PSYC 6700 test 3

Stroke video

- Face drooping, arm weakness, speech difficulty. time to call 99. - lost time=lost brain, clot busting drug gets rid of the clot causing the stroke - FAST

Messages that descend from the brain (Gate control theory)

- Efferent pathways - Neurons in the brainstem and cortex have efferent pathways to the spinal cord> their impulses can open or close the gate - Eg. the effects of some brain processes (such as anxiety or attachment) probably have a general impact, opening or closing the gate for local inputs from any areas of the body

Epilepsy

- A condition marked by recurrent, sudden seizures that result from electrical disturbances of the cerebral cortex - Affects approx 65 mil people worldwide - Electroencephalograph (EEG) records electrical potentials (voltage fluctuations, " brain waves") - EEG can be used to diagnosis epilepsy and to provide information about the cause and location of brain disfunction - Different varieties of epilepsy are associated with different abnormal electrical rhythms in the brain

The amount of activity in pain fibers (Gate control theory)

- A delta and C fibers - Activity in these fibers tends to open the gate (the stronger the noxious stimulus, the more active the pain fibers

Cancer

- A disease characterized by uncontrolled cell proliferation that usually forms a malignant neoplasm (tumor) - Second leading cause of death behind heart disease in the U.S. - In the US about 600000 people die from cancer and >1.6 million new cases are diagnosed each year

diagnosis of aids criteria

- Note: healthy CD4 counts are between 500 and 1500 cells/mm3 - Infection can cause severe depletion of "T-helper" (CD4) lymphocytes - Occurs when the # of cd4 cells falls below 200 cells per cubic millimeter of blood or - When you develop one or more opportunistic infections regardless of CD4 count

Myocardial infarction

- "heart attack": if the reduced blood supply is severe or prolonged, part of the muscle tissue of the heart (myocardium) may be destroyed Common symptoms of a heart attack: - Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest that lasts for more than a few minutes - Pain or discomfort spreading to the shoulders, neck, jaw, or arms - Shortness of breath - Lightheadedness, fainting, sweating, or nausea

Stroke prevention

- 80% of strokes can be prevented by exercising regularly, eating a healthy diet, and not smoking or drinking alcohol - These lifestyle changes reduce the risk of atherosclerosis and hypertension

The amount of activity in other peripheral fibers (Gate control theory)

- A beta fibers carry information about harmless stimuli of mild irritation (touching, rubbing, lightly scratching the skin) - Activity in A beta fibers tends to close the gate, inhibiting perception of pain when noxious stimulation exists - Explains why gently massaging or applying heat to sore muscles decreases pain)

Stroke

- A cerebrovascular accident (CVA), or stroke, occurs when the blood supply to part of the brain is disrupted by a blockage (clot) or rupture (bleed), - ischemic (clots) or hemorrhagic (bleed) - 2nd leading cause of death worldwide behind heart disease - 5th leading cause of death in the US - Leading cause of serious long term adult disability in the US - Every 4 mins someone in the US dies of stroke - Brain damage starts within minutes of a stroke and may be irreversible in as little as an hour - 80% of strokes can be prevented by exercising regularly, eating a healthy diet, and not smoking or drinking alcohol - These lifestyle changes reduce the risk of atherosclerosis and hypertension

Psychophysiological measures - Pain assessment

- Electromyograph (EMG); autonomic activity (e.g., heart rate, skin conductance); electroencephalograph (EEG) - e.g., EEG amplitude (hight and depth of a wave) increases with the intensity of the painful stimuli, decreases when participants take analgesics, and correlates with people's subjective reports of pain - Correlates with perceptions of pain

Stimulation produced analgesia (SPA)

- A phenomenon whereby stimulation to the midbrain causes insensitivity to pain - Stimulation of the periaqueductal gray area in the tegmentum of the midbrain travels down the brainstem to the spinal cord where serotonin activates nerve cells called inhibitory interneurons, - Impulses in interneurons then release endorphin at the pain fibers - Endorphin inhibits these fibers from releasing substance P (released in response to painful stim) - Endorphins decrease substance P and closes the gate - Less of a pain response sent to the brain, reduces pain messages to the brain from the transmission of cells

Hypnosis

- A state of deep relaxation that may reduce the intensity of pain (depending on a person's degree of suggestibility), but it is not effective for everyone - Only 2 to 5% of the population is classified as "highly hypnotizable" - People who can be hypnotized very easily and deeply gain more pain relief from hypnosis - Hypnosis is about as effective as relaxation therapy for the treatment of pain; regardless of which therapy people receive, pain relief is greatest if they are high in hypnotic suggestibility - Similar to relaxation techniques like PMR - People have even more benefit from meditation if they are high hypnotic suggestibility

Thrombi and emboli

- A thrombus is a blood clot that forms in a vessel and remains there - An embolism is a clot that travels from the site where it formed to another location in the body - Thrombi or emboli can lodge in a blood vessel and block the flow of blood in that location, depriving tissues of normal blood flow and oxygen which can result in: -- Damage -- Destruction (infarction) -- Death of the tissues (necrosis) in that area Infarcts: an area of tissue that undergoes damage as a result of obstruction of local blood supply , as by a thrombus or embolism

Medical treatments: Gate control theory

- According to this theory, separating physiological and psychological aspects of a person's pain experience is artificial; thus, chemical methods alone usually are not sufficient for controlling pain - Neural gate in spinal cord can modulate incoming pain signals - Gate-control theory proposes that pain can be controlled not only by biochemical methods that alter sensory input directly but also by modifying motivational and cognitive processes

Aids

- Acquired immune deficiency syndrome (AIDS) is a very different high-mortality chronic illness than heart disease, stroke, and cancer in 3 ways: - 1. AIDS is a "new" disease and was virtually unknown <1980 - 2. It is an infectious disease that is caused by a virus (human immunodeficiency virus = HIV) - 3. Although the death rate from AIDS is fairly low in developed countries, it is a worldwide epidemic with 1.7 million new infections and nearly 700000 deaths annually - Worldwide, there are about 37 million people living with HIV/AIDS, and many newly infected individuals per year are children (born to infected mothers) - In the U.S., the number of new HIV diagnoses annually is highest among 25-34 year olds and disproportionately affects Black and Latinx adults

Value of strategies for treating pain

- Active coping strategies effectively reduce acute pain - Distraction and imagery useful with mild to moderate pain - Redefinition effective with strong pain - Redefinition ore effective with chronic pain than distraction - For chronic pan, it is helpful to combine different strategies

How does gate control theory predict how counter irritation works?

- Activity in the a beta peripheral fibers carry signals about mildly irritating stimuli, tends to close the gate, thereby inhibiting transmission cells from sending pain signals to the brain, pg 300 - Led to development of TENS

Transition from acute to chronic pain

- Acute pain conditions are at risk for transitioning to chronic pain if the person has experiences many traumatic life events, reports high levels of depression, and has early beliefs that the pain may be permanent - The transition from acute to chronic pain is a critical time when many people become increasingly disabled - Especially if they experience a loss of self efficacy (feeling of control) for performing activities and a fear that certain behaviors will cause painful episodes or worsen their condition

Nociceptors

- Afferent neurons in the peripheral nervous system respond to unpleasant stimuli (physical pressure, intense cold/heat, itch) and carry the signal to the spinal cord (which carries the signal to the brain) - Sensory receptors that enable the perception of pain in response to potentially harmful stimuli - They exist in every body tissue except the brain

Translational research

- After efficacious treatments are identified, they must be tested for their effectiveness (study of intervention performance in diverse populations in real-world settings in which external validity is balanced with internal validity) - Finally, translational research moves scientific discovery along the pathway from bench to bedside population - Accelerating discoveries to benefit human health

Infarcts

- An area of tissue that undergoes damage as a result of obstruction of local blood supply , as by a thrombus or embolism

Ischemic strokes

- An ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain. It accounts for 87% of all stroke cases - A transient ischemic attack (TIA) is caused by a temporary clot. Often called a mini stroke, these warning strokes should be taken very seriously - Primary cause of ischemic stroke is atherosclerosis - A thrombus is a blood clot that forms in a vessel and remains there - An embolism is a clot that travels from the site where it formed to another location in the body

Treatment of epilepsy

- Anticonvulsant (antiepileptic) medications are the primary medical treatment - Goal: to suppress the rapid and excessive firing of neurons that start a seizure - Effective for about 60% of patients - Patients who don't respond to medications may have surgery (up to 70 % of patients become seizure-free after surgery) - Exercise, emotion regulation, and social activities also are important because they facilitate neuronal inhibition

Clinical pain

- Any pain that requires professional care - May result from known or unknown causes - May be acute or chronic

Health psych career opportunities

- Doctoral-level psychologists working in health care settings in the U.S. more than doubled from 20,000 in 1974 to 45,000 in 1985 ... and more than doubled again to 106000 in 2016! - Career opportunities for health psychologists likely will continue to grow - Health psychologists work in universities, medical schools, hospitals, primary care clinics, rehabilitation centers, specialty medical clinics (e.g., for pain, cancer, sleep), HMOs, and private practice /consultancy offices

Alzheimer's disease

- Approximately 10% of older adults (>70 years) meet DSM-5 criteria for dementia (i.e., Major NCD) - >60% of all Major Neurocognitive Disorder (NCD) cases are caused by Alzheimer's disease (AD) - 5.3 million Americans have AD - Amyloid-predominant neuritic plaques, tau-predominant neurofibrillary tangles and loss of acetylcholine (a neurotransmitter critical for learning and memory) - Direct correlation between the extent of cortical atrophy in the temporal lobe? And the degree of cognitive impairment in individuals diagnosed with AD - reduced size of gyri and increased size of Sulci produced by cell loss in the diseased brain - not due to delirium that could be hallucinations or a medication, its due to a neurocog degenerative disorder

Integrated health care teams video

- Behavior has a big impact on health, we need to change behavior to improve health - Better coordinated care across healthcare settings, - Providers from many disciplines, - Dedicated team providing families what they need - Teams make a significant impact on improvement of outcomes, - Improve quality of patients lives - best to train physicians and psychologists together so that they speak the same language

Emotions and Pain

- Biopsychosocial aspects of pain - Cognitive processes mediate the link between pain and emotion - e.g., patients with high dental anxiety expected and later remembered four times as much pain as they actually experienced; - low-anxiety patients expected and later remembered less than twice as much pain as they experienced - Anxiety can influence our expectations and remembrance of pain - Positive emotions (Laughter) reduce pain

Learning and pain

- Biopsychosocial aspects of pain - Pavlovian conditioning - Classical conditioning: symptoms (e.g., dizziness in migraine sufferers) become conditioned stimuli that produce distress (a conditioned response) that may heighten the perception of pain when it arrives - Operant conditioning: pain behaviors are part of the sick role and often are maintained by reinforcement without the person's awareness (e.g., facial displays of pain can become more pronounced if reinforced) -- Can be reinforced by social processes -- Can influence pain behaviors

Life-Span Health

- Childhood and adolescence are important periods with their own health threats (e.g., accidents) but these periods also are important because they set the stage for health in adulthood - Efforts to promote healthy behavior (e.g., proper diet, exercise, dental care, seat belt use) need to begin early - By the time people reach adulthood, most health-related behaviors are ingrained and difficult to change

Education, Social Support, and Behavioral Methods: Psychosocial interventions

- Chronically ill people and their families need correct information about the disease, its prognosis, and treatment - Effective systems of social support also are important - Support may come from family/friends or support groups that offer information and opportunities to meet with people who are in the same situation - Behavioral methods may be used to enhance adherence - Goal: enable patients and their families to self manage the condition effectively - e.g., tailoring the regimen to make it as compatible as possible with patients' habits, using prompts and reminders, having patients keep records of their self care activities, and providing a system of rewards through behavioral contracting

Seizure disorder classification

- Classification is based on symptoms and the distinction between partial and generalized seizures - Partial seizures capture only a part of the brain (abnormal electrical discharges are restricted to one or a few brain regions); 2 types - Generalized seizures involve the entire brain (abnormal electrical discharges occur in widespread regions of the brain); 6 types: - Unclassified epileptic seizures: cannot be classified because of inadequ=ate data (neonatal seizures)

Coping and crisis theory

- Coping begins with the cognitive appraisal, appraisal of the meaning or significance of the health problem to one's life - The outcome of this appraisal leads the person to formulate an array of adaptive tasks and to apply various coping skills to deal with these tasks

Heart disease

- Coronary heart disease (CHD): results from the narrowing & blocking of the coronary arteries which supply the heart with oxygen-rich blood - Blood vessels become narrowed as plaque builds up due to atherosclerosis - Cholesterol is the main culprit in the deposit of fatty plaques in our blood vessels (particularly, low-density lipoprotein, or LDL) - Brief reductions of oxygenated blood can produce pain ( angina pectoris) due to ischemia (lack of sufficient oxygen available to the heart muscles)

Factors Affecting Health Psychology's Future

- Cutbacks in governmental and private funding may reduce support for health psychology research, clinical intervention, and health promotion activities - On the other hand, increasing the role of health psychologists in primary care and other integrative medical settings has the potential to produce improved outcomes with reduced health spending

Coping skills to deal with adaptive tasks

- Denying or minimizing the seriousness of the situation, Beneficial in early stages - Seeking information about the health problem and treatment procedures - information is power - Learning to provide one's own medical care- self-administer drugs - Setting concrete, limited goals Recruiting instrumental and emotional support - Considering possible future events and stressful circumstances - Gaining a manageable perspective on the health problem - give meaning to problem

Pediatric pain clinic video:

- Designed for any child who has chronic pain, anything that does not resolve within an average reasonable time frame. - Manage headaches, sickle cell, other painful condition, musculoskeletal conditions - Range of integrative therapy: acupuncture, massage, aromatherapy, - Integrative nurse educator, pediatric pain psychologist, clinic physician, physical therapist - All members work very closely together. meet with families. Offer support, integrative therapies, have people explore different things and learn so they can apply it to real life. - Wide range of modalities. Help kids control pain through relaxation, biofeedback, meditation and deep breathing. - Do something every day to help yourself

Diagnosis of Epilepsy

- Diagnosis can be difficult because you have to capture an episodic event at the time the person is attached to the EEG - Activation procedures can provoke ictal pathology to appear during the recording period - e.g., flashing a light repeatedly in someone's eyes, hyperventilation, sleep or sleep deprivation. - Note: ictal activity not appearing on the scalp does appear in the brain - Depth electrodes can be implanted directly into the brain prior to surgery for intractable seizures when localization of the focus is a prime concern

RTC Video

- Fundamental part of clinical research - Seeing new treatment is safe and effective. - randomized control trial, to reliably say if new treatment is better than old process of - Randomization done by computers. - Compare groups of treatment to see which is best. - Control is the comparison, treatments are assigned at random - Randomization is the best and only reliable way to make comparison - Helps to avoid biases (wanting to give at risk people treatment) - At a minimum, patients receive the best possible standard treatment

Aids and NCD

- HIV disease is caused by infection with human immunodeficiency virus type-1 (HIV-1), - acquired through exposure to bodily fluids of an infected person through injection drug use, unprotected sexual contact, or accidental or iatrogenic exposure - HIV infects several types of cells, most particularly immune cells. - Some individuals with HIV infection develop a neurocognitive disorder (NCD) - Major or mild NCD due to HIV infection is usually more prevalent in individuals with prior episodes of severe immunosuppression, high viral loads in the cerebrospinal fluid, and indicators of advanced HIV disease such as anemia and hypoalbuminemia. Individuals with advanced NCD may experience prominent neuromotor features such as severe incoordination, ataxia, and motor slowing. There may be loss of emotional control, including aggressive or inappropriate affect or apathy. - Approximately 25% of individuals with HIV will have signs and symptoms that meet DSM-5 criteria for mild NCD, and ~ 5 % will meet criteria for major NCD - A NCD due to HIV infection can resolve, improve, have a fluctuating course, or slowly worsen

health psychology research

- Health psychology research aims to identify evidence-based interventions (EBIs): treatments or techniques with strong efficacy that have clear support across many high-quality studies, particularly randomized controlled trials

Collaborative or integrated care: Psychosocial interventions

- Ideally, interventions to help people with chronic health problems involve interdisciplinary teams of health care professionals working in an integrated manner - e.g., psychologists, physicians, nurses, dieticians, pharmacists, physical and occupational therapists, social workers, vocational counselors - Psychologists advise other team members on psychological and behavioral issues, and they help clients and their families cope with the psychosocial implications of the medical condition by using psychosocial principles to enhance the person's participation in (and adherence to) the therapeutic regimen

Lifespan health action

- In the U.S., an unusually high birth rate after WWII created a large generation of people called the " baby boomers " who are starting to swell the ranks of the population - Healthcare costs continue to increase - We need to develop effective ways to promote successful aging - We need to improve ways to help families cope with the difficulties of caring for older relatives

Integrated Health Care Teams

- Integrated health care teams incorporate behavioral healthcare into primary care settings & promote collaboration between professionals from multiple disciplines - In an interprofessional team, psychologists provide comprehensive care by collaborating with other disciplines to meet the physical, behavioral, and psychosocial need of the patient - Research has found that coordinated health care teams: 1. Enhances access to services 2. Improves overall quality of care 3. Reduces depressive symptoms 4. Lowers overall health care costs

Interpersonal and Family Therapy: Psychosocial interventions

- Interpersonal therapy is designed to help people change the way they interact with and perceive their social environments by gaining insights about their feelings and behavior toward other people - It is especially useful in helping patients deal with their anxieties and changed self concepts and relationships with family/friends - Family therapy aims to examine and change interaction patterns among family members - e.g., a family with a chronically ill member might meet to review household and medical‐regimen responsibilities, and plan ways to alter daily routines

Emotional symptoms following a stroke

- Left hemisphere associated with depression - Right hemisphere damage and ability to interpret and express affect - 25-50% develop depression - 25% exhibit symptoms of generalized anxiety disorder - Up to 50% experience catastrophic reactions and/or pathological affect (e.g., uncontrollable laughing or crying) - This is called emotional lability, can occur in varying degrees

Pain questionnaires - Pain assessment

- Mcgill pain questionnaire (MPQ) is the best-known and most widely used pain questionnaire, list of words to describe pain - Multidimensional pain inventory: accurately assesses peoples pain and its psychosocial effects

Early theories of pain

- Mechanistic view of pain perception: stimulus activates receptor, signal travels to spinal cord, then the brain - Specificity theory - Pattern theory

Pain clinics

- Multidisciplinary pain clinics that combine several effective approaches are likely to succeed for the largest percentage of pain patients and provide the greatest pain relief for each patient - e.g., medication reduction procedures, relaxation and biofeedback training, cognitive-behavioral therapy, physical therapy, family therapy, group therapy, nutrition planning, etc. - There also are specialty pediatric pain clinics - Meta-analyses have found that chronic pain patients who receive treatment at multidisciplinary pain centers report much less subsequent pain and are far more likely to return to work than patients who have standard pain treatment

MNCD video

- Neurons depend on long chains of molecule to transport nourishment across the cells, tao keeps the strips stable - In alzheimer's disease, tao begins to curl and tangle, causing strands to separate and collapse - In the spaces between the neurons, drift thousands of molecules of proteins - Beta analoid proteins, sus fragments, sticky and resilient, clump together to form and expanding mass - Attaches to the outside of a neuron - Brains defensive cells fight back releasing powerful chemicals - Counter attack backfires, chemicals set of a series of reactions that slowly destroy the neuron

Medical complaints regarding pain

- No medical complaint is more common than pain - Accounts for 80% of all visits to physicians - Headache back, and joint pain are very common causes of work absence and disability in the us - Costs tens of billions of dollars in lost productivity, treatment and disability payments each year

Hemorrhagic stroke

- Occurs when a weakened blood vessel ruptures (Bleeds) - Two types of weakened blood vessels usually cause hemorrhagic strokes: -- Aneurysms and arteriovenous malformations (AVM's - The most common cause of a hemorrhagic stroke is uncontrolled hypertension - Intracerebral hemorrhage - The rupture causes blood to spill into the tissues> extent of damage depends on the type of vessel that ruptures - Ruptures from large vessels put more pressure on the brain, constricting the ventricles and restricting blood supply to the rest of the brain> ischemia

Gate Control theory

- Our neural gate in the substantia gelatinosa of the dorsal horns (part of the gray matter that runs the length of the core of the spinal cord) can modulate incoming pain signals - The idea that brain impulses influence the gating mechanism explains why people who are distracted by competing environmental stimuli my not notice the pain of an injury

Physiology of pain perception

- Pain has no specific physical stimulus (the skin does not transduce "pain waves") - The body has no specific receptor cells that transmit information only about pain - Afferent neurons in the peripheral nervous system respond to unpleasant stimuli (physical pressure, intense cold/heat, itch) and carry the signal to the spinal cord (which carries the signal to the brain) are called nociceptors - They exist in every body tissue except the brain

Ronald Melzack

- Proposed the idea of a neuromatrix: a neural network in the brain that integrates information from the senses, stress regulation systems, and cognitive-emotional areas of the brain - Changed understanding of how humans feel pain. - Melzack rethought how humans really feel pain, a much more complicated mechanism than simple cause and effect. - Pain involves 3 broad dimensions: affective (emotional/motivational), sensory, and evaluative - participants sorted over 100 pain related words (310)

Randomized control trial (RTC)

- RCT: a study in which people are allocated at random (by chance alone) to receive one of several clinical interventions - One of these interventions is the standard of comparison or control - The control may be a standard practice, a placebo, or no intervention at all - RCTs measure and compare outcomes after participants receive the interventions - Because the outcomes are measured, RCTs are quantitative studies - In sum, RCTs are quantitative, comparative, controlled experiments in which investigators study two or more clinical interventions in a series of individuals who receive them in random order

Pain rating scales and diaries - Pain assessment

- Rate some aspect of discomfort on a scale - Pain diary: detailed record of a persons pain experiences - Visual analog scale: people rate pain by marking a point on a line - Box scale or numeric rating scale: series of numbers that represents levels of pain - Verbal rating scale: describe pain using words or phrases of several that are given

prevalence of cancer

- Rates for breast prostate and colorectal cancers have declined and are currently fairly low - Respiratory deaths are the dramatic exception, and their increase for males and females prior to 200 correspond to gender differences in the prevalence of cigarette smoking - almost all increase in cancer was caused by neoplasm in the lung (correspond with smoking) - Rates for respiratory cancer have been declining sharply for males since 1990 and have begun to decline for females - In the U.S., cancer incidence and death rates are higher for men than women in each ethnic group and far higher for black men - Although incidence rates are fairly high for White Americans, death rates are highest for black men partly because their diagnoses occur later.

Counterirritation

- Reducing ones pain by praying another (TENS) - Transcutaneous electrical nerve stimulation (TENS): placing electrodes on the skin near where the patient feels pain and stimulating that area with mild electrical current from a small portable device - Activity in the a beta peripheral fibers carry signals about mildly irritating stimuli, tends to close the gate, thereby inhibiting transmission cells from sending pain signals to the brain

Adjusting to a chronic illness

- Shock: the first reaction most people experience when a physician diagnoses a serious health problem - Being stunned or bewildered and behaving in an automatic and detached fashion - Crisis theory: the adjustment people make to learning that they have a chronic health problem depends on their coping process, which has 3 contributing influences - Describes factors that influence how people adjust

Gate control theory video

- Studied emotional behavior in dogs; the background of the animal had an impact on the pain. - Pain was understood to be simple cause and effect, nerve impulses travel to the brain and people feel pain, but too simple. - Challenged known pain pathway, rene descartes and the specificity theory - Phantom limb pain, woman had horrible burning pain in her phantom limbs, Collected over 100 pain descriptors. - Psychology and environment where key factors in how humans feel pain - Melzack and Wall introduced gate control theory. Gates either block pain signals or allow them to continue on. Come from personal experience, mood, or context. - Changed the focus of pain from the spine to the brain. - Pattern to words that were given to the pain problem. Lead mcgill pain questionnaire, describes variety and intensity of pain. gives cues to how neural mechanisms in the brian are working. used in research and treatment - Fascination with phantom limb pain inspired neuromatrix theory: Genetically determined neural networks, creates perception of our body, sense of self, and can generate pain. didn't have a model of the brain that would fit. - Developing a new way of looking at the brain

Behavioral assessment - Pain assessment

- The UAB Pain Behavior Scale may be used by nurses during their rounds (10 item measure) - Family members can also make careful observations and keep accurate record of the patients pain behavior in everyday life - People tend to exhibit behaviors when they are in discomfort, different patterns of behavior for different intensities

The opening and closing of the gate is influenced by (Gate control theory)

- The amount of activity in pain fibers (A-delta and C) - The amount of activity in other peripheral (A beta) fibers - Messages that descend (efferent) from the brain

Goals for health psychology

- The burden of health costs to different nations can be seen - This burden has risen sharply in the US since 1980 (neary doubling in the last 40 years - Health care is america's greatest economic sector at 3.5 trillion annual costs - Health psychology interventions have great potential to help slow and even reverse these trends if they can help prevent chronic illness and manage it more efficiently

Virtual reality video

- The goal is to put a stop to pain. - Meant to distract patients from painful procedures, elaborate distraction. - Reduces the amount of pain they feel - Pain during procedure is simulated with a thermal device on skin, participants ask them to rate level of pain - Regions of the brain that register pain show the least amount of activity with virtual reality and pain medication. - The more they can capture attention, the more success as a pain management technique

High mortality illnesses

- The majority of deaths in the U.S. result from chronic diseases - Heart disease, cancer, stroke, and lower respiratory disease - Most of the leading causes of death are largely - HIV/AIDS emerged in the 1980's as a high mortality illness - Worldwide 700000 people who are infected with HIV die each year - As you age, you have more knowledge of the status of hiv

What is pain?

- The sensory and emotional experience of discomfort, which is usually associated with actual or threatened tissue damage or irritation - Pain is adaptive to a degree: It motivates behaviors to terminate the source of the pain in order to prevent tissue damage

Cognitive Methods: Psychosocial interventions

- Therapists can use cognitive methods (e.g., problem‐solving training and cognitive restructuring) with individual clients or in groups to help them change their thought processes and feelings - e.g., these techniques are useful in managing symptoms of IBS, pain and depression in rheumatoid arthritis, and depression and fatigue in multiple sclerosis

pattern theory of pain

- There is no separate system for perceiving pain and receptors for pain are shared with other senses - People feel pain when certain patterns of neural activity occur

Relaxation and Biofeedback: Psychosocial interventions

- These approaches are useful for several chronic conditions - e.g., they help patients with diabetes manage their stress and glucose levels; biofeedback can increase muscle function after paralysis; people with epilepsy can benefit from relaxation, stress management, and biofeedback; PMR and biofeedback are helpful for people with asthma

Biofeedback therapy sessions video

- Type of therapy that gives you real time feedback in physical, audio, or visual form to let you know what's going on in your body. - Allows you to build awareness of your body's processes and learn how to self regulate those processes to improve or change symptoms - Used to manage migraines, abdominal pain, sleep disturbances, stress management, and chronic pain. - work together as an integrated team to help you develop management and relaxation skills to help you face pain anxiety and stress that are a part of living. - Training uses a variety of sensors to see what is going on in the body. Bvp sensor: blood volume pulse sensor measures variation and speed of your heart, changes in speed and depth of breath. Galvanic Skin response sensor -sweat, changes in skin temperature. - gives you a more complete understanding of what is going on - Gives exercises to practice to reduce symptoms - Can change how you respond to stressful events. - Regular and continued practice u can use these skills throughout the lifetime

Interpersonal therapy

- Uses cognitive-behavioral and psychoanalytic perspectives to help people adjust to chronic pain by changing the way they interact with and perceive their social environments - Therapy sessions involve discussions to help clients gain insights into their own motivations and how their behavior toward other people affects their own emotional adjustment - For chronic pain patients, the insights often relate to feelings they and their families have about the pain condition and how they deal with pain - Insights can help family members understand each other's feelings and points of view, which can help to break down any confusion/conflicts . that have developed over time - Research has found that interpersonal therapy reduces chronic pain and depression (a common comorbid condition among pain patients)

Dr Dynamite video

- Usually multiple health issues= multiple appts. only get help for some concerns, but are part of a full system. - Knowing all concerns helps people get the best care. integrated care practices. - Dentistry, addiction care, metal health. - Community and behavioral health centers teaming up. integrated care looks like : patients with multiple problems, diabetes and bipolar, primary care, mental health care and addictions treatment. - The center has a caring team of professionals all at the same location. diff doctors consulting each other, psychiatric consultants, social workers

Aids over time

- When HIV infection occurs, several years may pass before the person's immune function is impaired - Over time, the infection can cause severe depletion of "T-helper" (CD4) lymphocytes, resulting in severe immunocompromise, often leading to opportunistic infections and neoplasms - >> the diagnosis of AIDS is made once a person has reached this advanced form of HIV infection Individuals diagnosed with AIDS need antiretroviral therapy (ART) to prevent death - Without treatment, people diagnosed with AIDS typically survive about 3 years; once someone has a dangerous opportunistic illness, life expectancy without treatment falls to about 1 year

Physical therapy

- Widely used for treating arthritis and low back pain - Physical therapists are movement experts who incorporate a variety of techniques into individualized treatment programs (e.g., graded stretching and strengthening exercises including yoga postures

wellness prevention and intervention programs depend on...

- With the burden of health care costs rising, deciding whether to offer wellness prevention and/or intervention programs (e.g., at work, in medical settings) depends on 2 factors: 1. The interventions efficacy (study of intervention performance in a highly selected population in a controlled setting; emphasis is on internal validity) 2. The cost benefit ratio: (extent to which it saves more money in the long run than it costs) -- e.g., for a Workplace Wellness Program, health psychology researchers can compare data on the benefits of the program such as reductions in absenteeism and medical insurance claims as well an increases in workers' job satisfaction and productivity to the cost of the program

Substance P

- a peptide that is present in unmylinated primary afferents to the dorsal horn and is released in response to painful or noxious stimuli

Specificity theory

- body has a separate sensory system for perceiving pain - thought Mohave its own special receptors for detecting and interpreting pain stimuli, its own peripheral nerves and pathway to the brain, and its own area of the brain for processing pain

Afferent peripheral fibers that carry pain signals

1. A delta fibers: coated with myelin (a fatty substance that enables neurons to transmit impulses quickly) -- Associated with sharp and distinct pain experiences 2. C fibers: not coated with myelin -- Transmit impulses more slowly and are involved with dull, diffuse, burning, or aching pain experiences

6 types of generalized seizures

1. Absence seizures (petit mal) 2. Myoclonic seizures (motor jerks all over the body) 3. Clonic seizures (rhythmic movements) 4. Tonic seizures (stiffness/rigidity) 5. Tonic-clonic seizures (grand mal, most serious) 6. Atonic seizures (limpness)

Risk factors for stroke

1. Being over middle age 2. Being black 3. High blood pressure/ hypertension 4. Cigarette smoking 5. Cardiovascular disease, diabetes, high cholesterol, obesity, physical inactivity 6. Family history of stroke 7. Atrial fibrillation or arrhythmia 8. Drug or alcohol abuse 9. Mini strokes or transient ischemic attacks 10. Being male

Tasks related to general psychosocial functioning involve striving to...

1. Control negative feelings and retain a positive outlook for the future (optimism) 2. Maintain a satisfactory self image and sense of competence (self efficacy 3. Preserve good relationships with family and friends (social support) 4. Prepare for an uncertain future

Psychosocial interventions

1. Education, Social Support, and Behavioral Methods 2. Relaxation and Biofeedback 3. Cognitive Methods 4. Interpersonal and Family Therapy 5. Collaborative or integrated care

6 risk factors for heart attacks

1. High LDL (>100) with low HDL (<40) 2. Smoking 3. Stress 4. Obesity, BMI <30 5. DIabetes 6. Hypertension: diagnosed if a patient's blood pressure is consistently above or at 130 systolic over 80 diastolic

Three influences of crisis theory

1. Illness-related factors: disabling, disfiguring, painful, embarrassing, life threatening 2. Background and personal factors: age, gender, SES, resilience, self-esteem, emotional maturity, religious or philosophical beliefs, self-blame (rumination/catastrophizing ). 3. Physical and social environmental factors: hospital environment, home environment, social support

Pain assessment

1. Interview methods (clinical interview) - to effectively treat pain, supplemented by questionnaires 2. Pain rating scales and diaries 3. Pain questionnaires 4. Behavioral assessment 5. Psychophysiological measures

Medical treatments for pain

1. Neuroblastulation: removes or disconnects part of the PNS or the spinal cord, preventing oain signals from reaching the brain (rarely used and not known to work) - provides long term relief and often has side effects (producing numbness in effected region) 2. Laminectomy: removes part of a vertebra to reduce pressure on spinal nerves to treat back pain - Also known as decompression 3. Spinal fusion: joins two or more adjacent vertebrae to treat back pain - there is little evidence that it produces better long-term pain reduction than nonsurgical methods - less effective for people with depression and other psychological disorders - it is used at a far lower rate in other developed countries

8 risk factors for atherosclerosis

1. Obesity 2. Male gender 3. Diabetes melitus 4. Physical inactivity 5. Family history of premature cardiovascular disease 6. High cholesterol (LDL>100) 7. Hypertension (it damages the lining of blood vessels making them susceptible to atherosclerosis) 8. Cigarette smoking and exposure to tobacco smoke (the chemicals in cigarettes can damage blood vessels accelerating the development of atherosclerosis

Behavioral and cognitive coping mechanisms: pain

1. Operant approach: use extinction procedures for pain behaviors that are part of the sick role and use reinforcement for appropriate "well" behaviors 2. Fear reduction: use systematic desensitization and/or in vivo exposure 3. PMR: progressive muscle relaxation 4. Meditation: focus attention on a meditation stimulus or, in mindfulness meditation, attend to the pain and try to become detached from thoughts/feelings about it 5. Biofeedback: a technique in which an electromechanical device monitors the status of a person's physiological processes & immediately reports that information back to the individual 6. Distraction: focusing on a nonpainful stimulus in the immediate environment to divert one's attention from discomfort 7. Nonpain (guided) imagery: the person tries to alleviate discomfort by conjuring up a mental sense (image)- eg. a beach that is incompatible with the pain 8. Pain redefinition: substitute thoughts about the pain experience that arouse feelings of threat/harm with ones that are constructive/realistic ("Be brave," "It's not so bad") 9. Acceptance and Commitment Therapy (ACT): a cognitive-behavioral approach designed to promote active coping and pain acceptance that includes mindfulness meditation, in vivo exposure for feared activities, and assessment of life values 10. Active coping and pain acceptance

Medical treatments for pain: three chemical methods

1. PRN injections or pills: administer painkilling chemicals as needed 2. Epidural block: inject narcotics or local anesthetics epidurally to prevent pain signals from being transmitted to the brain - Epidural in the spinal cord during childbirth 3. Patient-controlled analgesia: allows patients to determine how much painkiller (e.g., morphine) they need without delay

Four types of pain relieving chemicals

1. Peripherally active analgesics: reduce pain by their action in the PNS (e.g., NSAIDs) (non steroidal anti inflammatory drug) 2. Centrally acting analgesics (narcotics): bind to opiate receptors in the CNS and inhibit nociceptor transmission (or alter the perception of pain stimuli) - Very effective in reducing severe acute pain, but less effective for chronic pain (and long term use is associated with tolerance and risk of addiction) 3. Local anesthetics: block nerve cells in the region from generating impulses (e.g., novocaine 4. Indirectly acting drugs: treat emotions that produce or contribute to chronic pain such as antidepressants (e.g., Cymbalta and Elavil)

DSM-5: Major or Mild Neurocognitive Disorder Due to HIV Infection

1. The criteria are met for major or mild neurocognitive disorder. 2. There is documented infection with human immunodeficiency virus (HIV). 3. The neurocognitive disorder is not better explained by non-HIV conditions, including secondary brain diseases such as progressive multifocal leukoencephalopathy or cryptococcal meningitis. 4. The neurocognitive disorder is not attributable to another medical condition and is not better explained by a mental disorder.

Four types of pain behaviors

1. facial or audible expression of distress (moaning, clenching teeth) 2. distorted ambulation or posture (guarded or protective movements) 3. negative affect (irritability) 4. avoidance of activity (staying home from work)

Interview methods - Pain assessment

A clinical interview - to effectively treat pain, supplemented by questionnaires - Detailed history of the pain problem - Patients emotional adjustment - Patients lifestyle (recreation, diet, exercise) - Pains impact on the patient relationships, work etc - Social contact of pain (how family members respond when pain occurs) - Factors that trigger attacks or make them worse - How the patient typically tries to cope with the pain

Mild Neurocognitive Disorder

A. Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on: - 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; and - 2. A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment. B. The cognitive deficits do not interfere with capacity for independence in everyday activities (i.e., complex instrumental activities of daily living such as paying bills or managing medications are preserved, but greater effort, compensatory strategies, or accommodation may be required). C. The cognitive deficits do not occur exclusively in the context of a delirium. D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder).

DSM: Major Neurocognitive Disorder

A. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on: - 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and - 2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment. B. The cognitive deficits interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with complex instrumental activities of daily living such as paying bills or managing medications). C. The cognitive deficits do not occur exclusively in the context of a delirium. D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder).

Two types of partial seizures

A. Simple partial seizures (consciousness is not impaired) - with motor symptoms - with somatosensory or special sensory symptoms - with autonomic symptoms - with psychic sysmptoms B. Complex partial (with impairment of consciousness) - 1. beginning as a simple partial seizure and progressing to impairment of consciousness - with no other features with features in a 1-4 with automatisms 2. with impairment of consciousness at the start C. partial seizures evolving to secondarily generalized seizures

Major or Mild Neurocognitive Disorder Due to Alzheimer's Disease

A. The criteria are met for major or mild neurocognitive disorder. B. There is insidious onset and gradual progression of impairment in one or more cognitive domains (for major neurocognitive disorder, at least two domains must be impaired). C. Criteria are met for either probable or possible Alzheimer's disease as follows D. The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder. For major neurocognitive disorder: Probable Alzheimer's disease is diagnosed if either of the following is present; otherwise, possible Alzheimer's disease should be diagnosed. 1. Evidence of a causative Alzheimer's disease genetic mutation from family history or genetic testing. 2. All three of the following are present: - a. Clear evidence of decline in memory and learning and at least one other cognitive domain (based on detailed history or serial neuropsychological testing). - b. Steadily progressive, gradual decline in cognition, without extended plateaus. - c. No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline). For mild neurocognitive disorder: Probable Alzheimer's disease is diagnosed if there is evidence of a causative Alzheimer's disease genetic mutation from either genetic testing or family history. Possible Alzheimer's disease is diagnosed if there is no evidence of a causative Alzheimer's disease genetic mutation from either genetic testing or family history, and all three of the following are present: 1. Clear evidence of decline in memory and learning. 2. Steadily progressive, gradual decline in cognition, without extended plateaus. 3. No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological or systemic disease or condition likely contributing to cognitive decline).

DSM 5: somatic symptom disorder

A. one or more somatic symptoms that are distressing or result in significant disruption of daily life B. excessive thoughts, feelings or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: -- Disproportionate and persistent thoughts about thought and seriousness of one's symptoms -- Persistent high anxiety about health of symptoms -- Excessive time and energy devoted to these symptoms/health concerns C. although symptoms may not be continuously present, state of being symptomatic is continuously present for more than 6 months -- Specify if with predominant pain (previously pain disorder) -- Specify if persistent- severe symptoms, marked impairment, and long duration Specify current severity -- Mild- only 1 symptom of B is fulfilled -- Moderate- Two or more of B are fulfilled -- Severe- Two or more are fulfilled, plus multiple somatic complaints Previously known as hypochondriasis

Acute vs chronic pain

Acute: - Discomfort people experience with temporary painful conditions that last <3 months Chronic: - When pain lasts longer than expected corse or for >3 months - Tend to have feelings of anxiety and to develop feelings of hopelessness and helplessness

Three types of pain

Chronic recurrent pain: - Stems from benign pain and involves repeated and intense episodes of pain separated by periods without pain Chronic intractable benign pain: - Refers to discomfort that is typically present all of the time, with varying levels of intensity, not related to underlying malignant condition Chronic progressive pain: - Continuous discomfort associated with malignant conditions and becomes increasingly intense as the condition worsens

major neurocognitive disorder and Alzheimer's

For major neurocognitive disorder: Probable Alzheimer's disease is diagnosed if either of the following is present; otherwise, possible Alzheimer's disease should be diagnosed. 1. Evidence of a causative Alzheimer's disease genetic mutation from family history or genetic testing. 2. All three of the following are present: - a. Clear evidence of decline in memory and learning and at least one other cognitive domain (based on detailed history or serial neuropsychological testing). - b. Steadily progressive, gradual decline in cognition, without extended plateaus. - c. No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline).

mild NCD and alzheimers

For mild neurocognitive disorder: Probable Alzheimer's disease is diagnosed if there is evidence of a causative Alzheimer's disease genetic mutation from either genetic testing or family history. Possible Alzheimer's disease is diagnosed if there is no evidence of a causative Alzheimer's disease genetic mutation from either genetic testing or family history, and all three of the following are present: 1. Clear evidence of decline in memory and learning. 2. Steadily progressive, gradual decline in cognition, without extended plateaus. 3. No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological or systemic disease or condition likely contributing to cognitive decline).

Congestive heart failure

Many older adults with CHD (especially those with previous heart attacks) develop congestive heart failure (CHF) in which the heart's capacity to pump no longer can meet the body's needs: A. They become short of breath with little exertion B. their lungs become congested with excess fluid C. their hearts become enlarged from being overworked

Chronic conditions

More than 130 million Americans (1 in 2 adults) are living with a chronic medical illness and about ¼ of them have daily activity limitations - Asthma - Epilepsy - Nervous system injuries - Diabetes - Arthritis - Alzheimers

Careers/Training in Health Psych

Most health psychologists follow one of three career paths: 1. Working in clinical capacities with patients individually and in small groups 2. Working in public health settings in designing & implementing broader-scale interventions (e.g., community or school-based health promotion) 3. Working in academic or research capacities - Many health psychologists have careers that combine these areas

Conditions that open/close the gate

Open: - Physical conditions: extent of the injury, activity level - Emotional conditions: anxiety, worry, tension, depression, - Mental conditions: focusing on the pain, boredom Close: - Physical conditions: medication/counter stimulation - Emotional conditions: positive emotions, relaxation, rest - Mental conditions: concentration or distraction, involvement in activities

Organic vs Psychogenic pain

Organic pain - Pain that is clearly linked to tissue pressure or damage Psychogenic pain - Pain that could result from psychological processes - Psychogenic pain is not experienced differently than organic pain, they both hurt

primary cause for ischemic stroke

Primary cause of ischemic stroke is atherosclerosis

Lateralized effect of a stroke

Right brain injury: - Paralyzed left side - Perceptual deficits - Quick impulsive behavioral style - Visual Spatial memory deficits Left brain injury - Paralyzed right side - Speech language deficits (Aphasia) - Slow cautious behavior style - Verbal memory deficits

Fiber paths to reach the brain

Signals from A-delta and C fibers follow different paths when they reach the brain: 1. A-delta fibers go to motor and sensory areas -- These signals receive special attention in our sensory awareness so that we can respond to them quickly 2. C fibers: terminate mainly in the brainstem, thalamus, hypothalamus, and limbic system -- Less likely to command our immediate attention but more likely to affect our mood and emotional/motivational states

steps of translational research

T1. Translation to humans: - Moves basic discovery into a health application primarily through efficacy studies performed by clinical and behavioral scientists T2. Translation to clinical settings: - Health services and public health scientists conduct effectiveness studies, systematic reviews, and meta analysis to develop clinical or community guidelines for using research-tested interventions T3. Translation to practice: - Implementation scientists identify strategies that can move clinical guidelines or evidence-based interventions (EBIs) into clinical and public health practice T4. Translation to populations: - Evaluates the real world use of EBIs and implementation strategies by organizations and individuals

Crisis theory adaptive tasks

Tasks related to the illness or treatment involve learning to: 1. Cope with the symptom or disability the health problem causes 2. Adjust to the hospital environment, medical procedures, and regimens needed to treat the problem 3. develop & maintain good relationships with practitioners

The most common cause of a hemorrhagic stroke

The most common cause of a hemorrhagic stroke is uncontrolled hypertension

Health psych training programs

Training in health psychology is offered at three educational levels: 1. Undergraduate courses 2. Graduate programs - Note: the Department of Psychology at Tulane has a doctoral certificate program in Health Psychology for students enrolled in the Psychological Science Ph.D. program 3. Postdoctoral programs

Healthy lifestyle to reduce heart disease (3)

When combined, 3 modifiable aspects of a healthy lifestyle can reduce your chances of heart disease by over 50%: 1. Being physically fit 2. Being healthy weight 3. Not smoking 4. Reduce dietary fat/cholesterol 5. Reduce high alcohol consumption