+ Individuals, Groups and Society (IGS)

Adherence Adherence means following the advice of health care professionals Most medical interventions rely on patient adherence Patients can sometimes not follow advice. Some patients may intend to take some

recommended medication but forget to do so. Others may disagree with the diagnosis and decide not to take on the advice

There are a number of factors that influence adherence as it is most likely when patients understand what they are asked to do and why

Non adherence Non adherence is defined as the failure to follow advice

How can adherence be increased? Patients are most likely to feel satisfied and understand advice when doctors find out what

they think is wrong and discuss Adherence is most likely when patients understand what they are being asked to do and why Patients must also remember what they are told if they to act on it later Satisfaction with the doctor increases adherence The doctor should seek an agreement with the patient to find out what is wrong with them

and what should be done about it Instead of encouraging adherence doctors should seek to establish concordance in their

consultations If doctors can concord about treatment then patients are most likely to adhere. Doctors should ensure that the recommended treatment is clearly understood Adherence is more likely when patients understand advice, remember it and feel satisfied

with the consultation Doctors can increases satisfaction by being more friendly and considerate Adherence is more likely when doctors consider and discuss the patients perspective and

understanding Doctors can increase understanding by simplifying instructions and information and

discussing the patients health beliefs Doctors can increase patients recall by giving specific advice and repeating instructions

Complimentary Therapies Complimentary Medicine

o Used alongside conventional medicine (in most cases) Alternative Medicine

o Substitute for conventional medicine (considered inappropriate) Reasons why people choose complimentary medicine

o Dissatisfied with conventional medicineo Risk associated with conventional medicine

Little or no pain Side effects with CAM

o Consultations tend to be longer so the person is able to convey symptoms and concerns more effectively, lead to higher satisfaction rating

Types of complimentary therapies:o Group 1: Osteopathy, Chiropractic , Accupuncture, Herbal Medicine, Homeopathy

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o Group 2: Therapies used to compliment conventional medicine and don’t claim to diagnose. Aromatherapy, Reflexology

o Group 3: Claim to diagnose and treat, Chinese Medicine, Crystal TherapyIllness

Subjective experience Different definitions by different people It is a social concept defined differently by different social groups Illness can be thought as a moral category especially in a society that emphasizes personal

responsibility for health People initially provide public accounts of their experience and concepts of illness in contrast

to more private accounts as the doctor-patient relationship grows There are various public accounts of illness It is split up into three groups

o Normal illness For example childrens infectious disease

o Real illness For example major life threatening diseases

o Health problems that are not illness Conditions with ageing

Reproduction It is important to distinguish between disease, health and illness

o Disease medical science plays a crucial role in defining disease but this definition changes

over time. Typically in western medicine disease are now thought to have signs and symptoms It is considered to be objective If the definition of normal relates to what is statistically normal is not always clear

cut when we get pathologically abnormal What is normal for one person isn’t always normal for another person Normality can be seen as socially rather than biologically defined

Stigma Associated with the works of Erving Goffman Severe social disapproval of personal characteristics or beliefs that are against cultural norms Examples of social stigmas can be found in physical mental disabilities or disorders Erving Goffman defined stigma as “a process by which the reaction of others spoils normal

identity." Goffman was particularly interested in the public humiliations and social disgrace that may

happen to people where highly negative labels were applied He made the distinction between

o Discreditable stigma One that is not known about the world at large. Only the person with the

stigmatizing condition and a few close inmates will know about it. For example – having a scar on your leg that is covered by a pair of trousers

o Discrediting Stigma Stigma that cannot be hidden from other people because it is obvious and visible For example, having a physical disability such as Duchene Muscular Dystrophy – this

can be physically seen. Stigmatization can be seen as a form of discrimination. There is a distinction between enacted stigma and felt stigma Enacted stigma

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o Real experience of prejudice, discrimination and disadvantage as the consequence of a particular condition

Felt Stigmao Scambler and Hopkins research has shown that in the case of epilepsy actual

stigma is rare. But the fear that discrimination might occur influences patients to a large extent

Race The concept of race does not exist in any biologically meaningful way Dividing people into populations or groups on the basis of various sets of characteristics on

ancestry The most common human racial categories are based on visible traits such as skin colour,

facial features etc

Ethnicity Complex concept consisting of the interplay between culture, history and language and so on Ethnic minorities are at an increased risk of poverty due to the effects of racism Population of human beings whose members identify with each other Ethnicity is also defined by others as a distinct group and by common linguistic, cultural,

behavioural, religious and biological traits Ethnicity is measured in the UK by asking people to assign themselves to a category, as in the

2001 census in England

Culture Set of shared beliefs, values and attitudes that guide behaviour People identify themselves as members of a group on cultural grounds, they may share

similar histories, think of themselves in relation to the colour of their skin, continent of ancestry and cultural background

Concepts of race, ethnicity and culture are related Art, literature and music can contribute to culture

Stereotype Generalization about groups and individual members of that particular group This may be positive, negative or prejudicial Most stereotypes make the person saying the phrase more superior to the group/person

being stereotypedDiscrimination

Behaviour or action intended towards a group because of the fact that they are in that particular group

Unequal treatment to people in a particular group Three types

o Personal Directed to a particular individual Refers to an act that leads to unequal treatment because of the individuals real

group membershipo Legal

Unequal treatment on the grounds of group membership that is guided by lawo Institutional

Unequal treatment that is entrenched in basic social institutions It results in advantaging one group over the other

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For example – the indian caste system For example: Discrimination of age, Gender, Sex, Sexuality, Race, Ethnicity

Prejudice Prejudging a particular person/group. Antipathy means negative feeling John Farley mentioned that there are two types of prejudice

o Cognitive prejudice Refers to what people believe to be true

o Affective prejudice What people like and dislike E.g. particular races, ethnicity

Prejudice is having bias and opinions about groups such o Racism, Heterosexism, Ageism, Feminism

Ageism Prejudice against old people simply because they are old Maybe because indictive fear of old age in contemporary society The fear is associated with the belief that chronological age results inevitably in mental and

physical decline Jerrome defined old age as

o “state of feeling and behaving rather than a chronological state”

Deviance Violation of social norms For example crime is the social deviance of law Staying in bed when others are working Deviance is not a characteristic of the behavior itself but it is the characteristic of its

interpretation The sick role is a response to deviance

Biographic disruption Rest of life has been changed due to illness Dreams and desires are harder to fulfil Plan of life has been altered due to the chronic illness Alteration in biography of the individual

AnxietyEmotional state that is divided into three components

o Thoughts Often act as trigger for creating the state of anxiety e.g. what if foot slips off a ledge

and i slipo Physical symptoms

These are numerous. Most commonly include an increased heart rate, blood pressure and feelings of tension in muscles, sweating and nausea

o Behaviour Involved in reduction of anxiety e.g. refusing to go on rockface or avoiding interviews

or deep breathing Types of anxiety problem

o High anxiety interferes with everyday function is categorised as: Phobias

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Fear that is out of proportion to the potential threat posed by a particular object or situation e.g. being afraid of a pit bull terrier wouldn’t be classed as a phobia but being afraid of a moth would as there is a significant risk to safety in first but not second

Generalised anxiety Refers to the experience of all pervasive anxiety not apparently linked to any

specific situation or object. The person experiences a high state of arousal and a general sense of dread. Likely to experience uncontrollable worry, a variety of somatic complaints, tension and restlessness

Panic attacks Sudden waves of acute anxiety that seem to come out of the blue. People may

be overwhelmed by feelings of loss and control and going mad and even dying. Panic attacks in public places involve a feeling of being trapped are called agrophobia

OCD Treatment

o Methods of treatment depend on: Nature of anxiety, Impact on everyday life, Individual preference

o Drugs; These can be worked to reduce physiological symptoms of anxiety

Stress Stress is generated when we think that we may not be able to meet perceived demands and

expect negative consequences to follow It arises out of the relationship between our perception of appraisal of environmental

demands and or own resources Our experience of stress doesn’t always correspond to others assessment of the demands

that we face Stress involves negative emotional response affecting physiological functioning Factors influencing Stress

o When we are familiar with an event we are less likely to feel stressedo For example – when a doctor who has previous experience of preparing surgery is less

likely to feel stressed than a doctor who has no experienceo Feeling stressed also undermines our performance as we may feel distracted by our own

worries and seek to avoid the task than manage it wello We are less likely to feel stressed when we know the demanding situation will be short

termo Greater control results in less stress – when people are unclear about their role in work it

is most likely to cause stresso Stress can also be caused by role conflict when the demands of one role prevent the

person fulfilling the demands of another role. Measuring Stress

o Numerous self report measures of stresso Holmes and Rahe in 1967 developed the first “life events” scaleo This approach involves asking people to list events in their recent past that might be

expected to be stressful and adding up the burdeno For example the death of a close family member warrants a high score (100) while

trouble with a boss attracts a lower score (23)o The scale acknowledges that change in general can cause stresso Stress affects the sympathetic nervous system and thus we can measure the sympathetic

nervous system activity as indicators of the arousal of stress

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o These include: Respiration rate, Blood pressure, Heart rate, Skin conductance, Corticosteroids, Catecholamines

Stress and the Cardiovascular System – PERSONALITYo Continued stress can damage the CV system over timeo Personality factors makes some people likely to experience stress more than otherso Two types of personality

Type A People who are very ambitious in relation to the amount they try to get done in

a limited time and are more likely to be competitive and hostile towards others This may result in strong, frequent stress responses which result in considerable

wear and tear on the cv system Such stress responses may precipitate a myocardial infarction

Type B Low on competitiveness Hostility appears to be a particularly dangerous personality trait with those

scoring highly on hostility having a greater chance of coronary heart disease Stress and Immune Response

o Stress is associated with weaker immune response and slower wound healingo For example - medical students report that higher stress during exams show reduced the

T helper (CD4) cellso Similar examination has shown that ongoing stress make us susceptible to infection, slow

wound healing and surveillance Stress and risk behaviour

o As well as affecting our CV and immune system stress an increase the likelihood of illness indirectly by means of our behaviour

o People who feel stressed are less likely to take preventative measureso They may take risks with their health through drug abuse and alcohol abuse and sleep

loss. Helping people deal with stress

o Social support and emotional supporto Encouraging people to change their appraisals o Relaxation training and alternative medicine

Quality of Life WHO – “individuals perceptions of their position in life in the context of the culture and

value systems in which they live and in relation to their goals, standards and concerns” Calmsn (1984) “The extent to which hopes and ambitions are matched by experience” 6 areas

o Physical healtho Psychological stateo Level of independenceo Social relationshipo Environmental featureso Spiritual concerns

QOL is a multidimensional concept that included both positive and negative aspects of life QOL used to be seen as a objective assessment of the persons functioning, whereas the

current approach tries to measure QOL as an individuals perceived health status or well being

QOL is individual Different factors affect QOL for different people

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QOL is a dynamic construct and changes over time QALYs

o Quality of life adjusted yearso Measure derived from a combination of mortality, morbidity and function o Improvement of the QOL will be the aim o the patient and the health professionalo QALYs quantify the capacity of the population to benefit from a health service

intervention o The capacity to benefit is one way of defining need

Models and psychosocial theories

Biomedical Model Most commonly held in western society and focuses on the physical process of disease and

mechanisms of action Childbirth is pathological and since we cannot predict its risks we must admit women to the

safest environment Pregnancy and childbirth are only safe in retrospect Emphasis:

o Risko Risk reductiono Illnesso Women = passive

Psycho-social Model General model that claims that biological, psychological, love and social factors play a

significant role in human functioning in the context of disease or illness It is a contrast to the biomedical model The treatment of a disease requires the health care team to look at psychological and

sociological factors as well Pregnancy and childbirth are normal events in most women’s life cycle 85% of all babies will be born without any complications Many risks in childbirth can be predicted and thus pregnant women most at risk can be

selected for hospital delivery at a specialist obstetric hospital Childbirth is normal until the pathology occurs Emphasis:

o Normalityo Social Supporto Healtho Women = active

Sick role model

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Developed by Talcott Parsons in the 1950s It is a contrast to the biomedical model, which pictured illness as a mechanical malfunction Parsons defined the sick role as a temporary, medically sanctioned form of deviant behaviour The sick role model outlined two rights and two obligations of the sick person Rights:

o The sick person is exempt from normal social ruleso The sick person is not responsible for their condition

Obligation: o The sick person should try and get wello The sick person should seek technically competent help and cooperate with the medical

professional

Stress coping paradigm The stress coping paradigm was originally developed by Lazarus in the 1980s

People have to cope and adapt to different things

The degree to which this produces stress is determined by the extent to which these external stimuli are perceived to exceed the ability of the person to deal with them, and so endangering their well being

When confronted with a stimulus that is potentially stressful an individual engages in two processes of appraisal

Primary appraisal

o is the means whereby the person determines whether or not a stimulus is dangerous or not

o If the stimulus is not dangerous then it isn’t relevant for them, If the stimulus is benign and positive. If the stimulus is perceived benign/positive/irrelevant then it is not a stressor. If the stimulus is regarded as stressful this is because it is perceived to represent harm, loss or threat

Secondary appraisal

o process is about mastering the condition of harm or threat

o Several forms of doing this: Seeking information, taking direct action, confronting the stressor, doing nothing, attempting to ignore, worrying

The importance of this model is that it recognises that stimuli are not themselves stressful. Stress arises as a consequence of the cognitive thinking process which people bring to bear on a particular stimuli. When the patient cannot control things then stress arises.

Stress and chronic illnessIt has been argued that stress and failure to cope is responsible for the development of a particular type of illness because certain biological responses in the individual lead to tissue damage

Strategies to coping with chronic illness

Normalising

Patient acknowledges the symptoms but redefines them as part of normal existence

Denial

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Patient denies the existence of illness altogether. his may have benefits especially in the early stages of a threatening diagnosis. Denial may help the patient draw back from the condition and resume their daily tasks in the short term. However, in the long term denial prevent the patient from confronting the illness

Avoidance

Don’t deny their problem. Set to avoid situations that might exacerbate their symptoms e.g. – a reformed alcoholic avoids going to occasions with alcohol. This poses threats as the person who is a reformed alcoholic might miss out on other social opportunities provided to them

Resignation

Person has totally embraced themselves in the illness and it is the most important thing to them. They resign themselves to the fate of the illness. In less serious conditions resignation leads to invalidism

Accomodation

Patient acknowledges and deals with the problem that the illness produces. The everyday handling of the disease is seen as part of normal living

Health Belief Model Psychological model that attempts to explain peoples health behaviours Focuses on peoples beliefs about the threat of ill health and the costs and benefits of health

behaviouro Perceived susceptibility

Ones opinion on the chances of getting a condition How likely am I to contract breathing difficulties or contract lung cancer if I smoke?

o Perceived severity The anticipated severity or consequences of an action How bad would it be if I suffered from breathing problems if i smoked

o Perceived Benefits Benefits of the health behaviour If I give up smoking what will i gain?

o Perceived Barriers Cost barriers associated with the behaviour How difficult would it be to give up smoking? What would i lose? How much money

will it cost?

Transtheoretical ModelIt is a model to show how people modify a problem behaviour or acquire a positive behaviourIt focuses on decision making of individuals and helps us understand behaviour changeInvolves emotion, cognition, behaviour . Constructs change as a process involving progress through a series of five stages

o Precontemplation Patient not taking action to modify behaviour for next six months

Traditional health promotion programs are not designed for such people Patient may be aware of importance of change in behaviour

o Contemplation Intent to change in next six months

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Aware of pros and conso Cost and benefits may keep people in this stage for a long time (chronic

contemplation)o Preparation

Plan to take action in next month Taken some significant action in last year

o Has planned and ready to take adviceo Action

Behaviour has changed Person made some change over last six months

o Vigilance against relapse importanto Mantainance

Working to prevent relapse Becomes easier as people become confident

Relapse or regression occurs when people go back to an earlier stage from action or mantainanceTechniques are used to try and move people between stages

E.g. motivation and sending them to health promotion and health education classes

Self Regulatory Model Useful model to understand how patients react to threatening stimuli A useful model for understanding how people react to threatening information is Self

regulation or parallel processing modelo Stimuli

Getting told you have cancero Representation of Danger/fear

You start to think about the consequences of cancero Coping procedure

If people find the information threatening the abilities to cope will be poor They may focus on managing there emotion at the expense of managing the danger

o Appraisal If a pt perceives their illness or the information they have been given as very threatening or

their abilities to cope with it very poor, they may focus on managing their emotion at the expense of managing the danger

Emotion focused coping strategies include avoiding thinking about the threat, distracting oneself from it or denying that it exists

However this may mean that pt delays seeking help/non-adherent to recommended treatment – may prove detrimental to health

As a result it is important to give threatening info in a way that prevents people from being overwhelmed by emotion – allows them to develop coping strategies

Problem focused coping strategies include problem solving, action planning, expressing emotions and seeking social support

Disability coping Model

Three different models or perspectives of disability

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Each contribute to a broader understanding and achieving better medical, social and psychological outcomes for patients

o Medical Model

Activity limitations can be seen as a direct consequence of an underlying disease or disorder that causes impairment with a resulting disability

Suggests that disability can only be reduced by treating the medical condition

o Social Model

Emphasises that activity limitations result from social and environmental constraints

The individual isn’t just limited by their medical conditions but by their behaviour of others and environmental barriers towards them

o Psychological Model

So the individual will be more motivated to engage in the activity because it will result in them doing the things they like as they believe other people who are important to them would want them to do it because they can.

Role of Carers 4 types of carers Carer as a resource

o Most common viewo Natural order of things for a family to be responsible for the care of its memberso Little concern from the carers as they are only doing there duty

Carer as a Co-Workero Aims to mantain and increase informal careo Carers are given some support – such as domestic help, holidays, education and adviceo Relatives become “semi-professionals”

Carer as a Co-cliento Indirect client – legitimate focus for support and serviceo Client finds it easier to get support from services than NHS unless service seen to have

direct clinical outcome- all members of family are treated as clients Superseded Carers

o Looks at the future of the dependent persono Tries to make them independent and less reliant on supporto Most appropriate for those dependent on parents

Burden of Carers The impact on family is usually referred to as a burden Two types:

o Objectiveo Subjective

Objective Compromises the things that are externally observable and objectively quantifiable Includes:

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o Financial problems Loss or earning through loss of job

o Disruption to household Loss of freedom and privacy Carer loses outside contact as he is constantly involved in caring

o Effects on carer Physical injuries

Back pain Social isolation

Little support availableo The tasks the carer does depends on who is being cared foro Elderly pts – focused on physical tasks as person maybe able to do little for themselveso Psychiatric pts – more supervision and responsibility for finances/medication

Subjective o Difficult to measureo How the carer feels about caringo The carers main complaint is the lack of support availableo Carer m ay feel isolated and withdrawn from the sense of freedomo Family life changed dramatically – person may resent new role e.g. from a wife to a carer

– loss of mutual support in relationshipo Caring for chronically ill has a greater psychological effect – inevitably become affected

themselves by illness of family members – loss in Q of L similar to those of pto Informal care is regulated by social, cultural and context specific system of rights, duties

and obligations – ‘moral minefield’o Carers often need ‘professional skills of a nurse, remedial therapist, psychologist and

speech therapist’ as well as ‘unfailing optimism & patience’ o THERE ARE ALSO MANY POSITIVE ASPECTS OF CARING WHICH BRINGS MANY REWARDS

AND PLEASURES

Personalities One view is that people have a fixed personality that is deep inside but it is covered up like

layers of an onion- if only we could strip the layers we can uncover the real person lying within – these layers give colour or characteristics to a person. This is the trait theory of personality

Trait Theory

o Nomothetic theories

o Individuals are thought of having many traits

o These can be described by different sets of adjectives relating to behaviour

o There are three factors in trait theory:

Introversion-extroversion

People who score highly in extroversion are sociable, lively and assertive in contrast to introverts who are more retiring and controlled

Neuroticism – stability

People who score highly on neuroticism show anxiety and guilt feelings

Psychoticism –impulse control

Aggressive

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Cold

Lack of empathy

o Trait theories describe differences but we also want to know the reasons for being different

Psycho-dynamic theory

o Ideographic theory

o Assumption that behaviour is influenced by unconscious mind

o Using an iceberg analogy he described the part above the water as representing the conscious experience and the part below the water as the unconscious experience

o 3 major systems:

Ego

The ego is conscious and is in touch with the real world

Id

Id is child like and demands that its needs need to be fulfilled

Super Ego

Individuals conscious and tends to be authoritarian

People with different personalities are more susceptible to different diseases: e.g. type A and type B personalities in ischaemic heart disease

Parent – Infant Attachment Secure

o Strongest type

o A child in this category feels he can depend on his parent or provider. He knows that person will be there when he needs support. He knows what to expect.

The secure child usually plays well with other children his age.

He may cry when his mother leaves. He will usually settle down if a friendly adult is there to comfort him.

When parents pick him up from childcare, he is usually very happy to see them.

o Avoidant

o Non secure

This is one category of attachment that is not secure. Avoidant children have learned that depending on parents won’t get them that secure feeling they want, so they learn to take care of themselves.

Children may seem too independent. They do not often ask for help, but they get frustrated easily.

They may have difficulty playing with other children their age. They may be aggressive at times.

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Biting, hitting, pushing, and screaming are common for many children, but avoidant children do those things

Ambivalent

o Ambivalence (not being completely sure of something) is another way a child may be insecurely attached to his parents. Children who are ambivalent have learned that sometimes their needs are met, and sometimes they are not. They notice what behavior got their parents’ attention in the past and use it over and over. They are always looking for that feeling of security that they sometimes get.

o Ambivalent children are often very clingy.

o They tend to act younger than they really are and may seem over-emotional.

o Ambivalent children often cry, get frustrated easily, and love to be the center of attention.

They get upset if people aren’t paying attention to them and have a hard time doing things on their own.

Disorganised

o Disorganized children don’t know what to expect from their parents. Children with relationships in the other categories have organized attachments. This means that they have all learned ways to get what they need, even if it is not the best way. This happens because a child learns to predict how his parent will react, whether it is positive or negative. They also learn that doing certain things will make their parents do certain things.

o Disorganized children will do things that seem to make no sense. Sometimes these children will speak really fast and will be hard to understand.

o There are two types of disorganized attachments:

1) Controlling-Disorganized, children who are controlling tend to be extremely bossy with their friends. 2) Caregiving-Disorganized, children who are caregiving might treat other children in a childish way, acting like a parent.

Social Class General measure obtained by combining occupational groups equal in skill and general

standing in the community to form occupational classes in the UK It can be seen as an indirect indicator of education, income, standards of living and working

conditions Death rates for UK can be calculated for occupational classes by combining data on birth and

death certificates with occupational data 5 social classes in UK Type I- Profession, Large employers Type II- Lesser Professions, Teachers, Trade

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Type III- Skilled/Non Manual, Clerk Workers, Skilled/Manual, Electricians/Lorry Drivers Type IV- Semi- skilled/Manual, Farm workers Type V- Unskilled Manual, Building Labourers

What are the key features of immunisations?

Two types of immunization

Passive immunisation:

o is the donation of host specific antibodies against a particular agent by the injection of blood products derived from immune animals or humans. It is primarily used to give temporary immunity to those who are not immune. Passive immunity to common infections occur naturally through the transplacental transfer of antibodies from mother to baby.

Active Immunisation:

o active immunity to an infection is acquired naturally after recovery from infection with the organism. Artificial active immunity can be induced by the administration of an appropriate vaccine which stimulates the production of antibodies. This provides complete or partial protection

There are four main types of vaccines:

Inactivated vaccines -are made from whole organisms which are killed during manufacture. E.g. infected polio

Live vaccines -are made from living organisms, which are either the organisms that cause the disease or organisms whose virulence has been reduced by attenuation methods

Toxoids -are produced from bacterial toxins artificially rendered harmless e.g. diphtheria

Component vaccines -contain one or more of the component antigens of the target organism which are necessary to provoke an appropriate protective antibody response.

Health Risks of immunizations

Critics claim that the public health benefits of vaccination are exaggerated. The mortality rates of certain illnesses was reduced before vaccination was introduced

Secondary long term effects for introducing immunogens and adjuvents are still unknown

It is still unclear whether or not vaccinations can actually create immunity against certain diseases as some people who have been vaccinated have still contracted the illness

Religious objections

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Live or attenuated virus vaccination can actually produce the infection that the vaccine is supposed to prevent. For example, live polio should never be administered to a child who comes in contact with an HIV patient, for the attenuated virus can "leap" to the HIV patient and produce polio. Reports exist of normal parents who have developed polio from the viral vaccine given to their children.

A second mechanism of damage comes from neurotoxic materials found sometimes in vaccines. Thimerosol is the most widely discussed, since it contains mercury. The amount is small. Each vaccine is equivalent to the amount of mercury found in a 6 oz. Can of tuna fish. Nevertheless, some argue that even these levels may be important in a vulnerable child

Allergic reactions and the development of an auto-immune response, stimulated by the vaccine and its adjuvant. Vaccines always contain adjuvants, which are substances known to amplify the body's response to the vaccine. These adjuvants are known to sometimes cause allergic and auto-immune responses on their own.

Why do people self medicate? Easier than seeing the doctor Over the counter drugs are easily accessible Problems

o Wrong dosage takeno Wrong diagnosis of illnesso Wrong medication taken

Tolerance Effectiveness of a drug dose in producing a physiological response

Dependence Series of complex homeostatic mechanisms to cause disturbances if the drug is stopped

being usedAddiction

Addiction is the “behavioural pattern characterised by compulsive use of a drug ” Two models:

o Life Process Model Addiction is not a disease But rather a habitual response and a source of gratification

o Disease Model Addiction is a lifelong disease involving biological and environmental source of origin Genetic tendency seems to be present. Addiction could be genetic

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