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PSYC 3170 – Health Psychology – Final Exam Notes.docx

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PSYC 3170
Jennifer Mills

PSYC 3170 – Health Psychology – Final Exam Notes – Chapter 11-15 Chapter 11 – Living with Chronic Illness  Increase in the rates of asthma among children in the past 20 years  Exposure to air pollutants, poor urban neighborhoods  Chronic health conditions are those which can impact day to day physical, emotional, and even social functioning and therefore take a toll on quality of life What Is Quality of Life?  Until recently, quality of life was not considered an issue of psychological importance  Self-reports of health status have found to predict morbidity and mortality beyond medical and psychological factors  Self-reported health is an important aspect of quality of life  Those with a chronic illness are more likely to suffer from depression, anxiety, and distress  Stress exacerbates symptoms  Quality of life has several components, specifically physical functioning, psychological status, social functioning, and disease or treatment related symptomatology  Quality of life is now assessed with emphasis placed on how much the disease and its treatment interferes with the activities of daily living, such as sleeping, eating, going to work, and engaging in recreational and social activities  Quality of life assessments gauge the extent to which a patient’s normal life activities have been compromised by disease and treatment Evaluating Quality of Life  There are general measures and measures that are specific to certain diseases  Compare quality of life of diseased to general population  Within Canada, men had quality of life scores that were substantially higher than women across all of the eight domains and summary scores  Compared to the U.K., Canadians scored somewhat higher on general health perceptions, vitality, social functioning, and mental health  For Canadian women then, living with a chronic illness further compromises quality of life  Culture and age can also play a role in how a chronic illness impacts quality of life  Many reasons to study quality of life  Provides an important basis for interventions designed to improve quality of life 1  Can help pinpoint which problems are likely to emerge for patients, helpful for anticipation  Assess the impact of treatments on quality of life  Information can be used to compare therapies  Information can inform decision makers about care that will maximize long- term survival  Most treatments target one chronic condition, however many people live with multiple conditions  Can have additive impacts on quality of life What Are the Emotional Response to Chronic Illness?  Immediately after being diagnosed, patients can be in a state of crisis marked by physical, social, and psychological disequilibrium  Habitual ways of coping with problems do not work  Symptoms get worse when coping efforts do not work  Eventually, the crisis phase of chronic illness passes and patients begin to develop a sense of how the chronic illness will alter their lives Denial  Denial is a defense mechanism by which people avoid the implications of an illness  Patients act as if the illness isn’t severe and will shortly go away  Patients may be unable to come to terms with the full range of problems posed by the illness at the time, so denial serves a protective function  May have adverse effects if it interferes with the ability to take in necessary information Anxiety  Many patients become overwhelmed by the potential changes in their lives, and in some cases, by the prospect of death  Anxiety is a problem not only because it is intrinsically distressing but also because it can interfere with good functioning Depression  Depression is a common and often debilitating reaction to chronic illness  Can be a sign of impending physical decline  Complicates treatment adherence and medical decision making  Sometimes a delayed reaction to chronic illness How Is the Self Changed by Chronic Disease?  Self-concept – a stable set of beliefs about one’s qualities and attributes  Self-esteem – the general evaluation of the self-concept, namely whether one feels good or bad about personal qualities and attributes  A chronic illness can produce drastic changes in self-concept and self-esteem 2 The Physical Self  Body image is the perception and evaluation of one’s physical functioning and appearance  Body image plummets during illness  A poor body image is related to low self-esteem and an increased likelihood of depression and anxiety  Body image may influence how adherent a person is to the course of treatment and how willing he or she is to adopt a comanagement role  Body image can be improved through psychological and educational interventions  Disfigurement threatens body image, often can not be overcome  When illness threatens sexual functioning body image may be affected  Body image can be improved by stressing other aspects of appearance and health The Achieving Self  Many people derive their primary satisfaction from their job or career  Others, in hobbies and leisure activities  If chronic illness threatens these valued aspects of the self, the self-concept may be damaged The Social Self The Private Self  Many illnesses create the need to be dependent on others, resulting in loss of independence  Strain of imposing on other How Do Individuals Cope With Chronic Illness?  People with chronic illness are vulnerable to other stressors unrelated to their illness which can exacerbate symptoms  Fear and uncertainty about the future were most common stressor  Followed by limitations in physical abilities, appearance  Followed by pain management  Social support, direct problem solving  Distancing (not letting it get to you)  Positive focus  Cognitive escape/avoidance  Behavioural escape/avoidance  More passive coping strategies than active coping strategies for those with chronic illness 3 How Do People Manage Chronic Illness? Physical Problems Associated with Chronic Illness Goals of Physical Rehabilitation  Physical rehabilitation of patients with chronic illness or disabled patients typically involves several goals o How to use one’s body as much as possible o To learn how to sense changes in the environment in order to make the appropriate physical accommodations o To learn new physical management skills o Learn a necessary treatment regiment o Learn how to control the expenditure of energy  Patients must learn to read bodily signs that signal the onset of a crisis, and know how to handle that crisis  Exercise is a critical component of recovery programs  Group interventions may be successful in getting people to adhere to physical activity Vocational Issues in Chronic Illness  Patients often have to restrict or change their work activities  Many patients with chronic illness face job discrimination  Large financial impact of chronic illness  Lose benefits if take off time from work Social Interaction Issues in Chronic Illness  Patients may have trouble re-establishing normal social relations  Claims of others pity and rejection  May withdraw from other people altogether Positive Changes in Response to Chronic Illness  Some people experience joy and optimism  Occur because people who have a chronic illness perceive that they have narrowly escaped death or because they have reordered their priorities in a more satisfying way  Ability to appreciate each day  Benefit finding – acknowledgement of the positive affects of illness in one’s life  Benefit finding is associated with good adjustment  Beneficial function in recovery from illness 4 Chapter 12 – Psychological Issues in Advancing and Terminal Illness How Does Death Differ Across the Life Span?  Average life span – 81 years  Most death arises from chronic illness Death in Infancy or Childhood  Canada still has a high infant mortality rate (5.1 per 1,000)  First nations infant death rates are higher  Poorer neighbourhoods have higher infant mortality rates  During the first year of life, the main causes of death are congenital abnormalities and sudden infant death syndrome (SIDS)  Infant stops breathing  A sleeping position has been linked to SIDS  After the first year, external causes are the main cause of death among children under age 15  Motor vehicle accidents, accidental drowning, poisoning, injuries, or falls in the home  Cancer, especially leukemia, is the second leading cause of death between ages 1 and 15 Death in Young Adulthood  Major cause of death in this age group is unintentional injury, mainly involving automobiles  Suicide is the second leading cause of death, cancer is the third, homicide the fourth Death in Middle Age  Fear of death is more prominent during middle-age than in later adulthood  The main cause of premature death in adulthood (death that occurs before the projected age of 79) is sudden death due to heart attack or stroke Death in Old Age  Elderly more prepared to face death What Are the Psychological Issues in Advancing Illness? Continued Treatment and Advancing Illness  Continued treatments with debilitating and unpleasant side effects  After several efforts to combat illness, patient may resist further intervention  Patients who have undergone repeated surgery may feel that they are being disassembled bit by bit  There comes a time when whether to continue treatments becomes an issue 5 What is a Good Death?  A good death is defined as one that is free from avoidable suffering for patients, families, and caregivers in general accordance with the patients’ and families’ wishes  Done through pain and symptom management, clear decision making, preparation for death, completion, contributing to others, and affirmation of the whole person  Also a scale: The Good Death Inventory  Assesses 10 dimensions associated with quality of death outcomes for patients Psychological and Social issues Related to Dying  Advancing illness can threaten the self-concept  Impacts biological and social functioning Are There Stages in Adjustment to Dying? Kubler-Ross’s Five-stage Theory  Lack of empirical support for the five-stage model  Denial o Defense mechanism to avoid the implications of an illness o Act as if illness isn’t severe o May deny even having the illness  Anger o Why me? o Directed at anyone nearby  Bargaining o Trading good behaviour for good health o Pact with God  Depression o Coming to terms with lack of control o Coincident with worsening of symptoms  Acceptance o Too weak to be angry, too accustomed to the idea of dying to be depressed o Peaceful o Make preparations  Kublers work has been useful for pointing out the counseling needs of the dying  Broken through silence and taboos surrounding death  Doesn’t acknowledge presence of anxiety What Are the Concerns in the Psychological Management of the Terminally Ill? 6 Medical Staff and the Terminally Ill Patient  Most deaths occur in the hospital (67 percent), large increase fro 1950s  Patients are very dependent on medical staff for care as well as information Risk of Terminal Care for Staff  Least interesting physical care because it is palliative care  Palliative care – care designed to make the patient feel comfortable  Rather than curative care, care designed to cure the patient  Terminal care involves a lot of unpleasant custodial work, such as feeding, changing, and bathing the patient  Canadian physicians believe patients want to know if their illness is terminal, European and South American physicians mostly do not  Thanatologists – those who study death and dying  Clinical thanatology – therapy with the dying  Symbolic immortality – leaving behind a legacy What Are the Alternatives to Hospital Care for the Terminally Ill? Hospice Care  The idea behind hospice care is the acceptance of death in a positive manner, emphasizing the relief of suffering and or improvement of quality of life rather than the cure of illness  Designed to assist patients in gaining more control over their lives, effectively manage pain, and provide palliative care and emotional support to dying patients and family members  May be provided in the home, also commonly provide in free-standing or hospital affiliated units called hospices  Painful or invasive therapies are discontinued  Patients encouraged to bring things in from home, become more comfortable  Improve patients social support system Home Care  Usually can receive as competent care at home as in the hospital, provided that there is regular contact between medical personnel and family members  Family should be adequately trained  Can be more stressful for the family Chapter 13 – Heart Disease, Hypertension, Stroke, and Diabetes What Is Coronary Heart Disease?  Number two killer in Canada  Chronic disease Understanding CHD  CHD is a general term that refers to illnesses caused by atherosclerosis 7  Atherosclerosis – the narrowing of the coronary arteries, the vessels that supply the heart with blood  Flow of oxygen and nourishment to heart is partially or completely obstructed  Temporary shortages of oxygen and nourishment frequently cause pain, called angina pectoris, which radiates across the chest and arm  When severe deprivation occurs, a heart attack (myocardial infarction) can result  Atherosclerosis  angina pectoris  myocardial infarction  Research has implicated inflammatory processes in the development of the disease  Inflammation can promote damage to the walls of the blood vessels  C-reactive protein is an indicator  High blood pressure, diabetes, cigarette smoking, obesity, high serum cholesterol level, and low levels of physical activity are risk factors  Metabolic syndrome – diagnosed when a person has three or more of the following problems o Obesity centered around the waist o High blood pressures o Low levels of HDL (good cholesterol) o Difficulty metabolized blood sugar (indicates risk for diabetes) o High levels of triglycerides (related to bad cholesterol)  Heart disease also has a family history component  Genetically based predisposition to cardiovascular reactivity  Can be exacerbated by low socio-economic status and a harsh early family environment Role of Stress  Chronic stress linked to coronary heart disease  Acute stress cam precipitate sudden clinical events, such as a heart attack, angina, or even sudden death  Heart disease is more common in individuals low in SES, especially males  Urban and industrialized countries have higher incidence of CHD than do underdeveloped countries  Migrants have a higher incidence of CHD Women and CHD  CHD is a leading killer of women in Canada and most other developed countries  Heart disease typically occurs later for women, and more dangerous when it does occur  Women are less likely to recover from a cardiac event compared to men  Women seem to be protected at young ages against CHD relative to men, possibly because of their higher levels of high-density lipoprotein 8  Women experience a higher risk of cardiovascular disease after menopause  Gain weight, increase in blood pressure, cholesterol, and triglycerides  Women are more likely to be referred to long-term-care facilities rather than sent home Cardiovascular Reactivity, Hostility, and CHD  Hostility more common in men, associated with CHD  Higher among non-whites and those of lower SES  Expression of hostility is more reliably associated with enhanced cardiovascular reactivity than is the state of the anger or hostility  Hostile individuals also have more interpersonal conflict and less social support  Hostility may be a social manifestation of cardiovascular reactivity  Stress can cause vasorestriction, attempt to transfer more and more blood through shrinking vessels, causing wear and tear on coronary arteries  Produces atherosclerotic lesions Depression and CHD  Independent risk factor for CHD  Strong link between depression and metabolic syndrome, between depression and cardiovascular disease, between depression and the likelihood of a heart attack, between depression and heart failure among the elderly  Depression related to elevated C-reactive protein, a marker of low-grade systemic inflammation  Atherosclerosis in an inflammatory process, depression promotes inflammation, may account for the relation between depression and atherosclerosis Other Psychosocial Risk Factors and CHD  Anxiety has been implicated in sudden cardiac death  Helplessness, pessimism, and a tendency to ruminate over problem also contributes to CHD Management of Heart Disease Role of Delay  One reason for high mortality and disability rates following heart attacks is that patients often delay several hours or even days before seeking treatment  Not acknowledging that they had a heart attack  Depression also leads to delay Initial Treatment  Some patients have coronary artery bypass graft surgery to treat block
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