| Term | Definition |
| mechanical nociception | mechanical damage to body tissue |
| polymodal nociception | pain triggers chemical reactions from tissue damage |
| A-delta fibers | small, myelinated fibers that transmit sharp pain/ first pain |
| C-fibers | unmyelinated fibers that transmit dull, aching pain/ secondary pain |
| A-beta fibres | Large diameter myelinated fibres that transmit info about vibration and position |
| SPA | Stimulation-Produced Analgesia |
| neurochemical basis of SPA effect is endogenous opioids | Beta-endorphnis, Proenkephalin, polynorphins |
| 3 types of chronic pain | chronic benign pain, recurrent acute pain, chronic progressive pain |
| chronic pain patients develop maladaptive coping strategies such as | wishful thinking, social withdrawal |
| pain techniques work with | acute but not chronic pain |
| the “neurotic triad”: | MMPI profiles in which the first three scales are all elevated (Depression, Hysteria, and Hypochondriasis). Seen in highly neurotic individuals. |
| neurotic triad profile elevates.... | after the onset of chronic pain rather than being a precursor |
| Counterirritation: | Inhibiting pain in one part of the body by stimulating or mildly irritating another area |
| Biofeedback | a method of achieving control over bodily processes ; used to treat chronic disorders such as, temporomandibular joint pain, hypertension and a broad array of pains |
| Does Biofeedback work? | only modest efficacy in reducing pain |
| Does relaxation work? | distinct from placebos and activate higher-order brain regions |
| Hypnosis: | one of the oldest techniques for pain |
| Hypnotherapy has successfully controlled... | irritable bowel syndrome, acute pain due to surgery, childbirth, dental procedures, burns, headaches and medical procedures, Cancer pain |
| Does distraction work for pain management? | is effective but most useful in conjunction with other techniques |
| Coping techniques: | some CBT techniques, focus on sensory aspects of the pain sensation and not the pain itself, active coping skills, expressive writing |
| Components of chronic pain management programs | education, training and group therapy, involvement of family, evaluation of pain management program |
| Percentage change in headache pain pre to post treatment showed: | Relaxation and biofeedback -60; Biofeedback only -45; Relaxation only -38; placebo biofeedback -20 |
| Quality of life includes | objective functioning and subjective wellbeing of both physical and mental being |
| How strongly are medical measures related to quality of life | weakly |
| Quality of life may be in a state of crisis during | acute and initial phases |
| Denial | can be important and protective in earliest stage |
| Depression: | has an impact on the overall prospects for rehabilitation or recovery |
| Depression: | can lead patients to make extreme decisions about their care |
| Depression is more common in | patients with physical limitations |
| Positive Responses | Hope and optimism can occur, particularly if patient feels they escaped death, Many come to reorganize their priorities in a meaningful way such as focusing on relationships more |
| benefit finding is associated with | better functioning psychologically and in illness and living |
| Self- concept | is a stable set of beliefs about one’s qualities and attributes. |
| Self-esteem | refers to an evaluation of the self-concept as good or bad |
| Patients have some primary stressors: | fear and uncertainty about the future, limitations in physical abilities, appearance, and lifestyle, pain management |
| Which coping strategies work? | active coping and coping with positive responses |
| Functional Somatic Syndrome | chronic fatigue syndrome (1.4% canadians) |
| Functional Somatic Syndrome | irritable bowel syndrome |
| Functional Somatic Syndrome | fibromyalgia (1.5% canadians) |
| #1 cause of death ages 1-15 | accidents (drowning, poisoning, injuries, falls, motor vehicle) |
| #2 cause of death ages 1-15 | Cancer, especially leukemia |
| young children (< 5 years) understand death as | associated with sleep, not as something final and irreversible |
| children 5-9 years understand death as | final, but do not understand biological death |
| at ages 9 or 10 understand death as | universal and inevitable |
| #1 cause of death ages 15-24 | Unintentional injury (especially car accidents) |
| Premature death before projected age of 81 usually due to | heart attach or stroke |
| Death in old age is typically due to | degenerative disease |
| The facotrs that predict decline in health are | psychosocial factors |
| What is a Good Death?: | free from avoidable suffering - 11 core themes |
| What is a Good Death?: | pain free, religiosity/spirituality, treatment preferences, Dignity, family, positive relationship with provider, quality of life, emotional wellbeing, sense of life completion, preferences for the dying process |
| Kϋbler-Ross’s 5 stages of adjustment to death | denial, anger, bargaining, depression, acceptance |
| Kϋbler-Ross’s 5 stages of adjustment to death does not fully acknowledge | the importance of anxiety |
| thanatologists | those who study death and dying, suggest behavioural and cognitive-behavioural therapies. clinical thanatology involves symbolic immortality. |
| CHD Coronary Heart Disease | Second leading cause of death |
| CHD Coronary Heart Disease | Disease of modernization—tied to current lifestyles |
| CHD Coronary Heart Disease | may be caused by inflammatory processes, high blood pressure, diabetes, cigarette smoking, obesity, high serum cholesterol level and low levels of physical activity |
| CHD Coronary Heart Disease | Risk factors include high blood pressure, diabetes, stress, inactivity, high cholesterol |
| CHD Coronary Heart Disease | a general term referring to illnesses caused by atherosclerosis, the narrowing of coronary arteries, the vessels that supply the heart with blood |
| What contributes to CDH (Coronary Heart Disease?) | low in socioeconomic status (SES), chronic and acute stress have all been linked |
| CHD Coronary Heart Disease | leading killer of women in the Canada and most developed countries |
| How does menopause effect CHD | Higher levels of HDL when younger protects & estrogen lowers sympathetic NS arousal |
| How does depression effect CHD | tied to elevated C-reactive protein (marker of inflammation) |
| Interventions for CHD risk behaviour | dietary intervention, stop smoking programs, aerobic exercise, relaxation training, speech style interventions (to modify hostility) |
| Medication for CHD | Beta-adrenergic blocking agents—resist NS activation, Aspirin is commonly prescribed—thins blood, decreases clots. Statins—for cholesterol |
| Cause of hypertension | 90% is essential (unknown), 5% is caused by failure of the kidneys |
| Systolic blood pressure is | the greatest force developed during contraction of the heart |
| Diastolic: | is the pressure in arteries when the heart is relaxed |
| Which has a greater value in diagnosing hypertension | systolic |
| Cause of hypertension | early blood pressure reactivity is a predictor.. genetic factors and emotional factors |
| Acculturation is associated with hypertension in... | Asian Canadians because their traditional lifestyle harder to maintain |
| Treatment of hypertension: | low-sodium diet , reduction of alcohol, weight-reduction, exercise, caffeine restriction, CBT |
| Drug treatments for hypertension | Diuretics – decrease volume of blood. Beta-adrenergic blockers & vasodilators, central adrenergic inhibitors, Statins |
| "the hidden disease" | Hypertension (often symptomless) |
| Stroke | 3rd leading cause of death in Canada |
| Stroke | Disturbance in blood flow to the brain and is responsible for nearly 14,000 Canadian deaths each year |
| Stroke | occur when blood flow to localized areas in the brain is interrupted due to arteriosclerosis or hypertension |
| Risk Factors for Stroke overlap with | heart disease |
| Risk Factors for Stroke overlap with | high blood pressure, heart disease, cigarette smoking, high red blood cell count and transient ischemic attacks |
| Consequences of stroke: | stroke affects all aspects of life—personal, social, vocational and physical |
| Consequences of stroke: | motor problems, cognitive problems. emotional problems, relationship problems |
| Types of rehabilitative interventions for Stroke | psychotherapy and treatment of depression, cognitive-remedial training, movement therapies, structured, stimulating environments to challenge |
| Diabetes | chronic condition of impaired carbohydrates, protein, and fat metabolism that results from insufficient secretion of insulin or from insulin resistance |
| Diabetes increases risk of | Heart disease by 2-4X & kidney failure |
| Diabetes increases risk of | Blindness (leading cause), blood vessel damage, diabetic neuropathy (nerve damage) |
| Risk factors for diabetes | overweight, over 65, apple shaped, little excercise, high blood pressure, genetics, high risk ethnic group (indigenous, black, latin, asian, pacific islander) |
| Type I Diabetes | insulin-dependent, abrupt onset of symptoms resulting from lack of insulin production by the beta cells of the pancreas, result of viral infection, autoimmune reactions, and genetics |
| Type II Diabetes | Non-insulin dependent, A disorder of middle-age, striking those over age 40, Obesity major contributor, |
| Type II Diabetes are sensitive to | Stress. Lack of social support even more problematic |
| Managing Type II Diabetes: | must reduce sugar and carbohydrate intake, encouraged to achieve normal weight, encouraged to exercise |
| Interventions with Diabetics: | cognitive-behavioural interventions to improve adherence to their regimen, weight control improves glycemic control, behaviour mod |
| Old knowledge about diet includes | increase nutrition, decrease unhealthy substances (eg triglycerides), while looking at health signs like obesity, diabetes and cholesterol |
| Insulin resistance | Sugar demands pancreas to produce insulin to tame glucose levels. System starts to wear out, increasing with age |
| The metabolic syndrome | heart disease, lipid problems, hypertension, type 2 diabetes, dementia, cancer, polycystic ovarian syndrome, fatty liver disease |
| Gluten triggers the release of | zonulin (controls gut permeability) |
| What is Psychoneuroimmunology?: | Interactions among behavioural neuroendocrine, and immunological process of adaptation |
| Indicators of immune functioning: | cells and antibodies, A state of Immunocompetence - immune system is working effectively |
| the surveillance system of the body | The immune system: |
| The immune system: | humoral and cell-mediated immunity |
| Interventions to enhance immune functioning: | Relaxation (research shows higher NK cell activity after relaxation intervention) |
| The immune system may be vulnerable to.. | stress, depression and grief (permanently affect the immune system in ways that persist into adulthood) |
| Autoimmune Disorders | Grave’s disease, chronic active hepatitis, inflammation of the liver, lupus, inflammation of connective tissue, M.S. destruction of myelin sheath, rheumatoid arthritis, IBD, such as Crohns or ulcerative colitis and Type 1 diabetes |
| History of Acquired Immune Deficiency Syndrome (AIDS) | first appearance is unknown, began in Central Africa, 1970s & spread rapidly. First diagnosed case in Canada 1982 |
| The viral agent in AIDS is | a retrovirus (Human immunodeficiency virus - HIV) - attacks helper T-cells, highly variable time between contracting and developing symptoms |
| How HIV infection progresses: | mild early symptoms - flu like 3-6 weeks - then asymptomatic period (Can be many years), immune system increasingly compromised, opportunist infections (kaposi sarcoma, gynecologic infection) |
| Treatment for HIV | highly active antiretroviral therapy (HAART)
- protects from advancing to AIDS |
| Negative beliefs about self is correlated with | decline in helper T cells |
| Cancer | Dysfunction of DNA-part of cellular programming that controls cell growth and reproduction |
| Why is cancer hard to study? | many cancers are species-specific, develop in different ways in different species, many cancers have long/irregular growth cycles, high within-species variability |
| What leads to cancer? | genetic basis, ethnically linked, lifestyle, SES risks, malnourishment, depression, repressive coping, |
| Mechanisms linking stress, coping and cancer: | Psychological stress lowers ability of NK cells to destroy tumours, alterations in biological stress regulatory pathways may affect course of cancer |
| Physical limitations of cancer | pain and discomfort, down-regulation of immune system, fatigue |
| Treatment-related problems of cancer | cosmetic problems, surgical removal of organs, body image concerns, use of prosthesis, nausea and vomiting, immune suppression |
| Rheumatoid Arthritis (RA): | crippling form of arthritis believed to result from an autoimmune process - affects small joints of hands, feet, wrists, knees, ankles and neck |
| Rheumatoid Arthritis (RA) in those age 65+....... 50-65...... 35-49... 18-34 | 45%.... 27%....... 9.7%....... 2.8% |
| Treatment of RA | aspirin, rest, supervised exercise, cognitive-behavioural interventions, enhancement of perceived self-efficacy |
| Osteoarthritis | Most common form of arthritis in Canada - 4.4 million in 2010 |
| Osteoarthritis | obesity is the only modifiable risk factor |
| Osteoarthritis | the articular cartilage (smooth lining of a joint) begins to crack or wear away because of overuse |
| Osteoarthritis | affects weight-bearing joints |
| Treatment for Osteoarthritis | keeping weight down, exercise, aspirin |
| Gout | build-up of uric acid crystals, treated by diet, fluids and exercise |
| Lupus | skin rash can appear on the face, leading to chronic inflammation, pain, heat, redness and swelling |
| what leads to greater expectancy for pain in the future? | memory of intensity of previous experience (versus the actual pai intensity) |
| pain behaviours | facial and audible expressions, distortions in posture or gait, negative affect, avoidance of activity |
| Chronic benign pain | persists longer than 6 months, intractable to treatment (ex chronic low back pain) |
| Recurrent acute pain | series of intermittent episodes that are acute but chronic (ex - migraines) |
| Chronic progressive pain | persists longer than 6 months, increases in severity over time |
| subjective reports of health have been found to predict objective measures such as | cortisol responses to stress, morbidity and mortality |
| One of the most important parts of evaluating quality of life is | psychological distress |
| most benefits reported by myocardial infarction patients involved....... while cancer patients reported changes in.... | lifestyle changes/health habits...... social relationships & meaning of life |
| self concept - | stable set of beliefs about one's qualities and attributes |
| self esteem | general evaluation of self concept (feel good or bad) |
| Aspect of cancer patients find most stressful | 41% uncertainty about future, 24% limitations, 12% pain management |
| Chronic illness sufferers use more | Passive coping strategies (positive focus, escape) than active (planning, problem solving, confrontative coping) |
| In families with chronic illness, divorce rates are | the same |
| why does caregiving compromise the health of a caregiver? | depression |
| Who has a higher burden of disease | women due to disproportionate burden of household responsibilities |
| A difference in psychotherapy done with medical patients | likely to be episodic rather than continuous |
| A difference in psychotherapy done with medical patients | collaboration with family and Dr. important & must have comprehensive knowledge of illness and treatment |
| A difference in psychotherapy done with medical patients | More frequently requires respect for patients' defences |
| Main cause of infant death in Canada | congenital abnormalities & SIDS |
| Leading cause of death in Canadian children after first year | accidents/ external causes |
| Second leading cause of death in Canadian children after first year | Cancer |
| Major cause of death in adolescence | accidents, especially automobile |
| Second leading cause of death in adolescence | suicide (followed by cancer then homicide) |
| Major cause of premature death in adulthood | heart attack or stroke |
| It is best to keep systolic blood pressure under | 120.... consistently between 140-159=hypertension |
| left brain stroke damage includes | communication disorders, difficulty learning new tasks, short term memory tasks, anxiety and depression |
| Right brain stroke damage includes | visual feedback problems, reading problems, alexithymia, indifferent emotional reaction |
| Many interventions to increase treatment adherence include | increasing awareness or education/ information ..... for |
| two general approaches to indicate immune functioning | measuring numbers of different kinds of cells in the immune system by looking at blood samples., and assessing the functioning of immune cells |
