Transcript Intro Lecture

Psychology of Patient Care
• Goal of psychology is to “understand and
predict human behaviour”
• Application to pharmacy practice situations
• Role of theory:
– in understanding/explaining behaviour
– in intervening to change behaviour
– in providing practical approaches to PC
Psychological Theory Applied to
Pharmacy Practice
View “Person” as a…
Anatomical being
Biological being
Temporal being
Thinking being
Psychological being
Social being
Relevant Theory
Neuropsychological
Behaviouralism
Developmentalism
Cognitivist
Psycho-analytic
Socio-psychological
Neuropsychological Approaches
• Focus on genetic components
• Deterministic model of human behaviour:
highly predictable outcomes from
interventions
• Reductionist approach to human behaviour
• Major focus of pharmacologic therapies
Behavioural Approaches
• Views human beings as biological entities
struggling for survival in complex systems
• Personality is a a learned behaviour that
confers an adaptive value
• Human responses are stable and predictable
in stable and predictable situations
• Environment “causes” personality
Developmentalist Approaches
• Psycho-social development is rooted in
physiological development
• Time is a major determinant of behaviour
and personality
• Clearly demarcated “stages of
development” that must be crossed in a
linear way
Cognitivist Approaches
• Human beings are unique in their ability to
reason and to think
• Behaviour is governed by thoughts aimed at
achieving goals - problem behaviours are a
reflection of problem goals
• Few, if any, instincts or unconscious
motivators
• Changing thinking can change feelings
Psychoanalytic Approaches
• Principle of psychic determinism: “nothing
happens by chance”
• Theories of personality structure and
formation
• Ego defences as primary determinants of
behaviour and personality
Socio-psychological approaches
• Behaviour is governed by social influences
• Issues of conformity, attitude formation and
group processes
• How do “others” influence behaviour (and
thoughts, attitudes and feelings)…the role
of social influence in personality
development and behavioural expression
Role of Theory
• Represents a continuum
• No one theory appears to adequately
account for the complexity of human
behaviour
• No model for integrating all theories
• Emphasis and application of key points to
specific situations
Case Study: Anxiety
CW is a 22 year old engineering graduate student.
Despite achieving good grades throughout high
school and her first two years of university, she is
complaining of numerous somatic symptoms: she
has mid-night awakenings, sweaty palms, racing
pulse and palpitations. At times the sensation is
unbearable, and she cannot sleep. Her MD has
ruled out any physical pathology and has
prescribed lorazepam SL 1-2mg tid prn and hs.
Background Terms:
Stress: An external stimulus interpreted as
dangerous
Fear: Short-term physiological/psychological
response to stress
Anxiety: Longer-term physiological or
psychological response to stress
Anxiety Disorders
• Most common mental illness in N. America
• <25% of Americans receive any kind of
treatment
• Mortality/morbidity significance
• Examples (DSM IV): panic, phobia, OCD,
post-traumatic stress, generalized anxiety
• Why does it only affect some people?
Neuropsychologic Approach
• Genetic component to anxiety: some
people are “born worriers”
• MRI studies suggest differences in the way
anxious and non-anxious people’s brains
respond to stress
• Anxiety = breakdown in mechanism that
keeps normal anxious response from
spinning out of control
Neuropsychological Interventions
1) Block stimulation of cortex
2) Block release of neurotransmitters from
the amygdala or other areas of the brain
3) Block end-organs (e.g. adrenal cortex,
cardiac tissue, respiratory system etc.)
4) Target neurotransmitter cascade through
CNS – role of pharmaceuticals
Issues with Medications in
Treatment of Anxiety
•
•
•
•
Side effects (including dependency)
Onset of action
Reduction of efficacy over time
“Masking” of symptoms rather than treating
underlying problem
• Short term efficiency vs. long term efficacy
• Does this approach make sense?
Behavioural Approach
Rather than “block” anxiety-provoking
stimuli, try to get patient accustomed to it so
they don’t experience it in the same manner
through use of:
• habituation techniques
• conditioning techniques (“desensitizing”)
• reward structures
Developmentalist Approach
• Anxiety can be seen as a mis-fit between
stage of development and the environment
• Use developmental theory to align
environment to individual’s stage and needs
• e.g. Stage 6 (Early Adulthood (20-35))
- major crisis is “intimacy vs. isolation”
- address this issue to deal with anxiety
Cognitivist Approach
Rather than “train” people to deal with
anxiety, encourage them to use the power of
the mind to reason through it.
- identify triggers
- identify goals for responding to triggers
- use cognitive models to understand how
anxiety can be “thought- through”
Psycho-analytic Approach
Recognize that you are anxious because you
WANT to be anxious (ie. Anxiety confers
some benefit to you)
- identify structure of personality and how this
has lead to certain, ritualized ego defences
that manifest as anxiety
- understanding this provides key to treatment
Socio-psychologic approach
• Determine how individual’s thoughts,
feelings and behaviours are influenced by
the real or imagined presence of others
• Define the construal: the way in which
people perceive, comprehend, and interpret
their social world
• Key is the peer group
So how does a tiny little pill like
that actually work?
Neuropsychologic: targets receptors
Behavioural: stimulus-response conditioning
Cognitive: mask symptoms to provide zone
for development of self awareness
Developmental: mask symptoms
Psychoanalytic: mask symptoms
Social-psychological: mask symptoms
Are there alternatives to the little
white pill?
Neuropsychological: other little white pills
Behavioural: biofeedback
Developmental: lifestyle changes
Cognitive: talk-therapy
Psychoanalytic: hypnosis, analysis
Socio-psychological: peer grouping
Summary
• Anxiety is one of a cluster of conditions that
form a large part of professional practice
• Anxiety is a multi-faceted medical problem
• Focus on neuropsychological approach
solely is unsatisfactory and ineffective
• Other interventions must be exercised in
combination
Summary
• Major issues in pharmacy practice include:
- mental health issues
- lifestyle modification issues (smoking, diet,
unsafe sexual practices, etc.)
- motivation for compliance to
medication/lifestyle modification regimes
Applying psychological theory to
pharmacy practice
• “Walk around the problem”: consider both
the physiological/pharmacological issues
and the psychological issues
• No single, perfect formula or solution to
complex human, behavioural issues instead, must rely upon using a variety of
methods to address individual needs
Case Study