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Health Psych 2

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Rutgers University
Mc Carthy

H ealth Psych Part 2 Ch. 10 CARDIOVASCULAR DISEASE & CANCER Cancer: Unregulated cell growth (neoplasm) that takes nutrients, offers no benefits • Agroup of diseases characterized by the presence of new cells that grow and spread beyond control • Any cell that is capable of division can transform into a cancer cell (including plants and animals) • Characteristics: o Neoplastic: Tumor. most common. Have nearly unlimited growth that robs the host of nutrients and the yields no compensatory beneficial effects (all true cancers share this characteristic).  May be benign or malignant—low risk and localized but still dangerous  Metastasis: the spread of malignancy (spread and form colonies) from one part of the body to another by way of the blood or lymph systems • Types: o Carcinomas o Sarcomas (connective tissue) o Leukemias o Lymphoma • Leading cause of death: skin cancer • Epidemiology: leading causes of death 1. Heart disease 2. Cancer 3. Cerebrovascular diseases 4. Chronic lower respiratory diseases 5. Unintentional injuries CVD death rate decline due to: • Lifestyle changes: Reduced smoking, Improved BP and cholesterol control, weight management, exercise • Improved medical care: Emergency care, improved diagnostic and preventative care Cancers on the rise: • Non-Hodgkin’s lymphoma—OftenAIDS-related • Liver, Melanoma, Espophagus, Leukemia, Soft connective tissue, Thyroid, Small intestines, Vulva Cancer deaths 1900-2010: Trend is starting to decline perhaps due to education and prevention Lung cancer mortality: as a result of smoking • Common and leading cause of cancer death, especially in men Cancer incidence and mortality • Declining by ~1.1% per year (2.1% in 2004) o Changes in smoking and diet (account for 67% of all cancers) o Rates dropping faster for men • Leading cancers decreasing o Lung (causes 27% of cancer deaths) o Colorectal (highest inAf.American) o Breast (incidence increasing; due to detection?) o Prostate (good survival rate) o Stomach (rare since refrigeration) Ch. 11 LIVING WITH CHRONIC ILLNESS Chronic illness: long term illness; persists in time, leading cause of death inAmerican • Incurable (although often treatable). You will have it the rest of your life, it can be treated but not cured, you must learn to live and deal with it • Demands management of symptoms o Engagement with health care system and psychological and social adaptation • Require adjustment o Adherence to treatment o Lifestyle changes o Confronting loss and mortality o Social changes Asthma: chronic inflammatory disease that causes constriction of the bronchial tubes, preventing air from passing freely • Asthma may not be one disease but rater a number of diseases that share symptoms yet have differences in underlying pathologies • Inflammatory lung disease: don’t feel unless you have symptoms • Risk factors o Hygiene hypothesis: asthma is a result of the cleanliness that has become common in modern societies. Exposure then leads to over responsiveness which produces inflammation; which forms asthma  Insufficient early exposure—people are not getting enough exposure to mild pathogens and dirt to build immune systems. o Genetic diathesis: asthma is an allergic reaction triggered by environmental allergens (smoke, dust)  Genetic vulnerability and in the right environment is exposed o Obesity and sedentary lifestyle • Treatment o Adherence to preventative care regimen—it is better to be a little afraid of having an attack because it keeps you alert and more likely to take the proper steps in prevention o Dilators tend to be overused o Identifying and managing triggers o Inflammation always present o Emergency treatment o Moderate level of fear and belief in treatment efficacy predict adherence Alzheimer’s: Neurodegenerative disease (degenerative disease of the brain) • Detection: o Accelerated forgetting, Agitation and irritability, Sleep problems, Delusions (paranoia), Hallucinations, depression o Decline in daily living skills—changing clothes, heating soup… o Inappropriate sexual behavior o Incontinence (cant control bowels and bladder) • Risk factors o Age (main risk), genes, cardiovascular disease risks, stroke, head injury, type 2 diabetes, low education, lack of stimulation • Treatment: o Medications slow progress of disease but do not stop o Behavioral approaches:  Maintain your brain  Reality orientation  Behavior plans for problem behaviors  Compensatory strategies o Caregiver support—they are severely burdened by caring, and may suffer from mental stress, illness  Caregiving associated with illness Diabetes: Insufficient or insensitive insulin from your pancreas • Type 1, type 2, gestational • Risk factors: Family history, low income, overweight, sedentary lifestyle, racial/ethnic minority, stress • Living with diabetes: o Coping with loss of health o Lifestyle adjustments—can be very burdensome and depressing for people to the point that they would rather have HIV because they have to constantly think about it  Diet, exercise, blood sugar monitoring, medication adherence, stress management o Maladaptive responses: Denial, aggression, hopelessness and depression o Patient model of disease and treatment important—what does the patient think the consequences are? Living with chronic disease • Dealing with the symptoms of the disease • Managing the stresses of treatment—adapting to treatment o Health care systems create frustrations and stress • Living as normal a life as possible • Facing the possibility of death • Adjusting to diagnosis o Diagnosis as crisis o Diagnosis as psychosocial transition • Maladaptive reactions: Denial, Hopelessness,Aggression • Adaptive reactions: Maintaining optimism, Enhancing self-understanding • Positive adjustment is possible • Good quality of life is possible • Pain, intrusive symptoms affect QOL (quality of life) more • Heart disease, RA, cancer worse than HTN, asthma diabetes • Better psychological functioning predicts QOL • Variety of coping strategies predictive of QOL Adapting to treatment • Treatment challenges o Loss of mastery/competency o Loss of dignity, autonomy o Negotiating relationships with providers  Hopelessness and helplessness may hinder care, in providers and patients o Avoidance coping is a problem for controllable problems Adjusting to chronic illness • Therapy and support groups help for patients and family o Invisible social support more effective • Disease requires change: Loss of health, grieving, Finding meaning, Self-perception, identity formation, Body image, Relationships • Adjustment also requires maintenance of routine Adjusting to the possibility or prospect of death • Chronic diseases are leading causes of death • Stages of grief (for ill and family)—not always linear, have some good days and some bad days o Denial, anger, bargaining, depression, acceptance • Chance to shape legacy, end of life care END-OF-LIFE ISSUES: (3 readings: Ditto, Winzelberg, & Fagerlin) 60 Min.: The Cost of Dying • Cannot tell people whether they will not be resuscitated after a stroke or not • It is the patients choice, o Even if it means that they end up a vegetable, it costs too much, and life is unlivable End-of-life planning • Advance directive/living will: Specify what measures you do or do not want taken in the future o What you want done if you are not able to communicate it yourself o Requires the following steps: 1. Individual completes a living will a. Only 25% do, not much higher in terminally ill 2. Wishes are authentic and informed a. Requires predictions about future wishes; unstable over time b. Answers depend on way questions posed, depression, past experiences, functioning, current state c. People often want to think positive d. Uncertainty leads to avoidance/postponement 3. Surrogate knows about living will 4. Surrogate interprets living will correctly a. Research suggests surrogate judgments are often inaccurate and based on projection; tend to overestimate desire for treatment 5. Surrogate able to honor wishes a. Can influence other participants 6. Doctor willing to honor wishes a. Ethical, professional, and personal values may influence care offered • Durable power of attorney for health care: Designate a surrogate decision-maker in case of incapacitation • Can be oral vs. written, informal vs. formal, general vs. specific Ditto & Hawkins, 2005: • Only about ¼ people have written a living will • Peoples wishes are not always followed • They usually end up over treated that what the person intended • The person needs to have the mental capacity to think about this • Mood congruent biases: the motions you are experiencing now affect the decisions you make o How authentic the wishes you make are questionable, therefore. o 20 vs. 80 and dying o Am I ready to die now? But don’t save me if it comes to it… Fagerlin et al. 2001: Accuracy of children’s interpretation of the parent’s intentions after life • Children tend to overestimate the parents desire for aggressive care regardless of the conversation • The bias in their interpretation tends to be a self directed manner • They tend to remember what their parents said with their own desires to keep them alive Principles of end-of –life decision making • Autonomy: o Is this the most important principle? • Comfort—more important than control o Be as functional as possible o Limit pain • Preserving cognition and functioning • Family burden • Fear about inviting problems by planning for them • Religious beliefs o Dying consistent with your religion Winzelber et al. 2005: • With capable patients of responding • Incapacitated people o Work with their family o Lay out options Enhance planning: • Conduct more research on what influences wishes and interpretation of wishes • Consider other goals beyond autonomy o Being mentally aware o Being at peace with god o Being able to help others o Not being a burden on society o Resolving conflicts o Feeling one’s life is complete • Recognize diversity in valued principles and preferences CH. 16 BEHAVIORALHEALTH TOPICS: PREVENTING INJURIES Why we need to talk about this: we want to move from knowing to understanding to preventing to treating • Behavior is the leading preventable cause of death so if we wanted to change the impact of death and disease, we need to target this in order to have a big public health impact • Tobacco use is leading behavioral cause • Less invasive, more efficient in prevent onset and progression of illnesses Behavioral health topics • Unhealthy behaviors: Behavior linked to injury o Drug use (Tobacco, alcohol, other drugs), eating, physical inactivity • Processes driving risky behavior • Behaviors: o The leading causes of preventable deaths o Linked to many diseases and forms of injury o Affect quality of life and functioning o Modifying behavior:  Acost-effective way to improve health  Minimally invasive and low risk  Away to exert control over health Injuries: No longer called accidents because no longer seen as random, inevitable • Affected by diverse influences: Public policy, Environment, Social norms, Individual behavior • Prevention: o MVA: seat belts, air bags, car design, road improvements, DUI enforcement  Parent & driver education: Use of child restraints, Drowsy driving interventions, Designated driver, free taxis o Home injury:  Parent behavior • Educate parents: Electrical outlet covers, Restrict access to hazards, Supervise around tubs, buckets, pools  Teach older children directly  Advocate comprehensive approach  Elder education: Tailored fall prevention program  Safety equipment (e.g. detectors) o Bicycle injury:  Helmet use, Rates low, Barriers (Cost, inconvenience, lack of knowledge, appearance), Visibility, Following traffic rules o Workplace:  Law (OSHA), culture, use protective gear and equipment, training with feedback, foster individual responsibility, incentives for safe behavior, security, management practices, employees screening, worker training Risky behaviors • Driving: no seat belt, no child restraint, fatigue, drug use, recklessness • Fire: smoking in bed, no smoke detectors • Bicycle: no helmet, drug use, recklessness • Drowning: unsupervised child, drug use • Poison: easy child access • Guns: loaded guns in open, drug use • Sports: not using safety gear • Workplace: no using safety gear, not following guidelines, drug use Domestic violence: Situation couples violence • Intimate terrorism: one partner enforcing restriction or control over their lives (seeing family, having a job, telling them they are worthless) o Denigration: Telling the person they are worthless, attack their sense of worth to keep them powerless o Isolation from other people • Prevention: o Improve women’s status o Focus on victim, not batter—Shelters, community-based referral, support programs, protective orders, law • Infancy and older adulthood at greater risk in domestic violence CH. 12 TOBACCO USE Tobacco: • Tobacco number one preventable behavior that kills people inAmerica • Leading killer • Affects some people more than others • Has enormous individual and societal costs • Why addiction happens: • Use is common, but declining slowly • Addictive and deadly • Quitting smoking is the best thing for health now and for future health Epidemiology: • 21% of American adults smoke (45 million) o 24% of 18-24 year olds smoke • Gender: 24% men > 18% women • Race/ethnicity o 32%American Indian, 22% White, 22% African-American, 16% Hispanics, 13%Asian-American • Education: o 33% < 12 years o 43% GED o 11% BA/BS  7% graduate degree • Poverty: smoking used to be a symbol of socioeconomic status, but now it is an indication of poverty and low health o 30% below poverty line o 21% above poverty line • Mental Illness: smoking higher in mentally ill o Mental illness:  75-90% schizophrenia—they smoke in a super intensive way that make normal smokers sick. They inhale a lot and quickly  49% depression  43% alcohol abuse  35% panic disorder o Diagnosis:  25% people w/ 1 diagnosis  31% people w/ 2 diagnosis  40% people w/ 3 diagnosis  52% people w/ 4 diagnosis o 44% of cigarettes in U.S.A. sold to mentally ill • Prevalence is declining o As prices and restrictions go up, people smoke less o There are fewer heavy smokers o More former smokers are quitting and living Health Effects • 430,000 + American deaths/year • 14 years of life lost • Leading preventable cause of death o Cardiovascular disease o COPD o Cancer: head, neck, lung, pancreas, cervix, bladder, kidney, stomach, leukemia • Fires,Appearance, Bone density, Periodontis, Erectile dysfunction, Respiratory infections, Poor wound healing • Risks to fetuses and children Addiction • Use despite consequences • Loss of control, Tolerance, Withdrawal, Time spent/ interference with life • 95% relapse rates • Addiction can develop quickly: Permanent changes with single doses o Our brains adapt very quickly and very well. Animals given a single dose of opiates will show immediate signs of withdrawal. • Developing addiction o Experimentation with tobacco is common  Social norms, genes, marketing, weight concerns, access, prices o Progression to addiction is related to: genes, social norms, optimistic bias, weight concerns • Prevention: school interventions, rejection skills, ad campaigns, price increases, change social norms • Rates of risk of smoking: o Experimenters—early adulthood…for social use o Were smoking heavily and regularly, and then quite in later 20s and then stopped entirely o People who start later in age, but end up smoking regularly through their mid 30s o People who start early and stay strong for the rest of their life How addicted smokers change: • 70% want to quite o 40% try to quit each year  75-90% quite “cold turkey” o 4-7% succeed • 50% of smokers are former smokers Christakis & Fowler, 2008 • Dynamics of smoking cessation is a large social network 1971-2003 o Quitting tends to spread through social networks. Social contagion becoming much more normative to quite when everyone around you is not smoking. It has become more of a non-social norm to smoke. o Support cessation CH. 13ALCOHOLAND OTHER DRUGABUSE Direct Health Hazards of alcohol—harmful physical effects of alcohol itself • Liver damage, Increase blood pressure, heart damage, Several cancers, Respiratory disease, Korsakoff syndrome, Infertility, amenorrhea • Miscarriage, stillbirth, low birth weight, cognitive problems in children, fetal alcohol syndrome Indirect Hazards of alcohol—harmful consequences that result form psychological and physiological impairments • Increased aggression o 67% of homicides linked to alcohol o Majority of assaults and domestic violence • Impaired judgment, Changes in attention • Unintentional injuries o Dose-response relationship with fatal injuries o 16,000 MVArelated to alcohol per year • Increased suicide attempts and completions • Illegal activities related to illegal drug use and distribution: violence • Sexually transmitted disease, Poor nutrition, Unhealthy lifestyle, Lack of preventative care, Unintentional injury **Benefits of Alcohol: increase good cholesterol (HDL) Health Hazards • Sedatives o Depressed respiration o Deadly withdrawal o Inhalants  Brain, kidney, liver damage, asphyxiation, heart failure • Narcotics: overdose, infection, organ damage due to additives, violence, HIV, HEP C, depressed respiration • Simulants: heart problems, convulsions, paranoid psycholsis, Meth-damage to dopamine system • Marijuana: respiratory illness, cancer of resp. tract, memory, cognitive problems • Hallucinogens: bad trips, flashbacks, psychosis, depression • Steroids: acne, breast development in mend, cardiovascular disease, cerebrovascular disease • GHB: depressed respiration, seizure, coma, sexual assault Addiction • Can develop quickly: permanent changes with single doses • Models of use o Drive model: we use because we have a drive to alter consciousness o Tension-reduction: we use to reduce tension o Positive reinforcement model: we use because it makes us high o Negative reinforcement model: we use because it eases our tension o Social learning: observational learning, cognitive processes o Alcohol myopia: EtOH changes attention, leads to extreme social behavior, and inflated self-evaluation, and reduced anxiety • Models of addiction o Moral model: people have free will to choose their behaviors, including excessive drinking. Thus, those who do so are either sinful or morally lacking in the self-deiscipline necessary to moderate their drinking o Disease: addiction as a chronic, incurable disease of unknown nature, etiology o Dependency syndrome: impaired control, at certain times and for a variety of reasons, they do not
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