CBT and ECT Flashcards
Define arbitary inference
Specific conclusion without supporting evidence/ despite contrary evidence
Name 5 limitations or careful considerations to the use of electroconvulsive eterapy
- Cerebral aneurysm
- Raised icp
- Recent mi
- Cardiac arrhythmia
- High anaesthetic risk
- Neurological conditions/ skull fractures
- Brain tumour
(no absolute contraindications)
What is the gold standard of electrode placement in ect?
Bilateral/bitemporal
Other placements: r unilateral, bifrontal
What is a therapeutic dose of ect?
Seizure 15-70s on eeg recording
What is the maximum time period for a seizure in ect?
2 minutes or more- promptly stop!
Name 6 adverse effects ect
- Death due to cardiopulmonary event : very rare
- Aspiration pneumonia
- Headaches
- Dental and tongue injuries
- Transient nausea
- Cognitive: acute confusion, retrograde and anterograde amnesia . Short term
- Epilepsy
8 anaesthetic events
What is the cognitive theory?
THOUGHTS are the primary determinants of EMOTIONS/FEELINGS and BEHAVIOUR, which in turn influences thoughts (“triad”)
Define intermediate core beliefs
How people derive the meaning of experience, develop over time
Define selective abstraction
Cognitive distortion in which Detail is taken out of context eg his arms are crossed, therefore he must be mad at me
Abstracting a general rule from a single or few isolated incidents refers to which cognitive distortion?
Overgeneralisation
Reaching a specific conclusion without supporting evidence or despite contradicting evidence refers to which cognitive distortion?
Arbitrary inference
Detail out of context refers to which cognitive distortion?
Selective abstraction
Focusing heavily on something or giving it great importance refers to which cognitive distortion?
Magnification
Overlooking or disregarding or not seeing something as important refers to which cognitive distortion?
Minimisation
Attributing events to oneself without evidence supporting causal connection refers to which cognitive distortion?
Personalisation
Categorising experience in one of 2 extremes refers to which cognitive distortion?
Dichotomous thinking
Eg those who are not for us are against us
Name the 5 principles of behaviour therapy
- Classic conditioning
- operant conditioning
- Positive reinforcement
- Negative reinforcement
- Punishment
- Extinction
Define classic conditioning
Associating an involuntary response and a stimulus
Define operant conditioning
Associating a voluntary behaviour and a consequence. Rewarded with incentives
Define extinction as a cognitive behaviour technique
Decrease behaviour following removal of responses
Name indications electroconvulsive therapy
DESPOND MBCHB
- depression: major episode, with melancholic features - if treatment resistant
- epilepsy (status)
- schizophrenia treatment resistant
- Parkinson’s
- OCD
- NMS last resort
- delirium severe
- mania: severe symptoms eg agitation/exhaustion / delirium, poor response, med intolerance
- bipolar treatment resistant
- Catatonia
- history of good response
- bad side effects to meds
Which medications must be stopped before ECT
- Anticonvulsant
- lithium (increase seizure duration, postictal confusion/ delirium
- theophylline (status risk)
- antidepressants (lower seizure threshold, TCA worsen cardiac irritability)
Name 6 cognitive distortions
- Arbitrary inference
- selective abstraction: detail taken out of context
- overgeneralisation
- magnification + minimisation
- personalisation
- dichotomous thinking: extremes eg those not for us are against us
Name 3 cognitive strategies in CBT
- Collaborative empiricism: dr + pt are co-investigators
- Socratic dialogue: promote new learning by asking probing questions
- guided discovery: behavioural / thought experiments
