26 - Introduction to Psychology Flashcards

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1
Q

What are the different ways in which psychology attempts to look at people?

A
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2
Q

How can you tell if two cognitive processes have distinct underlying mechanisms?

A
  • Single and double dissociation studies reveal underlying mechanisms.
  • If one patient has an impairment in process A but not B, while another patient has an impairment in process B but not A, then this suggests that the two processes are mechanistically distinct.
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3
Q

Give an example of a double-dissociation study.

A
  • In fluent aphasia, the speech is fluent but nonsensical
  • In non-fluent aphasia, the speech is not fluent but it mostly makes sense
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4
Q

Recall is a … process.

[IMPORTANT]

A

Reconstructive

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5
Q

What is meant by the reconstructive nature of recall?

[IMPORTANT]

A
  • Memory is a combination of actual events AND knowledge, experience and expectations.
  • In other words, recall of information is tainted by other factors.
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6
Q

Give an example of the reconstructive nature of recall.

A

Loftus & Palmer (1974):

  • Showed subjects a video of two car accident
  • Asked “What speed were the cars travelling when they collided / smashed?”
  • Results:
    • Use of the word “smashed” leads to higher speed estimates
    • False memory of glass on the road when prompted
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7
Q

What are some studies that show the impact of non-compliance with medical advice?

A
  • Approx 50% patients comply with medical advice but figure can drop as low as 10% (Ley 1997)
  • It causes half deaths of people with renal failure (Christensen & Moran, 1998)
  • Improving compliance to existing treatments can be more effective than improving treatment itself (Haynes et al., 1996)
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8
Q

What are the two main causes of patient non-compliance?

A
  • Patients beliefs that clash with treatment
  • Forgetting advice
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9
Q

Give some experimental evidence relating to patients forgetting advice from a GP consultation.

A

Average around 50%, but can be higher even a few minutes after consult. (Ley 1988)

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10
Q

What are some techniques for improving patient memory of medical advice?

A
  • Put important information first & last
  • Organize information into meaningful groups
  • Restrict info to what patient can process
  • Repeat and otherwise emphasize key information
  • Use simple words and short sentences
  • Be specific (walk 20 mins each day, rather than exercise more)
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11
Q

What is the serial position recall effect?

A

The way in which information presented at the start and end of a conversation is recalled much better than information in the middle of the conversation.

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12
Q

Is non-adherance a good term?

A
  • It is better than “non-compliance”, which is a more dated term that implies that the patient must “obey” the doctor
  • We are now moving more to terms such as “concordance” and “shared decision making”, emphasising the importance of including the patient and nurturing a better relationship with them
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13
Q

What are Medically Unexplained Symptoms?

[IMPORTANT]

A
  • Repeated medical help-seeking for multiple medical symptoms without organic disease.
  • In other words, it is when there are physical symptoms for which no clear or consistent organic pathology can be demonstrated.
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14
Q

What are Multiple Unexplained Symptoms very similar to and what is the difference?

A
  • Somatic Symptom Disorder (SSD) -> This is when a psychological illness is expressed through physical symptoms in cases where this cannot be explained
  • Multiple Unexplained Symptoms (MUS) -> This is when there are physical symptoms for which no clear or consistent organic pathology can be demonstrated.

Although the two closely overlap, the difference is that SSD is where a psychological disease presents as physical symptoms, while MUS is when there are unexplained physical symptoms. (CHECK THIS)

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15
Q

Give some clinical relevance relating to the importance of MUS.

A
  • UK GP study reported prevalence of 18% consecutive attenders with MUS (Taylor et al 2012)
  • Worldwide study 25-50% of primary care patients presenting with MUS (Edwards et al 2010)
  • Biological cause found for only 26% of 10 most common symptoms in primary care
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16
Q

How can Multiple Unexplained Symptoms (MUS) be treated?

A
  • Cognitive Behavioural Therapy (CBT) approaches have been shown to reduce the intensity and frequency of somatic complaints and to improve functioning in many somatising patients (Abbass et al 2009)
  • This starts with the mutual agreement that whatever the patient has been thinking and doing about the condition has not been successful.
  • It then challenges the patient’s beliefs and maladaptive behaviours, in a caring manner.
17
Q

Give an example of how CBT can be used to treat Multiple Unexplained Symptoms.

A
  • The diagram shows the MUS case, where the patient experiences more symptoms due to focusing on them
  • CBT can be used to take focus away from the symptoms
18
Q

How can you assess a patient with Multiple Unexplained Symptoms (MUS)?

A
  • Identify patients’ concerns and beliefs
  • Review history of functional symptoms
  • Explicitly consider both disease and functional diagnoses
  • Appropriate medical assessment with explanation of findings
  • Use screening questions for psychiatric and social problems

NOTE: Don’t just assume a psychological cause because the physical tests are negative.

19
Q

What is psychological debriefing?

A
  • A formal version of providing emotional and psychological support immediately following a traumatic event
  • The goal is to prevent the development of post-traumatic stress disorder and other negative sequelae.
20
Q

To whom was psychological debriefing frequently given?

A

Victims of civilian trauma and military personnel

21
Q

Describe an experiment relating to the success of psychological debriefing.

A

Mayou, Ehlers & Hobbs, 2000:

  • Took patients with experience of either high or low severity traumatic events
  • Divided these into debriefing and non-debriefing groups
  • Provided a 1 hour debriefing session to those in the debriefing groups
  • Followed up at 4 months and 3 years to assess the outcomes
  • All the groups saw a decrease in the impact of event score (i.e. the events became less traumatic in their memory), but the high trauma debriefing group saw a markedly smaller decrease
  • This suggested that, suprisingly, the debriefing appeared to be less effective than no debriefing
22
Q

What are some reasons why psychological debriefing might not be effective?

A

Mechanism unclear, but it could be due to:

  • Early exposure to memory of event interfering with natural recovery process
  • Debrief leading to additional rumination
23
Q

Do NICE guidelines recommend psychological debriefing?

A
  • No, they advise against it due to the poor (and possibly deleterious) effects.
  • Instead they suggest watchful waiting for the first 3 months and intervention only if the patient gets stuck in their recovery.