Duke PA Behavioral Medicine Final from powerpoints
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| coping style: more passive style, avoid unpleasant feelings, aim is palliative, methods of prayer, distraction/preoccupy mind, belief in God | emotion focused
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| coping style: active, attempts to reduce distress by changing the situation, obtaining information, methods of determination, self education and self discipline | problem focused
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| gender differences in coping styles | males used fewer numbers of coping methods, males used fewer emotion focused methods, males reported more self-management "success" stories
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| coping style of whites/non-Latino | used more problem focused methods
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| coping style of African Americans | used more emotion focused methods
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| difference found in self management success between races | no difference, however as use of problem focused methods increased so did diabetic control
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| necessary coping skills | realistic expectations, proactive efforts, request help, handle strong emotions, participate, live in the present, value what is good
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| factors that affect chronic illness adjustment | severity of the illness, social support, financial/socioeconomics, mental health/personality of patient prior to illness, prior experience with chronic illness
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| stages of chronic illness | crisis, isolation, anger, reconstruction, intermittent depression, renewal
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| general adaptation syndrome to stress | alarm phase, resistance phase, exhaustion phase
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| the stress response alarm phase results in __ | increased heart rate, elevation of BP, increased respiratory rate, mibilization of energy to muscle, shut down "non-essential" functions
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| the stress response resistance phase long term effects | chronic secretion of stres hormones leads to: susceptibility to infection, increased risk for multiple illnesses/disorders, emotional distress
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| on the social readjustment rating scale getting married was __ points | 50
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| on the social readjustment rating scale getting divorced was __ points | 85
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| on the social readjustment rating scale death of a spouse was __ points | 100
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| life changing events are associated with __ | heart disease, fractures, childhood leukemia, performance deficits, acute schizophrenia, depression and suicide
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| effect of adrenaline | releases sugars and increases heart rate
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| effect of norepinephrine | increases blood pressure and heart rate
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| effect of cortisol | regualtes blood pressure and body use of proteins, carbs and fat
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| chronic stress may shorten a person's life expectancy by __ years | 15-20
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| chronic stress stimulates __ cravings | sweet
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| sleep deprivation is associated with | slowed healing, decreased pain tolerance, increase susceptibility to infection, increased apathy, fatigue and poor judgment
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| HALT stands for | Hungry, angry, lonely, tired
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| stress tip-attend to basics consists of | exercise, nutrition, adequate sleep, moderated alcohol and caffeine consumption
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| stress tip--practice the relaxation response consists of | focus on one thing (breathing), be non-judgmental regarding wandering mind, regular time and place to practice
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| stress tip--be in the present consists of | mindfulness, use five senses, cue controlled relaxation
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| stress tip--breathing consists of | you really don't know?
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| stress tip--optimize social support consists of | friendships, church/synagogue/mosque, significant others, support groups
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| __ more potent indicator of cardiovascular outcomes than job stress for women | marital stress
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| good __ help fend of heart disease, arthritis, and other illnesses by reducing harmful inflammation | relationships
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| stress tip--be a fundamentalist consists of | schedule something for fun at least once a week
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| stress tip--use music therapeutically helps to __ | reduce anxiety, lower heart rate, decrease bp, reduce pain, improve mood, facilitate concentration and memory
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| stress tip--journal writing | writing about experiences and associated emotions for as little as 15 minutes over 3 days bring about robust health improvements. Improved immune function, mood, kidney function and reduced physician visists
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| stress tip--be a positive thinker | thoughts create feelinds, identify self-dialogue, strengthen rational voice, practice positive imaging
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| belief that bad events will last a long time, catastrophize, undermining of self, bad events are the fault of someone | pessimism
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| belief that bad events are just a temporary setback, positive take on reality, defeat is not my fault, unfazed by defeat | optimism
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| predictors of successful aging | optimism, ability to postpone gratification, altruism, future-mindedness, humor
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| stress tip--spend time in nature | go outside (ground breaking stuff!)
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| stress tip--humor | I would try to put something funny here but I just don't think it would be appropriate, we are trying to learn here!
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| stress tip--develop a sense of purpose | what is really important, the greater the sense of purpose the lower the levels of harmful stress hormones and harmful protein in our bodies
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| ecclesiogenic depression | depression related to religious beliefs, harsh religious beliefs may be harmful to individuals
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| what are the 12 stress reduction tips | basics, relaxation response, breath, mindfulness, social support, fun, music, journal, be positive, nature, humor, perspective
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| what is the #1 most preventable cause of death in the US and worldwide | smoking
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| impacts of smoking | fertility, pregnancy outcome, breast cancer, cataracts, macular degeration, cardiovascular problems
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| there is a __ year loss of life expectancy with smoking | 10
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| second hand smoke cause and increase in __ for exposed children | otitis media
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| within a year of quiting patients have a reduced | CHD risk (by 1/2)
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| within days of quiting smoking people __ better | smell
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| within a week or two after quitting smoking, people _________ better | taste
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| within weeks of quitting smokers have an increased __ | pulmonary function, increased exercise tolerance
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| within __ years after smoking cessation the CVD risk is the same as for a non-smoker | 15
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| all cause death rate reduced in __ years after smoking cessation | 2
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| cancer rate 50% reduced over __ years after smoking cessation | 10
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| if a 65 year old smoker quits he/she can add __ years to their life expectancy | 4
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| nicotine hits the brain in __ seconds | 11
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| after nicotine hits the brain __ is released along with other neurotransmitters | dopamine
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| nicotine withdrawal symptoms | anger, cravings, decreased concentration, hunger, wt gain, restlessness, drowsiness, fatigue, decreased task performance, sleep disturbance
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| the new model of behavior change | patient self-management
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| patient self-management includes | the activated patient, shared decision making with the provider, effective communication, self-efficacy to achieve desired behaviors and to manage symptoms
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| the five A's of self management | ask, advise, assess, assist, arrange
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| short cut to the five A's (3 A's) | ask, advise (tell), ask and refer
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| the fifth vital sign | asking about smoking (every visit)
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| what is the assess step in smoking cessation | is the patient ready to make a change
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| what are the stages of change | pre-contemplation, contemplation, preparation, action, maintenance
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| the pre-contemplation stage of change | the huh phase, not thinking about change, may be resigned, feeling no control, denial
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| the contemplation stage of change | the but phase, weighing benefits and costs of continuing/changing the behavior
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| the preparation stage of change | the I'm ready now phase, experiment with small changes
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| self-management skills | patient centered, attainable goals, problem solving, skills training
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| Assist patient in smoking cessation | get ready (set a quit date), get support, learn new skills and behaviors (BT and CBT), get meds and learn to use, be prepared for relapse or roadblocks
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| arrange follow up care within __ of quitting (in person, phone, electronic) | one week
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| how to set goals | set SMART goals, Specific, Measurable, Action oriented, Realistic, Timely
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| the five R's of smoking cessation | Relevance to patient, Risks, Rewards, Roadblocks, Repetition
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| questions to ask to get the smoker to see the disadvantages of not making a change | what would happen if you don't change? in what way does this concern you? why does this worry you?
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| questions to ask to get the smoker to see the advantages of change | what are the advantages of changing? how would you like for things to be different? what are the main reasons to change?
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| cigarettes are responsible for one in every deaths in the united states | 5
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| currently __% of US adults are smokers | 23
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| currently __% of US young adults are smokers | 26
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| smokers have __ the risk of fatal heart disease | twice
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| smokers have __x the risk of lung cancer | 10
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| in the US __% of cases of COPD occur among current or former smokers | 90
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| heavy smokers have a __ greater risk of age-related macular degeneration | 2.5
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| smokers die __ years earlier than never-smokers | 5-8
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| how are children of smokers affected | lower birth wts, more likely to be mentally retarded, have more frequent respiratory infections and less efficient pulmonary function, have a higher incidence of chronic ear infections, and more likely to become smokers themselves
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| only __% of smokers who attempt to quit are successful | 4
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| __% of smokers attempt to quit every year | 40
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| persons whose physicians advise them to quit are __times as likely to attempt quitting | 1.6
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| over 70% of smokers see a physician each year but only __% of them receive any medical quitting advice or assistance | 20
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| step 1 of the five A's of smoking cessation | ask: systematically identify all tobacco users at every visit
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| step 2 of the five A's of smoking cessation | advise: strongly urge all smokers to quit
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| step 3 of the five A's of smoking cessation | attempt: identify smokers willing to make a quit attempt
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| step 4 of the five A's of smoking cessation | assist: aid the patient in quitting
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| step 5 of the five A's of smoking cessation | arrange: schedule follow-up contact
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| weight gain occurs in __% of patients following smoking cessation | 80
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| spectrum of alcohol use | abstinence, moderate drinking, at-risk drinking, abuse (problem drinking), dependence (addiction)
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| a pattern or level of alcohol use that is associated with increased risk of development of adverse physical psychological, or social consequences | hazardous drinking
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| 13.6 g alcohol in __ beer or wine cooler | 12 ounces
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| 13.6 g alcohol in __ wine | 5 ounces
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| 13.6 g alcohol in __ spirits (80 proof) | 1.5 ounces
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| at risk drinking in men | >14 drinks/week, >4 drinks per occasion
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| at risk drinking in women | >7 drinks per week, >3 drinks per occasion
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| at risk drinking in persons over 65 years old | >7 drinks per week
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| substance abuse (DSM-IV) must fulfill at least 1 of 4 criteria | immediately hazardous to users or others (Risky), interferes with Role function, continues despite causing Relationship problems, results in recurrent legal problems (Run-ins with the law), and doesn't meet criteria for substance depencence
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| substance dependence (DSM-IV) must fulfill at least 3 out of 7 criteria | unsuccessful efforts to quit or cut down, uses more than intended, continued use despite adverse physical or psychological consequences, excessive time devoted to obtaining/using/recovering, change in activities/relationships, tolerance, withdrawal
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| alcohol withdrawal onset __ hours after last drink | 12-24
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| alcohol withdrawal peak intensity at __ hours after last drink | 24-48
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| clinical features of alcohol withdrawal | tremor, tachycardia, hypertension, sweating, insomnia, nausea/vomiting, photophobia, hallucinations, hyperreflexia, irritability, anxiety, alcohol craving, seizures possible
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| alcohol withdrawal delerium duration __ days | 4-7
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| alcohol withdrawal delerium has a __% mortality | 10-15
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| predictors of relapse | non-adherence to meds/diet/behavior change, low SES, low family support, psychiatric co-morbidity
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| heavy drinking is associated with what cancers | breast, liver, head/neck
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| __% of adult primary care patients are alcohol dependent | 5
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| __% of adult primary care patients abuse alcohol | 7
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| __% of adult primary care patients display at risk drinking behavior | 8
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| __% of adult primary care patients drink alcohol in moderation | 45
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| alcohol is implicated in __% of suicides | 33
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| alcohol is implicated in __% of MVA deaths | 40
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| alcohol is implicated in __% of domestic violence cases, homicides, and trauma center cases | 50
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| alcohol abuse related clinical tasks | prevent, recognize/diagnose/assess, brief intervention when appropriate, initial management (detox), refer, support
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| USPSTF recommends screening of all adolescents and adult patients for __ problems | alcohol
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| mnemonic for alcohol abuse screening | CAGE
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| what does CAGE stand for | Cut down, Annoyed, Guilty, Eye-opener
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| score of 1+ on CAGE- | warrants further investigation
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| score of 2+ on CAGE- | highly suggestive of alcohol dependence
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| FRAMES for brief alcohol intervention stands for | feedback, responsibility, advice, menu of options, express empathy, support self-efficacy
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| medications for alcohol dependance | naltrexone, acamprosate, disulfiram
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| in the setting of alcohol withdrawal basing benzodiazepine dose on __ score allow more precise dosing | CIWA (Clinical Institute Withdrawal Assessment)
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| medication that creates and adverse reaction to alcohol | disulfiram
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| neurotransmitter enhanced by ethanol | GABA-major inhibitory transmitter in brain
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| neurotransmitter suppressed by ethanol | Glutamate-major excitatory transmitter
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| opioid antagonist that reduces relapse/cravings in recovering alcoholics | naltrexone (revia)
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| effective psychosocial therapies for alcoholics | cognitive behavioral therapy, motivational enhancement therapy, 12-step (AA), individual drug/alcohol counseling, brief intervention for problem drinkers
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| positive AUDIT score for men 60 or younger | 8
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| positive AUDIT score for women | 4
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| a positive AUDIT result does not constitute a __ | diagnosis of alcoholism but does warrant further evaluation
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| if yes to one or more of the following questions it means that your patient meets criteria for alcohol abuse. in the past 12 months has your patient's drinking repeatedly caused or contributed to: | RISK of bodily harm, RELATIONSHIP trouble, ROLE failure, RUN-INS with the law
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| if the answer to three or more of the following questions is yes then your patient has alcohol dependance. In the past 12 months, has your patient | not been able to stick to limits. not been able to cut down or stop. Shown tolerance. Shown signs of withdrawal. Kept drinking despited problems. Spent a lot of time drinking. Spent less time on other matters
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| signs of withdrawal | tremors, sweating, nausea, insomnia when trying to quit or cut down
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| questions to ask to assess for readiness for change | what are your thoughts about your drinking? Do you have any concerns related to your drinking? How important is it for you to make a change in your drinking. How confident are you that you could successfully change if you wanted to?
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| intervention for moderate drinking | reinforce, educate re: limits
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| intervention for at-risk and problem drinking | brief alcohol intervention (BAI)
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| intervention for alcohol dependance | advise abstinence, refer for treatment
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| what to do for the alcohol dependant patient | recommend total abstinence, assess risk of acute withdrawal, assess psychiatric and medical comorbidity, refer for evaluation and treatment in a formal addiction treatment program, schedule follow-up to assess compliance
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| who do you recommend alcohol abstinence to | pregnant/contemplating pregnancy, medical conditions made worse by alcohol, on meds that interact with alcohol, past/current dependence
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| who should detox as inpatients | h/o seizure/delirium, medically unstable, psychosis, unstable environment, no support/transportation
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| who should detox as outpatients | no seizure/delerium hx, med/psych stable, can return daily, has social support
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| CIWA stands for | Clinical Institute Withdrawal Assessment
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| Easily administered, standardized rating scale to score withdrawal severity. | CIWA
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| basing benzodiazepine dose on __ score allows more precise dosing, avoiding under and over medication | CIWA
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| medical complications of cocaine | coronary vasospasm, myocardial infarction, cardiomyopathy, arrhythmia, hypertension, stroke, seizures, delirium, placental abruption, fetal growth retardation, trauma, HIV/HCV/HBV, abscess, endocarditis, trauma
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| psychiatric complications of cocaine | depression, mania/hypomania, anxiety, insomnia, irritability, sexual dysfunction, agitation, aggression, suicidal ideation, paranoia, psychosis, cognitive impairment
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| verbal consent is required for drug testing except __ | in a medical emergency
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| __ is more useful than __ for drug testing except in acute overdose | urine, blood
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| what must be followed to allow results of drug testing to be legally admissible | chain of custody
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| use of drug testing in medical context | initial evaluation for suspected use and to monitor ongoing treatment
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| what is in the standard "drugs of abuse panel" | amphetamine, barbituates, cannabinoids, cocaine metabolite (benzoylecgonine), opiates(does not detect methadone or buprenorphine, +/- oxycodone), phencyclidine (PCP)
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| positive drug screen after __ is highly unlikely | passive exposure
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| __ often triggers cocaine relapse | alcohol use
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| supplanting crack as leading stimulant of abuse in rurual NC counties, especially in mountain regions | methamphetamine
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| opioid dependence is infrequent with __ | medical use for analgesia in patients without history of addictive behavior
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| characteristics of opioid overdose | CNS depression progressing to coma, pinpoint pupils, resp depression, cardiovascular collapse, pulmonary edema (heroin), often lethal, rapidly reversible with IV naloxone
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| opioid withdrawal is __ but rarely __ in otherwise healthy individuals | profoundly unpleasant, dangerous
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| symptoms of opioid withdrawal | ab pain, N/V, diarrhea, piloerection, myoclonic jerks, lacrimation, rhinorrhea, anxiety, agitation, insomnia, irritability
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| severity of opioid withdrawal is scored using __ | COWS (Clinical Opiate Withdrawal Scale)
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| treatment of opioid withdrawal | clonidine (reduces adrenergic hyperactivity, sedating), NSAIDS, Loperamide (diarrhea), benzodiazepines (insomnia, irritability, agitation)
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| long acting synthetic opioid used as an opioid substitute | methadone
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| how to administer methadone | taper over several days in hospital, taper over several weeks for outpatient
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| __ blocks effect of self-administered opiates, but compliance is poor unless closely supervised | oral naltrexone
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| most effective treatment for preventing relapse in opioid dependence | methadone maintenance, buprenorphine maintenance
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| duration ranges of methadone maintenance | months to decades
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| requires daily clinic visits for med administration | methadone maintenance
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| opioid replacement that is initiated while patient is in withdrawal, safer than methadone during overdose, prescriptions are filled by pharmacies (no daily clinic visits after initial 2-day induction) | buprenorphine maintenance
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| __ can trigger relapse of alcohol dependance and other addictions | opioids
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| obesity is a BMI of __ or greater | 30
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| overweight is a BMI of __ | 25-29.9
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| morbid obesity is a BMI of __ or higher or BMI of __ or higher with co-morbidities | 40, 35
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| there are an estimated __ obese adults worldwide | 320 million
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| there are an estimated __ overweight adults worldwide | 1.1 billion
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| on of the national health objectives is to reduce the prevalence of obesity among adults to less than __% | 15
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| for each 5kg/m higher BMI there is an associated __% higher mortality | 30
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| at a BMI of 30-35 median survival is reduced by __ years | 2-4
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| ata BMI of 40-45 median survival is reduced by __ years (comparable to the effects of smoking) | 8-10
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| __ deaths annually are attributable to obesity and sedentary lifestyle | 400,000
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| estimated __% of national healthcare expenditures is related to obesity and its negative outcomes | 10
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| almost __ dollars is spent annually on obesity related health care | 100 billion
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| BMI below __ is underweight | 18.5
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| BMI of __ is considered healthy weight | 18.5 - 24.9
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| BMI is a __ tool not a diagnostic tool | screening
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| detrimental health outcomes increase with a waist measurement of over __ inches in men and over __ inches in women | 40, 35
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| BMI is combined with what further assessments to arrive at a more accurate health risk | waist circumference, evaluations of diet, physical activity, family history, BP, physical inactivity
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| components of metabolic syndrome | abdominal obesity (40in men, 35in women), serum triglycerides (>150), HDL cholesterol (<40 men, <50 women), hypertension (>130/85), insulin resistance/fasting blood glucose (>100)
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| approximately __% of the population in industrialized countries have metabolic syndrome | 20-30
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| obese applicants are viewed as having | poor self discipline, low supervisory potential, poor hygiene, less ambition and productivity
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| surgery for weight loss is only indicated for those with a BMI of __ | 40 or greater, or 35 with comorbidities
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| pharmacotherapy for weight loss is only indicated for those with a BMI of __ | 30 or greater, or 27 with comorbidities
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| five steps to facilitate behavior change | identify behavior change goal, review when/how behaviors will be performed, have patient keep record of behavrior change, review progress at next treatment visit, congratulate patient on successes
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| cardinal behaviors of successful long-term weight management | self monitoring, low cal/low fat, eat breakfast daily, regular physical activity
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| points to assessing weight loss readiness | motivation (patient seeks wt reduction), stress level (free of major life crises), psychiatric issues (free of severe depression/substance abuse/bulimia), time (patient can devote 15-30 min/d to wt control for the next 26 weeks)
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| what do you do if the overweight/obese patient is not ready to loose wt | prevent wt gain and explore barriers to wt reduction
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| calories in a 12oz beer | 160
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| calories in a 5oz glass of wine | 100
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| calories in a 2oz shot of liquor | 128
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| recommended nutrient content of a weight reducing diet | 55% carbs, 15% protein, 30% fat (1-8% saturated, 15% monounsaturated, 10% polyunsaturated)
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| medications that can cause weight gain | psychotropic medications, B-adrenergic receptor blockers, diabetes medications, highly active antiretroviral therapy, tamoxifen, steroid hormones
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| for the treatment of obesity nondrug interventions should be attempted for at least __ months before considering pharmacologic treatment | 6
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| drugs currently approved by the FDA for treatment of obesity | orlistat, sibutramine, phentermine
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| the most successful treatment for weight loss and maintenance | combined intervention of a calorie-deficit diet, increased physical activity, and behavioral treatment
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| __ helps preserve fat free mass during weight loss | physical activity
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| considerable __ is necessary for weight loss maintenance | physical activity
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| with wt loss surgery max of wt loss is in the first __ | 18-24 months
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| max amount of wt loss with surgery | 100-180 lbs
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| stage one of adult development | late adolescence (17-20something)
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| task of adult development stage one | find identity, to be oneself/share oneself, exploration of the virtue loyalty
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| stage two of adult development | young adulthood (20 something)
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| task of adult development stage two | resolve intimacy versus isolation, to lose and find oneself in another person, exploration of love
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| stage three of adult development | middle adulthood (30's to late 60's)
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| task of adult development stage three | resolve generavity (to promote positive values in the lives of the next generation) versus self absorbtion, to have empathy for others, to take care of others, exploration of care and caring
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| stage four of adult development | old adult (70's and beyond)
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| task of adult development stage four | resolve integrity vs despair, to be-through having been, to face not being, exploration of wisdom
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| robust predictors of poor aging | pessimism and inflexibility
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| __ of all pcp visits involve a family member | 1/3
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| __% of pcp visit time is spent discussing family issues | 10
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| when tp convene a family conference | pregnancy, critical illness, new diagnosis of chronic illness, non-compliance, family caregiver conflict, bereavement
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| using information and or targeted questions to help patients and their families prepare for upcoming transitions and crises | anticipatory guidance
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| four family life cycle stages | parenthood of first child, parenthood of adolescents, retirement, aging
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| in 2000 __ of all babies were born out of wedlock | 1/3
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| in 2000 nearly __ of never married women age 15-44 were mothers | 1/4
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| about __% of marriages in US end in divorce | 50
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| most marital arguments cannot be __ | resolved
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| risk factors for divorce | harsh startup, the four horsemen (criticism, contempt, defensiveness, stonewalling), flooding, body language, failed repair attempts, bad memories
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| the four final stages of divorce | the marital problems are seen as severe, talking things over seems useless, parallel lives begin, loneliness sets in
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| the seven principles of making marriage work | enhance your love maps, nurture your fondness and admiration, turn toward each other instead of away, let your partner influence you, solve your solvable problems, overcome gridlock, create shared meaning
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bwyche
Popular Psychology sets