Psychology Flashcards
Theories of Pain
**Specificity Theory
Presence of dedicated pathways for each somatosensory modality
4 types of sensory receptor controlling 4 types of sensory modality
- heat, cold, touch, pain
Nerve responds to only one modality
Nerve continuous from periphery to brain
**Gate Control Theory
(Melzack and Wall)
Allows physical distraction by a different stimulation closing the gate
- Large fibre stimulation – normal somatosensory input – gate closed
- Small fibre stimulation – pain – gate open
Explains why if we rub our leg after hitting it the pain lessens
Acute vs Chronic pain
* Acute A warning system Represents tissue damage Message – do something about this! Short duration Care and relief likely Suffering recognised
*Chronic
May or may not be associated with tissue damage – pain itself is disease
Long duration
No end in sight
Care and relief not likely
‘Psychosomatic’
Suffering may be dismissed – its all in your head!
Psychological methods of pain control
*Hypnosis
- Chronic Pain Psychological Therapy
- > Cognitive Behavioural Therapy
- Thoughts, beliefs, distorted thinking, catastrophising responsible for the consequences of events
- Identify and challenge distorted cognition
- Cognitive restructuring
- Coping skills training
- Imagery and relaxation
- Stress management
2 Main Classification systems of psychiatric disorders
- ICD-10 - WHO international classification of diseases
- Diagnostic and Statistical Manual of Mental disorders (DSM-V) - American Psychiatric Association
Purpose: Standardises diagnoses, enhancing ability to research disorders and build an evidence base for practice
Psychosis
Severe mental disturbance, loss of contact with external reality
Neurosis
Mental distress, but can still distinguish between symptoms originating in their own mind and external reality
Mood Affective disorders
Depression
o Dysthymia
Pt experiences chronic depressive symptoms, but not severe enough to warrant a diagnosis
o Mild
o Moderate
o Severe
Severity usually based on number of symptoms and impact on person’s life
Bipolar Disorder Episodes of depression and elation o Cyclothymia Episodes of mood swings but not severe enough for diagnosis o Bipolar I o Bipolar II
How depression diagnosed
At least 2 core symptoms + 2 other symptoms identified
Core symptoms of depression
- Depressed mood most of the day nearly every day
- Markedly diminished interest and pleasure in all or nearly all activities most of the day nearly every day
- Decreased energy or increased fatiguability
Other symptoms associated with depression
Decrease/increase appetite
Reduced self esteem and self confidence
Insomnia/hypersomnia
Psychomotor agitation/retardation
Fatigue/loss of energy
Feelings of worthlessness or excessive guilt
Decreased concentration or indecisiveness
Recurrent thoughts of death or suicidal ideation
[Do Rats In Prison Feel Fatigued During Races]
Biological features of depression
- Altered sleep patterns; usually decreased
- Early morning wakening; mood typically worse am
- Appetite reduced with weight loss
- Libido reduced or absent
- Motor activity agitation or retardation, including speech
Cognitive features of depression
- “Beck’s cognitive triad” = negative, pessimistic thoughts about: self, the world, the future
- ‘all or nothing’ thinking, personalising, focussing on negatives, catastrophising, jumping to conclusions
- Reduced attention, concentration, decisiveness
- Guilt, worthlessness, death or suicide
- Delusions and hallucinations can occur
Aetiology of depression
Combination of genetic factors and stressful life events
Also linked to some drugs
- steroids, OCP (contraceptive), chronic pain, terminal illness
Types of depression
SAD:
Seasonal affective disorder – lack of natural light
Abnormal grief reaction:
Delayed grief/excessive grief years later
Adjustment disorders:
Abnormal responses to big life changes
Instruments designed to measure anxiety and depression
Screening –
The 2 Question Test
1. During the past month, have you often been bothered by feeling down, depressed or hopeless?
2. During the past month, have you often been bothered by little interest or pleasure in doing things?
Yes to both – 96-97% sensitivity, 57-67% specificity
→ problem with detection of false positives
Hospital Anxiety and Depression Scale (HADS)
• 14 item self-rating scale for severity of depression and anxiety symptoms.
• 90% sensitivity, 86% specificity
Patient Health Questionnaire – 9 (PHQ-9)
• 9 item self rating scale measures proportion of time in past 2 weeks depressive symptoms present
• 80% sensitivity, 92% specificity
Psychological treatments of depression
CBT or interpersonal psychotherapy
(Defined very broadly)
• Cognitive – perception of events/ thinking errors
• Behavioural – changing behaviours
• Psychotherapy – how your past effects now
Pharmacological treatments of depression
Antidepressants
• SSRIs
= Selective Serotonin Reuptake Inhibitors
– Most commonly prescribed
– Block re-uptake of serotonin
• SNRIs
= Serotonin Noradrenaline Reuptake Inhibitors
• Tricyclics – older drugs
• Monoamine oxidase inhibitors – older drugs
*Developed based on Monoamine deficiency theory
Monoamine deficiency theory
Monoamine deficiency theory
• Imbalance in brain neurotransmitters – monoamines
• Depression caused by deficiencies of the MOAs: serotonin, dopamine, noradrenaline
• Theory supported by effects of antidepressants which increase monoamine levels
SSRIs
SSRIs
SSRIs block reuptake of serotonin so that it has a chance to activate its receptor for longer
• Serotonin - also known as 5 hydroxyl tryptamine - and its corresponding GPCR
• GPCRS are 7 transmembrane domain receptors – large family – ligand binding pockets – protein cascades
• Study of proteins and knowledge of their function is challenging, and compared to genetics, our knowledge is limited (but is growing rapidly)
• GPCRS everywhere – side effects
• Expression goes up and down drastically (downregulation) on rapid basis – moment to moment. Drug effects vary by:
• Individual
• Time
P11 may have a critical role, and may represent a new therapeutic target for depression
Efficacy of SSRIs
• Recent meta-analyses show selective serotonin reuptake inhibitors have no clinically meaningful advantage over placebo
• Claims that antidepressants are more effective in more severe conditions have little evidence to support them
• Methodological artefacts may account for the small degree of superiority shown over placebo
(Moncreiff and Kirsch 2005)
SSRIs Side Effects:
SSRIs Side Effects:
Headache, anorexia, nausea, indigestion, anxiety, sexual dysfunction
Increased risk of GI bleeding (especially elderly)
Increased agitation in first few weeks
Range of unpleasant withdrawal effects
Increased suicidal ideation and aggression (esp. under 18s)
Bipolar Disorder
Recurrent episodes of altered mood and activity
Major depressive, manic, hypomanic or mixed
Clinical features of manic episodes:
Elation (maybe irritable)
Increased psychomotor activity, including speech
Exaggerated optimism, inflated self esteem
Decreased social inhibition with no regard for safety
Insight absent, possible psychotic features
Bipolar 1
One episode of mania (don’t need to have experienced depressive episode)
Socially disinhibited
Increased risk taking
Complete disruption of normal activities
Bipolar 2
History of depressive episodes and hypomania
Hypomania – experience elation but can still engage in normal activities
Experience depressive episodes
