Study for the final exam - york
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| mechanical nociception | mechanical damage to body tissue
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| polymodal nociception | pain triggers chemical reactions from tissue damage
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| A-delta fibers | small, myelinated fibers that transmit sharp pain/ first pain
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| C-fibers | unmyelinated fibers that transmit dull, aching pain/ secondary pain
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| A-beta fibres | Large diameter myelinated fibres that transmit info about vibration and position
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| SPA | Stimulation-Produced Analgesia
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| neurochemical basis of SPA effect is endogenous opioids | Beta-endorphnis, Proenkephalin, polynorphins
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| 3 types of chronic pain | chronic benign pain, recurrent acute pain, chronic progressive pain
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| chronic pain patients develop maladaptive coping strategies such as | wishful thinking, social withdrawal
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| pain techniques work with | acute but not chronic pain
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| the “neurotic triad”: | MMPI profiles in which the first three scales are all elevated (Depression, Hysteria, and Hypochondriasis). Seen in highly neurotic individuals.
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| neurotic triad profile elevates.... | after the onset of chronic pain rather than being a precursor
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| Counterirritation: | Inhibiting pain in one part of the body by stimulating or mildly irritating another area
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| Biofeedback | a method of achieving control over bodily processes ; used to treat chronic disorders such as, temporomandibular joint pain, hypertension and a broad array of pains
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| Does Biofeedback work? | only modest efficacy in reducing pain
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| Does relaxation work? | distinct from placebos and activate higher-order brain regions
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| Hypnosis: | one of the oldest techniques for pain
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| Hypnotherapy has successfully controlled... | irritable bowel syndrome, acute pain due to surgery, childbirth, dental procedures, burns, headaches and medical procedures, Cancer pain
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| Does distraction work for pain management? | is effective but most useful in conjunction with other techniques
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| Coping techniques: | some CBT techniques, focus on sensory aspects of the pain sensation and not the pain itself, active coping skills, expressive writing
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| Components of chronic pain management programs | education, training and group therapy, involvement of family, evaluation of pain management program
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| Percentage change in headache pain pre to post treatment showed: | Relaxation and biofeedback -60; Biofeedback only -45; Relaxation only -38; placebo biofeedback -20
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| Quality of life includes | objective functioning and subjective wellbeing of both physical and mental being
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| How strongly are medical measures related to quality of life | weakly
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| Quality of life may be in a state of crisis during | acute and initial phases
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| Denial | can be important and protective in earliest stage
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| Depression: | has an impact on the overall prospects for rehabilitation or recovery
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| Depression: | can lead patients to make extreme decisions about their care
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| Depression is more common in | patients with physical limitations
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| Positive Responses | Hope and optimism can occur, particularly if patient feels they escaped death, Many come to reorganize their priorities in a meaningful way such as focusing on relationships more
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| benefit finding is associated with | better functioning psychologically and in illness and living
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| Self- concept | is a stable set of beliefs about one’s qualities and attributes.
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| Self-esteem | refers to an evaluation of the self-concept as good or bad
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| Patients have some primary stressors: | fear and uncertainty about the future, limitations in physical abilities, appearance, and lifestyle, pain management
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| Which coping strategies work? | active coping and coping with positive responses
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| Functional Somatic Syndrome | chronic fatigue syndrome (1.4% canadians)
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| Functional Somatic Syndrome | irritable bowel syndrome
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| Functional Somatic Syndrome | fibromyalgia (1.5% canadians)
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| #1 cause of death ages 1-15 | accidents (drowning, poisoning, injuries, falls, motor vehicle)
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| #2 cause of death ages 1-15 | Cancer, especially leukemia
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| young children (< 5 years) understand death as | associated with sleep, not as something final and irreversible
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| children 5-9 years understand death as | final, but do not understand biological death
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| at ages 9 or 10 understand death as | universal and inevitable
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| #1 cause of death ages 15-24 | Unintentional injury (especially car accidents)
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| Premature death before projected age of 81 usually due to | heart attach or stroke
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| Death in old age is typically due to | degenerative disease
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| The facotrs that predict decline in health are | psychosocial factors
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| What is a Good Death?: | free from avoidable suffering - 11 core themes
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| What is a Good Death?: | pain free, religiosity/spirituality, treatment preferences, Dignity, family, positive relationship with provider, quality of life, emotional wellbeing, sense of life completion, preferences for the dying process
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| Kϋbler-Ross’s 5 stages of adjustment to death | denial, anger, bargaining, depression, acceptance
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| Kϋbler-Ross’s 5 stages of adjustment to death does not fully acknowledge | the importance of anxiety
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| thanatologists | those who study death and dying, suggest behavioural and cognitive-behavioural therapies. clinical thanatology involves symbolic immortality.
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| CHD Coronary Heart Disease | Second leading cause of death
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| CHD Coronary Heart Disease | Disease of modernization—tied to current lifestyles
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| CHD Coronary Heart Disease | may be caused by inflammatory processes, high blood pressure, diabetes, cigarette smoking, obesity, high serum cholesterol level and low levels of physical activity
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| CHD Coronary Heart Disease | Risk factors include high blood pressure, diabetes, stress, inactivity, high cholesterol
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| CHD Coronary Heart Disease | a general term referring to illnesses caused by atherosclerosis, the narrowing of coronary arteries, the vessels that supply the heart with blood
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| What contributes to CDH (Coronary Heart Disease?) | low in socioeconomic status (SES), chronic and acute stress have all been linked
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| CHD Coronary Heart Disease | leading killer of women in the Canada and most developed countries
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| How does menopause effect CHD | Higher levels of HDL when younger protects & estrogen lowers sympathetic NS arousal
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| How does depression effect CHD | tied to elevated C-reactive protein (marker of inflammation)
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| Interventions for CHD risk behaviour | dietary intervention, stop smoking programs, aerobic exercise, relaxation training, speech style interventions (to modify hostility)
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| Medication for CHD | Beta-adrenergic blocking agents—resist NS activation, Aspirin is commonly prescribed—thins blood, decreases clots. Statins—for cholesterol
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| Cause of hypertension | 90% is essential (unknown), 5% is caused by failure of the kidneys
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| Systolic blood pressure is | the greatest force developed during contraction of the heart
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| Diastolic: | is the pressure in arteries when the heart is relaxed
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| Which has a greater value in diagnosing hypertension | systolic
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| Cause of hypertension | early blood pressure reactivity is a predictor.. genetic factors and emotional factors
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| Acculturation is associated with hypertension in... | Asian Canadians because their traditional lifestyle harder to maintain
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| Treatment of hypertension: | low-sodium diet , reduction of alcohol, weight-reduction, exercise, caffeine restriction, CBT
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| Drug treatments for hypertension | Diuretics – decrease volume of blood. Beta-adrenergic blockers & vasodilators, central adrenergic inhibitors, Statins
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| "the hidden disease" | Hypertension (often symptomless)
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| Stroke | 3rd leading cause of death in Canada
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| Stroke | Disturbance in blood flow to the brain and is responsible for nearly 14,000 Canadian deaths each year
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| Stroke | occur when blood flow to localized areas in the brain is interrupted due to arteriosclerosis or hypertension
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| Risk Factors for Stroke overlap with | heart disease
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| Risk Factors for Stroke overlap with | high blood pressure, heart disease, cigarette smoking, high red blood cell count and transient ischemic attacks
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| Consequences of stroke: | stroke affects all aspects of life—personal, social, vocational and physical
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| Consequences of stroke: | motor problems, cognitive problems. emotional problems, relationship problems
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| Types of rehabilitative interventions for Stroke | psychotherapy and treatment of depression, cognitive-remedial training, movement therapies, structured, stimulating environments to challenge
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| Diabetes | chronic condition of impaired carbohydrates, protein, and fat metabolism that results from insufficient secretion of insulin or from insulin resistance
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| Diabetes increases risk of | Heart disease by 2-4X & kidney failure
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| Diabetes increases risk of | Blindness (leading cause), blood vessel damage, diabetic neuropathy (nerve damage)
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| Risk factors for diabetes | overweight, over 65, apple shaped, little excercise, high blood pressure, genetics, high risk ethnic group (indigenous, black, latin, asian, pacific islander)
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| Type I Diabetes | insulin-dependent, abrupt onset of symptoms resulting from lack of insulin production by the beta cells of the pancreas, result of viral infection, autoimmune reactions, and genetics
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| Type II Diabetes | Non-insulin dependent, A disorder of middle-age, striking those over age 40, Obesity major contributor,
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| Type II Diabetes are sensitive to | Stress. Lack of social support even more problematic
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| Managing Type II Diabetes: | must reduce sugar and carbohydrate intake, encouraged to achieve normal weight, encouraged to exercise
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| Interventions with Diabetics: | cognitive-behavioural interventions to improve adherence to their regimen, weight control improves glycemic control, behaviour mod
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| Old knowledge about diet includes | increase nutrition, decrease unhealthy substances (eg triglycerides), while looking at health signs like obesity, diabetes and cholesterol
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| Insulin resistance | Sugar demands pancreas to produce insulin to tame glucose levels. System starts to wear out, increasing with age
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| The metabolic syndrome | heart disease, lipid problems, hypertension, type 2 diabetes, dementia, cancer, polycystic ovarian syndrome, fatty liver disease
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| Gluten triggers the release of | zonulin (controls gut permeability)
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| What is Psychoneuroimmunology?: | Interactions among behavioural neuroendocrine, and immunological process of adaptation
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| Indicators of immune functioning: | cells and antibodies, A state of Immunocompetence - immune system is working effectively
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| the surveillance system of the body | The immune system:
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| The immune system: | humoral and cell-mediated immunity
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| Interventions to enhance immune functioning: | Relaxation (research shows higher NK cell activity after relaxation intervention)
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| The immune system may be vulnerable to.. | stress, depression and grief (permanently affect the immune system in ways that persist into adulthood)
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| Autoimmune Disorders | Grave’s disease, chronic active hepatitis, inflammation of the liver, lupus, inflammation of connective tissue, M.S. destruction of myelin sheath, rheumatoid arthritis, IBD, such as Crohns or ulcerative colitis and Type 1 diabetes
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| History of Acquired Immune Deficiency Syndrome (AIDS) | first appearance is unknown, began in Central Africa, 1970s & spread rapidly. First diagnosed case in Canada 1982
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| The viral agent in AIDS is | a retrovirus (Human immunodeficiency virus - HIV) - attacks helper T-cells, highly variable time between contracting and developing symptoms
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| How HIV infection progresses: | mild early symptoms - flu like 3-6 weeks - then asymptomatic period (Can be many years), immune system increasingly compromised, opportunist infections (kaposi sarcoma, gynecologic infection)
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| Treatment for HIV | highly active antiretroviral therapy (HAART)
- protects from advancing to AIDS
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| Negative beliefs about self is correlated with | decline in helper T cells
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| Cancer | Dysfunction of DNA-part of cellular programming that controls cell growth and reproduction
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| Why is cancer hard to study? | many cancers are species-specific, develop in different ways in different species, many cancers have long/irregular growth cycles, high within-species variability
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| What leads to cancer? | genetic basis, ethnically linked, lifestyle, SES risks, malnourishment, depression, repressive coping,
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| Mechanisms linking stress, coping and cancer: | Psychological stress lowers ability of NK cells to destroy tumours, alterations in biological stress regulatory pathways may affect course of cancer
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| Physical limitations of cancer | pain and discomfort, down-regulation of immune system, fatigue
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| Treatment-related problems of cancer | cosmetic problems, surgical removal of organs, body image concerns, use of prosthesis, nausea and vomiting, immune suppression
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| Rheumatoid Arthritis (RA): | crippling form of arthritis believed to result from an autoimmune process - affects small joints of hands, feet, wrists, knees, ankles and neck
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| Rheumatoid Arthritis (RA) in those age 65+....... 50-65...... 35-49... 18-34 | 45%.... 27%....... 9.7%....... 2.8%
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| Treatment of RA | aspirin, rest, supervised exercise, cognitive-behavioural interventions, enhancement of perceived self-efficacy
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| Osteoarthritis | Most common form of arthritis in Canada - 4.4 million in 2010
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| Osteoarthritis | obesity is the only modifiable risk factor
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| Osteoarthritis | the articular cartilage (smooth lining of a joint) begins to crack or wear away because of overuse
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| Osteoarthritis | affects weight-bearing joints
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| Treatment for Osteoarthritis | keeping weight down, exercise, aspirin
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| Gout | build-up of uric acid crystals, treated by diet, fluids and exercise
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| Lupus | skin rash can appear on the face, leading to chronic inflammation, pain, heat, redness and swelling
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| what leads to greater expectancy for pain in the future? | memory of intensity of previous experience (versus the actual pai intensity)
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| pain behaviours | facial and audible expressions, distortions in posture or gait, negative affect, avoidance of activity
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| Chronic benign pain | persists longer than 6 months, intractable to treatment (ex chronic low back pain)
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| Recurrent acute pain | series of intermittent episodes that are acute but chronic (ex - migraines)
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| Chronic progressive pain | persists longer than 6 months, increases in severity over time
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| subjective reports of health have been found to predict objective measures such as | cortisol responses to stress, morbidity and mortality
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| One of the most important parts of evaluating quality of life is | psychological distress
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| most benefits reported by myocardial infarction patients involved....... while cancer patients reported changes in.... | lifestyle changes/health habits...... social relationships & meaning of life
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| self concept - | stable set of beliefs about one's qualities and attributes
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| self esteem | general evaluation of self concept (feel good or bad)
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| Aspect of cancer patients find most stressful | 41% uncertainty about future, 24% limitations, 12% pain management
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| Chronic illness sufferers use more | Passive coping strategies (positive focus, escape) than active (planning, problem solving, confrontative coping)
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| In families with chronic illness, divorce rates are | the same
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| why does caregiving compromise the health of a caregiver? | depression
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| Who has a higher burden of disease | women due to disproportionate burden of household responsibilities
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| A difference in psychotherapy done with medical patients | likely to be episodic rather than continuous
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| A difference in psychotherapy done with medical patients | collaboration with family and Dr. important & must have comprehensive knowledge of illness and treatment
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| A difference in psychotherapy done with medical patients | More frequently requires respect for patients' defences
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| Main cause of infant death in Canada | congenital abnormalities & SIDS
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| Leading cause of death in Canadian children after first year | accidents/ external causes
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| Second leading cause of death in Canadian children after first year | Cancer
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| Major cause of death in adolescence | accidents, especially automobile
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| Second leading cause of death in adolescence | suicide (followed by cancer then homicide)
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| Major cause of premature death in adulthood | heart attack or stroke
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| It is best to keep systolic blood pressure under | 120.... consistently between 140-159=hypertension
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| left brain stroke damage includes | communication disorders, difficulty learning new tasks, short term memory tasks, anxiety and depression
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| Right brain stroke damage includes | visual feedback problems, reading problems, alexithymia, indifferent emotional reaction
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| Many interventions to increase treatment adherence include | increasing awareness or education/ information ..... for
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| two general approaches to indicate immune functioning | measuring numbers of different kinds of cells in the immune system by looking at blood samples., and assessing the functioning of immune cells
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