26.1 - Introduction to Psychology

Question 1

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

Answer 1

Question 2

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

Answer 2

• 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.

Question 3

Give an example of a double-dissociation study.

Answer 3

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

Question 4

Recall is a … process.

[IMPORTANT]

Answer 4

Reconstructive

Question 5

What is meant by the reconstructive nature of recall?

[IMPORTANT]

Answer 5

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

Question 6

Give an example of the reconstructive nature of recall.

Answer 6

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

Question 7

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

Answer 7

• 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)

Question 8

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

Answer 8

• Patients beliefs that clash with treatment
• Forgetting advice

Question 9

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

Answer 9

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

Question 10

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

Answer 10

• 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)

Question 11

What is the serial position recall effect?

Answer 11

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.

Question 12

Is non-adherance a good term?

Answer 12

• 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

Question 13

What are Medically Unexplained Symptoms?

[IMPORTANT]

Answer 13

• 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.

Question 14

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

Answer 14

• 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)

Question 15

Give some clinical relevance relating to the importance of MUS.

Answer 15

• 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

Question 16

How can Multiple Unexplained Symptoms (MUS) be treated?

Answer 16

• 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.

Question 17

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

Answer 17

• 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

Question 18

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

Answer 18

• 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.

Question 19

What is psychological debriefing?

Answer 19

• 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.

Question 20

To whom was psychological debriefing frequently given?

Answer 20

Victims of civilian trauma and military personnel

Question 21

Describe an experiment relating to the success of psychological debriefing.

Answer 21

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

Question 22

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

Answer 22

Mechanism unclear, but it could be due to:

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

Question 23

Do NICE guidelines recommend psychological debriefing?

Answer 23

• 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.