Health Psych Exam 2

Main Ideas of Fallin-Bennett 2019 (e-cigarette ads targeting marginalized groups)

e-cigarette, vape and hookah use has increased in recent years

e-cigarettes are using marketing techniques to make marginalized/vulnerable groups feel empowered using them

strategies to lessen the impact include: educating healthcare workers, tobacco industry denormalization campaigns must be extended beyond traditional tobacco products to include e‐cigarettes, populations and communities at high risk for e‐cigarette use must be involved in the development of targeted interventions and advocacy efforts

What is addiction?

condition produced by repeated consumption of a natural or synthetic substance in which the person has become physically and psychologically dependent on the substance

What is physical dependence? Tolerance vs. withdrawal?

the body has adjusted to the substance and requires it for “normal” functioning

T: process through which body increasingly adapts to substance and larger doses of the substance required to produce the same effect

W: unpleasant physical and psychological symptoms experienced when a substance is discontinued or markedly reduced once person has become dependent

What is psychological dependence? Craving?

compulsion to use a substance for its pleasant effect without necessarily being physically dependent on it

C: motivational state involving strong desire to use substance

In substance use disorders, how many symptoms are considered mild, moderate and severe?

mi: 2-3

mo: 4-5

s: 6+

Which race/ethnicity smokes the most (greatest to least)?

Native American, Blacks, Whites, Latinx, Asian Americans

What education and income levels are more common to smoke?

low education and low income

How many current smokers are there compared to ex-smokers?

more ex-smokers than current smokers

Reasons for smoking

Bio

• Mother smoked when pregnant

• Genes

• damage to brain area called insula controls desire

Psycho

• Coping strategy for stress

• Rebellion, risk-taker

Social

• Peers, family

• Self-presentation (smoke to look cool in front of friends)

What’s in a cigarette?

Nicotine: highly addictive chemical

Carbon monoxide: poisonous gas

Tar: brown residue

How does nicotine get in our system? What are it’s side effects?

Lungs → Blood → Brain → Heart, etc in 7 secs

causes dopamine release, increased alertness, heart rate, blood pressure, hardens arteries, inability of cilia to clear lungs, narrows blood vessels

Interventions to prevent smoking

Macro-level interventions

• Change society by changing attitudes towards smoking

• negative image of smokers

• scaring with negative health effects

Structural influences

• Taxation

• Smoke-free environments

Medication: physiological and psychological withdrawal can lead to depression → antidepressants dopamine reuptake inhibitors

Most common groups to drink (greatest to least)

men, Whites, Blacks, Latinx, Asian Americans

What is binge drinking vs. heavy use drinking?

b: Drinking 5+ drinks on single occasion at once (men)/4+ (women)

h: Binge drinking 5+ times in a month

Reasons for drinking

Bio

• Genetic

Psycho

• Coping response to stress

• Extroversion

Social

• Celebrations

What are the immediate effects of alcohol?

stimulant and sedating effects, depressant for CNS, frontal lobe: higher-order processing and judgment, limbic system: memory & emotion, cerebellum: balance

heart: blood vessels relax → heart works harder (i.e.,increased heart rate)

How is alcohol metabolized? Is it different among genders?

20% is absorbed through the stomach; 80% through the

upper intestine → released into the bloodstream, can pass through blood-brain barrier and affect brain chemistry as a neurotoxin

metabolized by alcohol dehydrogenase — women have less than men (metabolism is slower)

men have less fat than women — lower BAC

What happens if alcohol is consumed at a faster rate than the liver can break it down/metabolize?

BAC will rise, immediate side effects

Legal BAC? Legal underage? Coma and possible death?

0.08

0.02

0.4

What diseases occur as a result of alcoholism? Which one is the most common to cause death?

fatty liver, hepatitis, cirrhosis — most common to cause death

What is fatty liver?

accumulation of fat within liver cells, can lead to inflammation → leading to scarring (fibrosis) and cirrhosis

no symptoms and treatment is to stop drinking

What is hepatits?

inflamed liver

symptoms: are variable, none, abdominal pain, jaundice (skin yellowing)

treatment is to stop drinking

What is cirrhosis?

spread of liver nodules (abnormal growth) and fibrosis (scar tissue), eats away at liver, regenerative liver cells cannot replace

no symptoms and no treatment but stopping drinking can slow down the process

What is fetal alcohol syndrome?

caused by mother’s excess drinking during pregnancy

behavioral: Hyperactive, Impulsive, Fearless, Irritable, Stubborn, Passive, Sleep difficulties

learning difficulties: Developmental delays, Attention deficit, Memory problems, Difficulty learning from experience Difficulty with abstract concepts, Poor math skills

Alcoholism interventions

Structural

• Drinking (and driving): Increased legal penalties

• Provide fun, alcohol-free alternatives on college campuses

Individual-level efforts

• Alcoholics Anonymous: Peer mentoring and social support

• Detox(ification)

• Supervised inpatient medical treatment

• Outpatient psychological treatment

What is appraisal delay?

the time it takes for a person to interpret a bodily sensation as a symptom or sign of illness

What is illness delay?

the time between a person recognizing that they are ill and the decision to seek care

What is utilization delay?

the time between deciding to seek care and actually going to get care

What are illness behaviors?

refers to the collective process of recognizing we have a problem, seeking treatment, and adhering to treatment

What are illness representations?

refers to all thoughts or cognitions about the subjective experience of an illness

What is the Commonsense Model of Illness Behavior (CSM)?

explains how individuals perceive, understand, and respond to health threats. It posits that people create cognitive and emotional "illness representations" (based on identity, cause, timeline, consequence, and control) that drive their coping behaviors and health outcomes.

What are the two fundamental elements of the CSM?

1. individuals are seen as active problem solvers trying to make sense of needed changes in their physical states while acting to avoid and control changes perceived as signs of illness (illness representation)

2. individuals’ decisions will be based on their beliefs, commonsense perceptions, and available skills at that point in time

Why are patient-provider relationships important?

they affect how much a patient will disclose, how much the patient will adhere to treatment, how many appointment the patient will miss and ultimately how effective the treatment will be

What is a doctor-centered interaction style?

Dr asks brief questions (yes or no)

Dr emphasizes on main problem and ignores other issues, not understanding the full context

Dr focuses on the link between the problem and organic causes (biomedical approach, seeing the body as a machine, not acknowledging psychological, social and environmental factors)

What is a patient-centered interaction style?

Dr asks open-ended questions

Dr avoids medical jargon, increases patient understanding, slows down

Dr encourages patient to participate in discussion, decision-making in treatment

Which patient-provider interaction style is associated with better outcomes?

patient-centered interaction style (Higher patient satisfaction, Fewer appointment cancellations, More significant diagnostic facts learned from patients)

Why do providers use jargon when talking to patients?

habit

belief that patient doesn’t need to know the specifics

belief that it reduces patient stress because it makes them feel like the provider knows what they’re doing - that the provider is trustworthy

keeps interaction short, benefits medical staff because they make more money from more patients

elevates status of physician

Why is being able to see medical test results fast through a patient portal not as good as it seems?

Because most patients don’t know how to interpret their results which causes more anxiety

What are the desired levels of participation based on gender and age? What’s the relationship between desired level of participation and satisfaction?

gender: women desire greater level of participation

age: elderly desire lesser level of participation

receiving desired level enhances adjustment and satisfaction

What are problematic patient behaviors toward providers?

• expressing criticism of or anger toward physician

• ignoring or not listening to advice

• insisting on unnecessary tests, medications, or procedures

• demanding inappropriate endorsement of disability claims

• sexual remarks or behaviors

What are problematic communication behaviors patients can display?

• vague, misleading, or unclear description of symptoms

• degree of attention to internal symptoms

• commonsense models of illness, which may lead to reporting only what they believe is important

• emphasizing or downplaying symptoms believed to signs of serious illness

• limited grammar (if young) or different primary language from physician

What are 10 helpful questions patients should ask to enhance the effectiveness of their treatment?

1. What is the test for?

2. How many times have you done this procedure?

3. When will I get the results?

4. Why do I need this treatment?

5. Are there any alternatives?

6. What are the possible complications?

7. Which hospital is best for my needs?

8. How do you spell the name of that drug?

9. Are there any side effects?

10. Will this medicine interact with medicines that I’m already taking?

What is adherence?

degree to which patient carry out recommended treatment and behavior

In general, is adherence to treatment common?

No!

• Adherence to short-term treatment for acute illness: 67%

• Adherence for long-term treatment for chronic illness: 50-55%

• Adherence is higher in days before/after visiting doctor (e.g. flossing before and after dentist, but then stopping in 3 weeks)

• Adherence to lifestyle changes (e.g., diet, smoking changes) often low

What psychosocial factors are associated with better adherence?

cognitive

• patients need to believe it’s worth it to adhere

• patients need to remember what they’re supposed to adhere to

emotion

• moderate anxiety is effective because it’s enough for the patient to care, but not so much that they overdo it

Personality

• self-efficacy — believing you are capable of engaging in a certain health behavior

Social

• social support

What can we do to improve patient adherence to treatment?

Social: get support system members involved so that they can best provide social + instrumental support

Behavioral:

• Tailor regimen to habits + rituals

• Provide prompts and reminders

• Self-monitoring (ex. paying attention if you’re taking your medication)

What is the definition of pain?

the sensory and emotional experience of discomfort usually associated with actual or threatened tissue damage

What is organic vs. psychogenic pain? Are there differences in experiences of pain depending on the type?

o: resulting from tissue damage

p: occurring in the absence of tissue damage

there are no differences in experiences of pain depending on the type

What is acute vs. chronic pain? What psychological factors are they associated with?

A: lasting less than 6 months, associated with anxiety that decreases as pain subsides

C: lasting longer than 6 months associated with anxiety, depression, hopelessness, and helplessness

What are the 3 types of chronic pain? Examples?

chronic recurrent: benign (i.e., harmless) causes characterized by repeated and intense episodes of pain (migraine headaches, tension-type headaches, and myofascial (jaw) pain)

Chronic intractable benign: discomfort present all the time with varying levels of intensity and not due to malignant (i.e., injurious) condition (chronic low back pain)

Chronic progressive pain: continuous discomfort associated with malignant condition and which becomes increasingly intense (rheumatoid arthritis and cancer)

What are nociceptors? How do they detect pain?

peripheral nervous system nerves that detect pain (tissue damage), found in skin, muscles, joints, bones

Aversive stimulus → nociceptors → release chemical messengers → thru spinal cord → thalamus & cerebral cortex message telling how to react

What is transduction and modulation? What’s the process of recognizing pain?

t: on receptor level, chemical, mechanical or thermal energy is converted into electrochemical nerve impulses

m: neural activity leading to pain control transmissions between brain parts

transduction → transmission → perception of pain → modulation

What are A-delta and C fibers? What pain are they each associated with? What is the experience of pain in terms of the fibers?

They are nociceptor axons (pain sensors)

A-delta: small, myelinated fibers that transmit sharp pain, myelin sheath allows for quick transmission — acute pain

C: small unmyelinated nerve fibers that transmit dull or aching pain, slower transmission — dull pain (mild but persistent)

experience of pain is the balance between A & C fibers

What are physical factors of pain? (Mechanical, Thermal, Chemical, Polymodal) Examples?

Mechanical: mechanical damage to body tissue (broken bone, wound)

Thermal: damage due to temperature exposure (sunburn, frostbite)

Chemical: damage due to chemicals (spices, environmental irritants)

Polymodal: detects multiple types of stimuli

What are psychological factors of pain?

Mindset/meaning of pain: soldiers having higher pain threshold and tolerance vs. civilians (pain level being a reflection of their service)

personality: extroverts have higher pain thresholds, internal locus of control allows to better cope with pain

What are the social factors of pain?

learning from modeling of pain behaviors (facial or audible expression of distress → person sees and also expresses distress)

learning from reinforcement (receiving attention from expressing distress → expresses distress more often)

What is clinical pain?

any pain that requires or receives professional attention

What are the symptoms of chronic pain syndrome?

tissue damage or irritation, persistent pain complaints and pain behaviors + another symptom on the list

What are surgical treatments for pain? Effectiveness?

synovectomy: removal of inflamed membranes in arthritic joints

Spinal fusion: joins two or more vertebrae to treat severe back pain

both are popular but don’t work better than others in long term

What types of chemical pain-relieving treatments are there?

Peripherally acting analgesics: Inhibit synthesis of neurochemicals that sensitize nociceptors (aspirin, acetaminophen, ibuprofen)

Centrally acting analgesics: Narcotics that bind to opiate receptors in CNS and inhibit nociceptor transmission → alters perception of pain stimuli (morphine, codeine, Demerol)

Local anesthetics: Block nerve cells in region from generating impulses

(novocaine)

Indirectly acting drugs: Affect nonpain conditions that contribute to pain

(sedatives, tranquilizers, antidepressants)

What are the goals of chemical pain treatment?

Reduce frequency + intensity of pain

Improve emotional adjustment

Increase social and physical activity

Reduce use of analgesic drugs over time

What types of cognitive pain treatments are there? What types of pain are they effective for?

Distraction: Focus on non-painful stimuli in environment to divert attention, Effective with mild/moderate pain

Guided imagery: Imagining a mental scene unrelated to or incompatible with the pain, Effective with mild/moderate pain

Redefinition: Substitute constructive thoughts for those arousing feelings of threat / harm (think in a different way - like “this could be worse”), Effective with strong pain

What type of stimulation pain treatments are there?

Counter-irritation: reducing one pain by creating another, works b/c distraction from stronger to milder pain

Acupuncture: Ancient Chinese technique in which needles are inserted into special locations on body

what types of physical pain treatments are there?

treatment involving a variety of techniques to enhance

strength and flexibility, Programs are tailored to patient’s needs