Preventive Medicine: Preventive Medicine 3
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Questions and Answers

What is typically defined as the medical condition or diagnosis itself?

  • Disability
  • Disease (correct)
  • Illness perception
  • Illness

    • What is the adverse impact of a disease on objective physical, psychological, and social functioning?

  • Disability (correct)
  • Recovery
  • Disease perception
  • Illness

    • What is powerfully influenced by patients' perceptions of their disease, its duration and severity, and their expectations for recovery?

  • Disease
  • Disability
  • Illness
  • Illness perception (correct)

    • What is the term for the adverse impact of a disease or disability on how the patient feels?

    <p>Illness</p> Signup and view all the answers

    What do a patient's illness perceptions strongly predict?

    <p>Recovery, loss of work days, adherence, and health care utilization</p> Signup and view all the answers

    What is the primary goal of tertiary prevention and rehabilitation?

    <p>Both improving patients' physical functioning and influencing their illness perceptions</p> Signup and view all the answers

    Why should a practicing clinician consider a patient's illness perceptions?

    <p>To understand which patients are at high risk of poor outcomes</p> Signup and view all the answers

    What is an opportunity for tertiary prevention?

    <p>The first sign of an illness</p> Signup and view all the answers

    What is the goal of symptomatic stage prevention?

    <p>To prevent or minimize impairment</p> Signup and view all the answers

    Why is early treatment of a disease in one person important?

    <p>To prevent transmission of the disease to others</p> Signup and view all the answers

    What is the focus of disability limitation?

    <p>Preventing or minimizing impairment</p> Signup and view all the answers

    What is an example of a chronic disease used to illustrate disability limitation?

    <p>All of the above</p> Signup and view all the answers

    What is the clinician's immediate goal when cardiovascular disease has already occurred?

    <p>To prevent death and permanent damage</p> Signup and view all the answers

    What risk factors should be addressed when cardiovascular disease has already occurred?

    <p>Hypertension, smoking, dyslipidemia, diabetes, diet, and exercise</p> Signup and view all the answers

    What is the approach used in tertiary prevention?

    <p>Disability limitation and rehabilitation</p> Signup and view all the answers

    Why is the urgency for action increased when cardiovascular disease has already occurred?

    <p>Because the risk of complications increases</p> Signup and view all the answers

    What should be the most important risk factor to modify in a patient?

    <p>The one the patient is most motivated to change</p> Signup and view all the answers

    What is one effect of smoking on the body?

    <p>It accelerates blood clotting and increases blood carbon monoxide levels</p> Signup and view all the answers

    What is the benefit of keeping glycosylated hemoglobin (Hb A1c) at less than 7%?

    <p>It reduces the effect of diabetes on the heart, kidneys, and eyes</p> Signup and view all the answers

    Why is managing diabetes considered equivalent to managing coronary heart disease?

    <p>Because diabetes has a similar risk of MI as established CAD</p> Signup and view all the answers

    What is the effect of severe hypertension on cardiovascular disease?

    <p>It quadruples the risk of cardiovascular disease in middle-aged men</p> Signup and view all the answers

    What is the primary goal of rehabilitation?

    <p>To reduce the social disability produced by a given level of impairment</p> Signup and view all the answers

    When should rehabilitation efforts begin?

    <p>In the early phases of treatment</p> Signup and view all the answers

    What is the benefit of early rehabilitation efforts?

    <p>It increases the cooperation of patients and family members</p> Signup and view all the answers

    What is the most effective type of rehabilitation program?

    <p>One that is tailored to meet the physical, emotional, psychological, and occupational needs of the individual</p> Signup and view all the answers

    What is a crucial step in helping patients quit smoking?

    <p>Providing behavioral advice and follow-up support</p> Signup and view all the answers

    What is a key aspect of cardiac rehabilitation?

    <p>Improving self-management of heart disease</p> Signup and view all the answers

    What is the primary goal of smoking cessation programs?

    <p>Achieving long-term abstinence from smoking</p> Signup and view all the answers

    What is a key factor in determining the success of smoking cessation programs?

    <p>The patient's readiness to change</p> Signup and view all the answers

    What is a common aspect of rehabilitation programs?

    <p>Providing individual and group counseling</p> Signup and view all the answers

    What is a key aspect of vocational counseling?

    <p>Addressing work-related stress</p> Signup and view all the answers

    What is a common outcome of cardiac rehabilitation?

    <p>Absence of clinically significant psychosocial problems</p> Signup and view all the answers

    What is a key aspect of the 'five A's' approach to smoking cessation?

    <p>Asking the patient about their smoking status</p> Signup and view all the answers

    What is a key goal of rehabilitation programs?

    <p>Acquisition of stress management skills</p> Signup and view all the answers

    What is the primary difference between permanent total disability and permanent partial disability?

    <p>The severity of the impairment</p> Signup and view all the answers

    What is the key factor in determining whether a disability is considered temporary or not?

    <p>The expected time for recovery and return to work</p> Signup and view all the answers

    What type of benefits are typically provided for less well-defined illnesses and injuries, such as repetitive motion or back injuries?

    <p>A mixture of financial and vocational rehabilitation benefits</p> Signup and view all the answers

    What model is suggested to be the most useful framework for understanding the development of mental health disorders?

    <p>Diathesis-stress model</p> Signup and view all the answers

    What type of factors may not be directly modifiable through education or treatment?

    <p>Temperament</p> Signup and view all the answers

    What represents inherited traits that are risk factors for disorder and are present before the disorder is expressed?

    <p>Endophenotypes</p> Signup and view all the answers

    What category of factors includes genetics and temperament?

    <p>Biologic factors</p> Signup and view all the answers

    According to research on genetics of addiction, what plays a more prominent role in the early stages of use?

    <p>Environmental factors</p> Signup and view all the answers

    What type of factors may be directly modifiable through education or treatment?

    <p>Psychological factors</p> Signup and view all the answers

    What is a significant risk factor for anxiety and depression?

    <p>Child abuse and neglect</p> Signup and view all the answers

    What increases the risk of depression among offspring?

    <p>Parental depression</p> Signup and view all the answers

    What is a risk factor for suicide?

    <p>Inaccessibility of mental health services</p> Signup and view all the answers

    What is a critical factor in determining both risk and resilience for mental health and behavioral disorders?

    <p>Diversity</p> Signup and view all the answers

    What is more prevalent among women?

    <p>Anxiety and mood disorders</p> Signup and view all the answers

    What is a significant risk factor for mental health and behavioral disorders?

    <p>Social injustice and discrimination</p> Signup and view all the answers

    What is a risk factor for substance use disorders?

    <p>Easy access to drugs and alcohol</p> Signup and view all the answers

    What is a risk factor for suicide among racial and ethnic groups?

    <p>Poverty and lack of access to adequate mental health care</p> Signup and view all the answers

    What is a risk factor for anxiety and depression?

    <p>Inadequate transportation</p> Signup and view all the answers

    What is a risk factor for mental health and behavioral disorders?

    <p>Poor parenting practices</p> Signup and view all the answers

    What is associated with a rapid onset of tics, Tourette’s syndrome, and obsessive-compulsive disorder in children?

    <p>Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)</p> Signup and view all the answers

    Why do users often report using substances?

    <p>To feel good, to feel better, to alter consciousness, and to do better</p> Signup and view all the answers

    What is a potential association between psychiatric and substance use disorders?

    <p>All of the above</p> Signup and view all the answers

    What is a risk factor for suicidal ideation?

    <p>The extent to which an individual believes that others would benefit from the person’s death</p> Signup and view all the answers

    What is associated with an increased risk of developing an anxiety or substance use disorder?

    <p>Exposure to anxious parents and substance-using peers</p> Signup and view all the answers

    What is a common factor in the development of mental health and behavioral disorders?

    <p>Inherited temperaments, sensitive neural systems, hormones, and early learning experiences</p> Signup and view all the answers

    What is a risk factor for substance use problems that persist into adulthood?

    <p>Externalizing disorders during childhood</p> Signup and view all the answers

    What is a potential consequence of distorted thought patterns?

    <p>Anxiety and depression</p> Signup and view all the answers

    What is a potential reason for the increase in nonmedical use of prescribed medications?

    <p>The perception that such drugs are safer than illicit substances and pose no serious health risks</p> Signup and view all the answers

    What is a risk factor for suicidal behavior?

    <p>Past suicidal behavior</p> Signup and view all the answers

    What is associated with good mental health?

    <p>Achieving developmental milestones at appropriate times, being physically healthy, and being physically active</p> Signup and view all the answers

    What is the primary goal of universal prevention efforts?

    <p>Reducing the incidence of mental health or behavioral disorders in an entire population</p> Signup and view all the answers

    What is the concept that was recently added to the health belief model?

    <p>Perceived self-efficacy</p> Signup and view all the answers

    What is the significance of secure attachment during infancy?

    <p>It contributes to the development of a positive self-image and adequate social skills</p> Signup and view all the answers

    What is the category of prevention that involves targeting individuals who possess risk factors such as anxious temperament or early childhood adversity?

    <p>Selective prevention</p> Signup and view all the answers

    What is the category of prevention that involves targeting individuals who are experiencing subclinical symptoms that do not meet the criteria for disorder?

    <p>Indicated prevention</p> Signup and view all the answers

    What is the significance of strong attachments to family, school, and community among adolescents?

    <p>It contributes to good mental and behavioral health outcomes</p> Signup and view all the answers

    What is the significance of cognitive ability in relation to mental health?

    <p>Possessing at least average cognitive ability is associated with lower rates of anxiety and depression</p> Signup and view all the answers

    What is the health belief model used for?

    <p>Understanding how people perceive themselves to be at risk for developing mental health problems</p> Signup and view all the answers

    What are school-based interventions effective in decreasing?

    <p>Substance use and mental health disorders</p> Signup and view all the answers

    What is the goal of universal efforts to prevent suicide?

    <p>To increase awareness of suicide symptoms and available resources</p> Signup and view all the answers

    What is the focus of gatekeeper training?

    <p>To recognize warning signs of depression and suicide</p> Signup and view all the answers

    What is the five 'A's program designed to assist physicians in?

    <p>Assessing patient smoking status and encouraging them to quit</p> Signup and view all the answers

    What do early home-based interventions aim to facilitate?

    <p>Maternal responsiveness and expression of positive affect</p> Signup and view all the answers

    What type of programs teach skills that are effective for increasing resilience and preventing mental health disorders?

    <p>School-based and community-based programs</p> Signup and view all the answers

    What is the goal of targeted brief interventions and brief treatments?

    <p>To improve treatment retention and reduce substance use</p> Signup and view all the answers

    What is the primary focus of school-based and community-based programs?

    <p>Encouraging prosocial behavior and teaching empathy and cognitive skills</p> Signup and view all the answers

    What are some strategies that have been shown to improve mental health outcomes?

    <p>Improving nutrition, housing, and education</p> Signup and view all the answers

    What is the purpose of reducing the toxicity of gasoline and car exhausts in suicide prevention efforts?

    <p>To reduce the availability of means for suicide</p> Signup and view all the answers

    What is the focus of selective or indicated prevention efforts?

    <p>Improving accessibility, affordability, and perceived helpfulness of mental health treatment</p> Signup and view all the answers

    What is the purpose of media campaigns in universal prevention efforts?

    <p>To raise awareness about the consequences of substance use</p> Signup and view all the answers

    What is the purpose of screening programs in universal prevention efforts?

    <p>To identify individuals at risk of substance use</p> Signup and view all the answers

    What is the primary goal of assessing motivation to quit smoking?

    <p>To guide treatment planning and enhance motivation to quit</p> Signup and view all the answers

    What is the four-item measure that assesses presence and frequency of suicidal ideation, presence of a plan, and pervasiveness of the desire to kill oneself?

    <p>Depressive Symptom Index (DSI) Suicidality Subscale</p> Signup and view all the answers

    What is the 20-item measure that can be used to identify individuals who are using or at risk for using illicit substances?

    <p>Drug Abuse Screening Test (DAST)</p> Signup and view all the answers

    What is the five-stage model that is comprised of the stages of change, and is reinitiated by a relapse?

    <p>Stages of Change Model</p> Signup and view all the answers

    What is the primary goal of a comprehensive assessment of smoking?

    <p>To identify the factors that affect whether a quit attempt is made and whether that attempt is successful</p> Signup and view all the answers

    What is the primary goal of contingency management models?

    <p>To increase motivation for abstinence</p> Signup and view all the answers

    What is a key aspect of social network and family models for substance dependence?

    <p>Involving drug-free family members and significant others in treatment</p> Signup and view all the answers

    What is the primary goal of using the contemplation ladder?

    <p>To assess motivation to quit smoking</p> Signup and view all the answers

    What is the primary goal of pharmacological interventions for anxiety and depression?

    <p>To reduce symptoms and improve overall quality of life</p> Signup and view all the answers

    What is the primary goal of cognitive restructuring and exposure therapies for PTSD?

    <p>To reduce symptoms and prevent relapse</p> Signup and view all the answers

    What is a limitation of contingency management models?

    <p>High rates of relapse once reinforcement is removed</p> Signup and view all the answers

    What is the primary goal of postsuicide intervention programs?

    <p>To provide resources and support for survivors</p> Signup and view all the answers

    What is the primary goal of cognitive-behavioral therapy (CBT) for anxiety?

    <p>To reduce symptoms and prevent relapse</p> Signup and view all the answers

    What is the primary goal of social network and family models for substance dependence?

    <p>To increase social support for patients</p> Signup and view all the answers

    What is the limitation of pharmacotherapy for treating anxiety?

    <p>It is effective only in the short term.</p> Signup and view all the answers

    What is the effect of adding CBT to pharmacologic treatment for anxiety?

    <p>It decreases the risk of suicide.</p> Signup and view all the answers

    What is the purpose of pharmacologic interventions for substance use?

    <p>To encourage abstinence initiation and prevent relapse.</p> Signup and view all the answers

    What is the current status of pharmacotherapies for stimulants such as cocaine?

    <p>None have received FDA approval.</p> Signup and view all the answers

    What is the purpose of naloxone in medical interventions for opioid addiction?

    <p>To reverse the effects of opiate overdose.</p> Signup and view all the answers

    What is the goal of needle exchange programs?

    <p>All of the above.</p> Signup and view all the answers

    What is the focus of harm reduction interventions in substance use treatment?

    <p>Reducing the risk of overdose and death.</p> Signup and view all the answers

    What is the current status of pharmacotherapies for marijuana?

    <p>None have received FDA approval.</p> Signup and view all the answers

    Study Notes

    Disease, Illness, and Disability

    • Disease is defined as a medical condition or diagnosis, e.g., diabetes, heart disease, chronic obstructive lung disease.
    • Disability is the adverse impact of a disease on objective physical, psychological, and social functioning.
    • Illness is the adverse impact of a disease or disability on how the patient feels.
    • Illness perceptions strongly predict recovery, loss of workdays, adherence, and healthcare utilization.

    Opportunities for Tertiary Prevention

    • The first sign of an illness provides an excellent opportunity to initiate tertiary prevention methods.
    • Early treatment of infectious diseases can prevent their transmission to others.
    • Early treatment of alcoholism or drug addiction can prevent social and emotional problems in family members.
    • Symptomatic illness can identify individuals most in need of preventive efforts.
    • The onset of symptoms can provide a "teachable moment" for health promotion aimed at preventing disease progression.

    Disability Limitation

    • Disability limitation includes therapy and attempts to halt or limit future progression of the disease.
    • Most medical or surgical therapy of symptomatic disease is directed at preventing or minimizing impairment.
    • Strategies of symptomatic stage prevention include modifying diet, behavior, and environment, screening frequently for incipient complications, and treating any complication that is discovered.

    Cardiovascular Disease

    • Cardiovascular disease encompasses coronary artery disease, cerebrovascular accident (stroke), heart failure, and peripheral artery disease.
    • The clinician's immediate goal is to prevent death and permanent damage, and then to slow, stop, or even reverse the progression of the disease process.
    • Risk factors to be addressed to slow or reverse disease progression include hypertension, smoking, dyslipidemia, diabetes, diet, and exercise.

    Risk Factor Modification

    • Modifiable risk factors to address in cardiovascular disease include hypertension, smoking, dyslipidemia, diabetes, diet, and exercise.
    • Smoking cessation is probably the most effective behavioral change a patient can make when cardiovascular disease is present.
    • Diabetes mellitus increases the risk of repeat MI or restenosis of coronary arteries.
    • Hypertension increases the risk of cardiovascular disease, and severe hypertension approximately quadruples the risk.

    Rehabilitation

    • Rehabilitation occurs after disease has already caused damage, and aims to reduce the social disability produced by a given level of impairment.
    • Rehabilitation must begin in the early phases of treatment to be maximally effective.
    • A rehabilitation program is tailored to meet the physical, emotional, psychological, and occupational needs of the individual.
    • Rehabilitation specialists can contribute to a patient's progress back from an illness.

    Categories of Disability

    • Disability is a socially defined concept with practical implications for financial support.
    • Most states delineate several categories for reimbursement of workers who have job-related injuries or illnesses, including permanent total disability, permanent partial disability, temporary total disability, temporary partial disability, and death.

    Risk and Protective Factors for Mental Health and Behavioral Disorders

    Biologic Risk Factors

    • Genetics account for 30-40% of risk for anxiety and depression, and 50-60% of risk for substance dependence
    • Endophenotypes are inherited traits that increase risk of disorder and are present before disorder is expressed
    • Other biologic factors associated with dysphoric mood:
      • Hormonal changes (e.g., postpartum onset)
      • Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)
      • Amount of daylight (e.g., seasonal pattern)
      • Disturbances of circadian rhythm

    Psychological Risk Factors

    • Maladaptive thought patterns contribute to anxiety and depression
    • Negative expectancies do not deter substance use, while positive expectancies increase use
    • Perceived burden and thwarted belongingness increase risk of suicidal ideation
    • Past suicidal behavior is a strong predictor of future attempts

    Social Risk Factors

    • Exposure to anxious parents increases risk of anxiety disorder
    • Exposure to substance-using peers increases risk of substance use disorder
    • Parental depression increases risk of depression in offspring
    • Direct exposure to threatening stimuli (e.g., trauma, social evaluation) increases risk of anxiety and depression
    • Poverty, social isolation, and inadequate access to health services increase risk of mental health and behavioral problems

    Cultural/Diversity Factors

    • Women are more likely to experience anxiety and mood disorders, while men are more likely to experience substance use disorders
    • Racial and ethnic minorities are at higher risk for mental health and behavioral problems due to social and economic disparities
    • Age is a risk factor for mental health and behavioral problems, with some research suggesting older adults are at higher risk, while others suggest young adults are at higher risk

    Protective Factors

    • Achieving developmental milestones, being physically healthy, and being physically active are associated with good mental health
    • Possessing at least average cognitive ability is associated with lower rates of anxiety and depression
    • Cognitive, social, environmental, and cultural factors contribute to good mental and behavioral health outcomes, including:
      • Secure attachment during infancy
      • Strong attachments to family, school, and community among adolescents
      • Social support and positive parenting practices
      • Adequate coping skills for managing stress
      • High self-esteem
      • Strong religious beliefs### Prevention and Intervention Strategies
    • DARE program has been shown to be ineffective in preventing drug use among youth
    • School-based interventions that teach drug refusal skills and address outcome expectancies can be effective in decreasing substance use
    • Gatekeeper training improves knowledge, skills, and attitudes toward intervening and can reduce suicidal ideation and attempts

    Brief Interventions

    • Motivational interviewing (MI) is a brief intervention that can enhance treatment retention and reduce substance use and related negative consequences
    • MI can also be effective in increasing motivation to engage in treatment for mental health disorders
    • The five "A" program is a brief intervention designed to assist physicians in encouraging patients to quit smoking
      • Ask about smoking status
      • Advise patients to quit and provide feedback on health risks
      • Assess smoking status and health risks
      • Assist patients in quitting
      • Arrange a follow-up appointment

    Longer-Term Interventions

    • Early home-based interventions that facilitate maternal responsiveness and teach effective parenting skills can enhance resilience in at-risk children
    • School-based and community-based programs that encourage prosocial behavior and teach empathy and cognitive skills can improve mental health and substance use outcomes
    • Cognitive-behavioral therapy (CBT) is effective in treating anxiety, depression, and substance use disorders
      • Focuses on restructuring maladaptive cognition and teaching effective coping strategies
      • Can also be used to prevent a first depressive episode and promote sustained abstinence

    Treatment of Substance Dependence

    • Contingency management (CM) models can increase motivation for abstinence and improve treatment compliance
      • Use reinforcements such as vouchers and retail items to encourage abstinence and participation in non-drug-related activities
    • Social network and family models can increase social support and improve treatment outcomes
      • Involving drug-free family members and significant others in treatment can improve substance use outcomes

    Medical/Pharmacologic Interventions

    • Pharmacotherapies such as SSRIs and SNRIs can be effective for treating anxiety and depression, but may have limited effectiveness after medication discontinuation
    • Cognitive therapy is more effective than pharmacotherapy for preventing relapse after medication discontinuation
    • Pharmacologic interventions for substance use can encourage abstinence initiation or prevent relapse
      • Antagonists block the effects of drugs and induce withdrawal symptoms
      • Agonists mimic the effects of drugs and prevent withdrawal
      • Vaccines prevent drugs from entering the brain and reduce euphoric effects

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