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DU PA Beha Med Fin

Duke PA Behavioral Medicine Final from powerpoints

QuestionAnswer
coping style: more passive style, avoid unpleasant feelings, aim is palliative, methods of prayer, distraction/preoccupy mind, belief in God emotion focused
coping style: active, attempts to reduce distress by changing the situation, obtaining information, methods of determination, self education and self discipline problem focused
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
coping style of whites/non-Latino used more problem focused methods
coping style of African Americans used more emotion focused methods
difference found in self management success between races no difference, however as use of problem focused methods increased so did diabetic control
necessary coping skills realistic expectations, proactive efforts, request help, handle strong emotions, participate, live in the present, value what is good
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
stages of chronic illness crisis, isolation, anger, reconstruction, intermittent depression, renewal
general adaptation syndrome to stress alarm phase, resistance phase, exhaustion phase
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
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
on the social readjustment rating scale getting married was __ points 50
on the social readjustment rating scale getting divorced was __ points 85
on the social readjustment rating scale death of a spouse was __ points 100
life changing events are associated with __ heart disease, fractures, childhood leukemia, performance deficits, acute schizophrenia, depression and suicide
effect of adrenaline releases sugars and increases heart rate
effect of norepinephrine increases blood pressure and heart rate
effect of cortisol regualtes blood pressure and body use of proteins, carbs and fat
chronic stress may shorten a person's life expectancy by __ years 15-20
chronic stress stimulates __ cravings sweet
sleep deprivation is associated with slowed healing, decreased pain tolerance, increase susceptibility to infection, increased apathy, fatigue and poor judgment
HALT stands for Hungry, angry, lonely, tired
stress tip-attend to basics consists of exercise, nutrition, adequate sleep, moderated alcohol and caffeine consumption
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
stress tip--be in the present consists of mindfulness, use five senses, cue controlled relaxation
stress tip--breathing consists of you really don't know?
stress tip--optimize social support consists of friendships, church/synagogue/mosque, significant others, support groups
__ more potent indicator of cardiovascular outcomes than job stress for women marital stress
good __ help fend of heart disease, arthritis, and other illnesses by reducing harmful inflammation relationships
stress tip--be a fundamentalist consists of schedule something for fun at least once a week
stress tip--use music therapeutically helps to __ reduce anxiety, lower heart rate, decrease bp, reduce pain, improve mood, facilitate concentration and memory
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
stress tip--be a positive thinker thoughts create feelinds, identify self-dialogue, strengthen rational voice, practice positive imaging
belief that bad events will last a long time, catastrophize, undermining of self, bad events are the fault of someone pessimism
belief that bad events are just a temporary setback, positive take on reality, defeat is not my fault, unfazed by defeat optimism
predictors of successful aging optimism, ability to postpone gratification, altruism, future-mindedness, humor
stress tip--spend time in nature go outside (ground breaking stuff!)
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!
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
ecclesiogenic depression depression related to religious beliefs, harsh religious beliefs may be harmful to individuals
what are the 12 stress reduction tips basics, relaxation response, breath, mindfulness, social support, fun, music, journal, be positive, nature, humor, perspective
what is the #1 most preventable cause of death in the US and worldwide smoking
impacts of smoking fertility, pregnancy outcome, breast cancer, cataracts, macular degeration, cardiovascular problems
there is a __ year loss of life expectancy with smoking 10
second hand smoke cause and increase in __ for exposed children otitis media
within a year of quiting patients have a reduced CHD risk (by 1/2)
within days of quiting smoking people __ better smell
within a week or two after quitting smoking, people _________ better taste
within weeks of quitting smokers have an increased __ pulmonary function, increased exercise tolerance
within __ years after smoking cessation the CVD risk is the same as for a non-smoker 15
all cause death rate reduced in __ years after smoking cessation 2
cancer rate 50% reduced over __ years after smoking cessation 10
if a 65 year old smoker quits he/she can add __ years to their life expectancy 4
nicotine hits the brain in __ seconds 11
after nicotine hits the brain __ is released along with other neurotransmitters dopamine
nicotine withdrawal symptoms anger, cravings, decreased concentration, hunger, wt gain, restlessness, drowsiness, fatigue, decreased task performance, sleep disturbance
the new model of behavior change patient self-management
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
the five A's of self management ask, advise, assess, assist, arrange
short cut to the five A's (3 A's) ask, advise (tell), ask and refer
the fifth vital sign asking about smoking (every visit)
what is the assess step in smoking cessation is the patient ready to make a change
what are the stages of change pre-contemplation, contemplation, preparation, action, maintenance
the pre-contemplation stage of change the huh phase, not thinking about change, may be resigned, feeling no control, denial
the contemplation stage of change the but phase, weighing benefits and costs of continuing/changing the behavior
the preparation stage of change the I'm ready now phase, experiment with small changes
self-management skills patient centered, attainable goals, problem solving, skills training
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
arrange follow up care within __ of quitting (in person, phone, electronic) one week
how to set goals set SMART goals, Specific, Measurable, Action oriented, Realistic, Timely
the five R's of smoking cessation Relevance to patient, Risks, Rewards, Roadblocks, Repetition
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?
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?
cigarettes are responsible for one in every deaths in the united states 5
currently __% of US adults are smokers 23
currently __% of US young adults are smokers 26
smokers have __ the risk of fatal heart disease twice
smokers have __x the risk of lung cancer 10
in the US __% of cases of COPD occur among current or former smokers 90
heavy smokers have a __ greater risk of age-related macular degeneration 2.5
smokers die __ years earlier than never-smokers 5-8
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
only __% of smokers who attempt to quit are successful 4
__% of smokers attempt to quit every year 40
persons whose physicians advise them to quit are __times as likely to attempt quitting 1.6
over 70% of smokers see a physician each year but only __% of them receive any medical quitting advice or assistance 20
step 1 of the five A's of smoking cessation ask: systematically identify all tobacco users at every visit
step 2 of the five A's of smoking cessation advise: strongly urge all smokers to quit
step 3 of the five A's of smoking cessation attempt: identify smokers willing to make a quit attempt
step 4 of the five A's of smoking cessation assist: aid the patient in quitting
step 5 of the five A's of smoking cessation arrange: schedule follow-up contact
weight gain occurs in __% of patients following smoking cessation 80
spectrum of alcohol use abstinence, moderate drinking, at-risk drinking, abuse (problem drinking), dependence (addiction)
a pattern or level of alcohol use that is associated with increased risk of development of adverse physical psychological, or social consequences hazardous drinking
13.6 g alcohol in __ beer or wine cooler 12 ounces
13.6 g alcohol in __ wine 5 ounces
13.6 g alcohol in __ spirits (80 proof) 1.5 ounces
at risk drinking in men >14 drinks/week, >4 drinks per occasion
at risk drinking in women >7 drinks per week, >3 drinks per occasion
at risk drinking in persons over 65 years old >7 drinks per week
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
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
alcohol withdrawal onset __ hours after last drink 12-24
alcohol withdrawal peak intensity at __ hours after last drink 24-48
clinical features of alcohol withdrawal tremor, tachycardia, hypertension, sweating, insomnia, nausea/vomiting, photophobia, hallucinations, hyperreflexia, irritability, anxiety, alcohol craving, seizures possible
alcohol withdrawal delerium duration __ days 4-7
alcohol withdrawal delerium has a __% mortality 10-15
predictors of relapse non-adherence to meds/diet/behavior change, low SES, low family support, psychiatric co-morbidity
heavy drinking is associated with what cancers breast, liver, head/neck
__% of adult primary care patients are alcohol dependent 5
__% of adult primary care patients abuse alcohol 7
__% of adult primary care patients display at risk drinking behavior 8
__% of adult primary care patients drink alcohol in moderation 45
alcohol is implicated in __% of suicides 33
alcohol is implicated in __% of MVA deaths 40
alcohol is implicated in __% of domestic violence cases, homicides, and trauma center cases 50
alcohol abuse related clinical tasks prevent, recognize/diagnose/assess, brief intervention when appropriate, initial management (detox), refer, support
USPSTF recommends screening of all adolescents and adult patients for __ problems alcohol
mnemonic for alcohol abuse screening CAGE
what does CAGE stand for Cut down, Annoyed, Guilty, Eye-opener
score of 1+ on CAGE- warrants further investigation
score of 2+ on CAGE- highly suggestive of alcohol dependence
FRAMES for brief alcohol intervention stands for feedback, responsibility, advice, menu of options, express empathy, support self-efficacy
medications for alcohol dependance naltrexone, acamprosate, disulfiram
in the setting of alcohol withdrawal basing benzodiazepine dose on __ score allow more precise dosing CIWA (Clinical Institute Withdrawal Assessment)
medication that creates and adverse reaction to alcohol disulfiram
neurotransmitter enhanced by ethanol GABA-major inhibitory transmitter in brain
neurotransmitter suppressed by ethanol Glutamate-major excitatory transmitter
opioid antagonist that reduces relapse/cravings in recovering alcoholics naltrexone (revia)
effective psychosocial therapies for alcoholics cognitive behavioral therapy, motivational enhancement therapy, 12-step (AA), individual drug/alcohol counseling, brief intervention for problem drinkers
positive AUDIT score for men 60 or younger 8
positive AUDIT score for women 4
a positive AUDIT result does not constitute a __ diagnosis of alcoholism but does warrant further evaluation
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
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
signs of withdrawal tremors, sweating, nausea, insomnia when trying to quit or cut down
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?
intervention for moderate drinking reinforce, educate re: limits
intervention for at-risk and problem drinking brief alcohol intervention (BAI)
intervention for alcohol dependance advise abstinence, refer for treatment
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
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
who should detox as inpatients h/o seizure/delirium, medically unstable, psychosis, unstable environment, no support/transportation
who should detox as outpatients no seizure/delerium hx, med/psych stable, can return daily, has social support
CIWA stands for Clinical Institute Withdrawal Assessment
Easily administered, standardized rating scale to score withdrawal severity. CIWA
basing benzodiazepine dose on __ score allows more precise dosing, avoiding under and over medication CIWA
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
psychiatric complications of cocaine depression, mania/hypomania, anxiety, insomnia, irritability, sexual dysfunction, agitation, aggression, suicidal ideation, paranoia, psychosis, cognitive impairment
verbal consent is required for drug testing except __ in a medical emergency
__ is more useful than __ for drug testing except in acute overdose urine, blood
what must be followed to allow results of drug testing to be legally admissible chain of custody
use of drug testing in medical context initial evaluation for suspected use and to monitor ongoing treatment
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)
positive drug screen after __ is highly unlikely passive exposure
__ often triggers cocaine relapse alcohol use
supplanting crack as leading stimulant of abuse in rurual NC counties, especially in mountain regions methamphetamine
opioid dependence is infrequent with __ medical use for analgesia in patients without history of addictive behavior
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
opioid withdrawal is __ but rarely __ in otherwise healthy individuals profoundly unpleasant, dangerous
symptoms of opioid withdrawal ab pain, N/V, diarrhea, piloerection, myoclonic jerks, lacrimation, rhinorrhea, anxiety, agitation, insomnia, irritability
severity of opioid withdrawal is scored using __ COWS (Clinical Opiate Withdrawal Scale)
treatment of opioid withdrawal clonidine (reduces adrenergic hyperactivity, sedating), NSAIDS, Loperamide (diarrhea), benzodiazepines (insomnia, irritability, agitation)
long acting synthetic opioid used as an opioid substitute methadone
how to administer methadone taper over several days in hospital, taper over several weeks for outpatient
__ blocks effect of self-administered opiates, but compliance is poor unless closely supervised oral naltrexone
most effective treatment for preventing relapse in opioid dependence methadone maintenance, buprenorphine maintenance
duration ranges of methadone maintenance months to decades
requires daily clinic visits for med administration methadone maintenance
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
__ can trigger relapse of alcohol dependance and other addictions opioids
obesity is a BMI of __ or greater 30
overweight is a BMI of __ 25-29.9
morbid obesity is a BMI of __ or higher or BMI of __ or higher with co-morbidities 40, 35
there are an estimated __ obese adults worldwide 320 million
there are an estimated __ overweight adults worldwide 1.1 billion
on of the national health objectives is to reduce the prevalence of obesity among adults to less than __% 15
for each 5kg/m higher BMI there is an associated __% higher mortality 30
at a BMI of 30-35 median survival is reduced by __ years 2-4
ata BMI of 40-45 median survival is reduced by __ years (comparable to the effects of smoking) 8-10
__ deaths annually are attributable to obesity and sedentary lifestyle 400,000
estimated __% of national healthcare expenditures is related to obesity and its negative outcomes 10
almost __ dollars is spent annually on obesity related health care 100 billion
BMI below __ is underweight 18.5
BMI of __ is considered healthy weight 18.5 - 24.9
BMI is a __ tool not a diagnostic tool screening
detrimental health outcomes increase with a waist measurement of over __ inches in men and over __ inches in women 40, 35
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
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)
approximately __% of the population in industrialized countries have metabolic syndrome 20-30
obese applicants are viewed as having poor self discipline, low supervisory potential, poor hygiene, less ambition and productivity
surgery for weight loss is only indicated for those with a BMI of __ 40 or greater, or 35 with comorbidities
pharmacotherapy for weight loss is only indicated for those with a BMI of __ 30 or greater, or 27 with comorbidities
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
cardinal behaviors of successful long-term weight management self monitoring, low cal/low fat, eat breakfast daily, regular physical activity
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)
what do you do if the overweight/obese patient is not ready to loose wt prevent wt gain and explore barriers to wt reduction
calories in a 12oz beer 160
calories in a 5oz glass of wine 100
calories in a 2oz shot of liquor 128
recommended nutrient content of a weight reducing diet 55% carbs, 15% protein, 30% fat (1-8% saturated, 15% monounsaturated, 10% polyunsaturated)
medications that can cause weight gain psychotropic medications, B-adrenergic receptor blockers, diabetes medications, highly active antiretroviral therapy, tamoxifen, steroid hormones
for the treatment of obesity nondrug interventions should be attempted for at least __ months before considering pharmacologic treatment 6
drugs currently approved by the FDA for treatment of obesity orlistat, sibutramine, phentermine
the most successful treatment for weight loss and maintenance combined intervention of a calorie-deficit diet, increased physical activity, and behavioral treatment
__ helps preserve fat free mass during weight loss physical activity
considerable __ is necessary for weight loss maintenance physical activity
with wt loss surgery max of wt loss is in the first __ 18-24 months
max amount of wt loss with surgery 100-180 lbs
stage one of adult development late adolescence (17-20something)
task of adult development stage one find identity, to be oneself/share oneself, exploration of the virtue loyalty
stage two of adult development young adulthood (20 something)
task of adult development stage two resolve intimacy versus isolation, to lose and find oneself in another person, exploration of love
stage three of adult development middle adulthood (30's to late 60's)
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
stage four of adult development old adult (70's and beyond)
task of adult development stage four resolve integrity vs despair, to be-through having been, to face not being, exploration of wisdom
robust predictors of poor aging pessimism and inflexibility
__ of all pcp visits involve a family member 1/3
__% of pcp visit time is spent discussing family issues 10
when tp convene a family conference pregnancy, critical illness, new diagnosis of chronic illness, non-compliance, family caregiver conflict, bereavement
using information and or targeted questions to help patients and their families prepare for upcoming transitions and crises anticipatory guidance
four family life cycle stages parenthood of first child, parenthood of adolescents, retirement, aging
in 2000 __ of all babies were born out of wedlock 1/3
in 2000 nearly __ of never married women age 15-44 were mothers 1/4
about __% of marriages in US end in divorce 50
most marital arguments cannot be __ resolved
risk factors for divorce harsh startup, the four horsemen (criticism, contempt, defensiveness, stonewalling), flooding, body language, failed repair attempts, bad memories
the four final stages of divorce the marital problems are seen as severe, talking things over seems useless, parallel lives begin, loneliness sets in
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
Created by: bwyche on 2009-04-10



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