CD4 above 800 bad200500 serious below200 0 Viral load normal 0 copies bad above 10000 serious above 100000 Diagram 00 0 Virus peaks If you treat is it goes very low When you get sick it goes back up 0 If u get exposed to the virus it is very high in the beginning therefore it is very easy to transmit even when you do not know you have HIV 0 It takes a while that you have the anti HIV blue line This is how you can test for it You don t know till later 0 Normal CD4 over 500 I CD4 cells go down over time 0 You follow the CD4 number and the virus red and green 0 Virus spies high low low med I virus low high high low antivirus the decreasing one is the CD4 count I Measures 0 normal CD 4 is above 800 0 normal viral load 0 copiesml O immune bad depletion 200500 I viral load above 10000 copiesmml 0 Serious immune damage below 200 CD4 O O I Above 100000 AIDS clinical diagnosis I Kaposi s Sarcoma I On skin Very rare I PCP pneumonia Diagnosis of AIDs I Low CD4 I Or 2 sarcoma and pneumonia mentioned before 5950 women and men Do psychosocial factors still matter Yes Quizz p 157 0 00000000000 0 No vaccine that prevents HIV but there is something you can take that decreses transmission Having a STD increases likely hood to get HIV Circumcisedl less risk These Q are on test Most people with HIV die from its complications Blood tests can not tell within a week after infection if you have HIV People do not get aids from swimmingpools and bathrooms You cant get it through insects Aids cannot be prevented with a vaccine People with the HIV can look and feel well Health workers donot have a high risk of getting HIV Kissing does not transmit the disease AIDS is less contagious then the measles 33 million people are infected with HIV 0 O in W 2 less then 33 million died EC look up how many people died in different wars P 379 stats 0 US 05 is infected with HIV I 5 about 15 million people 39 300 million people in USA I Ned 01 You can also transmit the infection during child birth 0 At J MH they can give u the anti retro viral medication almost no transmission Get testes and get tested again 6 months later Misconception 0 Can only happen to gay men and drug users It is rare for healthcare workers to get infected 0 Why OOOOOOO get medications right away Ignorance Having lack of available protection Guys do not want to use condoms You are more likely to get while using alcohol and drugs People are embarrassed by condoms especially women Younger adults are more likely to do risky sex if their parents reject them for their orientation Get tested together and get tested together again 6 months later 0 Be careful P 158 table 0 Different exposure patterns 0 US male to male sex is largest group O O 0 Second largest group is heterosexual group Predominantly the poor people AA Drug use Eastern Europe and Asia 23 finish Does info change peoples behaVior and knowledge 0 0 Not enough When u are young you think u are goingto live forever Someone with HIV does not necessarily have aids There are 21 million new infections per year 15 million deaths per year worldwide It is going down Risk Factors Chapter 14 6HIV 14aids when the virus has affected the body and you have low enough CD4 and clinical symptoms 0 unknown in 1980 O 27 million new infections every year 0 newly infected ppl are dec now 2 million 0 deaths annually 15 million I new infections and deaths are going down still high but still good Risk Factors 0 Blood and semen Men constitute 80 of all aids cases Rate of new infections in the US in the 1980s Mortality rates have declined Deaths among blacks and Hispanics greater than among whites 0 Even if you have an undetected viral load the virus still in body In macrophages and Tcells If untreated AIDS you usually die in18 months almost all by 3 years 0 Now well treated and a chronic illness you lose about 10 years of your life right now AIDS is a retrovirus gets into the RNA Combo Treatment antiretroviral 0 HART Highly Active Retrovial Therapy 0 cART combined antiretroviral treatment 0 O O 0 Greater adherence in older than younger 0 What interferes with adherence I Depression I Drug abuse I Social support I Cognitive difficulties Disease progression 0 Conscientiousness and personality 0 Ppl high in extraversion and high in openness have slower progression I These ppl are called creative interactors I Ppl in low faster called home bodies PsychoSocial Impact of AIDS 0 Health care workers refuse to treat some 0 Very stigmatized disease To buffer immune system nutrition and sleep 0 there are good psychological treatments for sleep 0 cookies and milk good for sleeping O Melatonin regularly and low dose 0 Normal to see delusions of dead ppl is right before you die and right after someone dies the next month this happens more often for these people 0 Read p384 In the US men constituted 80 of AIDS cases The rate for new infections peaked in the mid 1980 s Who gets medical care 0 AIDS death rates higher among blacks and Hispanics then among whites Transition from HIV to AIDS 0 Even if u have undetectable viral load u can still have HIV 0 Hides in Tcells and macrophages 0 If your viral load is 0 it does not mean you have HIV 0 CD4 below 400 O Sarcoma and pneumonia 0 Untreated from the im u get diagnosed 0 You usually die within 18 months Almost all people are dead within 3 year 0 Now u lose about 10 years 0 Treatments 0 Anti retroviral I Combi treatment HAART highly active antiviral retro therapy Of CART combined anti retro viral therapy 0 Very expensive not everyone can get this 0 Look up 0 In ironson study 177 people only one person could not get it 0 Greater adherence in older people then younger people 0 Look up number 0 What interferes with adherence O 0 Drug abuse 0 Poor social support 0 Cognitive difficulties 0 Depression and avoidance coping will progress the disease worse control of viral load 0 People who are high in extraversion and high in openness creative interacters have slower disease progression 0 Low in extraversion and low in openness homebuddies have faster disease progression 0 Psychosocial impact of AIDS 0 1980 s people got fired from jobs children were not able to go to school 0 I Coping 0 related to disease progression 0 avoidance coping do worse with HIV 0 If u are a boy use drugs and alcohol if you are in denial 0 Psychosocial intervention 0 stress management less depression less anxiety less viral load improve medication adherence 0 meta analysis good evidence that these interventions improve psychosocial function but less evidence on FINISH from book 0 People with HIV are more likely to smoke twice the rate of the general pop I Smoking related to depression and lower adherence to medical regimens I EC does smoking twice as high because they were smoking before HIV or because off HIV Bearevement Takes time to get over a loss It is expected that you will be in mourning and it is expected that you will have a lower immune function 0 Eat less or more 0 Higher stress hormones 0 Higher increase in death 0 You are in about a 2 year window to get illnesses middle age people more susceptible to disease 0 It normally takes a couple of months to get over a loss about a year unless you are dysfunctional depression moving slower less sleep etc get help Or antidepressant if u have more then 4 of the symptoms 0 Keep nutrition and sleep up 0 EC 10 page TREATMENTS FOR SLEEP psychological I only bedroom for sleep I don t put TV on before bed unless it relaxes u I Cookies and milk 0 Sugar makes u tired milk helps it to get it across the blood brain barrier quicker I Chamomile decaf tea I Melatonin I No computer I Hypnosis I Snap out of it 0 Right before u die u can see your dead relatives Delusion Missed this I Groups 0 Poor social support 0 Elderly people have a small social support I p 384 psychosocial interventions for bereavement READ NOT CHAPTER 13 Psychosocial Factors and Cancer December 2nd 2014 0 Background info O 0000 00000000 0 Cancer is the second leading cause of death 1 in 6 people over 65 In the past 50 years no significant decrease in deaths Heron et al 2005 5 year survival rate has increased from 50 to 66 About 30 of oncology patients show a significant level of distress that warrants psychological treatment Zabora et el 2001 1 in 6 men get prostate cancer 18 women get breast cancer 13 women get some sort of cancer each year there are 14 million cases 60 of ppl diagnosed with cancer live more than 5 years not great stat be not specific prostate cancer 5 year survival 99 Breast cancer 5 year survival 89 Lung cancer 5 year survival 16 Changes in behavior can be reduced by 23rds 0 Risk Factors 0 O O Heredity diet endocrine factors radiation chemical exposure smoking viruses bacteria age alcohol use obesity lack of physical exercise But most with these risk factors don t get it Incidence could be reduced by about 23rd s by changes in behaviors 0 P 373 Warning signs of cancer Sara no 0 Change in BowelBladder habits O A sore that does not heal Unusual bleeding or discharge Thickening or lump breast elsewhere Indigestion or difficulty swallowing Obvious change in wart or mole OOOOO Nagging cough or horseness O CAUTION Psychosocial factors and cancer incidence 0 Exposure to severe life events show some consistent links I Twofold increase in breast cancer risk after separation divorce or death of spouse Lillburg et al 2003 I Death of a spouse associated with 37 increase in breast cancer risk 11171 Metaanalysis Duijts Zeegers amp Vd Borne 2003 I Childhood physical abuse associated with 47 higher odds of being diagnosed with cancer FullerThompson amp Brennenstall 2010 Animal Studies Stress and Cancer 0 Study in rats injected with tumor cells showed early uncontrollable stress associated with less ability to fight off tumors in later life Seligman and Vistainer O Sloan Rats injected with tumor cells more likely to metastasize with stress blocked by betablockers Psychosocial factors and cancer incidence O Retrospective study of European Jews who survived holocaust n25 8048 and emigrated to Israel after 1945 0 compared to those who had emigrated to Israel before 1945 n57496 non exposed group 0 Exposed group had significantly greater breast and colon cancer 0 Effect was greatest for those who were children during the holocaust Psychosocial factors predicting incidence of cancer 0 Metaanalyses combining results of 165 studies Chida et al 2008 found small but significant but small effect of psychosocial factors on incidence 106 102111 I Stressful life events no increase in incidence I Stress prone personalitycoping significant increase I Depression significant increase I Social support no relation to incidence Inconsistent Studies null positive and negative studies 0 Nielsen amp Gronbaek 2006 0 Bergelt et al 2009 0 KeinanBoker et al 2009 0 Michael et al 2009 Personalitycoping related to incidence of cancer 0 Denial Repression O Conlfict avoidance 0 Type C Lydia Temoshok I Trouble recognizing they are stressed out Difficulty in recognizing internal cues of stress and distress in expressing ones emotions and needs It keeps the individual in a chronic state of unrecognized and unaddresses stress People pleaser Higher prevalence in adults with history of abuse Effects of cancer treatment that psychologists can address 0 Anticipatory Nausea and Vominiting I Happens 2550 of patients 0 Drug UCS Chemo Nausea Vomiting UCR 0 Hospital CS Nausea Vomiting CR 0 The hospital is related to getting chemo Therefore it gets the conditioned stimulus to get sick when seeing a hospital I Classical conditioning I TmT medicaions compensene anti nausea relaxation exercise behavioral treatment 0 Ftigue exercise 0 Food aversions I To prevent use a strongly avored unfamiliar food between the last meal before chemotherapy creating a scapegoat food Strongly avored unfamiliar food used as your conditioned stimulus Direct the learning process towards this new food and allowing it to become disliked Psychosocial RF and cancer progression depr symptoms and trauma history 0 Trauma history related to faster progression of metastatic breast cancer Palesh 2007 0 Depression predicts faster progression in live cancer Steele 2007 O Depressive symptoms and clinical depression associated with higher mortality rated Satin 2009 0 2 fold increase in lung cancer deaths attributed to psychological FINISH Psychosocial RF and cancer progression Social Factors 0 High levels of perceived social support associated with decrease in relative risk for cancer mortality Pinquart 2009 0 Patients separated at time of cancer diagnosis had poorest five and ten year survival rates relative to rates observed in other marital status categories Sprehn 2009 Psychosocial RF and cancer progression Meta analysis 0 Stress related psychosocial factors were associated with poorer cancer survival and higher mortality 0 Largest survival effects documented for I Hepatobilibary I Head and Neck I Lynphoid or hematopoetic O FactorsFINISH Breast cancer mortality risk Nurses health study relative risk of mortality 0 Socialy isolated nurses at twoforl O LOOK AT GRAPH Intervention Studies Effect on Mortality Treating Depression in Primary care 0 Ppts with depression in intervention practices were less likely to die than those in usual care practices half likely 0 Risk of death reduced in patients with major depression 0 Benefit FINISH Psych interventions successful at 0 Reducing smoking 0 Nausea paint 0 FINISH Intervention Studies Spiegel 1989 O Randomized 86 women with metastatic breast cancer to a one year expressivesupportive therapy group with self hypothesis for pain vs control group 0 After 10 year follow up patients in intervention group lived 18 months longer than those in control 0 Other study unable to replicate 0 They did not live longer then average cancer patients 0 People with cancer live longer if they have a psychological intervention Inteventional study Fawzy 1993 O 80 pts with melanoma 6 session 0 psycho education health education medical adherence cancer prevention behaviors stress management 0 2 times as likely to go to follow up the next yea O FOLLOW UP Interventional studies Anderson 0 FINISH 4 studies that show effect and equal number that doesn t show effect Negative intervention studies 0 Cunningham Can the mind heal cancer but those who were highly involved were less likely to die 0 These developed a program for themselves with changes in lifestyle regular relaxation imagery thought monitoring meditative or spiritual practice Open to self exploration new ways of thinking and behaving personal program despite obligations Studies of spontaneous remissions Lerner O Reagan Hirschberg O The have compiled spontaneous remissions I When they get better when they are not expected to Conclusions 0 Psychosocial factors including depression and the stress prone personality predeict the onset of cancer but is not a strong relationship 0 Psychocosial factors predict the progression of once you have it especially ocial support and depression 0 Stress Managament FINISH Extra credit How people do with cancer in Asian culture for those who are told vs those who are not told 3 types of treatment 0 Surgery I If early enough this alone can be effective I Take a few lymph nodes to make sure it did not spread I If spread It will not get all of them so you will need additional chemo or radiation I Breast Cancer they used to remove the breast radiation now they take out the tumor chemo O Chemo theraDV I Kills cells that divide rapidly I Also kills healthy cells that divide rapidly hair baldness skin sores I Nausea vomiting I Food aversion I find scapegoat 0 Radiation I Damages the DNA of cells I Cancer cells are less likely to repair then normal cells I Affects both healthy and malignant cells Area will get irritation and burns nausea near genitals you might become sterile I Testicular cancer very common in 30yr men PAIN chapter 11 and 12 Pain accounts for 80 of doctor visits 0 Nr 1 bleeding 0 13 in the US have a continuous pain or recurring 0 That s why there are so many pain medications I Stronger pain medications opioids Addictive 0 Organic pain and psychogenic pain I Organic pain tissue damage I Psychogenic pain no tissue damage exists Does not mean it is not real 0 You cant tell everything from and MRI Common cause of work disability is back pain 0 What helps I Protective support Acute paint less then 6 months 0 Chromic more then 6 months Box of burning pain Page 285 READ 0 Burns are very painful Often helpful to give the patient as much information as you can Pain signals are transmitted to your brain by adelta and cfibers 0 These are similar to light touch fibers Abeta 0 Light touching a pain helps because it interferes with the signals Meaning of pain 0 Beecker in book Soldiers who are wounded 49 claims to have moderate to severe pain Civilians 75 claims to have moderate to severe pain for the same wounds 32 soldiers requested meds 83 of civilians request medications If soldiers get wounded they get to go home I There is a role to the meaning of the pain How do we measure pain 0 We put a limp in ice bucket with ice and water 0 How long are you able to keep it in the ice water 0 Pain tolerance Study by amy walk 0 Compared how long people can keep there limp in ice water when she says a spiritual word vs when you say a normal word I People who hear spiritual words keep it in longer What you say to yourself is important Gate control theory 0 Pain signals gets through or does not get through 0 Light touch interferes with pain fibers and can effect the gate I Anxiety tension depression opens the gate I Light touch pos emotion rest intense concentration or distraction life activity close this gate Section in book Do emotions cause pain 0 They exacerbate pain 0 Stress can cause painl headaches O O O O 0 Migraines have biological components 0 Depressed individuals are more likely to have pain 0 Neurotic triat 0 High depression 0 High hysteria 0 High hypochondriasis I You are more likely to have chronic pain Cha 12 and Hypnosis and Interpersonal therapy beh and cog methods for treating pain the 2 parts you need to know from this chapter Ch13 only section you need to know is diabetes These are all of the readings that you have to know Ch 11 only rst 3 sections Next Thursday 11130 Have until following Monday for extra credit By Midnight g copies emgil version AND HARD COPY under her door bv 930 am TUESDAY Last Class 0 Today 0 Behavioral and cognitive methods for treating pain 0 Hypnosis 0 Diabetes Chapter 13 p 340344 0 Exam 0 Multiplechoice 0 Covers chapter 9 and parts of 11 12 and 13 0 EC due Monday 0 Final is in the class 0 11130 just be 111215 0 She will be in her office Tuesday 93011 0 If it is ambiguous write on the from of exam Behavioral Cognitive Methods for treating pain 0 1To reduce reliance on medication and to promote positive behaviors 2reducing disability and hvsteria and pain behaviors 0 The opporent approach we want to extinguish pain behaviors 00000 How do you do that 3 yr old girl has severe burns She would cry and complain of pain Nurses would put on her she would resist their efforts gtgt What do you do I Ignore pain behaviors similar to giving a dog treats when they bark I Rewards for compliant behaviors 0 If you do not cry when I put your splints on I will give you cookies I Praise her when she does not complain 0 Reduce reliance of medications 0 Pain medication when given often If you add avored syrup they will get used to the syrup taste You can lower and lower the dose Conditioned stimulus I Operant Conditioning 0 Her mother would need more and more to completely erase the pain But she only takes 1 a day to just let her get by Once in a while she takes two but not often so she doesn t build tolerance 0 Do not only administer it when they ask for it 0 Give it on a thick schedule 0 You want to alter consequences for promoting well behavior 0 Give a cookie when splints are put on 0 TV or other activity 0 Are operant techniques successful 0 Yes I Decreasing medication use I Decrease Patient pain report I Increasing activity levels I hels to decrease your focusing on pain 0 People who are not addicted to anything are less likely to get addicted to medications 0 Places where the opperent pain doesn t work 0 Chronic progressive paind I Metastatic cancer goal to control pain and not get anyone addicted I When the social support is not supportive I When someone is on disability Relaxation and Biofeedback I Usefor for anything Where there is a stress component 0 Headaches migraines and tension headaches IBS etc Relaxation and biofeedback Reduced frequency of headaches by about 12 0 Relaxation and biofeedback alone or together reduce it about a 12 0 Half of that effect if due to placebo O P 315 diagram Know I It does not work as well for the middle ages and the elderly 0 Massage therapy relaxation tech reduces chronic pain and improves sleep 0 Sleep is a major issue in people with pain and older people 0 You have to go to the bathroom at night 0 Massaging infants help them to gain weight 0 Massaging improves immune system 0 Are the effects durable of relaxation and biofeedback 0 The effect are very durable O 5 year study with 5 year followup I what we have done 0 progressive muscle relaxation relaxation technique 0 imagery coping techniques 0 You want to engage in all 5 senses 0 When you read up the script cell phones off dim light closed eyes Cognitive methods Chapter 12 I Distraction helps with pain For it to be effective it needs to be absorbing and interesting Requires your attention Has to be credible Ids Watch an interesting movie and ask them questions Channeling We are going to move from pain to something else Imagery where u engage in the 5 senses for mild and moderate pain not strong pain Pain redefinition useful even for strong pain I It hurts but there are benefits to this procedure I It s not so bad not the worst thing that could happen I It s terrible but I can get through it I With gods help I can get through this I I am brave I can get through this I This treatment will help me I A person replaces constructive and realistic thoughts about the pain experience for ones that are aroused feelings of threat and harm Page 317 0 Tell the patient how much pain discomfort codeword to expect I It normalizes it 0 When you have chronic pain know what you can and cannot do I Make sure your activity does not harm you further 0 Pain acceptance I Its ok to do activities even though you have that pain 0 O O O O O O 0 Active copings strategies we went through 0 acute pain Distraction hels O Mild moderate Distraction orimagery 0 Strong pain Redefinition 0 Chronic pain Redefinition might be better then distraction 0 Program for chronic low back pain 0 Most common reason for disability 0 Randomly assigned people to 3 different group p 318 bottom I Imagery redefinition progressive muscle relaxation I Relaxation I Control 0 Groups 1 and 2 had much less pain depression and disabilityl these programs work 0 The first group They had 60 more hours a week of employment then relaxation alone 0 Cognitive behavioral methods good for headaches arthritis and lower back pain 0 For headaches cognitive behavioral methods are as good as medication Hypnos1s I Hypnosis is used for pain 0 Only works for some peODle Least for academics scienty types As good as cognitive behavioral treatment but combined it doesn t work more Works well with childbirth Works about as well as relaxation for chronic pain Used for fears and phobias Treating trauma and sexual abuse but it takes a long time OOOOOO What u say in hypnosis 0 You talk in same voice as you would during relaxation 0 Well developed scripts 0 Suggestions are imbedded Interpersonal Therapy Secondary pain symphathy How you interacts with your social environment So you are not getting secondary pain not sympathy etc You are getting better rather then feeling like you are being 0 Severe pain 0 Transcutational electro light touch works on the same pathway as pain opioids 0 Pain is the 5th vital sign 0 Diabetes 0 anerglvcemig OToo much glucose in the blood 0 Type 1 insulin dependent diabeters 0 Do not have insulin 0 Genetic 0 Get it in childhood or adolescents 0 Cells of pancreas that make insulin do not work properly They are destroyed 0 What does insulin do 0 Helps Glucose to get from the blood into the cell 0 Type 2 diabetics 0 Insulin resistance You get insulin but it doesn t work very well 0 Older overweight 0 Normal weight type 2 You do not have enough insulin 0 Older islet cells aren t working as well 0 Both type 1 and type 2 have high blood glucose 0 Who 0 Older get type 2 O 17 of ppl over 60 have type 2 diabetes 0 African Americans have twice as much diabetes as whites also hypertension stroke cancer etc 0 Contribute to development of diabesis 0 Exercise 0 Weight 0 Diet 0 Intervention to exercise and weigh 0 If you are prediabetic you can reduce it by about half with exersize and diet the amount of people who become diabetic 0 Figure 132 Glucose tolerance test Look at box 0 With diabetics your bloodsugar stays up In healthy people is goes down after eating something 0 Why do you want to treat diabetis 0 If u are good at controlling your blood sugar you will not get complications I It is really hard to do that because a number of thing will throw off your blood glucose I Exercise a cold everything you eat etc You can become blind O O Kidneys can shut down 0 You can get amputation 0 Heart attacks etc I more atherosclerosis A 3rd of people who have diabetis do not even know it How would u know 0 Doctor blood glucose 0 Page 341 box 0 More thirsty O Unexplained large weightloss 0 ETC FINISH Adherence is a big issue with diabetics Psychosocial Factors 0 3 factors involved in getting diabetes Getting information and instruction proper instructions Social Support perceived social support but not actual social support is related to better glucose control Self efficacy Can u give yourself the shot Do u have the knowledge and efficacy to diet and exercise If you are prediabetic and follow diet and exercise you are half as likely to become diabetic 0 How stress impairs BS 0 Stress releasres epinephrine and cortisol Both are involves in glucose regulation Epinephrine causes the pancreas to decrease insulin production Cortisol causes the liver to increase glucose production and bodily tissues to decrease their use of glucose 0 You are not adherent when stressed You have to adjust your regimen for food exercise etc for your illness If you compare the parents goals and doctors goals for glucose control 0 Doctors think about long term effect I They want to keep the glucose down 0 Parents are more interested in preventing hypoglycemia Because they do not want their kids to pass out Carreers in Health Psychology Clinics Hospital Settings Academia 0 After PhD internship I VA Cancer hospital private practice giving talks to local physicians 0
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