Psychological Medicine Flashcards

Question

What other areas are involved in consciousness and sleep?

Answer 1

Anterior hypothalamus - Damage associated with insomnia (shorter sleep) (But not the major cause of insomnia) Neurotransmitter - GABA Posterior hypothalamus - Encephalitic damage associated with too much sleep (longer sleep) Neurotransmitter - Histamine

Answer 2

Intimately involved in regulation of sleep-wake cycle, arousal and attention Damage can lead to loss of consciousness and coma Interaction between 3 areas: cerebral cortex, reticular nucleus and thalamus Awake - cholinergic fibres increase firing Asleep - cholinergic fibres decrease firing

Answer 3

Awake - ACh system active - Sensory thalamus facilitated - Reticular nucleus inhibited - Thalamocortical neurons active - EEG desynchronous Asleep - ACh system inactive - Sensory thalamus inhibited - Reticular nucleus active - Thalamocortical neurons in slow rhythm - EEG synchronous

Answer 4

Generated by the interaction between 3 types of neurones Thalamocortical (in thalamus) Reticular (in reticular nucleus) Corticothalamic (in cerebral cortex)

Answer 5

Synchronised or NREM (Non-REM) sleep - EEG waves are slow and synchronised - Dominated by low frequency activity (e.g. delta waves <4Hz) Desynchronised or REM sleep - REM = 'Rapid Eye Movements' - High frequency activity in EEG (like waking state) - Also called paradoxical sleep - Abolition of muscle tone - Associated with dreams

Answer 6

Sleep is cyclical - each cycle lasts about 90 minutes, and involves multiple stages - Awake - REM sleep - Stage 1 non-REM sleep - Stage 2 non-REM sleep - Stage 3 non-REM sleep - Stage 4 non-REM sleep

Answer 7

Common disorders - Psychiatric conditions including anxiety - Indicators of other conditions: Obstructive sleep apnoea (temporary cessation of breathing) Enuresis (bladder control) Epilepsy (neuronal seizures) Rare disorders - Narcolepsy - spontaneous transition from wakefulness to REM sleep (can be caused by alterations in levels of orexin)

Answer 8

Short Term - Slower reflexes - Memory disorders - Muscle fatigue - Mood swings - Aggressive behaviour - Disorientation - Hallucinations Long Term (chronic) - Obesity - Diabetes - High blood pressure - Cardiovascular disease Insomnia can be insidious, and self-perpetuated by bad sleep habits

Answer 9

An internal clock, which may be demonstrated using light deprivation Body clock 'day' = 24.5 to 25.5 hrs

Answer 10

Neurones in the retina project to the Suprachiasmatic Nucleus (SCN) of the hypothalamus SCN innervates multiple nearby structures setting up a 'biological clock' SCN secretes neuropeptide vasopressin (to local brain areas only) Indirectly modulates the pineal gland, which releases melatonin, a sleep promoting neurohormone

Answer 11

Allows us to produce adaptive behaviour Supports sense of self and our culture Practical importance of memory failures Autobiographical memory gives rise to our self-identity, eroded in Alzheimer's disease

Answer 12

``` Sensory stores (<500ms) with attention goes to short-term store (a few seconds, longer with rehearsal) Short-term store can go to response (capacity limited by attentional bottleneck) Short-term store can go to long-term store (minutes to a lifetime) which has a huge capacity Memories can be retrieved to the short-term store ```

Answer 13

Participants look at letters to remember then asked to count backwards to prevent rehearsal Leads to forgetting the letters

Answer 14

Information is still held in LTM but can't be retrieved | Retrieving the particular memory you want is hard given other similar memories - interference

Answer 15

Ability to recall information later depends on how it was processed Three orienting tasks: Physical - is word in capitals? Acoustic - rhyme with pain? Semantic - does it fit sentence? Semantic encoding reduces interference - memories are more distinctive Processing meaning of the words helps memory

Answer 16

Match between environment (or state) between encoding and retrieval is crucial Divers learn list of words on land or under water, and then recall on land or under water - Memory better when same context of encoding and retrieval

Answer 17

Continuous cycle of sad thoughts -> depressed mood -> recall upsetting events -> sad thoughts And so on - Easier to recall unhappy events when sad which makes more sad

Answer 18

STM - Information is rapidly lost when we are distracted LTM - Cues are ineffective - can't access the memory - Many similar memories that cues don't separate - interference - But also involuntary retrieval when encoding and retrieval states match

Answer 19

Common causes - Viral infection (especially herpes simplex encephalitis) - Long-term alcoholism - Korsakoff's syndrome - Anoxia (cardiac arrest, carbon monoxide poisoning) - Head injury - Alzheimer's disease All associated with damage to medial temporal lobes Amnesia from damage to hippocampus and associated structures (fornix, cortex surrounding hippocampus, etc) E.g. conductor Clive Wearing who developed dense amnesia following herpes simplex infection (encephalitis) Herpes simples virus spreads from face along cranial or olfactory nerves to brain

Answer 20

Childhood memories are fine Events shortly before brain damage are not remembered Events since brain damage are not remembered - Birth to date of brain injury - retrograde period - Date of brain injury to present day - anterograde period Memories become less dependent on hippocampus following consolidation

Answer 21

Preserved in amnesia Normal retention of factual knowledge - semantic memory Normal on tests such as providing definitions, naming pictures, understanding sentences Conclusion - hippocampus is not final store of knowledge

Answer 22

Preserved in amnesia Mirror drawing - procedural memory Conclusion - hippocampus not required for some types of non-conscious long-term learning

Answer 23

STM Goes to LTM LTM splits into declarative/explicit and non-declarative/implicit Declarative/explicit splits in to episodic (events) and semantic (factual knowledge) Non-declarative/implicit splits into procedural (skills and habits), perceptual priming and classical conditioning (not dependent on the hippocampus) Role of hippocampus in episodic memory

Answer 24

Place - e.g. parahippocampal place area Object - e.g. inferior temporal cortex People - e.g. anterior temporal lobes All of these aspects bind together when forming the memory In retrieval one thing may trigger the retrieval of the others e.g. you go to the place remember the people and object This binding process is disrupted in amnesia

Answer 25

One element (cue) brings back whole experience - mental time-travel

Answer 26

Childhood memories and facts are stored in neocortex around hippocampus Through a process of consolidation, memories lose their reliance on the hippocampus - forming links in the neocortex

Answer 27

Damage to the neocortical store Subtype of frontotemporal dementia (FTD) Progressive loss of conceptual knowledge across modalities Other aspects of cognition are largely intact - Phonology/syntax - Visual-spatial skills - Non-verbal reasoning - Memory for recent events Can be tested using Ravens progressive matrices (test of non-verbal reasoning)

Answer 28

SD has a reverse temporal gradient - impaired repository of distant events as well as facts

Answer 29

Hippocampus - Episodic memory - Unique episodes involving people/places/objects - Damaged in amnesia Anterior temporal lobes - Semantic memory - Similarities between experiences to form concepts - Damaged in semantic dementia

Answer 30

Generally defined as behaviour that transgresses a society's rules, norms and laws and likely to cause harm to others Legally defined in the 2003 ASB Act as behaviour by a person which causes, or is likely to cause, harassment, alarm or distress to persons not of the same household as the person Thus 'domestic' aggression and abuse is not covered in this aspect of law, though is considered ASB more generally

Answer 31

About one in twenty (4.6%) 5-19 year olds meet the criteria for a 'behavioural disorder' Rates higher in boys (5.8%) than girls (3.4%) NHS digital survey (2017) Rates seem fairly similar across cultures

Answer 32

Behaviours that challenge is associated with an exceptionally high societal and economic burden Accounts for ~1% of all years lived with disability Exceeds autism and ADHD in this respect Mean cost per each young person with 'conduct disorder' estimated to be around £70k in 2001 (£103k today) Costs in terms of policing, social work, educational provision, impact of crime, criminal justice processes

Answer 33

Oppositional defiant disorder (ODD) - Younger children (<10) - Challenge adult authority Conduct disorder (conduct-dissocial disorder) - Tends to be adolescents - Repeated rule/law breaking - Disregarding the rights/wellbeing of others - Lacking empathy - can now be specified with or without low prosocial emotions Antisocial personality disorder (dissocial personality disorder) - Generally adults - Lacking empathy - Repeated flouting social morals and/or laws - Failure to respond to punishment - Risk taking, superficial charm, manipulative

Answer 34

Daring impulsive Callous unemotional Grandiose manipulative

Answer 35

Persistent behaviour problems Defiant, disobedient, provocative or spiteful behaviours Violate the basic rights of others or age-appropriate societal norms Now can be specified with or without Limited Prosocial Emotions (LPE) - daring impulsive, callous unemotional, grandiose manipulative Lacking these results in worse traits and less likely to respond well to treatment

Answer 36

Developmental issues - Specific and generalised learning problems - Literacy issues ('dyslexia' etc) - Speech and language problems - (Global) learning disability - Autism spectrum conditions (ASCs) - Attention deficit hyperactivity disorder (ADHD) Mental health issues - Depression ('depressive CD') - Anxiety - Substance misuse/dependency - Post-traumatic stress disorder (PTSD) - Attachment disorder/problems - (Emerging) personality disorder - Psychosis-spectrum illness (e.g. 'schizophrenia')

Answer 37

NICE guidelines (CG158) Holistic and multidisciplinary/agency Information from multiple sources/settings Developmental history and assessment Cognitive assessment often useful Mental health assessment (incl. screening) Early life history/care and trauma Think ACEs (Adverse Childhood Experiences)

Answer 38

Physical abuse Verbal abuse Sexual abuse Physical neglect Emotional neglect An alcoholic parent A family member in jail The disappearance of a parent through divorce, death or abandonment A family member diagnosed with a mental illness A mother who's a victim of domestic violence

Answer 39

``` Liking school Teachers who care Opportunities to have fun A predictable home routine Feeling comfortable with yourself Having a caregiver whom you feel safe with Beliefs that provide comfort Having good friends and neighbours ```

Answer 40

Adversity is associated with ASB Hereditary component to criminal behaviour (CB) Scandinavian adoption studies - Risk for all CB was significantly elevated in the adopted-away offspring of biological parents with CB (odds ratio (OR) 1.5, 1.4-1.6) - Risk also elevated if environmental risk factors in adoptive home - Genetic risk factors for violent and non-violent offending may be partially distinct

Answer 41

'Warrior gene'/s Monoamine oxidase A gene (MAOA) Breaks down MA neurotransmitters (e.g. dopamine, noradrenaline and serotonin etc) in synaptic cleft Low activity allele -> aggression in observational studies Risk of CD/ASPD much lower in absence of early childhood adversity Cadherin-13 (CDH13) Risk for ADHD and CD Impacts GABAergic function in hippocampus and cognition

Answer 42

Young people with CD often have other developmental or mental health issues Psychiatrists can help other professional and the CJS to understand if these play a role in offending ASB can be viewed as a public health problem Medical staff have a key role to play in the multi-agency response to ASB Feeding into child protection arrangements Leading teams that can deliver evidence-based management

Answer 43

Medication may have a role in treating comorbidity - ADHD - Depression - Anxiety The evidence for medication reducing aggression long-term is weak Low doses of the antipsychotic risperidone licensed for short-term use (<6 wks), including in autism Other medications have been trialled but little evidence of consistent benefit

Answer 44

Parent-management training (PMT) - More effective in under 11s - Supports carers in delivering consistent, effective parenting Cognitive-behavioural therapy (CBT) based approaches - May be used to improve 'anger management' - Useful in older children (>12 years) Multi-systemic therapy - Based on family therapy - Involves people and organisations involved with the young person - Good evidence, if young people and family engage

Answer 45

Snake venom - α-bungarotoxin Botulinum toxin Atropa belladonna - atropine

Answer 46

Can be excitatory or inhibitory Released at the synapse Currently there are >100 neurotransmitters Can be subdivided into two main types - Small molecule neurotransmitters (generally mediate fast synaptic signalling - Neuropeptides (composed of 3-36 amino acids, mediate slower synaptic signalling, modify ongoing synaptic function) Abnormalities of neurotransmitter function underlies a wide range of neurological and psychiatric disorders e.g. Alzheimer's, Parkinson's, Schizophrenia, Depression etc

Answer 47

Small neurotransmitters - Enzymes that are required to metabolise these compounds are produced by the nucleus and trafficked to the axon terminal - Enzymes metabolise neurotransmitter precursors and neurotransmitters are packaged into vesicles - Vesicles can release contents if neurone activated - Precursors taken back up into the neurone and process started again Peptide transmitters - Neuropeptide precursor and enzymes produced by the nucleus and transported together down the axon - Enzymes modify the neuropeptides - After release neuropeptides diffuse away and is degraded

Answer 48

Acetylcholine (ACh) (small) Biogenic amines (small) - Noradrenaline (NA) - Adrenaline - Dopamine (DA) - Serotonin (5-HT) - Histamine - Catecholamines Amino acids (small) - Glutamate (Glu) - Gamma-amino butyric acid (GABA) - Glycine (Gly) Gases (small) - NO (Nitric oxide) - CO (carbon monoxide) Neuropeptides (larger) - Substance P - Enkephalins/endorphins - Vasopressin - Oxytocin - Somatostatin - Thyrotropin releasing hormone (TRH)

Answer 49

Neurone can release more than one neurotransmitter (co-transmission) Synaptic vesicles can contain different transmitters Low frequency stimulation: release of small vesicles High frequency stimulation: release of small and large vesicles (neuropeptides) Co-transmitters give versatility to neurotransmission

Answer 50

1 - Chemical must be synthesised or present in the neurone 2 - When released the chemical must produce a response in the target cell 3 - Specific receptors are present on the post synaptic cell to continue the signal 4 - A chemical can induce the same response when placed on target 5 - The chemical must be removed from the synaptic cleft

Answer 51

According to the main neurotransmitter present using the 'ergic' suffix Although neurones can contain more than one type of neurotransmitter ``` Cholinergic neurones (contain acetylcholine) Glutamatergic neurones (contain glutamate) GABAergic neurones (contain GABA) Catecholaminergic neurones (contain noradrenaline/adrenaline/dopamine) Serotonergic neurones (contain serotonin/5-HT) Peptidergic neurones (contain peptides) ```

Answer 52

Ionotropic receptors - Movement of ions across the membrane - Open and close when ligand binds Metabotropic receptors - G protein coupled - Then activate ion channel or stimulates second messenger

Answer 53

Sympathetic - fight or flight - nicotinic linked ACh nerves link to muscarinic linked ACh nerves Parasympathetic - rest and digest - nicotinic linked ACh nerves link onto the epinephrine nerves

Answer 54

Acetylcholine The neurotransmitter at the neuromuscular junction Autonomic nervous system

Answer 55

In the CNS acetylcholine plays a role in: - Learning and memory - Sleep - Arousal - Biorhythms - Thermoregulation - Sexual behaviour Acetylcholine is found in neurones of hippocampus and cerebral cortex, regions devastated by Alzheimer's

Answer 56

Raise ACh levels using AChE inhibitors e.g. donepezil Neostigmine and physiostigmine used to treat - glaucoma - myasthenia gravis - smooth muscle dysfunction

Answer 57

Cholinergic receptor subtypes (ionotropic) - Nicotinic receptors found in NMJs, autonomic ganglia, adrenal medulla and CNS - Two types Nicotinic Nₙ postganglionic neurones and some presynaptic cholinergic terminals Nicotinic Nₘ skeletal motor endplates Muscarinic receptors (G-protein coupled) - Found in peripheral tissues, ANS and CNS 5 subtypes: M₁, M₂, M₃, M₄ and M₅ - M₁, and M₃, M₅ coupled to G-protein/PLC - M₂, M₄ coupled to Gᵢ/open K+ ion channels

Answer 58

Glutamate GABA Glycine

Answer 59

Amino acid One of the most important neurotransmitters for normal brain function Half of the brain's synapses use glutamate Nearly all excitatory neurones in the CNS are glutamergic Many brain pathologies are due to too much glutamate which at high extracellular concentrations kills neurones

Answer 60

In the presynaptic cell - Glutamine transported in to the cell - Converted to glutamate by glutaminase - Packaged into vesicles - Glutamate also transported into presynaptic cell from synaptic cleft Postsynaptic neurone - Glutamate crosses synaptic cleft and binds to glutamate receptors Glial cells - Glutamate transported into cell - Converted to glutamine by glutaminase Thought that a lack of glutamate transporters or dysfunction can lead to motor neurone disease, epilepsy, Alzheimer's

Answer 61

Three subtypes of glutamate ionotropic receptor - AMPA receptor - AMPA - NMDA receptor - NMDA - Kainate receptor - Kainate Drug agonists can preferentially activate each subtype NMDA receptors are implicated in epilepsy - Treat epilepsy by blocking NMDA is one approach currently being tested

Answer 62

Glutamate binds to the AMPA receptor causing it to open and sodium ions to flow through the membrane Glutamate also binds to the NMDA receptor however depolarisation of the cell due to an influx of ions causes release of magnesium ions which opens the channel This allows entry of calcium into the cell activating secondary messenger pathways Linkage between AMPA and NMDA receptors to produce a response in the postsynaptic cell

Answer 63

GABAergic | Glycinergic

Answer 64

Presynaptic cell - Glutamine is transported into the cell - Converted to glutamate by glutaminase - Converted to GABA by glutamate decarboxylase - Packaged into vesicles - Some GABA reuptaken Postsynaptic neurone - Crosses synaptic cleft and binds to receptor (ion channels) Glial cell - GABA transported into glial cell - Converted to glutamate by GAMA transaminase - Converted to glutamine by glutaminase - Transported out of cell

Answer 65

5 subunit, pentameric ion channel α, β and γ subunits Bind barbiturates, GABA and benzodiazapams Opens channel to allow in chlorine ions

Answer 66

Valium (diazepam) interacts with the GABA receptor to increase influx of Cl- ions into the neurone This hyperpolarises the neurone - inhibition Uncontrolled excitation in the brain Imbalance between excitatory and inhibitory neurotransmitters Can use diazepam to treat epilepsy This enhances the inhibition caused by GABA Also sodium valproate which increases GABA content of the brain

Answer 67

Glycine acts mainly in the brain stem and spinal cord; associated with brain stem nuclei involved in general motor and somatosensory systems Major spinal cord inhibitory transmitter Ionotropic receptor, ligand-gated ion channel Glycine receptors are linked to Cl- ion channels Inherited defects in Glycine receptor channels implicated in hyperekplexia Receptors blocked by strychnine, a potent convulsant Pharmacology of glycine receptors still remains limited

Answer 68

Presynaptic cell - Serine is converted to glycine by SHMT - Packed into vesicles - transported back into presynaptic cell from the synaptic cleft Astrocyte - Glycine is transported into the cell - Broken down into CO2 and NH3

Answer 69

Motor pathway - glutamate Motor neurone - ACh (branch to skeletal muscle) Renshaw cell - glycine Recurrant branch (from MN to Renshaw cell) Action of tetanus via Renshaw cell, blocks action leading to excessive movements

Answer 70

Catecholamines (noradrenaline, adrenaline, dopamine) | Serotonin

Answer 71

Dopamine (DA) Noradrenaline/norepinephrine (NE) Adrenaline/epinephrine All contain the catechol group All catecholaminergic neurones contain tyrosine hydroxylase which converts tyrosine to L-Dopa

Answer 72

``` Tyrosine (Tyrosine hydroxylase) L-Dihydroxyphenylalanine (dopa) (Dopa decarboxylase) Dopamine (Dopa β-hydroxlase) Noradrenaline (Phentolamine, N-methyltransferase) Adrenaline ```

Answer 73

- Uptake - Enzymatic breakdown: Catecholamines metabolised by MAO (MAOa and MAOb) MAOs widely distributed at nerve endings Or COMT-extraneuronal widely distributed in liver, kidneys and smooth muscle - Diffusion away from receptors

Answer 74

``` Tyrosine (Tyrosine hydroxylase) L-Dihydroxyphenylalanine (dopa) (Dopa decarboxylase) Dopamine ```

Answer 75

``` Mesolimbic pathway - Reinforcement Mesocortical pathway - Planning Nigrostriatal pathway - Movement ```

Answer 76

Number of dopaminergic receptors in the brain circa 300,000-400,000 Dopamine receptors classified as D₁-like or D₂-like D₁-like include D₁ and D₅ receptors are positively coupled to adenylate cyclase via Gₛ protein D₂-like include D₂, D₃ and D₄ receptors are negatively coupled to adenylate cyclase via Gᵢ protein

Answer 77

``` 3,4-dihydroxy phenylacetic acid (DOPAC) - MAO Homovanillic acid (HVA) - COMT, MAO ```

Answer 78

Clinical characteristics (TRAP) - Tremor of hands - Rigidity of muscles - Akinesia (impaired initiation of movement) - Postural problems Epidemiology - 1 in 500 cases worldwide, peak onset 60 years old Cause - not known Neuropathology - Degeneration of neurones in Substantia Nigra that project to striatum (part of the nigrostriatal pathway) - Decrease in dopamine availability Treatment - L-Dopa, a precursor of dopamine - This boosts dopamine levels in substantia nigra neurones still alive Side effects - e.g. reduction of effect of L-Dopa, schizophrenia-like symptoms Post-mortem -Degeneration of pigmented cells (dopamine-utilising neurones) in substantia nigra pars compacta

Answer 79

Dopamine (Dopa β-hydroxylase) Norepinephrine

Answer 80

One source of CNS noradrenergic neurones (noradrenaline containing) is the locus coeruleus which has projections to various parts of the brain Plays a role in sleep/wakefulness, attention and feeding behaviour A decrease in noradrenaline activity is thought to be related to depression Increases in noradrenaline activity are related to mania (overexcited behaviour) Noradrenaline is released from sympathetic postganglionic fibres in the PNS

Answer 81

The metabolism of both noradrenaline and dopamine

Answer 82

Noradrenaline -> Normetanephrine (COMT) Nometanephrine -> MHPG or VMA (MAO) Noradrenaline -> DHPG or 3,4-Dihydroxymandelic acid (MAO) DHPG -> MHPG (COMT) 3,4-Dihydroxymandelic acid -> VMA (COMT)

Answer 83

``` Serotonin is also known as 5-HT (5-hydroxytryptamine) Synthesised from tryptophan (meat and dairy products are rich in tryptophan) Serotonergic neurones (e.g. from raphe nuclei) are relatively few in number but play an important role in mood, emotional behaviour and sleep A decrease in serotonin leads to depression ```

Answer 84

``` Tryptophan (Tryptophan hydroxylase) 5-Hydroxytryptophan (5-HTP) (5-HTP decarboxylase) 5-Hydroxytryptamine (Serotonin, 5-HT) ```

Answer 85

- 5-HT is stored in presynaptic vesicles - reuptake into presynaptic neurone terminates mediated by Serotonin transporter (SERT) & reconcentrated into vesicles by VMAT - SSRI inhibit serotonin reuptake

Answer 86

At least 7 types receptors (5-HT₁ to 5-HT₇) 5-HT₁ group: 5-HT₁A , 5-HT₁B , 5-HT₁D , 5-HT₁E , & 5-HT₁F 5-HT₂ group: 5-HT₂A , 5-HT₂B , 5-HT₂C 5-HT₅ group: 5-HT₅A & 5-HT₅B Most are metabotropic but 5-HT₃ ionotropic Difficult to target just one in therapy resulting in more side effects

Answer 87

``` Pineal gland 5-Hydroxytryptamine (Serotonin, 5-HT) (5-HT N-acetyltransferase) N-Acetyl serotonin (5-Hydroxyindole-O-methyltransferase) Melatonin ``` 5-Hydroxytryptamine (Serotonin, 5-HT) (MAO + aldehyde dehydrogenase) 5-Hydroxyindoleacetic acid

Answer 88

Many drugs inhibit SERT - SSRIs - 5-HT₁A receptors are found in those regions of the brain that are implicated in the control of mood, cognition and memory - The role of 5-HT₁A in anxiety is well established - Buspirone acts pre-synaptically on 5-HT₁A receptors inhibiting synthesis and firing of 5-HT neurones & post-synaptically in hippocampus & cortex as partial agonist - 5-HT₁d and 5-HT₂ antagonists used to treat migraine

Answer 89

- Neurotransmitters can also not conform to the actions of neurotransmitter. In this case they are termed as acting as neuromodulators - It can be hard to determine, what is a neurotransmitter and what is a neuromodulator. - A neuromodulator is released by neurones - Neuromodulators do not directly activate ion-channel receptors but act together with neurotransmitters, to enhance the excitatory or inhibitory receptor response. - Neuromodulators modify post or pre-synaptic responses - Examples of neuromodulators are dopamine and neuropeptides. - Neuromodulator release can also be subject to modulation.

Answer 90

Antidepressant drugs: - MAO inhibitors: prevent enzymatic breakdown of noradrenaline and serotonin. - Tricyclics: block noradrenaline and serotonin transporters (prevent re-uptake) - SSRIs (selective serotonin re-uptake inhibitors): only block serotonin transporters e.g. fluoxetine (Prozac) Raises levels of noradrenaline and/or serotonin

Answer 91

Arg, Pro, Lys, Pro, Gln, Gln, Phe, Phe, Gly, Leu, Met, NH2 - Member of the Tachykinin family - Substance P binds to NK₁, NK₂ and NK₃ receptors. Binds strongest to NK₁ (neurokinin) - Wide distribution: Dorsal horn of spinal cord, Amygdala, medulla, Hypothalamus, Substantia Nigra, cerebral cortex & Striatum - SP present in C fibres and pain transmission

Answer 92

DSM (IV or V) - American Psychiatric Association, adopted by NICE ICD-10 - WHO National Institute of Mental Health's Research and Domain Criteria

Answer 93

``` Neurodevelopmental disorders Schizophrenia spectrum and other psychotic disorders Bipolar and related disorders Depressive disorders Anxiety disorders Obsessive-compulsive and related disorders Trauma- and stressor-related disorders Dissociative disorders Personality disorders ```

Answer 94

Aetiology - 'from neurones to neighbourhoods', hard to find a single cause Multidimensional complexity Co-morbidities Setting thresholds for diagnosis in a clinical setting

Answer 95

History Examination Screening questions Tools

Answer 96

PHQ-9 - patient health questionnaire (depression severity) GAD-7 - generalised anxiety disorder questionnaire HADS - hospital anxiety and depression scale

Answer 97

Worldwide - Predominant mental health problem worldwide is depression, followed by anxiety, schizophrenia and bipolar disorder (2013 Global Burden of Disease study) - WHO estimates between 35%-50% of people with severe mental health problems in developed countries, and 76-85% in developing countries, receive no treatment

Answer 98

Depression is one of the leading causes of disability worldwide 24% of women and 13% of men in England are diagnosed with depression in their lifetime Depression often co-occurs with other mental health issues Depression occurs in 2.1% of young people aged 5-19 Major depression is more common in females than in males

Answer 99

There were 8.2 million cases of anxiety in the UK in 2013 Women are twice as likely to be diagnosed with anxiety 7.2% of 5-19 year olds experience an anxiety condition

Answer 100

Provides data on the prevalence of treated and untreated psychiatric disorders in the adult population (over 16) Looks at common mental disorders Carried out every 7 years Each of the APMS surveys in the series used the revised Clinical Interview Schedule (CIS-R) One in six (17%) of people over the age of 16 had a common mental health problem in the week prior to being interviewed GAD, depression, phobias, OCD, panic disorder and CMD-NOS

Answer 101

- 1 in 6 adults had a CMD, ~1 in 5 women and ~1 in 8 men - Since 2000, overall rates of CMD in England steadily increased in women and remained largely stable in men - Women are also more likely than men to report severe symptoms of CMD - 10% of women surveyed reported severe symptoms compared to 6% of men - 39% of adults aged 16-74 with conditions such as anxiety or depression were accessing mental health treatment - In England, the rates of common mental health problems are highest in the South West (20.9%), North West (19%), West Midlands (18.4%) and London (18%) - They are lowest in the South East (13.6%) and the East (14.4%) - In the UK, the estimated cost of mental health problems are £70-100 billion each year and account for 4.5% of GDP - Strong links between physical and mental health problems, research found that 30% of people with a long-term physical health problem also have a mental health problem and 46% of people with a mental health problem also had a long-term physical health problem - In 2013 there were 6233 suicides recorded in the UK for people aged 15 and older, 78% were male and 22% were female

Answer 102

Mental health in the UK during the COVID-19 pandemic: cross-sectional analyses from a community cohort study - For both anxiety and depression, the means for the cohort were higher for both genders compared with their respective population norms and also for all age ranges between 25 and 64 years - For depression, being younger, female, living alone, and being in a recognised risk group for COVID-19 were all independently significantly associated with greater levels of depression - For anxiety being younger, female, being a key worker and being in a recognised COVID-19 risk group were independently significantly associated with greater levels of anxiety

Answer 103

Approximately 90% of common mental health disorders are managed in primary care NICE guidelines provide pathways of treatment which can lead to secondary care

Answer 104

Improving access to services Identification Developing local care pathways

Answer 105

``` Identify care needs of the patients Exploring causes Look at the trends in mental health Look at management Look at impact of events e.g. Coronavirus Pandemic ```

Answer 106

Hard to categorise and diagnose Relapsing and remitting nature of mental health conditions A substantial amount of mental health services are delivered outside the health sector Huge numbers of people Sub-groups in the population

Answer 107

Gathering existing data Biological measurements Diagnostic interview Screening assessment tools

Answer 108

Identifying the outcomes you need to measure Standards you are using to define mental illnesses Using a pre-existing screening tool vs creating one

Answer 109

``` What are you trying to measure? Why are you trying to measure this? What resources do you have? Population Ethical considerations Practical challenges ```

Answer 110

Lifestyle (diet/exercise) Social support Psychotherapy Antidepressants Record number of 70.9 million prescriptions for anti-depressants given in 2018 Up from 36 million in 2008

Answer 111

Dopamine - Nigrostriatal - initiation and control of movement - Mesolimbic - reward, reinforcement - Mesocortical - cognition, planning, motivation - 'Tubero-infundibular' (hypothalamus to pituitary) - inhibits the release of prolactin hormone from the pituitary gland Noradrenaline - Particularly released by neurones originating rom the locus coeruleus in the brainstem - Project widely influencing sleep, wakefulness, attention, feeding behaviour - Inactivated by reuptake into the pre-synaptic neurone (and oxidation)

Answer 112

Serotonin - Released by neurones originating from the Raphe nuclei in the brainstem - These project to various parts of the brain influencing mood, emotional behaviour, satiety and sleep - Inactivated by reuptake into the pre-synaptic neurone (and oxidation) GABA - Released by inhibitory neurones throughout the CNS - Once stimulated, GABA receptors allow a flux of Chloride ions across the post-synaptic membrane - This hyperpolarises (stabilises) the neurone

Answer 113

- Relapsing and remitting illness, typically starting in young adult life - 1% of the population - Significant hereditary linkage (10% in first degree relatives) with many genes involved - Characterised by 'positive' symptoms during episodes - hallucinations, delusions, thought disorder - An accumulation of 'negative' symptoms over time - lack of motivation, reduced speech, reduced emotion, social withdrawal

Answer 114

Genetic component and environmental factors lead to neurodevelopment abnormality This leads to schizophrenia

Answer 115

- Antipsychotics block dopamine receptors - Drugs that increase dopamine cause psychosis - amphetamine, cocaine, L-dopa - Reserpine depletes dopamine transmission and has an antipsychotic effect (stops MOAs getting into vesicles) - PET and SPECT scans show increased brain dopamine activity when people have schizophrenia

Answer 116

- Neurotransmitter effects are immediate but antipsychotics take 2+ weeks to work on symptoms - Other transmitters appear to be involved with psychosis - glutamate, 5HT2, 5HT1A - The cause of schizophrenia may be upstream - Critical potential role for environmental factors during brain development - Neurodegeneration associated with worsening symptoms, linked to glutamate induced excitotoxicity

Answer 117

- Mesocortical pathway | - Aim of treatment - increase dopamine transmission

Answer 118

- Mesolimbic pathway | - Aim of treatment - decrease dopamine transmission

Answer 119

- Antagonise D2 receptors in the mesolimbic system (and other receptors unfortunately) - Treat schizophrenia, particularly delusions, hallucinations, thought disorder - (also mania, depression with hallucinations/delusions, delirium etc) - e.g. Risperidone, Haloperidol - May take a few weeks to have full effect

Answer 120

``` First generation (Typical/classical/conventional) e.g. Haloperidol - target both D2 and D1 Second generation (atypical) e.g. Risperidone - target D2 less on D1 30% of patients indicated as resistant as dopamine levels not changed but glutamate are Clozapine used (but may cause agranulocytosis ```

Answer 121

Nigrostriatal -> 'extrapyramidal side effects' - Parkinsonism - Akathisia - Acute dystonias - Tardive dyskinesia Tubuloinfundibular -> excess prolactin - Galactorrhoea - Amenorrhoea - Infertility

Answer 122

Weight gain, diabetes, raised cholesterol Particularly second generation Important as people with schizophrenia may lose 15-20 years of life because of increased cardiovascular risk Arrhythmias Also, rare idiosyncratic 'neuroleptic malignant syndrome'

Answer 123

A 'syndrome' i.e. a collection of several symptoms occurring together Persistent low mood/self-esteem, reduced enjoyment/interest, fatigue Sleep, appetite, weight, concentration changes Loss of confidence, indecisiveness, guilt, hopelessness, suicidal thoughts and acts

Answer 124

Depression is a result of a deficiency in brain monoamine neurotransmitters - noradrenaline, serotonin, dopamine - Serotonin - influences mood, emotional behaviour and sleep - Noradrenaline - influences sleep, wakefulness, attention, feeding behaviour - Dopamine - influences motivation, reward

Answer 125

- Antidepressants increase the availability of monoamines at synapses - Reserpine which depletes monoamine transmission causes depression (stops monoamines getting into vesicles) - People with depression can have lower levels of monoamine precursors/metabolites in their CSF or blood

Answer 126

- Neurotransmitter effects of antidepressants are immediate but they take 2+ weeks to work on symptoms - Cocaine and amphetamine mimic NA and 5-HT but do not act as antidepressants - Inprindole is an antidepressant which does not effect NA or 5-HT reuptake (5-HT₂ antagonist)

Answer 127

Tricyclic antidepressant Selective serotonin reuptake inhibitors (SSRIs) Monoamine oxidase inhibitors (MAOIs) Serotonin noradrenaline reuptake inhibitors (SNRIs)

Answer 128

Block the reuptake transporter on the presynaptic cell stopping reuptake of serotonin

Answer 129

- Antagonises histamine (H1) receptors -> sedation - Antagonises muscarinic receptors -> dry mouth, blurred vision, constipation, urinary retention - Antagonises alpha adrenoreceptors -> postural hypotension - Can cause drug interactions as rely on hepatic metabolism via cyp450 - Potentiates the effect of alcohol and anaesthetics - Toxic in overdose

Answer 130

'Selective serotonin reuptake inhibitors' e.g. fluoxetine, citalopram Serotonin - influences mood, emotional behaviour and sleep

Answer 131

- Nausea and vomiting - Sexual dysfunction - Can inhibit metabolism of other drugs -interaction risk - Withdrawal reaction - Safer in overdose

Answer 132

Serotonin -> 5-Hydroxyindoleacetic acid via MONOAMINE OXIDASE - Inhibit monoamine oxidase and you inhibit the breakdown of serotonin - Phenelzine (nonselective, irreversible inhibition) - Moclobemide (reversible competitive inhibitor) - Segeliline (MAO-B selective inhibitor), used to target Parkinson's Can produce a 'hypertensive crisis' if people eat foods rich in Tyramine e.g. mature cheese, Bovril Significant side-effects - postural hypotension, insomnia, weight gain Potential interaction with other drugs (pethidine, TCAs)

Answer 133

One theory is that initially the increased 5-HT in synapses is cancelled out by auto-receptors reducing 5-HT release and more reuptake of the extra 5-HT in the synapses But after a couple of weeks, the auto-receptors desensitise and the blocked reuptake transporters get internalised So eventually there really is increased 5-HT in the synapses

Answer 134

A collection of illness Common thread is excessive fear and associated physical responses Nervousness, foreboding, agitation, palpitations, sweating, bowel upset Generalised anxiety, panic disorder (episodic), specific phobias

Answer 135

GABA released by inhibitory neurones throughout the CNS Once stimulated, GABA receptors allow a flux of chloride ions across the post-synaptic membrane This hyperpolarises (stabilises) the neurone

Answer 136

Bind to GABA receptor, potentiated the effects of GABA, increases Cl- flux and more inhibition e.g. diazepam (Valium), lorazepam (Ativan), temazepam Also used vs seizures and increased muscle tone ('spasticity') Side-effects - Drowsiness - Confusion - Forgetfulness - Impaired motor control - Tolerance and dependence - Respiratory depression - especially with alcohol

Answer 137

For anxiety - antidepressants - Sertraline (SSRI) - Venlafaxine (SNRI) and other e.g. Pregabalin For sleep - 'hypnotics' (potentiate GABA transmission) - 'Z-drugs' (Zopiclone, Zolpidem) - Short acting benzodiazepines (Temazepam)

Answer 138

Normal - it helps us perform better Darwinian survival function - 'fight or flight' Physiological arousal - increases adrenaline, cortisol, sympathetic autonomic nervous system, brain 5-HT and NA Becomes a problem when it interferes with someone's life/functioning Don't want to get rid of all anxiety, only to manage it successfully

Answer 139

- Muscle tension - headaches, pain, fatigue - Hyperventilation - (decrease in pCO2 = respiratory alkalosis -> blood Ca2+ falls -> decrease interaction with Na channels cell membrane -> vasoconstriction + decreased nerve transmission -> dizziness, tingling fingers + toes. If prolonged over-breathing -> tetany (carpo-pedal spasm) - Sympathetic overactivity - (increase heart rate + blood pressure, ectopic beats, sweating, pale skin (cf shock), dry mouth, 'butterflies', nausea, loose motions, frequent urination)

Answer 140

- CNS - poor concentration, memory, feeling unreal - Mood - fear, panic, worry, on edge, irritable - Thought - future danger: 'something bad will happen and I won't be able to cope' (v. depression: past loss), fear of dying/losing control, worry about worry: I will go mad/die just by worrying

Answer 141

1 - Pacing room, wringing of hands, sighing 2 - Attempts at coping (caffeine, smoking, alcohol, illegal or prescribed drugs) 3 - Avoiding fear-provoking situations 4 - Safety behaviours (e.g. agoraphobia only go out with friend, carry mobile) 5 - Asking for reassurance (visiting GP, increase somatic complaints, checking body) CBT involves dropping 3, 4 and 5

Answer 142

- Education/explanation - Relaxation - e.g. muscle relaxation, imagery, controlled ('square') breathing - Advice on sleep - Cognitive behaviour therapy - a psychological treatment that teaches us how to feel better by changing the way we feel think and behave = change behaviour (eg graded exposure) and/or change thinking (eg anxiety is unpleasant but not dangerous) - SSRIS (selective serotonin reuptake inhibitors) - eg sertraline - Benzodiazepines - eg diazepam - Beta-blockers - eg propranolol

Answer 143

- Normal reaction to stress? (if so, educate) - Secondary to physical (eg hypothyroidism) or mental illness (eg depression): treat 1st - Lifelong personality trait or state? - Triggered by a specific object eg spider (a phobia) or free floating? - If free floating, present from time to time (panic) or all the time (generalised anxiety)?

Answer 144

Sensation - e.g. heart racing or feeling dizzy Interpretation - I'm having a heart attack/stroke/going mad Panic Sensation (and etc.)

Answer 145

Trigger -> Viewed as a threat -> Anxiety and panic circle (physical mental symptoms then misinterpretation) Feeding into the anxiety and panic circle - Safety behaviours - sit down, grab onto something, check pulse - Avoidance - distract myself, avoid exercise and going to work - Selective attention - stay vigilant to fears and body changes

Answer 146

Learning is a relatively permanent change in behaviour that occurs as a result of experience It enables person/organism to adapt to environment and increase chances of survival Neuronal basis - amygdala = almond structure in temporal lobes is involved in learning + expressing fear - more axonal connections between neurones? - increased efficiency of neurotransmitter release between neurones across synaptic cleft?

Answer 147

Associative - learning that certain events go together e.g. classical and operant conditioning Vicarious - learning by direct observation (modelling) Factual transmission - this is an example Complex - e.g. social learning, emotional intelligence (E.Q.)

Answer 148

Classical conditioning | Operant conditioning

Answer 149

Other name - Respondent learning Described by - Pavlov 1927 (Russian physiologist) Involves - Learning that one event predicts another stimulus Theme (cognitive) - A reliably predicts B Subject is - Passive Definition - A learning process where a previously neutral stimulus becomes associated with another stimulus by repeated pairing Types and examples - Classical (Pavlov's dog), Neoclassical (taste aversions eg food poisoning) Phobias - May explain origin

Answer 150

Other names - Instrumental learning Described by - Skinner 1938 (American behaviourist) Involves - Learning that a particular response predicts an event Theme (cognitive) - Outcome is controllable Subject is - Active Definition - The alteration of behaviour by reward or punishment: i.e. certain responses are learned because they affect (operate on) the environment Types and examples - Positive reinforcement (praise), negative reinforcement (picking up crying baby), punishment (smacking), extinction ('time out') Phobias - explains maintenance

Answer 151

Normal child development + parenting skills Child problems eg conduct, hyperactivity, enuresis Your teaching and learning skills at all ages Learning disability: behavioural problems (Cognitive)-behavioural therapy (CBT) = a major evidence-based treatment of choice for may mental disorders eg phobias, anxiety, depression, OCD, physical health

Answer 152

Pavlov's dog - UCS - Unconditioned stimulus (food) -> UCR - Unconditioned response (salivation) - CS - conditioned stimulus (bell) -> no salivation - CS -> UCS -> UCR (conditioning) - CS -> CR - conditioned response (salivation) (testing) (UCR and CR are the same) E.g.s - Product advertisers using attractive models - Food cues - salivation to pictures of chocolate - Music in films (eg horror) - enhance emotions - Meeting an old friend - memories return - Conditioned emotions (Albert) - origin of phobias/ - Visit to the dentist/doctor's surgery - pain/anxiety linked to white coats, disinfectant smell, equipment - Chemotherapy - anticipatory nausea entering t=room - Treatment of bed-wetting (pad and bell)

Answer 153

4 basic types - stimulus given, increases behaviour - positive reinforcement (reward) - stimulus given, decreases behaviour - punishment - stimulus withheld, increases behaviour - negative reinforcement (escape, avoidance) - stimulus withheld, decreases behaviour - extinction

Answer 154

Involves - presenting a pleasant stimulus after a desired behaviour has occurred Effect - Increases the likelihood of the desired behaviour E.g. - praise for a good exam result

Answer 155

Reinforcement - INCREASES Involves - removing an unpleasant stimulus after a desired behaviour has occurred Effect - increases the likelihood of the desired behaviour e.g - picking up a crying baby

Answer 156

Involves - presenting an unpleasant stimulus after an undesired behaviour occurs Effect - decreases the likelihood of the undesired behaviour e.g child accidentally touches hot stove

Answer 157

Involves - removing a previously pleasant (reinforcing) stimulus Effect - decreases the likelihood of the undesired behaviour e.g. 'Time out' for toddlers

Answer 158

Successful behaviour will be repeated (+ vice versa) Reinforcers can be - Primary - food, water, escape from pain/cold - Secondary - money, praise, attention, success Reinforcer must be immediate/linked to act e.g. praise for using potty (explains 'lack of willpower' to lose weight, stop smoking, cut down alcohol)

Answer 159

Continuous reinforcement - every response is reinforced (rare in real life) Partial reinforcement - reinforcement occurs, but not after every response e. g. - Ratio schedules - depend on the number of responses eg factory worker gets paid for every 3 shirts made - Interval schedules - depend on the time interval eg nurse only gives paracetamol every four hours if PT asks - May be fixed (predictable) or variable (unpredictable eg slot machines)

Answer 160

- People work harder under partial than continuous reinforcement - Effort increases with the time or ratio ('more work, less pay') - to a point - Extinction of a response much slower with: Partial v continuous reinforcement, and Unpredictable v predictable schedules eg gambling

Answer 161

Shaping (approximation) - Rewarding behaviours which increasingly approximate to the desired more complex behaviour eg learning to walk, talk, drive, play piano, disability tuition, animal trainers Chaining - Breaking down complex behaviours into series of simple acts - each reinforces next (or last) in chain - Reinforce first eg 1st holding spoon then later add need to put spoon in bowl to get praise

Answer 162

Removal of an adverse stimulus after a desired behaviour has occurred NB increases behaviour (unlike punishment) eg baby cries -> mum picks baby up -> baby stops crying -> mum negatively reinforced ('do it next time') (but baby positively reinforced to cry)

Answer 163

A marked and persistent fear Triggered by a specific object/situation Leads to avoidance of that situation Interfered significantly with life 3 types - Agoraphobia (public places, crowds, shops) - Social phobia (eating, speaking, performing) - Specific phobia (animals, heights, needles)

Answer 164

Phobic stimulus -> anxiety -> avoidance or escape -> anxiety reduced -> phobic stimulus Treatment = graded exposure (the deliberate confrontation of a feared object or situation until the anxiety evoked reduced (habituates)) - in reality or imagination, suddenly or gradually

Answer 165

Type of non-associative learning in which repeated exposure to a stimulus leads to decreased responding

Answer 166

Graded exposure (stay in each situation till fear goes: physiological adaptation) S.M.A.R.T targets (specific, measurable, achievable, realistic, timed): easiest 1st eg anxiety ladder for Rachel's bird phobia - put picture of Robin on bedroom wall - watch Hitchcock film 'The Birds' - visit pet shop, stand next to Parrott - walk in local park alone and feed ducks

Answer 167

Presentation of an unpleasant stimulus after an undesired behaviour occurs To be effective punishment must - link response to consequences (no time delay) - be consistently applied (reinforced) - sufficiently applied the first time (not built up) e. g. - child is scolded for drawing on wall - adult burns hand when touching hot pan prisons

Answer 168

Physical or emotional harm or injury eg smacking Paradoxical attention - can act as +ve reinforcer of negative behaviour (any attention better than none Teaches aggression as model to solve difficulties No alternative behaviour provided (reward = 'repeat this', punishment = 'stop it') Leads to fear/dislike of person (parent, teacher, employer) and situation (home, school, office) = classical conditioning

Answer 169

A decrease in behaviour by withholding a previous reward (classical or operant) eg - child crying in bed every night - remove reinforcing parental attention by leaving to cry for 10 minutes before checking, then increased to 20, 40, 60 mins etc - 'time out' for toddler tantrums (decrease attention) - depression - lack of pleasure so stop doing things and achieve less, worsening mood in a 'vicious circle'

Answer 170

``` D - Depressed mood E - Energy loss/fatigue P - Pleasure lost (anhedonia) R - Retardation or agitation E - Eating changed (appetite/weight) S - Sleep changed S - Suicidal thought (or future bleak) I - I'm a failure (loss of confidence/self esteem) O - Only me to blame (guilt) N - No concentration (not able to function) ``` No of symptoms: 4 = mild depression, 5 or 6 = moderate, 7+ = severe Minimum of 2 weeks Take into account not just number of symptoms but functioning in daily life Treatment = CBT or medication (SSRI antidepressant or both) Screening for depression (PHQ-2) - in primary care and general hospital

Answer 171

Cognitive - challenge unhelpful and extreme ways of thinking eg using thought records Behavioural - behavioural activation, inc. activity scheduling + goal setting eg using an activity diary Therapy - a talking (or should that a 'doing'?) treatment - also includes generic skills (empathy, listening, therapeutic relationship)

Answer 172

Low mood -> extreme and unhelpful thinking styles switched on -> Negative thought -> problems look bigger, stop doing things, criticise self, feel useless -> Low mood etc

Answer 173

Depression is caused and maintained by negative views of: - The Self - as worthless eg I'm weak - The World/other - as unfair eg people are bullies - Future - as hopeless eg things will never improve

Answer 174

Early experience -> core beliefs -> unhelpful assumptions and rules -> trigger (critical incident) -> negative thoughts -> behaviours and feelings CBT aims to deconstruct this

Answer 175

Low mood -> no pleasure or interest, everything is an effort, cannot focus -> Doing less -> achieve less - confidence falls, no rewards (friends, hobbies), more time spent brooding on negative thoughts -> Low mood etc.

Answer 176

Don't just sit there - do something - 'what have you got to lose by trying' Stop avoiding and ruminating (= unhelpful behaviours) - 'how helpful is it sitting in the house all day avoiding things?' Reverse vicious circle (Seligman's 'learned helplessness') - 'activate' yourself towards desired/useful goals, 'Miracle Q'

Answer 177

Reverses vicious cycle by reintroducing positive reinforcers in life (rewards), regain sense of control (combat learned helplessness) - Baseline measure - assess activities, review progress - Regain sense of control - something I can do myself - Rate pleasure and achievement - do more of the activities that boost mood + self worth, examine/drop others - Set goals - restart old hobbies and activities ('S.M.A.R.T' targets - specific, measurable, achievable, realistic, timed)

Answer 178

Health psychology is devoted to understanding psychological influences on how people stay healthy, why they become ill, and how they respond when they do get ill

Answer 179

- “Attribution theory deals with how the social perceiver uses information to arrive at causal explanations for events. It examines what information is gathered and how it is combined to form a causal judgment” - 'naive psychologists' trying to make sense of the social world Internal vs external Stable vs unstable Global vs specific Controllable vs uncontrollable

Answer 180

- “people’s beliefs in their capability to exercise some measure of control over their own functioning and over environmental events” - belief that we can succeed at a specific activity we want to do Outcome expectancy - that the behaviour will lead to a favourable outcome Self-efficiency - that one can perform the behaviour properly

Answer 181

'Pressure', 'tension', 'body's reaction to feeling threatened or under pressured An imbalance between the demands made on us and our personal resources to deal with these demands

Answer 182

``` Life events (LE) - work problems, changes, debts, relationships difficulties (divorce, birth of child), family problems, moving house, examinations, diagnosis of physical illness Not the LE's themselves that cause the stress but the interpretation and the meaning to the individual If issues linked to physical illness - a particular sense of out of control (immediacy, ambiguity, uncontrollability and undesirability) ``` LE -> Appraisal -> Stress Key component - Appraisal Primary - appraisal of the event Secondary - appraisal of personal coping abilities of personal resources and also the resources external to them, mainly in the immediate social network (Primary appraisal) Life event -> Stress response (emotional, cognitive, behavioural, physiological) (Secondary appraisal) Coping -> Stress response and life event

Answer 183

- Feeling on edge - Feeling sad - Irritability - Tearful - Over-reacting

Psychological Medicine Flashcards

(208 cards)