Psychology of Patient Care

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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.

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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

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Anxiety Disorders

• Most common mental illness in N. America
• lt25 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?

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Neuropsychologic Approach

• Genetic component to anxiety some people are
  born worriers
• MRI studies suggest differences in the way
  anxious and non-anxious peoples brains respond
  to stress
• Anxiety breakdown in mechanism that keeps
  normal anxious response from spinning out of
  control

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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

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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?

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Behavioural Approach

• Rather than block anxiety-provoking stimuli,
  try to get patient accustomed to it so they dont
  experience it in the same manner through use of
• habituation techniques
• conditioning techniques (desensitizing)
• reward structures

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Developmentalist Approach

• Anxiety can be seen as a mis-fit between stage of
  development and the environment
• Use developmental theory to align environment to
  individuals stage and needs
• e.g. Stage 6 (Early Adulthood (20-35))
• - major crisis is intimacy vs. isolation
• - address this issue to deal with anxiety

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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

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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

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Socio-psychologic approach

• Determine how individuals 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

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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

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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

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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

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Summary

• Major issues in pharmacy practice include
• - mental health issues
• - lifestyle modification issues (smoking, diet,
  unsafe sexual practices, etc.)
• - motivation for compliance to medication/lifestyl
  e modification regimes

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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

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Case Study