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Department of nervous diseases, psychiatry and medical psychology




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Ministry of Health of Ukraine

Bukovynian State Medical University

Department of nervous diseases, psychiatry and medical psychology



Approved on the methodology meeting

of the Department of nervous diseases, psychiatry

and medical psychology

on “____” ___________ 2009 (Report No __).

Chief of the Department

_______________________

Professor V.M.Pashkovskyy


MethodOLOGical INSTRUCTION

for the lesson

Theme 8: Psychological aspects of addiction. Suicidal behavior, prophylaxis and early recognition of suicidal tendency. Psychological aspects of dying and death. Euthanasia.


For 4-th year students of medical faculty No 2


Module 1. Medical psychology

Topical module 2. Practical aspects of medical psychology


Сhernivtsi, 2009


^

1. Actuality Aim

Addiction means a person has no control over whether he or she uses a drug or drinks. A person who's addicted to cocaine has grown so used to the drug that he or she has to have it. Addiction can be physical, psychological, or both.

2. Hours: 2


3. Teaching goal

The students must know:


  • Psychological aspects of addiction;

  • Suicidal behavior;

  • prophylaxis and early recognition of suicidal tendency;

  • Psychological aspects of dying and death;

  • Euthanasia.


and be able to:

  • objectively and scientifically determine the psychological factors of addiction;

  • interpret suicidal behavior;

  • analyze psychological peculiarities of patients with suicidal behavior;

  • to determine the psychological aspects of dying and death;

  • to determine the Euthanasia.

Assimilate practical skills

  • analyze psychological peculiarities of personality of suicidal behavior;

  • communication with patients;

  • experimental-psychological research of personality.


^ 4. List of disciplines necessary

for learning theme 1


Title of the discipline

Content of the discipline necessary for learning medical psychology

Anatomy

Brain construction

General psychology

Psychic functions of a normal person. Consciousness and self-consciousness. Psychology of personality.

Neuropsychology

Functions of different brain structures.

Normal physiology

Brain functions. Physiology of high nervous activity.


^ 5. Content of the theme


Addiction means a person has no control over whether he or she uses a drug or drinks. A person who's addicted to cocaine has grown so used to the drug that he or she has to have it. Addiction can be physical, psychological, or both.

Physical addiction is when a person's body actually becomes dependent on a particular substance (even smoking is physically addictive). It also means that a person builds tolerance to that substance, so that person needs a larger dose than ever before to get the same effects. When a person who is physically addicted stops using a substance like drugs, alcohol, or cigarettes, he or she may experience withdrawal symptoms. Withdrawal can be like having the flu — common symptoms are diarrhea, shaking, and generally feeling awful.

Psychological addiction happens when the cravings for a drug are psychological or emotional. People who are psychologically addicted feel overcome by the desire to have a drug. They may lie or steal to get it.

A person crosses the line between abuse and addiction when he or she is no longer trying the drug to have fun or get high, but because he or she has come to depend on it. His or her whole life centers around the need for the drug. An addicted person — whether it's a physical or psychological addiction or both — no longer has a choice in taking a substance.

Signs of Addiction

The most obvious sign of an addiction is the need to have a particular drug or substance. However, there are many other signs that can suggest a possible addiction, such as changes in mood or weight loss or gain. (These are also signs of other conditions, too, though, such as depression or eating disorders.)

Signs that you or someone you know may have a drug or alcohol addiction include:

^ Psychological signals:

use of drugs or alcohol as a way to forget problems or to relax

withdrawal or keeping secrets from family and friends

loss of interest in activities that used to be important

problems with schoolwork, such as slipping grades or absences

changes in friendships, such as hanging out only with friends who use drugs

spending a lot of time figuring out how to get drugs

stealing or selling belongings to be able to afford drugs

failed attempts to stop taking drugs or drinking

anxiety, anger, or depression

mood swings

Physical signals:

changes in sleeping habits

feeling shaky or sick when trying to stop

needing to take more of the substance to get the same effect

changes in eating habits, including weight loss or gain

^ Getting Help

A lot of people think they can kick the problem on their own, but that doesn't work for most people. Find someone you trust to talk to. It may help to talk to a friend or someone your own age at first, but a supportive and understanding adult is your best option for getting help. If you can't talk to your parents, you may want to approach a school counselor, relative, doctor, favorite teacher, or religious leader.

Unfortunately, overcoming addiction is not easy. Quitting drugs or drinking is probably going to be the hardest thing you've ever done. It's not a sign of weakness if you need professional help from a trained drug counselor or therapist. Most people who try to kick a drug or alcohol program need professional assistance or treatment programs to do so.


All patients with a serious interest in assisted suicide suffered from depression and feelings of hopelessness

"The difference between the ordinary suicidal person and the terminally ill suicidal patient is the reaction he meets in the therapist"

"Physician-assisted suicide" involves a medical doctor who intentionally provides a patient with the means to kill him or herself, usually by an overdose of prescription medication. Assisting in a suicide is not necessarily an action limited to physicians. The term "assisted suicide" applies if a layperson provides the deadly means to the patient.


The current legal and policy debate in the United States involves physician-assisted suicide, not euthanasia.


The term "euthanasia" comes from the Greek word for "good death." Based on the word's origin, many view euthanasia as simply bringing relief by alleviating pain and suffering. The word has also been used to represent the decision to refrain from using "heroic" measures in an end-of-life situation. The term "passive euthanasia" has been used in this context.


Euthanasia involves the intentional and direct killing of a patient by a physician or another party, ostensibly for the good of the patient or others. In other words, someone administers the means of death to the patient. The most common form of euthanasia by a physician is lethal injection. Euthanasia can be voluntary (at the patient's request), non-voluntary (without the knowledge or consent of the patient) or involuntary (against the patient's wishes).


While non-voluntary or involuntary euthanasia is viewed by some as a justified response to a patient's suffering, such actions often involve a physician or third party who is motivated by misguided compassion or has decided the patient's life has become a burden.

It is important to note that a person can reject medical treatment at the end of life without committing euthanasia. The present euthanasia debate is not about refusing treatment or using extraordinary measures. The issue is whether physicians should be allowed to intentionally kill their patients, either by providing the means of death or by directly ending the patient's life. There is a tremendous distinction between allowing someone to die naturally when medical technology cannot stop the dying process and causing someone to die through physician-assisted suicide or euthanasia. The question is one of intent. Physician-assisted suicide and euthanasia come into play if the intention is to cause the death of the patient.

While apparently accepting the concept of rational suicide, psychologists need to observe several caveats. First, there is an elevated rate of depression among those with medical and terminal illness, which, if untreated, could lead a patient to contemplate suicide. Second, psychologists always should be working to improve the patient's quality of life and to make the necessity of decisions about ending life as infrequent as possible. Third, if suicide is presented too readily as a rational option, our society may become more generally suicide-permissive. Finally, societal acceptance of suicide could open elderly and terminally ill patients to family and institutional pressures to end their lives prematurely.

Acceptance of the concept of rational suicide necessarily does not imply that the legalization of assisted suicide is seen as a wise decision in the current health-care climate. Thus, while a majority of psychologists in a recent survey believed that assisted suicide was morally acceptable under certain conditions, there may be good reason to be cautious about legalization. First, there are widely varying interpretations of the practice of voluntary euthanasia and assisted suicide in the Netherlands. Some argue that the Dutch have lost adherence to medical standards and have abandoned efforts at palliative care to the convenience of euthanasia or assisted suicide. Others arguing that the evidence does not support the notion that the Dutch have gone into a moral decline on this issue. Second, the health-care system in the United States currently is preoccupied with medical-cost containment, a situation that easily could lead to coercive practices concerning suicide and the terminally ill. The society might be served better if it focused on attaining a more stable health-care environment before attempting the legalization of assisted suicide.


Psychologists have a great deal of expertise that can be utilized for the benefit of patients who are faced with end-of-life decisions. They have therapeutic skills in facilitating communication at these difficult times. Those in behavioral medicine have developed strategies to aid in pain management and stress management. Many have expertise in assisting patients and their families with the grieving process. They can be qualified by education and experience to evaluate the terminal patient's capacity to make end-of-life decisions, such as refusing life-sustaining treatment or agreeing to increased pain relief that also may hasten death. Regarding the evaluation of the terminally ill patient who requests assistance in suicide, psychologists need to investigate if their state mental health laws allow them to conduct such evaluations and refrain from preventing the suicide. In addition, the current APA code of ethics needs to be examined to see if it will allow for participation in assisted suicide. Since a large percentage of psychologists seem to believe in the possibility of rational suicide for the terminally ill, some have called for a reexamination of psychology's standards and principles in this regard.


^ 5.2. Theoretical questions:

  1. Psychological aspects of addiction.

  2. Suicidal behavior.

  3. Prophylaxis and early recognition of suicidal tendency.

  4. Psychological aspects of dying and death.

  5. Euthanasia.


^ 5.3. Practical training during the tutorial

1. Clinical observation of the behavior of patients with addiction.

2. Research the psychological aspects of addiction.


5.4. Materials for self-control

A. Questions for self-control:

  1. Psychological aspects of addiction.

  2. Suicidal behavior.

  3. Prophylaxis and early recognition of suicidal tendency.

  4. Psychological aspects of dying and death.

  5. Euthanasia



B. Tasks for self-control

1. Typical, ordinary – II level.

2. Untypical, no ordinary – III level.

C. Tests for self-control.


Literature

  1. R.J.Gatchel An introduction to health psychology. – New York: Random house. – 386 p.

  2. Lectures.

  3. Internet resource.

  4. Вітенко І.С., Вітенко Т.І. Основи психології: Підручник для студентів вищих медичних навчальних закладів ІІІ – ІV рівнів акредитації. – Вінниця, 2001.

  5. Вітенко І.С., Чабан О.С., Бусло О.О. Сімейна медицина: психологічні аспекти діагностики, профілактики і лікування хворих. – Тернопіль, ”Укрмедкнига”, 2002.

  6. Гавенко В.Л., Вітенко І.С., Самардакова Г.О. Практикум з медичної психології. – Харків: Регіон-інформ, 2002.

  7. Квасенко А.В., Зубарев Ю.Т. Психология больного. М., 1980.

  8. Лакосина Н.Д., Ушаков Г.К. Медицинская психология. М., 1984.

  9. Менделевич В.Д. Клиническая и медицинская психология. – М.: Мед.прес., 1998.

  10. Мягков И.Ф., Боков С.Н. Медицинская психология: основы патопсихологии и психопатологии: Учебник для вузов.- М.: Издательская корпорация „Логос”, 1999.



Prepared by assistant N.V,Bagriy


Positive review

Prof. assistant N.S. Karvatska


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