Health Psych: Lesson 10, Chapter 13

Given the strong link between type 2 diabetes and lifestyle factors, how would you design an intervention targeting adolescents with prediabetes? What would your message be and how would you deliver it? What aspects of health promotion do you think would be relevant and what model of health behavior might apply?

Consider teachable moments in designing your intervention. If you are focusing on exercise, you may want to incorporate your message into a physical education class. If your intervention includes a diet component, you may want to deliver your message around mealtimes or in areas where adolescents tend to eat. I suspect you would want to incorporate both diet and exercise in your intervention as both are linked with improved health and outcomes among prediabetics. Be cautious of using scare tactics as these are known to not be particularly effective, especially among adolescents. Focusing on empowerment (how adolescents have the power and ability to make these changes) is likely an important component of a successful intervention.

Cardiopulmonary resuscitation (CPR)

A method of reviving the functioning of heart and lungs after a loss of consciousness in which the patient's pulse has ceased or lungs have failed to function appropriately. Family members of the MI patient should be trained in CPR.

Metabolic syndrome

A pattern of risk factors for the chronic health problems of diabetes, heart disease, and hypertension, characterized by obesity, a high waist-to-hip ratio, lowered HDL cholesterol (triglycerides), high fasting glucose levels and and insulin resistance. It is exacerbated by inactivity, overeating, age, and hostility

John Henryism

A phenomenon, associated most with Blacks, that refers to a personality predisposition to actively cope with stressors; becomes lethal when the coping strategies are unsuccessful; the syndrome has been especially documented among lower-income Blacks at risk for or suffering from hypertension

Hypertension (also known as high blood pressure or CVD)

Excessively high blood pressure that occurs when the supply of blood through the blood vessels is excessive, putting pressure on the vessel walls; a risk factor for a variety of medical problems, including CHD

Hostility has received a great deal of attention for its role in heart disease. Describe the sources of hostility and when would be a good time to intervene in this development.

Hostility seems to develop in childhood and may result from insecurity about self. Hostility may be partially a result of genetic influences and abusive or punitive parenting as well as conflicted early environments. It makes most sense to intervene early before these risk factors can develop into a hostile orientation in the child.

What major systems of the body are involved in the effect of cardiovascular reactivity on heart disease?

cardiovascular and nervous systems

Cardiac invalidism

A psychological state that can result after a myocardial infarction (MI) or diagnosis of coronary heart disease, consisting of the perception that a patient's abilities and capacities are lower than they actually are; both patients and their spouses are vulnerable to these misperceptions

Type 2 diabetes is associated with cardiovascular disease including hypertension and stroke. As such it is known as one aspect of the deadly quartet. What are the other three aspects?

- Intra-abdominal fat - hypertension - lipids

Hypertension characteristics:

- Most hypertension is of unknown origin, although genetic factors do play a role - shows heightened reactivity to stressful events - the biggest problems related to control of hypertension concern high rates of non-diagnosis and non-adherence to therapy

Emotional effects of stroke

- Patients with left-brain damage often react to their disorder with anxiety or depression - patients with right-brain damage often have alexithymia, which involves difficulty in identifying or describing feelings

Approaches to stroke interventions:

- Psychotherapy, including treatment for depression - cognitive remedial training to restore intellectual functioning - movement therapies, which may include training in specific skills development - the use of structured, stimulating environments to challenge the stroke patient's capabilities - individual counseling and group therapy

Symptoms of a stroke

- Sudden numbness or weakness of the face, arm, or leg - Sudden confusion, trouble speaking or understanding - Sudden trouble seeing in one or both eyes - Sudden trouble walking, dizziness, loss of balance or coordination - Sudden, severe headache with no known cause

Treatment for diabetes

- The goal is to prevent blood glucose levels from getting too high without causing them to drop too low. - weight-management interventions - training in problem-solving skills and active coping methods

Type I characteristics:

- Typically first diagnosed in late childhood or adolescence - Insulin is a hormone secreted by the pancreas that is used to convert the sugars and starches form food to usable energy for the body. - Without intervention, these blood sugars or blood glucose and A1C level remain too high in type 1 diabetics and can lead to hypertension, cardiovascular disease, heart attack, stroke, kidney failure, neuropathy, amputations and blindness.

Risk factors of stroke include:

- high blood pressure - heart disease - cigarettes smoking - a high red blood cell count - transient ischemic attacks, which are little strokes that produce temporary weakness, clumsiness, or loss of feeling in one side or limb - old age - depression

Managing Type I

- need to monitor their glucose levels throughout each day and take immediate action when it is needed - regular drug treatments - Regulation of sugar levels is typically accomplished through regular insulin injections, dietary control, weight control, and exercise

Risk factors for type II diabetes:

- overweight - high blood pressure - having a sibling or parent with diabetes - having a baby weighing over 9 pounds at birth - being a member of a high-risk ethnic group, which includes African Americans, Latinos, Native Americans, Asian Americans, and Pacific Islanders

Type II characteristics:

-Typically has onset in adulthood, but is now being more seen in adolescents - the pancreas may not produce enough insulin, or the body may be insensitive to the insulin it does produce. - obesity is a major contributor

Myocardial infarction (MI)

A heart attack produced when a clot has developed in a coronary vessel, blocking the flow of blood to the heart

Type II diabetes

A metabolic disorder characterized by high blood glucose in the context of insulin resistance; often co-occurs with risk for heart disease

Stroke

A condition that results form a disturbance in blood flow to the brain, often marked by resulting physical or cognitive impairments and, in the extreme, death

Ischemia

A deficiency of blood to the heart due to obstruction or constriction of the coronary arteries; often associated with chest pain

Coronary Heart Disease (CHD)

A general term referring to illnesses caused by atherosclerosis, which is the narrowing of the coronary arteries, the vessels that supply the heart with blood

Type I diabetes

An autoimmune disorder characterized by lack of insulin production by the beta cells of the pancreas

Cardiac rehabilitation

An intervention program designed to help heart patients achieve their optimal physical, medical, psychological, social, emotional, vocational, and economic status after the diagnosis of heart disease or a heart attack. Components to intervention include training in smoking cessation, exercise therapy, psychological counseling, support groups, nutritional counseling, and education about CHD

Role of depression in the development of CHD

It is an independent risk factor in its own right, and it appears to be environmentally rather than genetically based. Exerts its adverse effects through: elevated heart rate, low heart rate variability, low cardiovascular reactivity during stress, heightened inflammation, and delayed recovery following elevations in heart rate, as due to exercise, for example.

What are three sources of stress that have been linked to heart disease?

Job stress, low SES, negative emotionality, imbalance between control and life demands, social instability

What are three aspects of treatment, aside from medication, that have been shown to be associated with successful treatment of hypertension? (Incidentally, they also tend to be effective for diabetes and other forms of heart disease.)

One aspect of treatment, aside from medication, that has been shown to be associated with successful treatment of hypertension is cognitive-behavioral treatments. These can vary from biofeedback, meditation, or even deep breathing techniques. Another aspect of treatment is reduction of one's alcohol intake. Also, physical exercise or weight loss has been associated with successful treatment of hypertension.

Briefly discuss two challenges in the self-management of diabetes

One challenge in the self-management of diabetes is the non-adherence to treatment interventions. For example, type 2 diabetes patients are encouraged to achieve a normal weight and for some individuals it is a challenge to lose the weight they are advised to lose. Another challenge in the self-management of diabetes is not having sufficient information to understand how to manage their diabetes, such as metabolic control of insulin.

What are three factors associated with protection against coronary heart disease listed in the textbook?

One factor associated with protection against coronary heart disease is positive emotions. When an individual has negative emotions, such as anger and hostility, it only increases one's risk of CHD and acts as a potential trigger for heart attacks. Another factor is emotional vitality. Along with positive emotions and emotional vitality, another factor associated with protection against coronary heart disease is optimism.

Prediabetes

Prior to the onset of type 2 diabetes, this refers to a rise in one's blood glucose levels, but not to the extent to meet the diagnostic criteria for diabetes.

How can atherosclerosis be described as a mediator in the stress-heart attack relationship?

Stress can lead to negative health behaviors such as eating a diet high in fat and becoming less active physically. These behaviors can lead to the development of atherosclerosis, which can result in temporary blocking of oxygen to the heart resulting in heart attack.

Coronary artery bypass graft (CABG)

Surgery to treat blockage of major arteries, which may cause cognitive dysfunction that required intervention

Cardiovascular reactivity

This is the tendency of the cardiovascular system to react in the presence of stress. Hence, stress plays an indirect, albeit important, role in the development of heart disease