Block 6 - Psychological Medicine 2 Flashcards
1
Q
2 characteristics of Schizophrenia
A
Relapsing
Remitting
2
Q
What type of symptoms are thought disorder and decreased speech?
A
Thought disorder: +
Decreased speech: -
3
Q
4 examples of extra pyramidal side effects
A
Acute Dystonia
Akathinisia
Parkinsons
Tardive Dyskinesia
4
Q
Give 3 examples of infundibular side effects
How are they all caused?
A
Decreased periods, Decreased breast milk production, Infertility
Decrease in prolactin
5
Q
Which disorder is classed as a syndrome?
A
Depression
6
Q
What is the hypothesised cause of Schizophrenia?
A
+ symptoms: Increased dopamine in mesolimbic tracts
- symptoms: Decreased dopamine in mesocrotisol tracts
7
Q
What are the arguments for and against the dopamine hypothesis of schizophrenia?
A
FOR: Antipsychotics work on domamine; drugs that increase dopamine cause psychosis, changes in dopamine activity on brain scans
AGAINST: Drugs take a while to work (another mechanism?)
8
Q
What causes a hypertensive crisis when consumed with MAO’s
A
Tyramine
9
Q
What is the hypothesised cause of depression?
4 other theories
A
Decreased in neurotransmitters that are broken down by MAO
Behavioural, cognitive, physiological and endocrine
10
Q
What are the arguments for and against the MAO hypothesis for depression?
A
FOR: Drugs that decrease MAO work; there are less precursors to MAO neurotransmitters in the blood
AGAINST: Drugs take weeks to work, some drugs don’t target neurotransmiters, cocaine mimics neurotransmitters but is not an antidepressant
11
Q
What do autoreceptors do?
A
Cancel out the effects of neurotransmitters
12
Q
What hormone does anxiety increase the level of?
A
Cortisol
13
Q
How do calcium ion changes occur when you are having a panic attack?
A
Decreased carbon dioxide levels
14
Q
9 physiological symptoms of anxiety
A
Decreased concentration and memory
Fear, panic, worry, irritability
Fear of death, danger, losing control
15
Q
5 unhelpful behaviours associated with anxiety
A
Avoidance, coping mechanisms (e.g. drugs), pacing, safety behaviours, wringing hands
16
Q
Define learning
A
Permanent change in behaviour due to experience
17
Q
What area of the brain is involved in learning?
A
Amygdala
18
Q
Why do we learn?
A
To adapt and survive
19
Q
What are the 4 types of learning?
A
Associative
Complex
Factual Transmission
Vicarious
20
Q
What is associative learning?
2 e.g.
A
Learning that events come together
e.g. classical and operant
21
Q
What is vicarious learning?
e.g.
A
Learning by observation
e.g. modelling
22
Q
What is complex learning?
2 e.g.
A
Learning in social situation
e.g. emotional intelligence
23
Q
What is factual transmission?
A
Doing things with information to incorporate it into your brain
24
Q
What is the difference between continuous and partial conditioning?
Which is more common?
A
Continuous: Every experience is reinforced
Partial: Reinforcement doesn’t happen every time
Partial is more common
25
What are the four types of partial conditioning?
Interval schedules: Depends on the time interval
Fixed: Predictable
Ratio schedules: Depends on the number of responses
Variable: Unpredictable
26
Explain 'Thornicke's Law of Effect'
Successful behaviour will be repeated
| The reinforcer is IMMEDIATELY linked
27
Give an example of a primary and secondary reinforcement mechanism
Primary: Food
Secondary: Money`
28
Define shaping
| What type of reinforcement is it?
Rewarding smaller behaviours with the aim of rewarding the desired and more complex behaviour
Positive
29
Define chaining
| What type of reinforcement is it?
Breaking down complex behaviours into a series of simple acts which reinforces the next
Positive
30
Define phobia
A marked and persistent fear triggered by a specific object/situation that leads to avoidance
31
What are the three types of phobia?
Agoraphobia
Social phobia
Specific phobia
32
Define Agoraphobia
| Give and example
Fear of public places
| e.g. crowds
33
Define social phobia
| Give and example
Fear of public performance
| e.g. eating in public
34
Define specific phobia
| Give and example
Specific fear
| e.g. spiders
35
What type of reinforcement maintains phobia?
Negative
36
What are SMART targets?
A set number of targets which each increase in difficulty to treat anxiety or phobias
37
4 problems with punishment
Aggression
Fear or person
Physical/emotional harm
May increase the behaviour (e.g. child knows they get attention if they are naughty)
38
What are the symptoms of depression?
| mneumonic
```
Depressed mood
Energy loss/fatigue
Pleasure lost
Retardation/agitation
Eating changes
Sleep changes
Suicidal thoughts
I'm a faliure (loss of self-esteem and confidence)
Only me to blame (guilt)
No concentration
```
39
What is Annedonia
Decrease in pleasure
40
What is the difference between the somatic and autonomic nervous system?
Somatic: External environment
Autonomic: Internal environment (systems and homeostasis)
41
What are the somatic nervous system neurones, neurotransmitters and effectors?
Neurones: Single LMN from the CNS
Neurotransmitter: Excitatory ACh
Effector: Skeletal muscle
42
What are the enteric nervous system plexuses?
Myenteric and submucosal
43
How is the enteric system up/down regulated?
By the parasympathetic and sympathetic nervous systems
44
What are the neurotransmitters and effectors for the autonomic nervous system?
Neurotransmitter: ACh and noradrenaline
Effector: Cardiac smooth muscle, glands and organs
45
Where are the pre and post ganglionic neurones for the autonomic nervous system?
Pre-ganglionic: CNS, horn cells and cranial nerve nuclei
| Post-ganglionic: In the ganglia
46
Where do the preganglionic neurones from the parasympathetic nervous system arise from?
Cranial nerves 3, 7, 9 and 10
47
Where do the preganglionic neurones from the parasympathetic nervous system end?
S2-S4
| lateral part
48
Where is the postganglionic neurone from the parasympathetic nervous system?
What does this mean for the lengths of the pre and post ganglionic neurones
Near the organ
| The pre ganglionic neurone is a lot longer than the psot ganglionic neurone
49
2 places where preganglionic axons do not travel
Within rami communicants or spinal nerves
50
```
What class of neurones are in the parasympathetic nervous system?
What are the differences between them?
```
Cholinergic
Post-ganglionic: Nicotinic
Pre-ganglionic: Muscarinic
51
What type of secretion is the parasympathetic nervous system responsible for?
Secretomotor
52
Where do the pelvic splanchnic nerves arise from?
S2-S4
53
What are the lengths of the pre and post ganglionic neurones in the sympathetic and parasympathetic nervous system?
Parasympathetic: The pre-ganglionic neurone is longer than the post ganglionic neurone
Sympathetic: The post-ganglionic neurone is longer than the pre-ganglionic neurone
54
What class of neurones are in the parasympathetic nervous system?
Post-ganglionic: Nicotinic cholinergic
| Pre-ganglionic: Noradrenaline
55
Where are paravertebral ganglia?
Sympathetic trunk in the thorax
56
How do pre-ganglionic neurones leave the spinal cord and enter the body?
Pre-ganglionic neurones leave the spinal cord and enter the paravertebral sympathetic trunk
Spinal rami transport the pre-ganglionic neurones to the body
57
What does the adrenal medulla act as?
A ganglion with no post ganglionic neurones
58
What are the three thoracic splanchnic nerves?
Greater
Lesser
Least
59
What does the greater splanchnic nerve supply?
Coeliac ganglion
60
What does the lesser splanchnic nerve supply?
Superior mesenteric ganglion
61
What does the least splanchnic nerve supply?
Inferior mesenteric ganglion
62
Which post- ganglionic neurones release NO?
| What does it lead to?
Nitroxidergic
| Vasodilation
63
What is the role of the limbic system?
Emotions about neurological function
64
What is ptosis?
Lazy upper eyelid
65
What is anhydrosis?
No sweating on one side of the face
66
What is miosis?
Constricted pupil
67
Explain the parasympathetic and sympathetic control of the bladder?
Parasympathetic: Always excitatory
Sympathetic: Inhibitory to the muscle and excitatory to the sphincter
68
What is Brown-Sequard Syndrome?
Sensory loss (pain and temperature contralateral) and motor loss due to hemisection
69
9 side effects of overstimulating muscarinic and nicotinic neurones
3 for muscarinic specifically
4 for nicotinic specifically
Both: Diarrhoea, lacrimination, mitosis, perspiration, salivation, vomiting
Muscarinic: Bradycardia, coma, confusion
Nicotinic: Agitation, hypertension, tachycardia, tachypnoea
70
What is the structure of a muscarinic cholinergic receptor?
| What type of response does it produce?
G protein receptor with 7 transmembrane protein that uses ATP to cause an indirect response
71
What is the structure of a nicotinic cholinergic receptor?
Ligand gated ion channels
72
What is the difference between uptake pathway 1 and 2?
Uptake pathway 1: Uptake at the neurone (e.g. breaking down the neurotransmitter)
Uptake pathway 2: Away from the neurone (e.g. MAO in liver)
73
How does the adrenal medulla release adrenaline?
Adds a methyl group
74
Which adrenergic neurone does adrenaline mainly work on?
Beta
75
What is the structure of an adrenergic receptor?
7 transmembrane G protein
76
What two behaviours are impaired in a learning disability
```
Adaptive behaviour (reading, writing, maths)
Social functioning
```
77
Give 3 examples, other than IQ, of intelligence tests
| What do they look for
Stanford-Binet Scale: Compared children to age based norms
Wechsler Adult Intelligence Scale: Less biased as it has verbal and performance scales
Culture Free Intelligence Tests: Identify congitive impairments without looking at language or formal education
78
When do you have a learning disability on an IQ scale?
-2SD below the norm
79
What are the 4 categories of learning disability?
| What are the IQ's for each one?
Mild (50-70)
Moderate (35-50)
Severe (20-35)
Profound (0-20)
80
Define advocacy
The patient cannot make decisions
81
What is death by indifference?
When people with learning disabilities find it harder to go to the hospital so they are neglected
82
What is it called when you provide a quiet room for a patient with a learning disability to sit in if they get anxious when there is a lot of people
Reasonable adjustment
83
6 major causes of learning disability
```
Genetic
Infection
Metabolic
Trauma
Toxins
Tumours
```
84
Give an example of a toxin which can cause a learning disability
Give 5 symptoms
Foetal alcohol syndrome
| small head, short nose, underdeveloped jaw, flat midface, thin upper lip
85
Give an example of a tumour which can cause a learning disability
How does it cause a learning disability
Tuberous sclerosis
| Calcified growths form which can press on the brain
86
5 things that increase in risk if you have Down's Syndrome
```
Increased risk of cardiac effects
Hypothyroidism
Leukaemia
Epilepsy
Chest Infections
```
87
What is cerebral atrophy?
| What increases the risk of it?
A brain morphology
| Alzheimer's
88
Give an example of a metabolic condition which can cause a learning disability
Explain what happens and how it is diagnosed
Phenylketonuria
No phenylalanine hydroxylase enzyme to hydrolyse phenylalanine
Epilepsy, autism, ADHD, odour (increased ketones)
Heel prick test
89
Give 5 examples of infections which can cause a learning disability
Herpes, HIV, Rubella, Syphilis and Toxoplasmosis
90
What is encephalitis?
A complication when contracting herpes
91
Define psychosis
Fundamental and characteristic distortions of thinking and perception by inappropriate or blunted affect
Maintenance of consciousness and intelligence
92
3 criteria for a schizophrenia diagnosis
1 or 2 syndromes for at least one month
No maniac or depressive episodes before this
Not caused by brain disease, alcohol/drug intoxication, dependence or withdrawal
93
What is the average IQ of a person with schizoprehnia?
| What may happen to this?
95
| It may decrease
94
What are 5 positive symptoms of schizophrenia?
```
Thoughts
Delusions
Hallucinatory voices
Disordered thought
Catatonic behaviour
```
95
What are negative symptoms of schizophrenia?
| Give 7 examples
An absence of something that shouldn't be there
Apathy, Avolition, Anergia, Algolia, Anhedonia, Ascociality, Affective flattening, impaired Attention
96
What 4 things can happen to your thoughts in schizophrenia?
Echoed, inserted, withdrawn or broadcast
97
Two characteristics of schizophrenic delusions
| What does the patient think of them?
Persistent and impossible
| A vague idea that they're untrue
98
3 characteristics of disordered thought
Derailment, irrelevance and inchoherance
99
3 characteristics of catatonic behaviour
Excitement, mutism and unconciousness
100
What are the three groups of psychosis?
Reality distortion: Hallucinations and delusions
Disorganisation: Thought disorder and inappropriate affect
Psychomotor poverty: Poverty of speech and blunt affect
101
What happens to the ventricles, cortex and neurones in schizophrenia?
Ventricle volume increases
Cortex volume decreases
There are more neurones with decrease connections
102
Which brain area is responsible for auditory hallucinations?
Broca's Area
103
Which brain area is responsible for negative symptoms?
Prefrontal cortex
104
Which brain area is responsible for passivity?
Cingulate gyrus
105
7 examples of risk factors for schizophrenia before and after birth
Prematurity, unwanted preganncy, rubella, influenza, malnutrition, LBW, brain abnormalities, birth complication
106
2 examples of childhood risk factors for schizophrenia
Late milestones
| Mixed handedness and hand eye dominance due to brain lateralisation
107
Give 5 examples of drugs which can increase the risk of schizophrenia
Cannabis, hallucinogens, amphetamines, cocaine and crack
108
What risk factor will give an earlier onset of schizophrenia?
A biological risk factor
109
What area of the brain are D2 receptors most hyperactive in schizophrenia?
Striatum
110
What three functions is dopamine involved in?
| Which one is important for schizophrenia and why?
Reward, learning and salience
| Salience: Filters irrelevant things, without this, irrelevant things become important
111
8 conditions which have a similar diagnosis to schizophrenia
```
Schizoffective disorder
Schizoid /schizotypal personality
Autism spectrum disorder
Intoxication
Delirium
Depressive psychosis
Bipolar effective disorder
Persistent delusion disorder
Acute transient psychotic disorder
```
112
What are the symptoms of Acute transient psychotic disorder
| What is their timescale
ACUTE onset of delusions, hallucinations and incoherent speech
In LESS THAN 2 WEEKS
Younger patients have a larger gap
113
Give 7 examples of non-pharmacological treatments/help for psychosis
Family therapy, CBTp
Housing, employment, education and community support
Treatment for substance abuse
114
Define 'at risk mental state'
+ symptoms that are not severe enough for a psychosis diagnosis
Family history
Decline in psychological functioning
115
Why is primary prevention and early intervention important for psychosis treatment?
Decreases the risk of aggressive treatment
116
What support are you given if you have an 'at risk mental state'?
Open referral
2 weeks for assessment
3 years support
6 month treatment
117
Define personality
Stable characteristics that differentiate one person from another
Demonstrated in the consistent an predictable way that people behave in different situations over an extended period of time
Habitual patterns of behaviour, cognition and emotion over time and situation
118
What do psycho-dynamic theories believe that personality is due to?
Unconscious internal conflicts between pleasure-seeking impulses associated with childhood; and social demands associated with adult life
119
What are Freud's 3 levels of awareness?
Conscious mind: Contact with the outside world
Pre-conscious mind: Just below the surface (easy to retrieve)
Unconscious mind: Well below the surface (hard to retrieve)
120
Which level of awareness plays the biggest role in personality?
Unconscious mind
121
What are the two types of personality which the psychodynamic theory developed by freud discovered?
Which personality balances this?
The id and the superego
| The reality
122
What 4 things is the id based on?
What does it avoid?
When does it want to do everything?
Based on life and death instincts, pleasure and biological urges
Avoids pain
Do everything now
123
Define eros
Life instinct
124
Define thantos
Death instinct
125
How does the ego combine the id and superego?
| What does decisions does it make?
Combines the two through conscious processing by higher mental processes
Looks at consequences and makes rational decisions and compromises
126
What 3 things is the superego based on?
What does it stop us from doing?
What does it suggest?
Based on morality, reality and societal roles
Stops us from causing harm
Knows some things are not right
127
Define conscience
The notions of right and wrong
128
Define egoideal
How we'd ideally like to be
129
What did Freud believe that personality develops because of?
Unresolved conflicts in early childhood
130
What are Freud's 5 stages of personality development?
| What ages do they occur at?
```
Oral (0-18 months)
Anal (18-36 months)
Phalic (3-6 years)
Latency (6 years - puberty)
Genital (puberty onwards)
```
131
What do defence mechanisms do?
| What does this reduce?
Balances tension between the id and superego to reduce anxiety
132
Give 6 examples of defence mechanisms
```
Repression
Projection
Denial
Displacement
Sublimation
Regression
```
133
Define repression (as a defence mechanism)
Removing threatening thoughts from awareness
134
Define projection (as a defence mechanism)
Projecting your attributes onto others
135
Define denial (as a defence mechanism)
Refusal to recognise a threatening situation/thought
136
Define displacement (as a defence mechanism)
Substituting a less threatening object for impulses
137
Define sublimation (as a defence mechanism)
Challenging impulses to socially acceptable outlets
138
Define regression (as a defence mechanism)
Return to a less mature state
| Increase anxiety and decrease behaviour
139
What was Carl Jung's theory of personality? (2)
Personal vs collective unconsciousness
| Introvert vs extrovert
140
What was Alfred Alder's theory of personality?
The superiority complex
141
What do humanistic theories believe personality is based upon?
Experiences
| Humans have choices and these choices help to shape our personality
142
Define self-actualisation
Realise your personal potential
| Fulfilment and personal growth is more important than what other people think
143
Who were the two people who produced humanistic theories of personality?
Carl Rodgers and Maslow
144
List Maslow's heirachy of needs
Physiological - Safety - Love/belonging - Self-esteem - Self-actualisation
145
Define self-concept
Own perception of ourselves
146
What was Carl Rodger's personality theory based on? (2)
| When do you get anxious?
Self-concept
Your personality is based on experience and what you see other people doing
Anxiety: When you are not being yourself
147
What do trait theories identify?
| What is the scale?
The basic traits that differ between people
| You have more/less of a trait
148
Who were the three people who produced trait theories of personality?
Jung, Eysenck and Cattell
149
What is Eysenck's three factor theory?
Introvert vs Extrovert
Emotional stability vs Neuroticism
Impulse control vs Psychosis
150
What did Cattell discover?
| What three types of data did he use?
The 16 personality factors
| L, Q and T data
151
What is L-data?
Life record
152
What is Q-data?
Personality questionnaire
153
What is T-data?
Objective tests which 'trap' personality
154
What are the 'Big Five Personality Factors'
| What is the mneumonic
```
Openness (to experience)
Consciousness
Extroversion
Agreeableness
Neuroticism
```
155
What does Openness (to experience) include?
Curiosity, imagination, insight,intellectualism, interests
156
What does Consciousness include?
Thoguhtful, organised, impulse control, goal irected behaviour, careful, persistant, dependable, responsible
157
What does Extroversion include?
Assertive, excitable, expressive and talkative
158
What does Agreeableness include?
Affection, generosity , kindness selflessness, trust and warmth
159
What does Neuroticism include?
Anxiety, insecure, instability, irritable, moody, sad
160
Positives and negatives of the Big 5 personality factors
+ Used in mental health and jobs
| - No comment on development and misused
161
Explain the difference between the internal and external locus of control
Internal: You control your own destiny (failing is your fault)
External: Fate controls your density, you cannot stop it (failing is the teacher's fault)
162
Three ways of measuring personality
Personality Assessments
Objective Personality Tests
Assessment Centres
Projective Personality Tests
163
How do objective personality tests work?
If x happened would you do y or z
164
Which personality test is this?
| 'Subject responds to an ink blot on a piece of paper'
Projective Personality Test
165
Three words to describe a 'Type A' behaviour
Competitive, dominant and hostile
166
7 effects of having a Type A behaviour
CHS, stroke, somatic illness, emotional instability, bipolar, schizophrenia, personal life effects
psychosis and somatic illness
167
Define 'personality disorder'
A diverse category of psychiatric disorders which are characterised by long term behaviour that deviates from cultural expectations
168
3 characteristics of the behaviour of a person suffering from personality disorder
Pervasive, inflexible and stable over time
169
What are the three types of personality disorders?
```
Cluster A (weird)
Cluster B (wild)
Cluster C (worried)
```
170
What are the characteristics of someone with a Cluster A personality disorder?
Eccentric, Odd, Paranoid, Suspicious
| Finds faults with people
171
What are the characteristics of someone with a Cluster B personality disorder?
Dramatic, emotional, erratic, impulse, narcissistic
Caught in their own self image
Outgoing and bubbly to crisis
172
What are the characteristics of someone with a Cluster C personality disorder?
Anxious, avoidant, compulsive, dependent, fearful, obsessive
173
Define attachment
A deep and enduring emotional bond that connects two people across time and space
It's evolutionary purpose is to protect the baby by keeping it safe with its mother
174
Define attachment disorder
Disorders of mood, behaviour and social relationships due to a failure to form attachments to primary caregivers in early childhood
175
What percentage of the population are secure?
50-55%
176
What percentage of the population are insecure-avoidant?
20-25%
177
What percentage of the population are insecure resistant?
10-15%
178
Explain secure attachment
- protection...
- when caregiver leaves...
- caregiver response...
- explore...
- distress...
Children feel protected by their caregiver
Distressed when they leave but compose themselves as they know they will return
Caregiver responds to the child's needs
The child uses the caregiver's secure base to explore their environment
The child seeks the caregiver when distressed and is comforted by them
179
Explain insecure-avoidant attachment
- distress...
- child's needs...
- explore...
Children do not seek the caregiver when distressed
Caregiver neglects the child's needs
Child does not use the caregiver to explore
180
Explain insecure-resistant attachment
- relationship...
- security...
- explore...
- comfort...
- response...
```
Child is clingy but also rejects
No security from the caregiver
Child will not explore the environment
Child is hard to comfort
Caregiver gives an inconsistent response
```
181
Explain disorganised attachment
- child's feelings...
- attachment...
- comfort...
Child is fearful, depressed and withdrawn
Lack of attachment
Seeks comfort but freezes
182
What type of attachment will lead to long term outcomes of anxiety, depression and stress
Disorganised
183
What ages are the different ways to measure attachment used?
```
1-2 years: Strange situation procedure
2-4: Preschool attachment assessment
4-7 years: Story stem
7-15 years: Child attachment interview
15+ years: Adult attachment interview
```
184
How would an insecure-avoidant child react during the strange situation procedure?
No crying
| Plays throughout
185
How would an insecure-resistant child react during the strange situation procedure?
Cries when both leave
| Comforted by the stranger and cries when the parent returns
186
What is the difference between an insecure avoidant and insecure resistant child in a story stem attachment interview?
Resistant: Mummy angry
Avoidant: No parents
187
Explain how Video Interaction Guidance works
| What three things does it enhance?
3 filmed video interactions to pick up on the positives
| Enhances relationships, communication and social well-being between the parent and child
188
Explain how parent-child psychological therapy works
| How does it improve the relationship
Varying sessions with the parent AND child / parent OR child
| Improve the relationship by improving interaction with the social environment
189
Explain how the home-visiting programme works
- Timescale
- How does it improve the relationship
12 weekly/monthly sessions for 30-90 minutes across 1 8 months
Improve the relationship with positive reinforcement
190
Explain how parental sensitivity and behaviour training works
- What does it encourage
- Types
- Timescale
Encourage understanding and management of the child's behaviour to improve parental sensitivity and quality
Many types with the parent alone/group/ parent and child
5-15 weekly sessions
