health psyc chapter 13

shock

the first reaction most people experience when a physician diagnoses a serious health problem

• a person might be stunned or bewildered and behave in an automatic and detached fashion

crisis theory

• developed by Rudolf Moos

• - the adjustment people make to learning they have a serious chronic illness depends on the coping process, which has three contributing influences

three contributing influences of crisis theory

1. illness related factors

2. background and personal factors

3. environmental factors

illness-related factors

will it be disabling, disfiguring, painful, embarrassing, life threatening?

background and personal factors

age, gender, SES, resilience, self-esteem, emotional maturity, religious or philosophical beliefs, self-blame (rumination/catastrophizing)

environmental factors

will it require hospital environments, home environments, or social support?

first step of coping process

• cognitive appraisal of the meaning or significance of the health problem to one’s life

• outcome of the appraisal leads to a formulation of adaptive tasks and an application of various coping skills to deal with these tasks

adaptive tasks related to the illness or treatment involve

1. cope with the symptoms or disability the health problem causes

2. adjust to the hospital environment, medical procedures, and regimens needed to treat the problem

3. develop and maintain good relationships with practitioners

adaptive tasks related to general psychosocial functioning involve

1. controlling negative feelings and retaining a positive outlook for the future

2. maintaining a satisfactory self image and sense of competence

3. preserving good relationships with family and friends

4. preparing for an uncertain future

coping skills

There are several different skills that patients and their families employ to deal with the adaptive tasks, which include

• recruiting emotional support from friends, family, and practitioners

• seeking information to be aware of all health aspects

chronic diseases

• last over a year and require ongoing medical attention, limit activities of daily living, or both

• account for the most illness, disability, and death, and are the leading drivers of healthcare costs in the US

chronic disease statistics in the US

• 60 of Americans have at least one and 40% of two or more

risk behaviors for chronic disease

• smoking

• poor nutrition

• physical inactivity

• excessive alcohol use

epilepsy

• a brain disorder caused by seizure

• spontaneous, excessive, and abnormal discharges of brain neurons as a result of scarring (e.g. from injury, infections, or tumors)

• afflicts approx. 50 million people worldwide

epilepsy syndrome

• a characteristic cluster of clinical and EEG features supported by specific etiological findings (e.g. structural, genetic, metabolic, immune, and infectious)

EEG

• records electrical potentials (voltage fluctuations, brain waves)

• can be used to diagnose epilepsy and provide information about the cause and location of brain dysfunction

• different varieties of epilepsy are associated with different abnormal electrical rhythms in the brain

elements of consciousness

• awareness of ongoing activities

• memory of time during the event

• sense of self as being distinct from others

• responsiveness to verbal and nonverbal stimuli

classification of seizures

• diagnosis is difficult because one must capture an episodic event at the time the person is attached to the EEG

• Activation procedures can provoke ictal pathology to appear during the recording period

  • e.g., flashing a light repeatedly in someone’s eyes, hyperventilation, sleep, or sleep deprivation

depth electrodes and ictal activity

• ictal activity not appearing on the scalp does appear in the brain

• depth electrodes can be implanted directly into the brain prior to surgery for intractable seizures when localization of the focus is a prime concern

focal

generalized

epilepsy treatment

• Anticonvulsant (antiepileptic) medications are the primary medical treatment

• goal is to suppress the rapid and excessive firing of neurons that start a seizure

• effective for about 70% of patients

what do patients do when they don’t respond to medication

they may have surgery (up to 70% of patients become seizure free after surgery)

non medical treatments of epilepsy

• exercise, emotional regulation, and social activities

• they facilitate neuronal inhibition

Alzheimer’s disease

• approx. 10% of older adults (greater than 70 years) meet the DSM-5 criteria for dementia (ie. major NCD)

• greater than 60% of all major NCD cases are caused by alzheimer’s disease

• over 7 million Americans are diagnosed with Alzheimer’s disease

• 6th leading cause of death in the US

diagnosing Alzheimer’s

• There must be evidence of significant cognitive decline from a previous level of performance in one or more cognitive demise (complex, attention)

characteristics of AD

• am