Psychological Medicine

Question 1

What are the 5 most common psychological problems patients bring into primary care?

Answer 1

Anxiety

Job stress

Family problems

Chronic pain

Depression

Question 2

What is depression?

Answer 2

A disorder of emotion (affective disorder)

Question 3

What are the two main types of depression?

Answer 3

Unipolar: depressive state. Patients have constant tiredness and low moods. Once experienced, it is likely to happen again due to stressful triggers.

Bipolar: involves rapid transition between depressive and manic phases.

5% of population will suffer at lease one episode of unipolar depression. Prevalence of depression is especially high in clinical populations.

Question 4

What is the ABC of depressive symptoms?

Answer 4

Symptoms of depression are clustered

Affect - persistently lowered mood, diminished interest or pleasure in activities

Behaviour - loss of appetite, disturbed sleep, lowered libido, social withdrawal

Cognition - depressive ideation (guilt), suicidal thoughts, fatalastic (hopelessness)

Question 5

What is the step-care model for depression?

Answer 5

1. Known and suspected presentation of depression - assessment, support, education, monitoring (referral and sessment for interventions)
2. Persistent subthreshold depressive symptoms or mild depression - low-intensity phychological interventions, psychological interventions, medication and referral
3. Persistent subthreshold depressive symptoms or mild/moderate depression with inadequate response to initial interventions - medication, high intensity psychological interventions, combined treatments
4. Severe complex depression, risk to life, severe neglect - medication, high-intensity psychological interventions, combined treatments, multiprofessional inpatient care

Question 6

What are the criteria for major depression?

Answer 6

Depressed mood
Substantial weight loss/gain
Insomnia or hypersomnia
Feelings of worthlessness or inappropriate guilt
Recurrent thoughts of death or suicide attempts
Decreased interest or pleasure
Psychomotor retardation or agitation
Fatigue or loss of energy
Diminished ability to think or concentrate

Five or more in the same two week period - which is a change from normal

Question 7

What two questions could you use to screen for depression?

Answer 7

During the past month, have you been bothered by feeling down, depressed or hopeless?

During the past month have you been bothered by little interest or pleasure in doing things.

Symptoms should be present for at least 2 weeks

Question 8

Following a positive screen for depression, what else do you need to assess?

Answer 8

Detailed assessment to determine symptom severity and suicide risk.

Question 9

Name four key approaches used in psychological medicine

Answer 9

Egan’s 3 stage model
Cognitive behavioural therapy
Psychodynamic therapy
Humanistic approach
Systemic approach
Transactional analysis
Integrative approach

Question 10

Outline Egan’s 3 stage approach to counselling

Answer 10

Explore - what is the problem?

Understand - how has the problem arisen? what does it mean to the patient? what change is sought?

Action - how can the change be acheived? what strengths and resources does the patient have?

Review and evaluate the outcomes of the strategies for change

Question 11

What are the aims of CBT?

Answer 11

Acheive positive change in behaviour which has been negatively affecting an individual’s functioning.

Identify thinking that causes problematic feelings and behaviour

Question the individual’s negative thinking to enable positive change in their thought process

Identify unwanted behaviour patterns

Plan behavioural goals and the step by step process for the acheivement of those goals

Question 12

Name four areas where the use of CBT can be beneficial?

Answer 12

Anxiety and panic attacks

Addictions (pathological gambling)

Depression

Obsessive-compulsive disorder

Drug/Alcohol problems

Eating disorders

Phobias

Chronic fatigue syndrome

Question 13

Name four techniques used in CBT

Answer 13

Challenging irrational beliefs

Reframing/replacing irrational beliefs with alternative rational thoughts

Thought stopping

Graded exposure

Assertiveness

Social skills training

Problem solving training

Relaxation techniques

Question 14

What are the benefits of CBT?

Answer 14

Quick

Cheap

No medication required (no side effects)

Question 15

What are they key aspects of the psychodynamic approach?

Answer 15

Assumption that a patient’s current difficulties have their origins in earlier experiences (particularly childhood).

Explores issues from the past which produce defence mechanisms.

Assumes that the patient may not have a conscious awareness of the real motives or impulses which influence their actions (motivational drives, biological, psychological, relationship behaviour needs to be understood)

Question 16

Name three psychological conditions that psychodynamic therapy can be used for

Answer 16

Depression

Anxiety states

Post-traumatic stress disorder

Eating disorders

Addictive behaviour

Schizophrenia

Question 17

What are defence mechanisms?

Answer 17

Psychological strategies brought into play by the unconscious mind to help protect an indiviual’s sense of self.

e.g. denial, regression, withdrawal

Question 18

What techniques are used in psychodynamic intervention?

Answer 18

Encourage the patient to explore and reflect on significant issues

Interpret behaviour or feelings (present alternative perceptions)

Challenge the patient with important consequences of their behaviour which the patient may be avioiding (consciously or subconsciously)

Convey empathy (show patient their feelings are recognised and understood)

Reinforce positive change made by patient with approval

Question 19

What is the humanistic approach?

Answer 19

Humanistic approach focuses on choice, values and purpose in life.

Person centred, and non-judgemental

Emphasis is on positivism and the wholeness that an individual can acheive

Focuses on the impact of self-evaluation of life experiences (particularly the the extent of unconditional love and acceptance that has been experienced)

Question 20

What are the key stages of the humanist approach?

Answer 20

Establishing trust

Intimacy, so the patient is able to share deep levels of experience

Mutuality between the therapist and the patient (therapist is experienced as a real person)

Question 21

How can you convey positive regard (unconditional acceptance) to patient?

Answer 21

Giving positive attention

Active listening

Giving your time

Remembering the person’s name

Introducing yourself

Not interrupting

Question 22

How can you convey empathy?

Answer 22

Reflecting back to the other person feelings that you are picking up

Behavioural mirroring (smiling when the other person smiles etc)

Question 23

In what situations can humanistic therapy be useful?

Answer 23

When addressing factors which may lie behind substance abuse disorders e.g. lack of meaning in a person’s life, anxiety about failure, fear of death, alienation from others, spiritual emptiness.

To address a person’s self-awareness. Attempts to help people gain control of their lives and make positive choices about their future e.g. self-esteem, bereavement, assertiveness

Question 24

What are the key concepts of the systems approach?

Answer 24

Suggests that as family, work and social group dynamics change, an individual’s identity and sense of purpose can change.

Views problems as contextual and interpersonal - emphasises relationships and networks. Patient’s family, work and community relationships are taken into account when considering options for the patient.

Question 25

In what clinical situations would the systems approach be useful?

Answer 25

Working with patients and their failies

Recognising the significance of supportive networks in aiding recovery (what does the illness mean to the patient and their fmaily?)

Recognising the aspects of the environment where a patient lives/works that negatively affects health and well-being.

Question 26

What are the key concepts of transactional analysis?

Answer 26

Uses concepts from humanistic, psychodynamic and cognitive approaches.

TA is a theory of personality that describes how people function and express thier personality in their behaviour.

Explores how values and attitudes learnt from parents and other significant people in childhood can exert a strong influence on an adult (adult patterns developed in childhood that we continue to replay)

Question 27

How can transactional analysis be useful?

Answer 27

Helps patients to:

reflect on their ways of thinking and behacing

be more aware of the impact we have on others

improve the clarity and directness of communication with others