Health Psych week 6 class notes
Health Psych week 6 class notes Psyc 400
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This 8 page Class Notes was uploaded by Samantha Riley on Thursday February 25, 2016. The Class Notes belongs to Psyc 400 at Humboldt State University taught by Carrie Aigner in Winter 2016. Since its upload, it has received 33 views. For similar materials see Health Psychology in Psychlogy at Humboldt State University.
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Date Created: 02/25/16
Week Six Class Notes Tuesday, 23 February 2016 Announcements: • “Possible Faculty Strike” o If there is no resolution on the pay increath th § There will be a strike from April 13 - April 19 • Exam #3 will be moved FROM Thursday, April 14 TO Tuesday, April 12 th Stress I. Stress, Portrait of a Killer (National Geographic) Video • Stress was once a survival mechanism • Today it’s becoming a health problem • Stress is measurable and can be dangerous • Stress can o Unravel chromosomes o Increase fat on the body o Kill brain cells • Bamboos were used to measure the effects of stress o Drew blood to measure hormones related to stress § Adrenaline § Glucocorticoids o Looked for a link between stress and the hierarchy of the troop § Bamboos rank correlated to stress level § Higher rank had little stress § Low rank had higher stress • Increased heart rate • Higher blood pressure • Humans trigger stress responses for none life-threatening situations o Sends our bodies into unnecessary psychological panic that turns into a physiological response • A large component of stress is the element of control perception o Stress in relation to human hierarchy § Subordinates • Higher stress levels were related to lower positions (getting worse the lower you got) o Higher risk of heart disease, among others § Dominants • Lower levels of stress related the higher you go up • The baboon and Whitehall studies ruled-out confounders of serious health difference in the group o Ex: diet; health care respectively • Ulcers used to be the only risks believed to be related to stress o A bacteria was later linked to ulcers § 2/3 of the world’s population has these bacteria • not everyone gets these ulcers because it requires the immune system to be disrupted by stress to allow the bacteria to start causing problems • Stress in rats caused brain cell branches to shrink o The parts involved in memory (hippocampus) o Long term we can lose the capacity to remember things as we need to o Short-term forgetfulness can occur from acute stress • Stress inhibits the dopamine receptors o Which in turn makes things around you less pleasurable • Whitehall also studied about stress and weight o It could affect fat distribution § Putting on weight around the central areas was shown to be related to chronic stress • Fat brought on by stress is more dangerous because of where it is on the body • Research on the pregnant women during the Dutch famine during WWII o The dutch winter children had increased risk of Cardiovascular disease o In generally poorer health than those conceived before or after the famine o Stress hormones in mom’s blood interacted with the fetus and affected them from before even birth • Telomeres in the chromosomes have been shown to deteriorate from chronic stress. o There is an enzyme that can potentially repair this damage • Perceived control increases the higher up the hierarchy • Our culture does not seem to value stress-reduction II. Class Discussion: • During stress-response, the digestive system slows down o Which could be a contributor the increased body fat from stress • Whitehall was done in the UK o If it were replicated in the US, findings would not be regulated for the healthcare confounding variable because most companies doe not have equal healthcare across the board • Social support had a reversing and a slowing effect on the unraveling of Telomeres Thursday, 25 February 2016 Pain • International Association for the Study of Pain definition: o An unpleasant sensory AND emotional experience associated with actual or potential tissue damage, or described in terms of such damage I. Types of Pain a. Somatic – skin and musculoskeletal tissue i. Ex: Postsurgical pain, injury due to excessive activity or stretching ii. Described as aching 1. Ex: Headache b. Visceral – injury to internal organs i. Bowel (impaction, constipation), indigestion, tumor progression ii. Described as 1. Pressure-like 2. Deep 3. Squeezing c. Neuropathic –injury to spinal cord or peripheral nerves i. Can occur in feet, legs, hands, toes ii. Described as 1. Burning 2. Shooting 3. Stabbing 4. “Pins and Needles” d. Acute i. Begins suddenly ii. Usually sharp in quality iii. It serves as a warning of disease or threat to the body 1. Has an adaptive function a. Ex: moving a hand away from a hot surface iv. Ex: Surgery, buns or cuts, childbirth v. Usually occurs for <6months 1. Not a definite time frame though e. Chronic i. Persists despite the fact that the injury may have healed ii. Not adaptive 1. Results in pain management behaviors iii. Ex: low back pain, arthritis, nerve damage II. Steps in Pain Processing a. Nociception i. Process of perceiving pain ii. Nociceptors are sensory receptors that perceive painful stimuli including 1. Heat 2. Cold 3. Cutting 4. Burning b. Afferent i. Sensory Neurons 1. Relay information from sense organs to brain a. Some areas (hands) have more receptors and are more sensitive i. Why? 1. You explore the world with your hands 2. You need the hands more for survival c. Info routed to the Dorsal Horn of the spinal cord and relayed to different areas of the brain for processing i. Ex: Somatosensory cortex in the cerebral cortex d. Descending pathways i. Originates in the brain ii. Emotion processing centers are activated and can alter our experience of pain 1. Emotion usually accompanies pain 2. Explains how two people can have different perceptions of pain for the same injury iii. Triggers release endogenous opioids 1. Painkillers a. Such as endorphins iv. Helps to explain why distraction (and mood) can alter pain perception 1. Placebo Measuring Pain I. Self-Report Measures a. Visual Analogue Scale (VAS) i. Rate your pain by circling one number that best describes your pain on average 0 1 2 3 4 5 6 7 8 9 10 No As bad Pain as you can imagine ii. This is the “gold standard” for pain assessment iii. Brief Pain Inventory 1. Take the average of the first 4 items on the survey and then enter the score a. (Activity done in class) iv. Especially useful for children and elderly with cognitive problems 1. Visual Analogue Scale (VAS) (faces) v. 60% of severely demented patients can’t rate pain with VAS scales 1. Then have to use other means of assessment II. Behavioral Measures a. Alternative: i. Assess gait 1. Ex: limping ii. Facial expressions 1. Ex: grimaces iii. Posture iv. Dilated pupils b. Poor assessment of pain may contribute to under-treatment in the elderly III. Physiological Measures a. Heart rate b. Hand Surface temperature c. Electromyography (EMG) – measures muscle tension i. Could distinguish those with low back pain vs. no back pain, but not level of pain d. Not as accurate as Self-report or behavioral Psychosocial Aspects of Pain I. Chronic Pain: Comorbid Factors a. People are more likely to be comorbid b. People suffering from chronic pain are more likely to i. Be depressed ii. Abuse alcohol iii. Be smokers c. Causal Direction is unclear d. “Downward spiral” in conceptualizing chronic pain and depression i. Everything, all factors, feed into each other and effects each other II. Biopsychosocial Model of Pain Social/Environmental -Social Support -Insurance Coverage Pain Psychological Biological -Negative affect -Genetic Factors -Pain Catastrophizing -Illness a. Pain Anxiety, Catastrohpizing i. When I’m in pain… 1. Ex: I worry all the time about whether the pain will end 2. Ex: I feel I can’t go on 3. (From the Pain Catastrophizing Scale) ii. Difference between Chronic and Acute pain 1. People may not have recovered from pain 6-months after a surgery iii. Relates to higher rates of healthcare usage 1. Longer hospitalizations 2. Increased pain medication usage 3. Longer time to reach rehabilitation milestones during surgical recovery iv. This means attitude matters 1. The way you think about and perceive your pain is a predictor of adaptiveness III. REMEMBER a. Just because psychological factors may influence the experience of pain, doesn’t mean pain isn’t “real” or that the person is “crazy” Evidence for the Biopsychosocial Model in Pain I. Research Examples a. Study 1: i. Study of 611 breast cancer patients ii. Persistent post-mastectomy pain was associated with 1. Anxiety 2. Depression 3. Catastrophizing 4. Somatization iii. But was not associates with 1. Medical-related factors pre-surgery 2. Disease-related factors pre-surgery 3. Ex: Type of cancer treatment received in addition to mastectomy b. Study 2: Implantable Devices for Pain Management i. Over half of cancer patients experience cancer-related pain ii. Spinal cord stimulators (SCS) and Intrathecal pumps iii. MD Anderson Pain Center: Multi-disciplinary approach 1. Psychological evaluation for implantable devices 2. Research on psychological factors and implantable outcome limited 3. Study procedures a. Retrospective medical record review of cancer patients who received SCS or intrathecal pump b. Pain, Depression and anxiety were assessed using the ESAS Baseline Trial 3-week 3- 6- and Follow- month Month Surgery up Follow- Follow- up up Pain Pain Pain Pain ESAS 4. What was found a. People with higher anxiety had their pain return back to the original levels of before surgery b. Those with less anxiety were actually benefiting from the surgery in maintained lowered pain levels 5. Implications a. Importance of psychological symptoms in surgery outcome b. Limitation i. Retrospective Design ii. Potential Confounding variables c. Role of multi-disciplinary care in pain management Prescription Drugs for Pain Management I. Brief, Minor History of Pain management a. There are doctors that work with pain exclusively b. A push to be more aware of pain brought the medical field to find that pain was undertreated II. Chronic Pain in the United States a. 30% of people have Chronic Pain b. Most common = headache and lower back pain i. Back Pain 1. 80% of people in the US have back pain at some time 2. Common Causes: injury or stress to muscle, nerve and ligament a. Worse with aging b. Affects 90% of pregnant women 3. Treatment often involves analgesic medications a. Analgesic Medication (Pain killers) i. Opioids 1. Hydrocodone a. Ex: Norco, Vicodin 2. Morphine 3. Oxycodone a. Ex: OxyCotin, Percocet ii. Non-Narcotics 1. NSAIDs (Non-steroidal anti- inflammatory drugs a. Ex: Advil, Aleve 2. Acetaminophen a. Ex: Tylenol 3. Neuropathic pain medications (anticonvulsants) 4. Ex: Gabapentin
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