Applications of Psychology to Medicine

Question 1

1. describe the 4 aspects of learning disability.
2. How can intelligence be measured? (3)
3. What IQ is required for a diagnosis of learning disability?
4. Describe the following
   a) Mild LD
   b) moderate LD
   c) Severe LD
   d) . profound LD

Answer 1

1. significant impairment of intelligence
   significant impairment of adaptive behaviours (reading, writing, numeracy, self care etc)
   significant impairment in social functioning
   onset during the developmental period
2. IQ - mental age/chronological age x 100
   Stanford Binet Scale - 1000s children compared to produce age level norms
   Wechsler adult intelligence scale - as well as norms included in Stanford Binet Scale, this also includes verbal and performance subscales
3. less than 70
   4a) 50-70. Language fair with little sensory or motor deficits. Reasonable level of independence
   4b) 35-49. generally better receptive than expressive language
   4c) 20-34. Increased sensory and motor deficits. 50% will have epilepsy
   4d) <20. Increased need and vulnerability. Developmental level around 12 months

Question 2

1. Describe a cause of LD related to trauma
2. Describe a cause of LD related to toxins
3. Describe a cause of LD related to tumours
4. Describe a cause of LD related to genetics
5. Describe a cause of LD related to metabolism
6. Describe a cause of LD related to infections

Answer 2

1. trauma related to forceps or ventouse delivery, or hypoxia during delivery
2. foetal alcohol syndrome
3. Tuberous Sclerosis. - growths in brain that calcify and become hard and sclerotic. Also tumours on skin and vascular system. 50% of people with tuberous sclerosis have LD. Autosomal dominant disorder.
4. Downs Syndrome. Trisomy 21. Syndrome of conditions including LD
5. Phenyketonuria - recessive mutation causing loss of function in phenylalanine hydroxylase, thus build up of phenylalanine. This causes microcephaly, epilepsy, overactivity and autism
6. toxoplasmosis (foetal contraction via placenta; cat litter)
   rubella, cytomegalovirus, congenital syphylis. Meningitis and Encephalitis

Question 3

1. What is death by indifference?

2. What is diagnostic Overshadowing?

Answer 3

1. increased mortality in people with learning difficulties associated with: neglect within healthcare system; institutional discrimination; delayed diagnosis/treatment; lack of reasonable adjustments and capacity decisions
2. Attribution of all health problems to the diagnosis of learning disability.

Question 4

In terms of LD, what are the roles of the following professionals:

1. Psychiatrists
2. community nurses
3. speech and language therapists
4. psychologists
5. social services/care managers

Answer 4

1. diagnose and treat mental illness, medication, risk assessment
2. offer support and adivce on mental and physical health issues
3. look at total communication and help people express themselves
4. provide support with relationships, greif and moving house etc
5. incorporate various services into a care plan - finance, supported accomodation, work, day services, social clubs etc.

Question 5

what is personality?

Answer 5

relatively stable characteristics that differentiate one person from another, demonstrated in the consistent and predictive way in which people behave in different situations over extended periods of time

Question 6

PSYCHODYNAMIC THEORIES

1. what do behaviour patterns, thoughts and feelings arise from?
2. What life period is important? What does this suggest about personality?
3. Name the 3 levels of awareness
4. What is the:
   a) Id
   b) Ego
   c) Superego
5. How do the three interract?
6. Name criticisms of this theory

Answer 6

1. unconscious internal conflicts associated with childhood experience and between pleasure-seeking impulses and social restraints
2. childhood. Suggests personality is fully formed by adulthood

3. conscious mind (in contact with outside world)
preconscious mind (just below level of awareness)
unconscious mind (well below surface of awareness, difficult to retrieve)

4a) primitive thinking, driven by biological urges. seeks pleasure and avoids pain. Operates unconsciously
b) conscious processing. Intelligent consideration of reality. Rational decision making and problem solving.
c) partially conscious, partially unconscious. Stops us from gratifying every whim because they are immoral
5. Id and superego interact for form Ego

6. developed around sexual behaviour. Too restrictive

Question 7

HUMANISTIC THEORIES

1. what do humanistic theories focus on?
2. What do these theories suggest about personality?
3. What is self concept?
4. What is a fully functioning person able to do?
5. What is self actualisation?

Answer 7

1. subjective human experience and perspective
2. people have free will and they are basically good, and that fulfillment and growth is a basic human motive
3. our own image or perception of ourselves. Comprises self image, self esteem and ideal self
4. open to experience; able to live for the momentl able to trust their own feelings; creative and fulfilled.
5. the realisation of personal potential and becoming everything one is capable to become.

Question 8

TRAIT THEORIES

1. what are the basis of these theories?
2. Eysenck’s three factor theory - which three fundamental factors determine personality?
3. What are the big 5 personality factors?
4. What are the criticisms of trait theories?

Answer 8

1. that there are basic enduring dimensions (traits) in which people differ from one another; for each trait we are on a scale
2. introversion v extroversion
   emotional stability v neuroticism
   impluse control v psychosis
3. Openness, conscientiousness, extroversion, agreeableness, neuroticism.
4. does not comment on personality development; is a poor predictor of future behaviour; offers nothing about changing personality.

Question 9

SOCIAL COGNITIVE THEORIES

1. what are these based on?
2. what do they emphasise?
3. What is the basis of this theory
4. What is locus of control

Answer 9

1. interrelationship of the individual with others and environment
2. role of learning in the development of personality
3. HOW ENVIRONMENT SHAPES PERSONALITY
4. an individual’s belief system regarding the causes of his or her experiences and the factors to which that person attributes success or failure.

Question 10

1. How is personality linked to physical health?

2. How is personality linked to mental health

Answer 10

1. Type A behaviour associated with higher rate of heart disease
   optimism and conscientiousness associated with better health
   neuroticism associated with reduced lifespan and increased incidence of somatic illness

Question 11

1. What is personality disorder?
2. What is cluster A personality disorder?
3. What is cluster B personality disorder?
4. what is cluster C personality disorder?
5. What do people with personality disorders have difficulties with? (7)

Answer 11

1. category of psychiatric disorders characterised by long term behaviour that deviates markedly from that expected by the person’s culture and interferes with daily life.
2. odd or eccentric - suspicious, paranoid, schizoid and antisocial
3. dramatic, emotional and erratic - emotional and impulsive, narcissistic and histronic
4. anxious and fearful - avoidant, dependent and obsessive compulsive
5. making and keeping close relationships
   getting on at work
   keeping out of trouble
   controlling feelings and actions
   listening and co-operating with other people
   worse physical functioning
   developing other mental health problems, and drug and alcohol problems.

Question 12

1. what is attachment?

2. what is an attachment disorder?

Answer 12

1. the deep and enduring emotional bond that connects people across space and time
2. disorders of mood, behaviour, and social relationships, arising from a failure to form normal attachments to primary caregivers during early childhood

Question 13

Describe what is meant by the following in terms of child and care giver:

a) secure attachment
b) insecure avoidant attachment
c) insecure resistant attachment
d) disorganised attachment

Answer 13

a) children show some distress when carer leaves but are able to compose themselves knowing they will return
child uses caregiver as secure base to explore novel environments
seek out caregiver in times of distress; easily soothed by caregiver
Caregiver is sensitive to child’s cues and responds appropriately to their needs

b) child does not orient to the caregiver when investigating the environment
physically and emotionally independent of the caregiver and does not seek them during times of distress
caregiver is insensitive and rejecting of the child’s needs

c) child is clingy and dependent towards caregiver, but rejecting of caregiver during interraction
fails to develop any feelings of security from caregiver
has difficulty in moving away from caregiver to explore novel environments
difficult to soothe
inconsistent level of response to their needs from caregiver

d) associated with trauma
defined by fear or fright
lack of attachment behaviour

Question 14

1. How is secure attachment associated with positive long term outcomes?
2. how is insecure attachment associated with negative long term outcomes?

Answer 14

1. children are more likely to have good self confidence and social-emotional well being, due to good relationships with parents
   as a result, they are able to form good social relationshiops
2. more likely to be anxious or depressed, and do nnot learn how to regulate their emotions. Likely to have behavioural problems/conflict and thus poor social skills.

Question 15

1. Describe the strange situation procedure
2. describe the story stem attachment profile
3. describe the child attachment interview
4. describe the adult attachment interview

Answer 15

1. observational procedure
   parent and infant introduced to experimental room
   parent does not participate whilst child explores
   stranger enters. Parent leaves
   strangers behaviour is geared towards that of infant
   parent re-enters and comforts infant, and then leaves again
   stranger leaves
   stranger re-enters and gears behaviour towards that of infant
   parent re-enters

2, interview procedure whereby children are asked to respond to a set of narrative story stems.
Allows assessment of the child’s expectations and perceptions of family roles, attachment and relationships
assesses verbal and non-verbal communication

3. focusses on current memories and assesses children’s perceptions of their attachment figures’ current availability and sensitive responsiveness through eliciting internal representations of attachment figures
   ask children to recall and describe their attachment exoeriences, in particular at times of hurt, emotional upset, illness, separation and loss
4. similar to child attachment interview but asks the adult to focus on past events in childhood