psychobiology

Question 1

what is stress

Answer 1

can be a stimulus - events that place high demands on us are stressors eg exams

can be a response - physiological fight/flight response, presence of -ve emotions - feeling tense, temper, difficulty concentrating - can have behavioural impacts

it is an interaction of stimulus and response as a person-situated interaction

pattern of cognitive appraisals, emotional reactions, physiological responses and behavioural tendancies that occur in response to a percieved imbalance between situational demands (primary appraisal) and the resources needed to cope with them (secondary appraisal)

Question 2

describe the stress response

Answer 2

SNS activated with stress = high HR, dilation of skeletal bv, constriction of digestive bv, defication and urination - get rid of waste

activation of the hypothalamo-pituitary-adrenal axis = cortisal that allows mobilisation of energy and a more sustained response to stress

Question 3

describe general adaption syndrome

Answer 3

stage 1 - alarm rn - shift to sympathetic dominance = increased arousal

stage 2 - resistance - endo system releases hormones to maintain increased arousal and adaption of immune system to deal with response = increased level of resistance to stress

stage 3 - exhaustion - adrenal glands and immune system lose their ability to function normally - depletion of resources = more vulnerable to adverse consequences - happens in carers/people who have had trauma

Question 4

describe the path of appraisal of stress

Answer 4

primary appraisal is determining if threat is perceived from the stimulus

if there is threat - secondary appraisal is whether you have the ability to deal with the threat

if you think you do = positive stress

if you think you dont = negative stress

also need to take into account potential consequences and seriousness

also the psychological meaning of the consequences - related to your beliefs about yourself or the world - this varies between people

Question 5

describe Yerkes-Dodson law

Answer 5

at low level of stress - increased attention and interest - a bit of arousal = increased performance

there is an optimum

too little/much arousal = poor performance

Question 6

describe the effect of appraisals

Answer 6

they effect emotions towards possible threats which dictates the coping response

Question 7

describe how stress can relate to disease

Answer 7

event = stress = behavioural changes

• harder to adhere when stressed
• dont do healthy behaviours - eg reduce exercise, increase smoking/drinking
• social support reduces the change in unhealthy behaviours eg smoking unchanged and alcohol reduced in stress compared to neutral if you have good support network - support is a mediator

stress = physiological changes

• for people who are vulnerable to MI - srress can act as a trigger

Question 8

describe the relationship between anxiety and heart disease

Answer 8

anxiety = increased risk of CVD independant of traditional risk factors

therefore anxiety management could be a target for CVD risk reduction

higher cortisal activity in stressful situations is associatd with greater extent of coronary artery calcification - could be that higher calcification means more likely to have higher stress response

Question 9

describe wound healing and stress response

Answer 9

in stressful situation wounds took 3days longer to heal - happened in all subjects

perhaps because level of IL-1 declined in times of stress

Question 10

describe how personality type effects CHD

Answer 10

type A behaviour doubled risk of developing CHD in healthy males when cardiac risk factors are accounted for

when compared to type B (more serene and lack of time urgency) - type a alone accounted for increased risk

Question 11

what is type a behaviour

Answer 11

time urgency

free floating hostility

hyper-aggressiveness

focus on accomplishment

competitive and goal driven

Question 12

why do people with type a behaviour have a higher CHD risk

Answer 12

hostility is the key factor - quickness to aggression

perhaps because of poor health behaviours

or increased physiological response to stressors = endothelial dysfunction = atherosclerosis

Question 13

describe type d behaviour and its health impacts

Answer 13

characterised by social inhibition and -ve emotions

relationship with CHD

perhaps because of underreporting of symptoms, or it is a risk factor for depression, or lack of social support

Question 14

describe the relationship with depression and CHD

Answer 14

effect on aetiology and prognosis

pts with CHD with depression have increased risk of mortality in 2yrs

perhaps because of physiological changes (eg platelet activity) and behavioural changes (eg low levels of physical activity) - lack of drive and increased lethargy

higher predictor of mortality than having had previous MI or severity of MI

Question 15

what are the different mechanisms of coping with stress

Answer 15

problem focused coping - useful for conditions that need long term management, counter productive when condition cant be cured - planning, active coping and problem solving, suppressing competing activities, restraint, assertive confrontation

emotion focussed - helpful in acute period - +ve reinterpretation, acceptance, denial, repression, escape-avoidance, wishful thinking, controlling feelings

seeking social support - help, emotional support, affirmation of worth, tangible aid

Question 16

what does the coping style depend on

Answer 16

the usefulness depends on the individual and the situation

approach - activity orientated towards threat can be helpful - discuss info and treatment in detail

avoidance - activity orientated away from threat - eg denial/destraction - find it difficult to engage in discussions around illness and treatment - this can be functional

Question 17

what is the placebo effect

Answer 17

The phenomenon in which a placebo - an inactive substance like sugar, distilled water, or saline solution can sometimes improve a patient’s condition because the person has the expectation that it will be helpful.

Question 18

what is the nocebo effect

Answer 18

a -ve effect that occurs after therapy/med even when the treatment is inert (ie placebo)

this is because the pve expectations effect the SE - warnings about the SE make it more likely the pt will report having these effects

Question 19

describe the effect of swearing as a pain reliegf

Answer 19

considered maladaptive because it is associated wuth -ve and unhelpful thoughts - catastrophising events - seeing the worse in situations

however - swearing during a cold pressor test showed an increase in cold-pressure latency, and HR (proxy for stress response as it signifies activation of SNS) and decrease in perceived pain - increase activation of SNS - tap into the fight/flight response and increase ability to withstand pain

Question 20

describe the benefits of social support for health outcomes

Answer 20

increases liklihood of survival compared to those with poor or insufficient social relations

they are beneficial beyond just the psychological role ie reducing depression

the effect of a support network is comparable with quitting smoking and exceeds other risk factors

therefore there is a movement for social cure/social prescription - GP make people more socially engaged in order to reduce their health risk

Question 21

describe the effect of branding medications

Answer 21

targeted branded medication results in better outcomes than non-marketed drugs even when placebo is used - ie placebo better than non-branded placebo

Question 22

describe use of placebo as a treatment

Answer 22

the chronic use of medication is increasing

eg increase in opiod prescribing

when people were treated for psoriasis - give normal corticosteroids, half steroids half placebo, half vol of steroids - people with half vol had higher relapse rate than people with half and half - suggesting a dose-extending placebo effect

Question 23

what is the dose extending placebo effect

Answer 23

body learns the response for the drugs - conditioned to have that response

therefore you can reduce the dose = reduce the SE and cost (may still have nocebo effects but wont have the biochemical SE like liver toxicity)

Question 24

what is the clinical use of placebos as treatment

Answer 24

reduce SE

the effect of interventions may be increased by the way that they are presented - in form and manner ie if you frame the effects differently or have brand - give stimuli with unconditioned response ie the brand

can be useful in conditions with a psychological component/pain which is a subjective experience

Question 25

describe the evidence for using placebos w/o deceptions

Answer 25

pts informed that they were taking sugar pill and that it has been shown to have effect in some patients

the symptoms and QOL were better in people who knew that they were taking a placebo

this overcomes the ethical issues of decieving the patients

Question 26

what are the psychological mechanisms underlying the placebo effect

Answer 26

framing - same information presented in different ways alters the interpretation of risk

social learning - seeing others getting better

experiential learning - learn through the experience of the positive result in the active medication, influences the response from the simulated medication

conditioning - US = medicine, UR = therapeutic effect, CS is the placebo delivered in the same way = CR