Final

Question 1

ECT answer structure

Answer 1

• ECT definition
• Against arguments (John Read)
• Against argument (reported as success)
• For arguments adressed by Read
• C.F Meechan et al For arguments
  Overall belief

Question 2

Against arguments John Read

Answer 2

-8
Evidence of persistent/ permanent memory loss occurred in 12-55% of patients
- Psychiatrists attempt to discredit these criticisms riddled with misprepresentations, omissions and inconsistencies
- Only ever been 11 placebo controlled studies with small sample sizes from 1986
- No studies found convincing evidence that ECT is better at the end of treatment
- None assess quality of life
- None are double blind
- Mean quality score attained was 12.3 out of 24
- 2 higher quality studies produces near 0 effect size

Question 3

For argument adressed by read

Answer 3

-5
ECT used for long time (lobotomies)
- Unfair to critique 1986 RTCs with today standards (Admits lack of evidence)
- Unethical to conduct study that withhold treatment from ill (Eliminates ECT from evidence based medicine)
- non-placebo studies sufficient (2017 review found 89% of other types of studies produced no good follow up data after end of treatment)
- ECT is long term if you use antidepressants after it (shows no evidence after treatment period + ECT is reccomended for treatment resistant MDD)

Question 4

C.F Meechan et al For arguments

Answer 4

• 4
  Evald and approved by major health/ drug boards (NICE, FDA)
• UK ECT review group found 6 relevant trials that support ECT as opposed to SECT effect size of 0.91
• Remission rates are higher for ECT vs rTMS with reduction of depressive symptoms in ECT group BUT neither found significant diff after disconitnuation
• RCTs provide converging evidence for the efficacy of ECT over numerous comparators like sECT, pharmacological+ non pharma interventions and alt modes of ERCT

Question 5

Overall ECT

Answer 5

Lack of convincing evidence for ECT

Question 6

What is Agoraphobia answer structure

Answer 6

• Definition and Symptoms
• Criteria for diagnosis
• Prevalence
• Drug treatment
• other treatment
• Potential causes
• how it is maintained

Question 7

Agoraphobia definition and symptoms

Answer 7

Anxiety disorder/ phobia where individual experiences fear specific to leaving their home and travelling to public places. Anxiety disporportionate to actual danger posed by situation.
- Causes clinically significant distress or impairment in social, occupation or other areas of functioning
- lasts 6 or more months

Question 8

Agoraphobia criteria for diagnosis

Answer 8

5
Individual presents with fear in at least 2 of the situations:
- Public transit
- Large open spaces
- Enclosed spaces
- Larger crowds
- Being outside the house in general

Question 9

Agoraphobia prevalence

Answer 9

• 5
  1.7% overall
• Females twice as likely
  Develops in late adolescence, tapers off in late adulthood
  HIGH COMORBIDITY WITH PTSD
  Comorbid with other anxiety, depressive and substance use disorders

Question 10

Agoraphobia drug treatments

Answer 10

5
Ketamine
Memantine
Riluzole
Valproic acid etc
Same drugs treatments for social anxiety disorder or GAD

Question 11

other treatment for agoraphobia

Answer 11

4
Exposure techniques most effective
Combintation of CBT and exposure therapy is effective when comorbid with panic disorder
Group therapy + individual therapy was 60-80% improvement rate when they don’t have panic disorder
BUT high relapse rate so patients should attend booster sessions

Question 12

Agoraphobia potential causes

Answer 12

5
Generalisable to other anxiety disorders
- Learned association (Classical/operant)
Maladaptive assumptions and negsative appraisals about the environment
Fear through observation and imitation
GENETICS: MUTATION OF SEROTONIN TRANSPORTER GENE RELATED TO REDUCTION IN SEROTONIN ACITIVITY AND INCREASE IN ANXIETY RELATED TRAITS

Question 13

how agoraphobia is maintained

Answer 13

Aographobia leads to avoidance behaviours. If the patient stays at home and lets the anxious thoughts develop, they have no way for the thoughts to be proven wrong
Usually also leads to isolation so no one is around to dispute anxious/ disporportionate thoughts, inward spiral

Question 14

Millions personality theory answer structure

Answer 14

Definition of personality disorder
Evolutionary adaptation viewpoint
Personality as a product of 4 domains
Personality polarities (3)
r and k strategy
Balance and Maladaptive traits
taxonomy of personality disorders

Question 15

Def of personality disorder

Answer 15

Enduring patter of inner experience and behaviour, which deviates markedly from cultural norms in two or more areas:
- Cognition
Emotional response
Interpersonal functioning
Impulse control

Question 16

Millions evolutionary adaptation viewpoint

Answer 16

He viewed personality as an evolutionary adaptation, personality disorder is a problem in the adaptation , which gives rise to individual differences in personality style, ranging from normal to disordered

Question 17

4 Domains of personality to Million

Answer 17

Believed personality was a product of four interacting Domains
- Interpersonal
Biological
psychodynamic
congitive

Question 18

MIllion classified 3 personality polarities/ motivating aims

Answer 18

Personality disorder is a dysfunctional adaptation of personality polarities
Existence (Type of reinforcement)
- Pain–> pleasure
Adaptation (Coping style)
- Active –> Passive
Replication (Source of reinforcement)
- Self–> other
(R strategy at polar extreme of ‘self’, self propagating strategy, K Strategy as extreme of the ‘other’, other nurturing strategy)

Question 19

Maladaptive traits due to lack of balance of personality polarities

Answer 19

• Adaptive inflexibility
• Vicious circles
  Tenous stability
  Could results in personality disorder

Question 20

Millions Taxonomy

Answer 20

Milions approach to personality disorders involves mapping personality disorders onto his model of personality polarities to form a taxonomy of personality disorders

Question 21

Approaches to describing the severity of personality disorder answer structure

Answer 21

Millions approach
Tyler and Johnson approach
Widiger and Sanderson
DSM categorical approach
Fallon’s approach
Other

Question 22

Millions approach to describing the severity of personality disorder

Answer 22

internal psychological organisation can be placed on the spectrum of functionality (to dysfunctionality) depending on how well and consistently it performs within and social context
- Hints that ASPD is the leasdt severe group because it has better social adaptation than other PDs like Schizoid

Question 23

Tyler and Johnson approach to severity

Answer 23

4 point scale
0- no disorder
1- personality difficulties
2- simple PD
3- diffuse PD
The approach lacks clinical utiity
Ordinal organisation invites bias and limitations

Question 24

Widiger and Sanderson approach to severity of PD

Answer 24

Defined it using criteria/ ratings within each PD
- Attempts to have a categorical and dimensional approach
- rejected by DSM IV

Question 25

DSM approach to severity of PD

Answer 25

• Cateogorical approach, defining qualitatively distinct clinical syndromes
• Acknowledges the dimensional perspective that personality disorders are representations of maladaptive traits that merge into normality and into eachother

Question 26

Fallon’s approach to severity of PD

Answer 26

Individuals who suffer from PD will likely have ASPD and pose a risk of causing serious harm to others
- Circular and unrelated to clinical issues

Question 27

Other approaches to Severity of PD

Answer 27

• based on subjective distress or risk the patient poses to themselves
• Using the extent of comorbidity including substance use