Transcript definitions of medical psychology

Medical psychology: definition, subject and tasks. Development of
medicopsychology in the world and on Ukraine. Role of medical psychology in
forming of modern pictures of unity somatic and psychical. Psychosomatic and
somatopsikhichni co-operations: basic theoretical conceptions. Determination of
:
psychical health. Criteria of WHO.
AGENDA
• DEFINITIONS of medical psychology
• LEVELS of medical psychology: individual
psychological issues of the patient, patient-physician
relationship, cultural and social issues
• MODELS OF illness: biomedical model,
biopsychosocial model
DEFINITIONS OF MEDICAL
PSYCHOLOGY
 Medical psychology entails the atitude towards illness
and the patient, atitude of the healthy and sick
individuals towards healthcare systems, and also the
atitude of the doctor towards the medical profession.
 This is the branch of psychology that integrates
somatic and psychotherapeutic modalities into the
management of mental illness and emotional,
cognitive, behavioral and substance use disorders".
Clinical psychologists
 are rained for
 service in primary care centers,
 hospitals,
 residential care centers,
 long-term care facilities
 multidisciplinary collaboration and team treatment.
Responsibilities of medical
psychologists
Psychotherapy - helping
patients manage the emotional
include:
aspects of chronic illnesses.
 · Pain Management - finding ways to curb the physical
symptoms of a disease and minimize the side effects of
treatments.
 · Pharmacology - prescribing psychotropic medications
for patients with mental issues or disorders.
 · Behavior Therapy - initiating and implementing
behavioral interventions and stress reduction techniques
that will positively affect patients' immune systems.
Pain management
 Pain is a combination of many things – the
actual physical site of the pain, exacerbated by
tension, fear, and anxiety. When the patient can
learn to relax his or her body, there is a natural
reduction of pain. Most of my work in Medical
Psychology is as a pain specialist (cancer,
fibromyalgia,arthritis, etc.) and allergy
elimination work (yes, in most cases, allergies
can be permanently eliminated).
 Others specialize in neuromuscular, genetic, or
birth disorders, gynecological problems, or
other specific ailments.
THE RELATIONSHIP BETWEEN
MEDICAL PSYCHOLOGY AND OTHER
FIELDS
MEDICAL psychology is intricated with other research fields:
 psychopathology,
 holistic psychology,
 antropology,
 psychoanalysis and dinamic psychology,
 cronobiology,
 etology,
 sociology,
 experimental psychology,
 neurophysiology.
POSTULATES IN MEDICAL PSYCHOLOGY
•1.„There
is no illness,ofthere
are only sick people”
The individuality
the patient
• More clearly: there is no illness separated from the
sick person with his/her individual characteristics and
particularities
• Sometimes fighting the illness is essential for
healing, some other times changing individual
particularities of reaction is required
• From the viewpoint of medical psychology, these
reactive particularities are physical and related to
person and personality
•.
POSTULATES IN MEDICAL PSYCHOLOGY
2.Patient-physician
Patient – physician
relationships
relationships
involve contrary directions,
from idealization to cynical despair
• According to the manner in which each “actor” plays the role
assigned due to various expectations, either satisfying,
effective relationships or suspicious, frustrating, disappointing
ones are underlined
• Patients are specifically tolerant to the therapeutic limitations
of medicine in a context of respect and genuine
communication and empathy from doctors/medical staff.
• Doctors/medical staff deal with sick people, not clinical
syndromes, and sick people bring a complex influence in the
patient-physician relationship – a merge between biological
factors, psychological dynamics and social context
Indicators of
communicati
onal
difficulties
Predominance of
clinician’s
speaking time
Unbalanced focus
on medical themes
Abrupt transitions
and deadlocks
(premature
consolations,
denial of
preoccupations,
closed questions)
Introduction of a
third person
Distance,
agressivity,
indifference
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CST-Example: Introduction of a « Third »
C
… well, that’s about
what I can tell you about
the situation, did you talk
to your
family ?
P
(sights) I
have small children …
C
we have also social
workers or psychooncologists in this
clinic, they can be of
great help !
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Communicational
Difficulties
are related to
a lack of technique,
but also…
levels of anxiety and
defensive styles of
clinicians when facing
external and internal
pressure
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1. Lack of Technique: Examples
Structuring the interview
Negociating the agendas
Closing topics, transitions
Transmission of information
Preparation, setting
2. External Pressure: Examples
 Complex informations
 Disclosure of diagnosis
 Relaps, progression
 Patient’s emotions
 Irritated patient
CST-Example: Relapse
C:
… to summarize, the results show that
cancer has come back again
P:
but I thought I was cured !
C:
but I have told you that the chance for
is not 100% !
P:
well …
the
cure
3. Internal Pressure: Examples
• Professional identity
• Ego and Ego-Ideal
• Narcicistic vulnerability
• Ambivalence of the patient
• Identification, projection
Real Life-Example: Professional identity /
ovarian cancer
P:
Is there no possibility to clean up this
situation with more surgery ?
C:
What do you think !
C:
Or to utilize again a strong medication ?
P:
In your situation, a chemotherapy ? I could
rather kill you right away ...
LEVEL
OBJECTIVE
MEANS
LEVELS OF PATIENT-PHYSICIAN
Intelectual
Understanding
RELATIONSHIP (apud Tatossian
A.)
and
Conceptualization
explaining illness in
accordance with
scientific models
Conceptualization
Affective
Understanding the
personality of the
sick person with its
subjectivity and
mechanisms.
Identification
Crisis
According to the contemporary approach, illness can be considered a crisis.
Especially this concerns serous, prolonged, disabling illnesses. An individual
reacts to the stress of a disease by activating his/her capacity to adjustment.
If the defence mechanisms fail, the balance is disturbed, and pathological
reaction of the personality appear.
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Danger
In the case of a serious disease, danger threatens the happy
family life, the satisfaction of a favorite work and other sides of
usual everyday life, and the patient experiences painful anxiety
and fear ("What will happen to me?").
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Past experience
 The reaction to illness depends not only on the
personality features of the patient, but also on
his/her past experience. The horror of the
disease can increase, if someone else in the
family, or a friend has had a similar illness or
operation with a sad outcome. The patient's
apprehension and fear is grounded on what
he/she sees, hears, imagines, has once read or
learned about the illness.
 Life events and stress can
bring on feelings of sadness
or depression or make a
disorder harder to manage.
Nonverbal Cues of Self-Healing or
Disease Prone Personality
 Self Healing
 Calm-even speech
 Even hand gestures away from body
 Open, relaxed body
 Mutual gaze
 Smooth movements
 Charismatic & optimistic
Nonverbal Cues of Self-Healing or
Disease Prone Personality
 Disease Prone
 Uneven speech
 Loud, explosive voice
 Sighs, stutters, ums
 Clenched fist, teeth
 Closed body posture
 Fidgets shifts tapping
 Shifty-eyed,downcast
 Facial grimace
 Vocal gesture impatience
 Over controlled calm
unexpressiveness
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Factors related to illness
 Acute
 Chronic
 Life threatening
 Terminal
Psychological Adjustment to Physical Illness
Emotional distress
6 months
Time
Adherence
 Entering into a continuing treatment programme
 Keeping referral and follow-up
 Taking medication correctly
 Following recommended lifestyle changes
Psychiatric problems
 Depressive disorders
 Anxiety states
 Sexual problems
 Alcohol problems
Depressive symptoms
 Mood and motivation
 Persistent low mood
 Diminished interest or pleasure
 Social withdrawal
 Loss of energy
Depressive symptoms
Cognitive changes
Depressive thoughts,
Worthlessness,
Self blame
Suicidal wishes,
Hopelessness
Depressive Symptoms
Biological symptoms
Poor appetite,
Weight loss,
Sleep disturbance,
Poor concentration,
Decreased sex drive,
Retardation or agitation
Prevalence of psychiatric disorder in different organic
conditions (bars show the highest and lowest recorded
rates)
Per cent
Prospective Longitudinal Cohort Study of
Anxiety and Depression in Medical In-Patients
Acute medical inpatients
(n=263)
Follow-up 5
months later
(n=218
)
Psychiatric diagnosis
Health Status-SF-36
Duke Severity of Illness Scale
Karnofsky Performance Status
Scale
Health care costs
Creed et al, Psychosomatics;
43:302-309
Prevalence of psychiatric disorder
 27% of acute medical in-patients had diagnosable
depressive or anxiety disorders
 A further 41% had sub-threshold disorders
Mean SF36 scores for physical dimensions at 5 months
follow-up, adjusted for severity of illness
Main findings
 Patients with depression and anxiety had significantly
lower quality of life than controls
 Recovery from depression following discharge was
very unlikely
 Costs incurred by patients who were depressed were
higher than controls, but there was no effect on
length of stay
Mean HRQOL in CD by Depression
*
*
*
*
*
*
*
*
Irvine et al 2002
Anxiety states
Panic disorder
Agoraphobia
Generalised anxiety
disorder
Specific phobia
Social phobia
Obsessional
compulsive disorder
Post-traumatic stress
disorder
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Sexual problems
 Common
 35-40% diabetic males
report sexual problems
 Caused by:
 the condition itself
 Effects of drugs and
other physical
treatments
 Psychological sequelae
of the condition
 Co-existing psychiatric
disorder
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Sexual problems
 Enquiry
 Know something about the patient and their
circumstances before asking
 Detailed enquiry not necessary
 One or two relevant screening questions
 Enquire in a matter of fact but sensitive way