Medical Psychology PDF

Medical Psychology 1 Burnout definition: syndrome conceptualized from workplace stress that has not been managed People most prone to experiencing burnout are ‘overachievers’ Not classified as an official medical condition, yet is becoming an increasingly popular reason why adults see...

Medical Psychology 1 Burnout definition: syndrome conceptualized from workplace stress that has not been managed People most prone to experiencing burnout are ‘overachievers’ Not classified as an official medical condition, yet is becoming an increasingly popular reason why adults seek psychological help Sources: ○ Individual ○ Interpersonal ○ Institutional Symptoms: physiological/ emotional/ behavioural (may be expressed as aggressive behavior or escape behaviour): ○ Feelings of exhaustion ○ Mental distance from job ○ Reduced professional efficacy Process of Burnout (American Psychology Association): 1. The honeymoon: falling for your work/ full satisfaction with your achievements/ dominated with energy & enthusiasm 2. The awakening: starting to notice their perception of work is unrealistic, therefore starts to work more to protect their idealistic picture from being ruined 3. The brownout: accomplishment of tasks require more effort, therefore trouble begins to appear socially & professionally 4. Full scale burnout: full scale physical/ mental exhaustion 5. Phoenix phenomenon: healing from burnout, can succeed or fail (failure causes person to go back to brownout) 3 Dimensional Theory (Christina Maslach) 1. Emotional exhaustion a. Discouragement to work b. Reduced activity c. Pessimism d. Constant psychophysical tension e. Irritability f. Somatic changes g. Decreased interest in personal matters 2. Depersonalisation a. Distancing from clients problems b. Cynicism c. Blaming patients for failures 3. Reduced sense of personal achievement: a. Dissatisfaction with achievements  b. Lack of competence c. Loss of faith in own abilities d. Loss of ability to solve problems e. Inability to adapt to difficult professional conditions Medical Psychology 2 Stress: a complex phenomenon viewed from different perspectives It exceeds or is appraised as exceeding coping possibilities of the person Interaction (transaction) between the person and their environment (external world) that is appraised as taxing, exceeding resources or threatening their wellbeing Consequences: physiological, behavioural, cognitive, emotional, interpersonal, social, economic Stressor: a stimulus which causes stress and, ○ Feels threatening ○ Disrupts activities ○ Impedes satisfactions of needs Stress can be good because a lack of stress causes low performance and boredom Coping with stress depends on the person and their environment; Functions of coping: ○ Problem solving ○ Regulation of emotions Conflict between functions (Eg. reduction of anxiety about some health problems postpones a visit to GP) Collaboration of functions (Eg reduction of anxiety enables a better answer in an exam) Ways of coping (Lazarus & Folkman) Confrontive coping: aggressive efforts to alter the situation and suggests some degree of hostility and risk-taking Distancing: cognitive efforts to detach oneself and to minimize the significance of the situation Self-controlling: efforts to regulate one’s feelings and actions Seeking social support: efforts to seek informational, tangible and emotional support Accepting responsibility: acknowledges what is going on and tries to make it right Escape-avoidance: wishful thinking and behaviours to escape the problem Planful problem solving: deliberate problem-focused efforts to alter the situation Positive reappraisal: an effort to create positive meaning by focusing on personal growth Strategy effectiveness: Does this specific strategy give positive effects directly after using it, or in a time perspective? Stress tolerance: The ability of sustaining direction of activity, performing efficiently/organised, despite the stressfulness of the situation Things that determine stress tolerance; ○ Childhood experiences ○ Individual pattern of emotional response ○ Properties of nervous system ○ Self-esteem ○ Individual type of motivation Long term consequences of stressful situations Physical level ○ Digestive system ○ Cardiovascular system ○ Musculoskeletal system ○ Reproduction system ○ Skin conditions Mental / emotional level ○ Depression ○ Anxiety ○ Bipolar disorder ○ Cognitive problems (confusion, difficulty concentrating, trouble with new information, decision-making problems) ○ Personality changes ○ Problematic behaviour Domestic Violence Domestic abuse: A pattern of coercive, aggressive and controlling behaviour which is a life-threatening crime affecting people in all communities regardless of gender, race and age. Types of domestic violence; Emotional / psychological Physical Sexual Economical (often culture dependant) Neglect 10 red flags of abuse: Controlling behaviour Humiliates you Guilt trips Forced you to take responsibility for their feelings Ultimatimatum Physical violence Bad temper Forces you to do things you don’t want to do Constantly checks up on you Picks fights Signs & Symptoms Injuries that point to defensive position over the face Injuries to chest/stomach Injuries do not match cause given Delay in requesting medical care Repeat injuries (“accident prone”) Injuries during pregnancy psychological/ behavioural problems ○ Signs: multiple visits, lack of appointment commitment, not displaying emotion, negligence, defensive position, stilted speech, avoiding eye contact + partner’s behavior: extreme jealousy, controlling of time spent with healthcare providers Suicide attempts/ signs of depression Procedure for doctors if they suspect domestic abuse (Source) 1. Ensure Safety: Assess the immediate safety of the patient. If there is an immediate risk of harm, it's crucial to take steps to protect them. 2. Create a Safe Environment: Conduct the examination or discussion in a private, comfortable setting where the patient feels secure and can speak freely.  3. Build Trust: Approach the topic sensitively. Use open-ended questions to encourage the patient to share their experiences without feeling pressured. 4. Listen Actively: If the patient discloses abuse, listen without judgment. Validate their feelings and experiences, and avoid blaming or making them feel guilty. 5. Provide Information: Educate the patient about domestic abuse and its impact. Offer information on available resources, such as shelters, counseling services, and hotlines. 6. Document Findings: Accurately document any physical injuries, emotional distress, and disclosures made by the patient in their medical records, while maintaining confidentiality. 7. Assess for Further Needs: Evaluate if the patient needs immediate medical care for injuries or mental health support. 8. Discuss Reporting Options: Depending on the laws and regulations in their area, discuss the possibility and implications of reporting the abuse to authorities. This should be done carefully, respecting the patient’s autonomy. 9. Develop a Safety Plan: If appropriate, help the patient create a safety plan for leaving the abusive situation, including contacts for support and resources. 10. Follow-Up: Arrange for follow-up appointments to check on the patient’s physical and emotional health and to provide continued support. What doctors can do for an abused patient: Talk with her/him privately about suspected abuse Assess degree of danger Develop safety plan Document incidents in medical records Plan for follow-up Give information on resources Medical Psychology 3 Taking the psycho-social history of a patient means asking for: Occupation Finance Environment Education Family Lifestyle The above are very important for identifying somatic disorders in patients Somatic disorders  Situational risk factors contribute to onset and development of somatic disorders - Life events such as death, separation and changes at work are situational - The life events study (SRRS) listed life events and in a questionnaire asked participants to score them between 0-100 based on ‘life change units’ (study may be vague and give subjective appraisals), patients between 150-299 have 50% chance of somatic disorders Personality risk factors in somatic disease: Suppression of emotion High need for achievement Responsibility Compulsive traits Tendency to be depressed Type-D personality, a distressed personality (studies show they have higher disease disks) Type-A personality, intense need of achievement with aggression and need for dominance High Behavioural dynamism Energy in action Hurry Impatience The protective role of social support: Types: emotional support, informational, instrumental, material Perspectives: Received and perceived support Correlation with health: Main effect and buffer effect Making plans with patients 1. Recognise behaviours needing attention and help 2. Work with intention 3. Coping with barriers 4. Positive reinforcement 5. Follow-up to check progress Attitude toward illness Cognitive aspect - Aware of condition and its details Emotional Aspect - Feels like a burden having to ask for things - Humorous to keep spirits up Motivational aspect - Wants to live a life without other people's help - “Every day there are small wins” ATI diagnosis (attitude favourable for the treatment, ambivalent, unfavourable, lack of acceptance, with high anxiety Balte’s SOC theory Selection Optimisation Compensation Medical psychology 4 Death and Dying DABDA Denial Anger Bargaining Depression Acceptance Mnemonics for breaking bad news 1. ABCDE (steps for breaking bad news) Advanced preparation Building therapeutic environment Communicate well Deal with patient and family reaction Encourage and validate emotion A- Advanced preparation Arrange for an adequate time with privacy and no interruptions Review relevant clinical information Mentally rehearse, identify words or phrases to use and avoid Prepare yourself emotionally B- Building a therapeutic environment/ relationship Determine what and how much the patient wants to know Have family or support people present Introduce yourself to everyone Warn the patient that bad news is coming Use touch when appropriate  Schedule follow-up appointments C- Communicate well Ask what the patient and their family knows Be frank but compassionate Avoid medical jargon Allow for silence and tears Proceed at the patient’s pace Have the patient describe his or her understanding of the news, repeat this information at subsequent visits Allow time to answer questions Write things down and provide written information Conclude each visit with a summary and follow-up plan D- Deal with patient and family reactions Assess and respond to the patient and the family’s emotional reaction Repeat at each visit Be empathetic Do not argue or criticize colleagues E- Encourage and validate emotions Explore what the news means to the patient Offer realistic hope according to the patient’s goals Use interdisciplinary resources 2. SPIKES S - Setting up interview P - Assessing patient’s perception I - Obtaining the patient’s invitation to share the news K - Giving knowledge and information to patient E - Addressing the patient’s emotions with empathetic response S - Strategy or Summary 3. BREAKS Background: knowledge about patient’s situation (cultural/ethnic background), prepare the right environment for the conversation Rapport: comfort for the conversation Explore what the patient already knows and understands, or what their concerns are Announce: getting the consent, breaking news, avoiding medical jargon Kindling: asking what the patient understood Summarise: main points, treatment plans