Psychology, Psychiatry and the Mind

Question 1

What factors contribute to us making a ‘free’ choice?

Answer 1

Genetic
Previous experience
Social experience
Culture
Neuroanatomy

Question 2

What are agnosia?

Answer 2

Disorders which are usually the effect of a stroke.

You lose the ability to know that you’re damaged.

Individual knows they’ve had a stroke but not that they are hemiplegic and this can lead to accidents.

If you ask them about their disorders with will give inaccurate answers and believe that they can do everything fine, however if asked HOW they would do something they give very strange answers - they have lost some component of mind

Question 3

How much information can a human store at any one time?

Answer 3

7 pieces - MILLER

This is very low, but there are things going on that we aren’t aware of - e.g. cocktail party effect. brain is receiving sensory information but can’t relay everything

Question 4

What was the Wegner and Erskine experiment on free will?

Answer 4

asked people to do simple actions such as answer phone or pick up brick and ask if they did that or if it just happened.

Discovered that if you tell people to do something and then make them do it again when thinking very strongly about something else and feels less like you did it when thinking about the other thing

Question 5

Why can it not possibly be us making the choice to do something?

Answer 5

In order for you to have a thought the brain has to change - but in order for the brain to change you have to have already changed the brain. So therefore cant possibly be you doing it, as the brain has changed already in order t have the thought.

Question 6

What was the Libbet experiment on free will?

Answer 6

Was a simple experiment on this where got people to try and move one finger. Sitting in chair which minimised movement in front of a clock which made movements not every second but went round whole clock once a second. Scanned the brains of these people seeing which area was active in making the movement happen.

As there is the clock in front of them they can record the position of the clock when they have the intention to move the finger. Said to move the finger randomly when feel like it, record time on the clock and say whether it is right or lef.t data showed that in terms of the clock position and the intention to move the finger, the intention incurred after the brain area had already caused the movement.

Brain has done the action before you become aware of the fact that you’re going to do it. This is problem as tend to equate ourselves with consciousness, and although its still us doing it, it is just our unconscious mind. This makes its less intentional.

Humans aren’t vey comfortable with this idea. The experiment also found that after the brain area responsible for the movement occurs first, then become aware of the intention, and then the movement. May not have free will but said that you may be able to stop it as you become aware of it just before it happens.

The problem with this is that when he told people to try and do this in front of the clock (stop the movement) found that the inhibition area of the brain fires after the area of intention still before the area of awareness and then movement. This is hard for people to believe because none of us are aware of the area of the brain with the intention, only of the awareness and the movement.

Also showed that the brain messes around with the timings and puts some experiences before other experiences.

Brain only allows certain information form processing through to consciousness - know this because of things like the cocktail party effect.

Question 7

What is an example of not having free will through the media?

Answer 7

‘Bad is stronger than good’ - why we are sensitised to notice bad things. Media is a good example of this - negativity catches our attention so hardly any stories in papers are positive. Why is it the case that we are programmed to notice the bad things - evolutionarily it is more important for us to notice these things as they are potential threats. This has developed to enable us to survive. The problem with the brain deciding what it will pay attention to is that this is clearly not free will.

Question 8

About feelings accompanying actions (free will/agency)…

Answer 8

• Intentions, goals and plans are often experiences yet actions can still be unwilled as long as the individual reports they are
• Consciously willing an action requires that one feels they were consciously willing it
• Many and possibly most actions are accompanied by this feeling
• But not all…

Some that may not feel willed could include spending more or drinking more than you has anticipated. These things can be done without awareness.

Question 9

What is alien hand syndrome?

Answer 9

• Often results following damage to middle of the frontal lobe or Corpus Callosum.
• Patients report one hand operates as if it has a mind of its own
• The ‘alien’ hand operates autonomously
• Eg a patient reports their right hand ‘automatically’ reaching out to pinch an attractive nurses bum while their left hand restrains it
• Another reports their left hand unbuttoning a shirt they are trying to put on

Corpus callosum gives 80-90% of the hemispheric communication. Can be severed to try and lessen the effects of epilepsy because means that the electrical storm occurs only in one hemisphere as it cant spread across.

Alien hand syndrome is when one hand does things you don’t want it to do, and the other will try and stop it - eg buttoning shirt and unbuttoning with the other, trying to hurt self and the other hand trying to restrain it, etc.

This tells us that if you sever the corpus callosum you get two centres of human agency which can act against each other. Its almost like you have two brains which can want two different things and can act independently. Some animals can do this and shut down half their brain - dolphins and wales can do this allowing it to sleep half the brain and carry on swimming without getting air and then sleeps the other one - otherwise will drown. Can function normally with half its brain shut down.

Question 10

What is frontal syndrome?

Answer 10

Frontal syndrome - can lose 30% of front portion of your brain and still be fine. Phineas gage for example who got the railroad spike through his brain. He was fine but had personality change with lack of inhibition. Whatever stops you from doing things in every day life, they don’t have this. Any attractive stimulus they will take it up and not be able to stop themselves.

Question 11

What are some examples of involuntariness?

Answer 11

• The alien hand appears to act involuntarily
• Other examples:
• Hypnosis - things are happening but ‘you’ are not doing them - Lynn et al 1990, roughly 15% of people are responsive to this with subgroups within this. Lift study is a more simple version of this where people turn around to go along with the crowd, these people are more likely to be hypnotisable
• Everyday examples - Dostoyevsky’s protagonists, wrote about characters who constantly acted against their own best interest.
• Experiment - try another persons hands

Not your hand experiment - put someone elses arms through so looks like your arms and make them do simple actions for a few minutes and then at the end pull elastic band on their wrist and you feel the pain.

Phantom itch syndrome and phantom limb.

Shows that something even as radically as personal as pain isn’t necessarily your own. If we had an MRI scanner would see your brain acting exactly as if it was happening to you.

Question 12

What are critical distinctions of agency?

Answer 12

Feeling, not feelings as doing
Doing, voluntary action, automatism
Not doing, illusion of control, normalnaction

Question 13

How is will also a force?

Answer 13

• Will refers not only to an experience but can also be conceptualised as a force
• For example when e restrain ourselves we experience a perception of out consciousness as ‘causing’ the control of action
• While a dog may be brown or black we seem to have a power within that ‘causes’ our actions, but does it?

Question 14

What is causality?

Answer 14

Hume - causality is not a property of object or things we cannot see causality we infer it

It is a judgement and a decision. we like causality because it allows us to explain the world around us.

Question 15

How do we infer causality?

Answer 15

• Priority - causal events precede their effects in time (eg turning on the lights - Michotte 1963)
• Priority helps humans perceive causality as thoughts usually precede actions
• Consistency - the resulting action should be consistent with the prior motion or action-in the human terms the prior thought is consistent with the result
• Exclusivity -we discount causal inference if other potential causes are apparent (Kelly 1972) -

Usually don’t give people the benefit of the doubt when they do something odd -infer that is the characteristics of that person not the situation (fundamental attribution error?) which is useful to us because if say it’s the situation then cant say much about the person, but if say it’s the person we are able to predict and base our behaviour on what they are likely to be like.Milgram experiment with the electric shocks in other room and ~68% of normal people went right up to ‘chance of death’ due to command, the situation, power. The situation is a very powerful determinant of behaviour.

Situation is actually a better predictor of behaviour, but human prefer to belief it is more based on personality because we want to know ourselves and not feel that we change with situations.

Question 16

What is human causal agency?

Answer 16

Causal agents ar goal seeking - we often feel a desire to describe phenomena in goal directed terms (Heider and Simmel video of shapes moving).

We understand the world around us by goal based terms - where things are headed. We look for goals within things.

Question 17

How do babies see causality?

Answer 17

Neonates have nothing innate to help them with causal ascriptions. Good evidence now that causal ascription is a learned behaviour and occurs between 2 and 3 years of age. Found this out by getting a baby with a screen in front of them and roll a tennis ball seen, behind the screen, then seen again. An adult would look to where the ball would come out because they understand that it will continue on its trajectory, but a baby wont look for it because they don’t understand that the rolling causes it to continue its motion and it isn’t just gone behind the screen. There is a moment of shock from the baby when they see it the other side of the screen. This is how they learn about causality.

Question 18

What are the two explanatory systems that humans have?

Answer 18

• one for minds

- one for everything else

Question 19

What did Spinoza say about agency and volition?

Answer 19

“men are mistaken in thinking themselves free; their opinion is made up of consciousness of their own actions, ignorance of the causes by which they are determined. Their idea of freedom, therefore, is simply their ignorance of any cause for their actions” (Spinoza 1677)

Question 20

What is modularity of mind?

Answer 20

there are a lot of perceptual/visual illusions that if shown you see it. If you then show the visual illusion again and know it is wrong then it doesn’t change how you see it. That is why the mind is said by Fodor to be impenetrable (eg blind spots and brain filling in the gaps)

Question 21

What did Wegner and Wheatley say about free will (1999)?

Answer 21

“people experience conscious will when they interpret their own thought as the cause of their action”

We think of ourselves as causal when:

- We experience relevant thoughts of the act in advance of the act and infer our mental processes have 'caused' the act
- Third variable problem?

Question 22

What are quantitative methods?

Answer 22

Measurements (numeric, quantification)

Using scales (e.g. for pain but can be problematic in humans as subjective)

induces PREDICTABILITY - this is often the goal of science (allows survival)

makes science apolitical, valueless and unbiased

Question 23

What are qualitative methods?

Answer 23

Describing, understanding a phenomena.

Understanding what it’s like to be or to have.

The EXPERIENCE

This is also SUBJECTIVE but qualitative takes much more account of individual perceptions than quantitative

Question 24

What are the levels of measurement?

Answer 24

(LOW/MINIMUM/DISCRETE)
1. Nominal
2. Ordinal
3. Interval
4. Ratio
(HIGH/MAXIMUM/CONTINUOUS)

Only higher levels allow prediction

Question 25

What is NOMINAL measurement?

Answer 25

1 (lowest)

categorical, but sometimes no categorical/quantitative difference between categories. Only allows for descriptive stats

Question 26

What is ORDINAL measurement?

Answer 26

2

still categorical but starting to be able to say one is bigger than another eg political voting behaviour. There may not be units between points.

Question 27

What is INTERVAL measurement?

Answer 27

3

no zero eg age or height which we can measure and find infinite divisions and we know there is always the same difference between intervals (in a cm for example)

Question 28

What is RATIO measurement?

Answer 28

4 (highest)

a continuous scale where there is an absolute zero e.g. velocity.

Question 29

About qualitative types of procedure

Answer 29

Historically, qualitative information has been missed.

Observation - ask them to describe their experience eg with colorectal cancer (very common, 3rd most
Likely cause of death with ~10,000 deaths in UK per year).

–> If we can understand what it’s like to have something then their care can be improved - what they would have liked to happen.

Want as big n as possible in quantitative BUT in qualitative we want a representative but not too huge as analysis takes a very long time –> 6-20 subjects average for qualitative

Science protects objectivity. Science sometimes finds answers which aren’t pleasant or beautiful (eg evolution) - people don’t always like it.

Science often wants truth which can be unpleasant - eg a diagnosis (colorectal cancer!) - but this is a truth.

Humanity has sought to protect this method/science –> apolitical, valueless, unbiased.

For qualitative research:

- Need 6-20 subjects
- Can conduct interviews
- Input is always verbal or textual (interview is verbal [recordings, transcription, thematic analysis], diaries or facebook is textual)

Question 30

What are types of qualitative methods?

Answer 30

• discourse analysis
• thematic content analysis
• grounded theory

Question 31

What is discourse analysis?

Answer 31

Qualitative method

Much more attentive to the type of language they used than the meaning of it. How they use language is very important and it is thought to say something about their experiences and beliefs - eg swearwords in languages and cultures (fewest in Japanese and most in Russian).
WHY does this vary culturally? Believed that language reflects the culture - needed to develop a language to reflect their experience - “language encodes culture”

Question 32

What is thematic content analysis?

Answer 32

Qualitative method

This is the process of extracting themes and immersing oneself in the data trying to understand as if it were yourself whilst trying not to bring bias and also you are not them so this is very hard. They are a different person with different subjective views, which can never be overcome. No matter what you do no one will ever fully understand you. Psychologists have said because of this that you are truly alone from other subjects and objects. One day we may be able to upload our self and our experiences to some kind of machine so it wouldn’t be lost when we die and could be explored by others. We can do this yet so instead we do qualitative research.

If 200-300 themes are extracted from data then we look for the common recurring ones until we have 5-10 overarching themes which encompass all of the 300 themes. Then a short paragraph would be constructed encapsulating what each theme is/means, with as much of what they actually said as possible. We can quantify the ones which are the most mentioned - what’s not there is as important as what is there.

Question 33

What is grounded theory?

Answer 33

Qualitative method

Start with theoretical premise which is dangerous in qualitative because you may interpret their subjectivity through your theoretical framework eg holding doors - kind or sexist? A priori theory is where you make a theory before hand and this takes certain stand points eg what it’s like to be a woman in the 21st century.

Question 34

What is scientific tenure?

Answer 34

Tenure was originally developed to allow scientists to ask these questions without consequences in order to protect science.

Question 35

What are the types of statistics?

Answer 35

1. descriptive stats
2. non-parametric stats
3. parametric stats

Question 36

What are examples of descriptive stats?

Answer 36

graphs, bar charts, mean, mode, median

Question 37

Why are non-parametric stats?

Answer 37

can be used if data can be ranked but is less accurate (e.g. chi squared)

Question 38

What are parametric stats?

Answer 38

T-tests, ANOVE (analysis of variance - amount of variability within your data)
Eg mean IQ in males vs females. Mean IQ globally for both makes and females is 1–, but really doesn’t stand world wide as female education is rare in many places. If it is measured in the right way in the right places then you can get the same value.

Question 39

What does a T-test show?

Answer 39

• Nothing to do with relationship
  
  • To do with variance within 2 groups can not do it with more than 2 groups
  • Tells you if there’s a significant different between the two values
  • Continuous data
  • Looking for a difference in the score on the two groups
  • Eg statistically comparing males and females IQ

P value = 0.05 –> means that if the value is below 0.05 there is a 95% certainty that the results are not due to chance. If the value is set at 0.01 then there is a 99% certainty.

Question 40

What are experiments?

Answer 40

Experiment = GOLD STANDARD!

1. Manipulation of one variable = independent variable
2. Look for effect on dependent variable - continuous
3. Random allocation to groups

Finds CAUSALITY which is the only way can establish predictability. Psychiatrically we cant give someone a disorder so can’t really do experiments, so cant really establish causation. To get around this we use correlational data. This can’t establish causality. Instead finds a linear relationship between two variables - cant establish causality with this.

When there is a linear relationship between 2 variables we like to say that one causes the other.

Question 41

What are the problems with correlation?

Answer 41

1. We like to infer causation because this allows predictability (previously would help survival)
   
   2. 3rd variable problem - when another variable that you’re not measuring causes both fo the other things - eg hot weather on ice cream sales and drowning
      
      • Partial correlation = correlation between 2 variables while controlling for another variable. If you take out the third variable then the one youre controlling for then the correlation drops to ZERO and this shows the relationship between the two isnt real and was caused entirely by the third variable - a spurious relationship.

Measurements at one time point = cross sectional
Measurements at several time points = longitudinal or cohort

Question 42

How might experiments be done in a drug trial?

Answer 42

Three groups (control, old drug, new drug) given IQ test and measure how long they take to solve it to find speed of processing which is the dependent variable. One month after the drug is given you would retest and compare the mean of the two set of results. We would predict that the control group stays the same, the rug currently used would have some effect and the new proposed drug would have more of an effect than that.

To test for significance we use analysis of variants = for more than two groups
If three groups, for example, then the results of analysis of variance gives an f value which states whether there is significance at p=0.05. The problem is that it doesn’t show WHICH groups are significant from which others.

We then do post-hoc tests.

Question 43

What are post-hoc tests?

Answer 43

These are only done if significance is found - otherwise it isn’t worth it. These are types of t-tests between the groups, between each possible pairing of the three groups.

In total at this point you would have done 3 tests –> CAPITALISATION ON CHANCE which says that the more tests you do, the more likely you are to find something significant by chance. This has to be corrected for statistically by setting the p value lower making it harder for something to be accepted as significant.

Question 44

What is the Bonferroni correction?

Answer 44

• Work out how many tests you’re doing (eg = 4), and you want the p value to be 0.05
  
  • Divide the p vale by the number of tests
  • Eg 0.05/4 = 0.0125 0.013 - which is now your new p value

This is how you account for capitalisation on chance. The problem with this however is that it will approach zero (0.001) with the more tests you do, eventually making it near impossible to find anything significant.

Question 45

What is multiple regression?

Answer 45

If we want to predict a variable fro 2 other variables we do this by multiple regression. We predict one variable from several others - needs interval or ratio level of measurement. Gives three axes with a 3D plane on the graph. (A line of best fit on a scatter grpah shows correlation aka simple regression).

N dimensional space - can be 5 places.

Multiple regression allows us to make predictions on things such as likelihood of getting certain diseases.

Question 46

What is parsimony?

Answer 46

Aparsimoniousmodel is a model that accomplishes a desired level of explanation or prediction with as few predictor variables as possible. For model evaluation there are different methods depending on what you want to know.
–> The simplest explanation is the best.

Question 47

How are clinical interviews used in psychological investigations?

Answer 47

Another form of test used in psychiatry (less so in psychology) is clinical interviews and also get a score for diagnosis.

Clinical interviews are not completely subjective. Questions are asked which map on to a specific diagnosis. We can also do single case studies when you find someone with a conditions and describe it in detail - especially done when the field/condition is new.

Question 48

What are the demographics of a psychological history?

Answer 48

• Name
• Age
• Gender
• Employment
• Relationship status
• Children
• [Summary of diagnoses]

Question 49

What are the presenting circumstances of a psychological history?

Answer 49

• Circumstances of presentation
• Context of presentation
• Timeline of problems
• Precipitating events
• Perception of problems

Question 50

Under what circumstances could someone come to a psychiatrist?

Answer 50

• under a section 136 - when someone is brought in from the public place by a police officer for example, someone who was acting in a manner suggesting they may be suffering from a mental disorder and in need of care and control
  
  • Referred by their GP
  • Present to A+E in crisis with suicidal feelings or following self harm or suicide attempts
  • Referral from other specialists

Timeline of problems can be years apart.

Question 51

What are the essential areas of affective symptoms on a psychological history?

Answer 51

• core symptoms
• somatic
• psychology

Question 52

What are the core symptoms in history taking?

Answer 52

• Low mood - feeling unhappy, sad, down.
• Poor energy/fatigue
• Anhedonia - inability to feel pleasure

Question 53

What are the somatic symptoms in a psychological history?

Answer 53

• Poor appetite (or increased)
• Weight loss (or increased)
• Insomnia (or hypersomnia) - typically wake up tired, unrefreshed, but unable to return to sleep
• Loss of libido - women is mainly loss of interest, in men sexual dysfunction can be caused by depression or by antidepressants, but in general the effect on libido of depression is mainly loss of interest rather than erectile dysfunction/vaginal dryness.
• Poor concentration/short-term memory

Question 54

What are the psychological symptoms in a psychological history?

Answer 54

• Helplessness
• Hopelessness
• Worthlessness
• Guilt
• Suicidal thoughts - have to ask about it. Direct approach often appreciated by patients, talking about it openly rather than making it a taboo subject to encourage people to give honest answers.
• [psychotic]

Question 55

How can we split symptoms?

Answer 55

Can split symptoms into affective and psychotic. Always want to ask about related symptoms, not just the initially obvious ones.

Affective means to do with mood - affect is like saying the weather specifically today, but mood is saying that it is January so what it is like normally (in context)

A normal mood should fluctuate throughout the day/week and with events.

Question 56

What is needed to diagnose depression?

Answer 56

For depression has to be consistent low mood, most of the day, most of the days, for two weeks or more. Typically lowest in the mornings and evenings, more severe more the time.

By ICD-10 need 2 core and 2 associated for mild depression.

Moderate: 2 core and 4 associated

Severe: 3 core and 6 associated

Psychotic: must be severe + psychosis

Question 57

What needs to be asked about suicide in a history?

Answer 57

• Nature and duration of any suicidal thoughts
• Intent
• Plans
• Previous suicidal behaviour
• Deliberate self harm

Intent - many people have suicidal fantasies but wouldn’t ever act on it

Question 58

What is asked about psychosis in history taking?

Answer 58

• Open questioning - have you had any other unusual experiences recently, like seeing or hearing things that other people cant that shouldn’t be there. Any other worries that we haven’t talked about, like people trying to harm you or send you special messages?
• Delusions
• Hallucinations

Question 59

What other areas are asked about in a history?

Answer 59

• Anxiety - becomes pathological when it is of frequency or intensity that it interferes with your ability to function (socially, occupationally, etc)
• Gender identity
• ADHD - hyperactivity symptoms and inattention symptoms
• Eating disorders
• Paraphilias - a condition characterized by abnormal sexual desires, typically involving extreme or dangerous activities
• PTSD
• Memory
• Substance use

Question 60

Past psychiatric history

Answer 60

• Previous diagnoses
• Previous hospitalisations
• Previous treatments

Question 61

Past medical history

Answer 61

• Comorbid medical problems
• Particularly metabolic disorders
• Recent blood tests
• Head injuries/CNS surgery

Question 62

Social history

Answer 62

• Current home circumstances
• People at home, relations and ages
• PoC - package of care
• Employment/income
• Financial situation

Question 63

Family history

Answer 63

• history of illnesses in family

- include relation and age

Question 64

Drug history

Answer 64

• psychoactive medication
• others
• allergies

Question 65

Substance history

Answer 65

• alcohol
• tobacco
• recreational drugs
• OTC
• herbal treatments

Question 66

Personal history

Answer 66

• life story!
• psychosexual history - current relationships, first relationship, pattern of relationships, gender preferences, previous marriages, etc

Question 67

Mental state examination

Answer 67

• Appearance
• Behaviour
• Speech
• Mood
• Thought
• Perception
• Cognition
• Insight

Question 68

About appearance in the mental state examination

Answer 68

• Dress
• Self-care
• Age
• Ethnicity
• Gender

Tells you a bit about how long the problems may have been there for.

Manic can also be seen through dress - bright colours etc

Question 69

About behaviour in the mental stat examination

Answer 69

• Appropriateness of behaviour
• Eye contact
• Rapport
• Engagement
• Any particular abnormal movements, stereotyped movements, mannerisms, tics etc

Question 70

About speech in the mental state examination

Answer 70

• Rate
• Rhythm
• Tone
• Volume
• [content] - eg frequent swearing
• Other abnormalities

Question 71

About mood in the mental state examination

Answer 71

• Subjective - how they describe their mood
• Objective - how we objectively assess someone’s mood
• Affect - reactive affect, depending on what you’re talking about how they react

Question 72

About thought in the mental state examination

Answer 72

• form
• content
• remember suicide!

Question 73

About perception in the mental state examination

Answer 73

• Hallucinations
• Other abnormalities of perception
• Reported or apparent from observation

Question 74

About cognition in the mental state examination

Answer 74

• Not always needed to formally assess
• [Orientation]
• Other formalised
• AMTS
• MMSE
• ACE

Question 75

About insight in the mental state examination

Answer 75

• Insight into condition
• Extent of condition
• Attribution of symptoms

Question 76

What is diagnosis?

Answer 76

The identification of the nature of an illness or other problem by examination of the symptoms.

DIFFERENTIAL DIAGNOSIS: a possible list of diagnoses pertaining to a specific symptom/set of symptoms

DIAGNOSTIC CRITERIA: a list of criteria or algorithm required to demonstrate a specific diagnosis

Question 77

Why do we need diagnosis?

Answer 77

• To enable following treatment protocol and rehabilitation strategies including national guidelines eg NICE guidelines
• To enable patient education
• To access services
• To aid in focusing research questions

To be able to pertain to treatment protocol, patient education so they can look up what they have and come back with questions, research

Question 78

How do we go about making a diagnosis?

Answer 78

• Shortness of breath: differential diagnosis:
	- Asthma
	- COPD
	- Pneumonia
	- PE
	- Pneumothorax
	- Malignancy
	- Interstitial lung disease
	- Pulmonary oedema
• Patient history
• Examination
• Investigations
	- Peak flow
	- Lung function tests
	- ABG
	- Chest x-ray
	- Chest CT
	- VQ scan
	- Bronchoscopy
	- Lung biopsy

Question 79

Making a psychiatric diagnosis…

Answer 79

• History
• Mental state examination
• Physical examination
• Investigations
	- Blood tests
	- Imaging
	- Psychological questionnaires
	- Other investigations eg EEG, LP
• Collateral history, MDT input
• Longitudinal documentation

Question 80

What is meant by the mental state examination providing longitudinal documentation?

Answer 80

Provides longitudinal documentation, like a photograph which can be lined up to see if the patient is getting better or worse. Only thi

Question 81

What are the possible differential diagnoses in psychiatry e.g. from hearing voices?

Answer 81

• Side effects of L-Dopa
• Psychosis associated with tumour
• Psychosis associated with infection (eg HIV)
• Psychosis associated with autoimmune disease
• Drug-induced psychosis (substances)
• Schizophrenia
• Mania
• Psychotic depression
• Post-partum psychosis
• Emotionally Unstable Borderline Personality disorder

Question 82

How can we cut down the differential diagnosis of hearing voices with investigations?

Answer 82

• Side effects of L-Dopa - medication review
• Psychosis associated with tumour - CT/MRI head
• Psychosis associated with infection (eg HIV) - blood test, CSF test
• Psychosis associated with autoimmune disease - blood test
• Drug-induced psychosis (substances) - urine drug screen
• Schizophrenia
• Mania
• Psychotic depression
• Post-partum psychosis - has the patient given brith recently?
• Emotionally Unstable Borderline Personality disorder

We don’t do all of these tests on everyone - needs to be some kind of indication

Question 83

What are the different methods of diagnosis?

Answer 83

ICD 10
DSM V
Formulation

Question 84

About ICD 10 diagnosis

Answer 84

• 10th revision of the international statistical classification of diseases and related health problems listed by WHO
• >14,400 codes for symptoms, disease, social circumstances
• Work on ICD-10 began in 1983, completed in 1992, though it is now on it’s 5th edition
• Awaiting ICD-11…
• Used in 27 countries for resource allocation in healthcare
• 110 countries use it for statistical purposes
• Notable change/inclusion:
- Homosexuality removed from ICD-10 after 1992
- Gender identity disorder - F64.0
- Fetishism still in the ICD-10 (F65) (F56.1: transvestitism, F65.51: masochism, F65.52: sadism)

Question 85

About DSM V diagnosis

Answer 85

• Diagnostic and statistical manual of mental disorders
• Published by American Psychiatric Association
• Classification of mental disorders based on standard criteria
• DSM V - 2013
• Used in the US
• On-going issues around credibility, possible cultural bias - in 1973 5854 for removing homosexuality vs 3810 against!

Question 86

What is Axis I of DSM V diagnosis?

Answer 86

Principle disorder that needs immediate attention e.g. major depressive episode, acute psychotic episode in schizophrenia

Question 87

What is Axis II of DSM V diagnosis?

Answer 87

Personality disorders; developmental disorders, learning disability that may shape Axis I

Question 88

What is Axis III of DSM V diagnosis?

Answer 88

Medical or neurological problems relevant to psychiatric history e.g. asthma may be confused with acute panic attacks

Question 89

What is Axis IV of DSM V diagnosis?

Answer 89

Major psychosocial stressors e.g. family bereavement, divorce, loss of employment

Question 90

Wha tis Axis V of DSM V diagnosis?

Answer 90

level of function; global assessment of function, out of 100

Question 91

What is the GAF scale

Answer 91

move up the scale with better levels of functioning - 0-100

Question 92

What is formulation?

Answer 92

combination of predisposing, precipitating and perpetuating self, family and environmental factors

Formulation is the process of making sense of a person’s difficulties in the context of their relationships, social circumstances, life events, and the sense that they have made of them. It is a bit like a personal story or narrative that a psychologist or other professional draws up with an individual and, in some cases, their family and carers.

Question 93

When does something become a psychiatric disease?

Answer 93

Disease:

i. Discovered the causes
ii. Understood the pathogenesis
iii. Comprehensively described the clinical picture and the reaction to treatment
iv. Measured the natural history

None of the illnesses with which psychiatrists deal satisfies these criteria –> would it then become neurology

Question 94

What are the positives to diagnosis?

Answer 94

• Education and health care plan (EHCP)
• Social care package
• Access to community activities
• DLA
• Freedom pass
• Free prescription
• Housing aid
• Help with CV/job-seeking

Means that the patient gets access to these things. EHCP - teaching assistant for example.

Question 95

What is behavioural consistency?

Answer 95

Eg dress code (a casual dress sense causes people to take a person less seriously and less professionally).

Characteristics within behavioural consistency can reflect character or context, and we should ask which of these is more likely to determine the factor, such as dress sense. We ask ourselves this both consciously and subconsciously.

Dress code is mostly due to the context of the situation. It is hard for us to believe that this is the case for many factors because it means we aren’t in charge of the way we are - it is due to something external.

Science wants to predict, and so do humans. People acting dependently on context makes prediction hard as people may change depending on the environment.

Question 96

What is personality?

Answer 96

Traits and characteristics that don’t vary across time and situation.
Eg introversion and extraversion are known to be more biological as can be measured from birth - crying baby or quiet?

Question 97

What is personality disorder?

Answer 97

Behaviour that consistently transcends social norms.

- ICD10 and DSMIV/V give 9-11 forms
- Psychopath is an example (aka 'dangerous and severe PD' or 'antisocial PD'
- 4-10% (~8%) of people are affected by a form of PD
- This is the only psychiatric disorder diagnosed on the basis of behaviour
- 1% of the worlds population is schizophrenic therefore much more likely to encounter PD

Question 98

What is the critical period for human brain plasticity?

Answer 98

In humans the critical period is 0-12 years of age of maximal brain plasticity - personality sort of solidifies at aged 12. Biological maturity Is reached around 21-23 years old and it is a decline from then on. This is shown in increasing defective reproductive rates as age increased. The current social norms are jut under 30 for marriage and 31 for having children. >35 is when a real risk of birth defect begins to occur.

We are always looking for what is ‘normal’ in society, culture, those around you from the day you are born, and looking at how to behave.

- Eg if both parents smoke then ~80% likelihood a child will too, but I the whole country smoking rates are ~20%
- Eg twin studies

Question 99

What are the 5 stable characteristics of personality? The Big Five.

Answer 99

1. Openness to experience
   
   2. Conscientiousness
   3. Extraversion
   4. Agreeableness
   5. Neuroticism (propensity to experience negative feelings on a regular basis, but useful in spotting threat)

Question 100

how does an abusive childhood impact personality?

Answer 100

An abusive childhood heavily impacts personality, with 92% of people with a PD having suffered abuse. Society diagnosis and treatment of disorders such as schizophrenia do vary culturally - eg might be made leader of a tribe in some places as might be thought to be communicating with the spirit world.

If someone suffers from a PD and never acts within norms then there are two options –> they don’t know, or they don’t care.

Question 101

What are some factors that contribute to personality that aren’t included in the big five?

Answer 101

• Time keeping
  
  • Spending behaviour
  • Humour
  • Consistent negativity
  • Proclivity to opposite/same sex (obsession)
  • Stubbornness
  • Aggression/violence

Question 102

What are contributing factors to personality?

Answer 102

Genetics
IQ
alcohol
Appearance
Sex
Childhood
Morality
Society
Religion
gender
sex
attitudes
personality
peer group
diet

Question 103

How do genetics contribute to personality?

Answer 103

• 50-54% of personality is inherited from parents.
  
  • Means we are not as unique as we might like to think.
  • Intelligence is >50% inherited.

Question 104

How does IQ contribute to personality?

Answer 104

• Data shows that as IQ increases, length of life increases too
• Less likely to engage in risky behaviour
• Not just for that reason however, the main reason is nothing to do with human behaviour
The latest theory is that IQ is a very rough measure of how well you are put together as a biological machine (this doesn’t necessarily mean better though!

Question 105

How does alcohol contribute to personality?

Answer 105

30% of all UK hospital admissions every year (mostly on Friday and Saturday night). Society and culture affects this with difference age limits and rules.

Question 106

How does appearance contribute to personality?

Answer 106

better and younger looking get shorter sentences, more success, more jobs etc.
We tend to judge attractive people are more intelligent, which there may be a link with. Similarly to IQ, attractiveness may also be a rough measure of how well the biological machine is put together.

Question 107

How does childhood contribute to personality?

Answer 107

experiences, nutrition, oxygen, in the womb etc

Question 108

how does society contribute to personality?

Answer 108

• Laws
  
  • Convention (subjective)
  • No objective reason for things being right or wrong, if was for an objective reason then go to either religion or morality

Question 109

How does religion contribute to personality?

Answer 109

religions make us quite predictable as they often enforce a code of conduct

Question 110

How does our peer group contribute to personality?

Answer 110

social norms - behaving in socially acceptable ways

Question 111

How might diet contribute to personality?

Answer 111

different foods affecting health?

Question 112

What is personality?

Answer 112

• Traits that are stable across time and situations
• But beware: most often the situation one finds oneself in is a better determinant of eventual behaviour
• Fundamental attribution error = individuals tendency to overemphasise internal characteristics in explaining behaviour rather than external factors. Converse = actor-observer bias which people overestimate role of situation and underemphasise personality
• Milgram experiments 1960’s and 1970’s

Milgram showed that if you take normal people and put them in a situation where you demand they kill someone else, 70% of the did (electric shock experiments) - and most almost did.

This is an example of how you can take a normal individual and make them do something which society says is horrific, quite easily.

People are very good at doing bad things when they have been told to do it and so therefore they can shift the blame to someone else. This makes them a lot more likely to do it. This is known as the fundamental attribution error.

Actor observer bias is when people put more on the situation. Real world examples of this include bystander apathy - when you see something bad happening but don’t do anything about it, eg there was a rape in Central Park New York and there was over 150 witnesses yet no one did anything about it, they just watched. There is a phenomenon that the more people that watch something, the less likely any one person is to do something about it. Everyone diffuses the responsibility, and doesn’t feel individually responsible for what they are witnessing. Assume that someone else will do about it, and when all assume the same thing, no one does anything about it at all.

Question 113

Who said that 50% of variations in the 5 dimensions of personality are determined by genetics?

Answer 113

Any, Lively and Vermon 1996

the five were derived through factor analysis. Started off with 150-160 criteria that were stable over time and didn’t vary between individuals. Then did factor analysis which tells you if they are all statistically different, or if there are categories of higher order things which could explain a number of other things and these five were found to be able to explain all of the others.
• But beware what is inherited are more likely to be limits around set points rather than absolute characteristics
The environment clearly plays a role

Question 114

What are the 5 dimensions of personality?

Answer 114

John and Srivastava 1999

OCEAN

Openness
Conscientiousness
Extraversion
Agreeableness
Neuroticism

Question 115

What is Openness?

Answer 115

willingness to try new things, ‘openness to experience’, like novelty, get bored easily

Question 116

What is conscientiousness?

Answer 116

Hardworking, committed, plan, ensure goals

Question 117

What is extraversion?

Answer 117

Sociability, more likely to be happier on the whole, less likely to get psychologically sick, lots of social contact which is the most protective and beneficial ting humans can do (introverts risk psychopathologies of certain forms but also more likely to come up with new ideas through focus etc)

Question 118

What is agreeableness?

Answer 118

The extent to how agreeable you are, being a person that people want to be around, helpfulness, if you help other people lessen your own likelihood of survival in evolutionary terms (eg giving food away), makes sense in kin but not in non-kin, in modern day agreeableness is useful as need to get on with other people in order to get by (non-agreeableness has advantages in someone who you need to go and get something serious from someone else eg politicians)

Question 119

What is neuroticism?

Answer 119

Propensity to feel negative, not necessarily pathological, means you regularly feel quite off, don’t feel happy very often, but there is nothing wrong with you. Could be useful in terms of recognising threat, may be able to better understand other people’s pain and unhappiness, in evolutionary terms might have been made a doctor/healer/spiritual teacher/watchman

Question 120

What is meant by the 5 dimensions of personality being orthogonal?

Answer 120

Modern research is showing they are ‘orthogonal’, particularly neuroticism - can be extremely positive and extremely negative at the same time. One does not preclude the other - one makes the other less likely but there are still instances where you can have both.

Question 121

What is meant by the 5 dimensions of personality being bipolar factors?

Answer 121

These are all known as bipolar factors, eg agreeable, disagreeable and a midpoint where you are neither. There is a scale from one end to the other.

Question 122

How do we test personality?

Answer 122

• Almost invariably assessed by questionnaire
• Based on research some more narrow traits have been identified but factor analysis suggests the big 5 encompass most fo the information
• Big 5 inventory where do you fall?
• Alternative models - Jung

Question 123

Does personality predict important outcomes?

Answer 123

What are important outcomes?

- Individual outcomes - that can be manifested by an individual outside of a social context. Eg. Physical health, psychopathology, happiness
- Interpersonal outcomes - involve other individuals and it generally matters who the other is eg forming and maintaining quality relationships
- Social/institutional - more impersonal, organisational, societal=level processes involving interactions with more generalised others eg work satisfaction and performance

If we ask what does personality predict, what do we find? We separate outcomes into three (individual, interpersonal and social).

Extraverts live slightly longer
More conscientious live longer
Neuroticism more likely to become pathological so might get some form of mental health issue
Highly disagreeable more likely to die

Mental illness has advantages as evolution hasn’t got rid of it, 25% of people have some sort of mental health problem, in very influential/dynamic/world changing people = more than 50% of them had something. Mental illness may influence genius/creativity etc.

Question 124

How does personality affect happiness and subjective well being?

Answer 124

• Happiness and subjective wellbeing
• SWB includes a cognitive component/judgement of one’s life satisfaction (Diener et al. 1985), and an affective component that includes
• And an emotional component comprising of the experience of positive and absence of the negative emotions (Larsen 2000)
• Importantly personality dispositions are strong predictors of most components of Subjective Well Being (SWB) (see Diener and Lucas 1999)
• Furthermore, demographic factors, including age, sex, marital status, employment, social class, and culture, are only weakly to moderately related SWB (Diener et al. 1999, Ryan and deci 2001)
• In detail - people high in extraversion and low in neuroticism tend to see events and situations in a more positive light and tend to discount opportunities that are not available to them
• Differences in conscientiousness, agreeableness and openness to experience are less strongly and consistently associated with SWB (Diener and Lucas 1999)
• Personality traits have a stable effect on health and longevity (Caspi et al 2005)
• Longevity studies show - positive emotionality (extraversion) and conscientiousness predict longer lives (Danner et al 2001, Friedman et al 1995), and hostility (low agreeableness) predicts poorer physical health (eg cardiovascular health(
• Neuroticism and health and longevity is more complex, some studies suggest an association between neuroticism and increased disease risk, whereas other show associations with illness behaviour only (Smith and Spiro 2002)
• Whether personality has a causal role remains unclear (Caspi et al 2005)
• Goodwin and Friedman (2006)
• Examined 5 factor personality and health in 3032 representative North Americans
• Conscientiousness is associated with reduced physical and mental health risk
• Neuroticism is associated with increased physical and mental health risk
• Inconsistent effects of other personality characteristics

Personality more affects how happy you are than any factors such as employment, marriage, age, social class, sex. This is interesting as society teaches us that these things make you happy, but actually your character which we don’t choose is what makes you happy.

Hedonic Treadmill - seeking pleasure, but this is bad news in humans as it means that (illustrated by human temperature regualtion) human temp is 37*, if we get any hotter we start sweating caused by homeostasis, and this also occurs for happiness. Which is why happiness is set largely by the factors making up your personality.

The other factors do make a difference and can help you to move towards a different state, but you are fighting against homeostasis. This is why unhappy lottery winners are happier for a while, but after 6 months to a year their happiness levels falls back down as that is what their personality is telling them to do.

Neuroticism is related to mental health illnesses - but the relationship is messy

The problem with all of this is that the data is correlational so we cant confer causality. Does your personality cause you to have happiness or does happiness cause you to have a certain personality? Longitudinally we have seen that it is more that personality later maps onto your happiness. We know this because a lot of these things operate from birth and we can track people over time.

Self selection of environment - when we reach biological maturity we select our own environment partially on the basis of personality. For example might choose a job which suits you - selecting an environment which agrees with your personality. This can be a problem because this might mean that although we said that personality doesn’t change over time and situation, maybe its because we are choosing for it not to. This means that we won’t change.

Studies have been done on this, eg conscientiousness associated with reduced mental health risk.

Question 125

What are the interpersonal effects of personality?

Answer 125

The strongest personality links shown for empathy, ie a combination of extraversion and agreeableness, and emotional regulation, best predicted by low neuroticism

Romantic relationships - neuroticism and low agreeableness consistently shown to be predictors of negative relationship outcomes eg relationship dissatisfaction (Karney and Bradbury 1995)

Certain pathologies make this not possible (understanding how other people see the world) eg psychopaths because they don’t have the mental models. About 10-15% of people can be ‘naughty’ and it’s useful because boundaries are pushed and things advance when things are questioned.

As psychopaths struggle with empathy, they struggle also with guilt, remorse and regret - this significantly affects their behaviour.

Extroversion and agreeableness are linked to emotional regulation.

Question 126

What are the social effects of personality?

Answer 126

• Barrick et al 2003, larson et al 2002
• Examined using meta analysis relations between personality traits and occupational types
• Extraversion was related to social and enterprising occupational
• Agreeableness to social interests
• Openness to investigative and artistic interests
• Neuroticism not related to any occupational interest
• Barrick et al 2001
• Conscientiousness predicts work performance across occupations
• Ways, in all included occupations. Smaller, though nearly as broad, effects were found for
• Extraversion and emotional stability - smaller effects but are important for some, though not all occupational groups
• Only weak and narrow effects for agreeableness and openness were identified
• Agreeableness related to job performance when a teamwork is important
• Best known occupation-specific measure of job performance is grade point average (GPA) in the US. But in the UK school leaving exams are related to later work outcomes and- there is a positive relation between GPA and conscientiousness (Paunonen 2003)
• Years o education, is related to intellect, or openness (Goldberg et al 1998)
• Thoresen et al 2003 extraversion and emotional stability associated with jo satisfaction and organisational commitment. Furthermore, they are negatively related to a wish to change jobs and burnout.
• Conscientiousness best predicts how well one performs at work
• But extraversion and emotional stability are more important for understanding how one feels about work
• Roberts et al 2003
• Emotional stability (negative emotion) is strongly related to financial security
• Agreeableness (positive emotion-communion) related to occupational attainment
• Resource based power and work involvement predicted by extraversion (positive emotion-agency)
• Low conscientiousness consistently associated with various aspects of criminal/antisocial actions. And is related to adolescent behaviour problems (Shiner et al 2002), deviance and suicide attempts (Verona et al 2001)
• Low agreeableness, and low conscientiousness associated with substance abuse (Walton and Roberts 2004)

This says that your personality leads you to certain environments.

Dichotomy between affect and … - how good you are at your job and how you feel about it

There has been seen to be combinations/patterns of personality traits which lead to things such as spending habits.

Occupational attainment is linked to being more agreeable than actually being any better at your job.

Question 127

What is the relationship between personality and age?

Answer 127

• Stability or change?
• Roberts, walton and viechtbauer 2006
• With age conscientiousness and emotional stability increase especially between 20 and 40
• Openness decreases across the lifespan
• Agreeableness rises
• These changes are independent of sex
• Carstensen - individuals change their social networks - also positivity effect
• Diary studies

Personality kid of sets the limit on how happy you can be, which is basically what we all want. Maybe chasing after happiness is just down to convention.

Also sets limits around the quality of engagement you might have with relationships with people etc

Rates of various disorders (eg PTSD) go down with age. Age is protective because your social network is adjusted, a lot of factors which make sense when young don’t make sense when you’re old, such as chasing things which pay off in the future as opposed to immediate results. Older people don’t chase after future satisfaction as they have to wait, staying unhappy in the moment so that you can have more pleasure in the future. An older person doesn’t do that as they might not be there in 6 months time, they do whatver they want to do in order to make them happy right now.

Question 128

What are extreme stressors?

Answer 128

Extreme stressors are events that are potentially traumatic of that involve severe loss.

After exposure, most people will experience distress but will not develop a condition that needs clinical management

This might lead to PTSD

Examples - abuse, bereavement, car accidents - things that are out of the ordinary.

Most people have coping mechanisms but experience some distress.

Palpitations were almost a universal stress response to extreme situations such as earthquakes - heart very fast as though going to have a heart attack and very scared.

Cortisol firing, increasing HR, fight or flight. Following disasters etc this keeps occurring because baseline stress level is so high. This isn’t PTSD, it is normal stress for someone who has been in that situation - these people need to know that this is normal and they are doing well - positive coping mechanisms.

Question 129

What are two types of conditions following exposure to extreme stressors?

Answer 129

Problems and disorders that are more likely to occur after exposure to extreme stressors but that also occur in the absence of such exposure:

- Depressive disorder
- Psychosis
- Behavioural disorders
- Alcohol use and drug disorder
- Self-harm/suicide
- Other significant emotional or medically unexplained complaints

Problems and disorders that require exposure to extreme stressors:
- Significant symptoms of acute stress
- Post-traumatic stress disorder (PTSD)
- Grief and prolonged grief disorder
These often occur in combination with other conditions.

Grief is normal but prolonged grief isn’t eg a partner or a child
Some people never recover from it

Explain that conditions following exposure to extreme stressors fall into two categories.
Explain that the biggest mistake many clinicians make when treating people after trauma exposure is to only think of conditions specifically related to stress. Explain that many clinicians forget that many mental disorders (e.g. all those listed on the slide) are more common after extreme stress.
Emphasize the importance of assessing other possible mhGAP conditions as appropriate.

Question 130

Prevalence of mental illness after humanitarian disaster

Answer 130

Prevalence almost doubles after a disaster and normal distress is everywhere

Question 131

Symptoms of acute stress

Answer 131

• After recent exposure to potentially traumatic events, people’s reactions tend to be diverse.
• symptoms of acute stress (within one month of the traumatic event) cover a wide range of symptoms occurring in both adults and children, such as:
  
  • feeling tearful, frightened, angry or guilty
  • jumpiness or difficulty sleeping, nightmares or continually replaying the event in one’s mind
  • physical reactions (eg hyperventilation)
• These symptoms can indicate mental disorder, but often are transient and not part of a disorder. If they impair day-to-day functioning or if people seek help for them, then they are significant symptoms of acute stress.

Emphasize that most symptoms of acute stress are normal and transient. People tend to recover from them naturally. However, sometimes there is a need to intervene when they impair day-to-day functioning or if people seek help for them

Question 132

What are the three key symptom clusters following trauma?

Answer 132

• Three clusters of traumatic stress symptoms require attention
1. Re-experiencing symptoms
2. Avoidance symptoms
3. Symptoms related to a sense of heightened current threat
• In people with PTSD, the event occurred more than approximately one month ago, at least one symptom from all 3 clusters is present, and the symptoms cause difficulties in day-to-day functioning.

Avoidance
Re-experiencing
Heightened sense of recurring threat - jittery

Question 133

What is re-experiencing symptoms after trauma?

Answer 133

• These are repeated and unwanted recollections of the traumatic event.
• 3 types of re-experiencing symptoms:
  
  • An intrusive memory is unwanted, usually vivid, and causes intense fear or horror.
  • A flashbacks is an episode where the person believes and acts for a moment as though they are back at the time of the event, living through it again. People with flashbacks lose touch with reality, usually for a few seconds or minutes.
  • Frightening dreams
• In adults, the frightening dreams must be of the event or of aspects related to the event.
• In children, re-experiencing may involve frightening dreams without clear content, night terrors or trauma specific re-enactments in repetitive play or drawings.

Remembering things to the point that it affects you to the point of interfering with everyday life e.g. have to leave a shop as distressed

Question 134

What are avoidance symptoms?

Answer 134

• These include purposely avoiding situations, activities, thoughts or memories that remind the person of the traumatic event.
  
  • a person may not want to get in a car after a road accident
  • a rape survivor may all the time try to avoid thinking of the rape.
  • the person may wish not to talk about the event with the health-care provider
• Paradox: trying very hard not to think of something, makes one think more it.
• Exercise (plenum): try not to think of a white elephant for 1 minute.

Question 135

What are symptoms related to a sense of heightened current threat?

Answer 135

• Affected persons may feel constantly in danger,
• 2 types of symptoms related to a sense of heightened current threat
• Hypervigilance: exaggerated concern and alertness to danger
○ Eg the person is much more watchful in public than others, unnecessarily selecting “safer” places to sit.
• Exaggerated startle response: being easily startled or jumpy - reacting with excessive fear to unexpected sudden movements or loud noises.
○ Eg person reacts much more strongly than others and takes considerable time to calm down.

Question 136

What are features associated with PTSD?

Answer 136

• All ages
  
  • Anxiety, depression, anger
  • Numbing, insomnia
  • Medically unexplained complaints
• In adolescents and adults
  
  • Alcohol and drug use problems
• In adolescents
  
  • Risk-taking behaviour.
• In children
  
  • Regressive behaviours, such as bedwetting, clinging and temper tantrums.

This slide covers associated features with PTSD. These are not PTSD symptoms (according to current draft ICD 11 proposals) but they often co occur with PTSD.
Explain that age groups differ in associated features. Knowing the features associated with PTSD helps in suspecting PTSD.

Question 137

What is the importance of communication in individuals following trauma?

Answer 137

COMMUNICATION SKILLS
• People who have traumatic stress may avoid communicating about traumatic events because talking about it may trigger re-experiencing symptoms.
• Important to ensure confidentiality when discussing traumatic and private issues.
• E.g. people often have great difficulty talking about sexual violence and torture.
• Never pressure the person to talk about the issue.
• It is very important to listen if the person wants to talk about the issue.

Emphasize the importance of talking about the traumatic experience at the pace with which the patient is comfortable. People may be very reluctant to talk about what happened. Talking about the stressor may make the person very emotional. It may take some time to build the trust necessary for the person to talk to someone about the stressor. People may take weeks or months before they are ready to share

Question 138

What symptoms apply to DEP and STR presentations?

Answer 138

• Low energy is common in depression and grief.
• Sleep problems are common in depression and traumatic stress.
• Anxious or irritable mood is a common associated features of depression and traumatic stress.
• Medically unexplained somatic symptoms are common associated features of depression, grief and traumatic stress.
• Difficulties in carrying out work (whether at school, home or the office) are common in depression and traumatic stress.

Question 139

Assessment of individuals following traumatic events…

Answer 139

1. Significant symptoms of acute stress
2. PTSD
3. Grief
4. Prolonged grief disorder
5. Concurrent conditions

Question 140

What is management of acute stress symptoms?

Answer 140

1. Significant symptoms of acute stress
2. PTSD
3. Grief
4. Prolonged grief disorder
5. Concurrent conditions

Relaxation, breathing exercises, doing things you like to do, talking about what has happened to you if its something you want to do. The exception might be in the case of rape for legal implications.
Don’t force people to talk if they don’t want to.
Attend to peoples basic needs if they are in distress whatever that might be.
Help people to connect with family or other people that could help them.
Safe places to stay.

Dot give medication generally for stress disorders although there might be a pressure to do this.
Managing stress disorders like insomnia by breathing exercises, avoid coffee, avoid tv, routine etc.
There are specific techniques for dealing with bedwetting.
Cycle education is explaining to the person that this is a stress response and that external factors can make your heart go faster as a response, this is not a heart attack. Explaining why stress might cause you to get more cold etc.

Question 141

What is PFA?

Answer 141

Psychological first aid
• Psychological first aid is a humane, supportive response to a fellow human being who is suffering and who may need support
• All health workers should be able to provide very basic psychological first aid.

Question 142

What is STR psychological first aid?

Answer 142

• Key actions:
  
  • listen to the person without pressuring them to talk.
  • provide practical care and support without asking intrusive questions.
  • assess needs and concerns.
  • help the person to address immediate, basic physical needs (e.g. shelter for the night).
  • help connect to services, family, social supports and accurate information.
  • As far as possible, protect people from further harm.

Question 143

Addressing current psychological stressors (STR)

Answer 143

• Sometimes the trauma is ongoing (eg domestic abuse) or can lead to a whole new range of stressors (eg refugee camp life).
• Ask about current psychosocial stressors and as far as possible, use problem-solving techniques to help the person reduce major psychosocial stressors or relationship difficulties,
• Assess and manage any situation of abuse (e.g. domestic violence) and neglect (e.g. of children or older people).
• As appropriate, Identify supportive family members and involve them as much as possible.

Explain that providing assistance with current psychosocial stressors may help to relieve some of the symptoms.
Explain that the health care worker should involve community services and resources as appropriate (eg with the person’s consent). It may be necessary and appropriate to contact legal and community resources (eg social services, community protection networks) to address any abuse (eg with the person’s consent).
Ask the group for some other examples of ways that the healthcare worker might help with psychosocial stressors.

Question 144

Problem solving in 6 steps (following trauma)

Answer 144

Identify and define the problem
Analyse the problem
Identify possible solutions
Select and plan the solution
Implement the solution
Evaluate the solution

Not all problems can be ‘solved’

Question 145

How can we strengthen positive coping methods and social supports?

Answer 145

• Encourage the person to seek the support of trusted family members, friends or people in the community.
• Build on the person’s strengths and abilities.
  
  • Ask what is going well.?
  • What are some methods to cope with hardship that have worked in the past?
• Encourage resumption of social activities and normal routines as far as possible
  
  • school attendance, family gatherings, outings with friends, visiting neighbours, social activities at work sites, sports, community activities.
• Alert that use of alcohol and drugs does not help recovery and can lead to new problems.

Question 146

Insomnia as a symptom of acute stress (within 1 month of the event)

Answer 146

• Apply general management strategies for symptoms of acute stress. In addition:
  
  • Rule out or manage external causes (e.g., noise) and physical causes (e.g. physical pain).
  • Ask for the person’s explanation of why insomnia may be present.
  • In adolescents and adults, consider relaxation techniques and advice about sleep hygiene (regular bed times, avoiding coffee and alcohol).
  • Explain insomnia is a common problem after experiencing extreme stressors.
• If the problem persists after one month, re-assess for and treat any concurrent mental or physical disorder.

Explain that we DO NOT prescribe any psychotropics for symptoms of acute stress.
The only exception to the rule is for insomnia and only in exceptional circumstances as outline in the next slide.

Question 147

Pharmacological management of insomnia

Answer 147

In exceptional circumstances only

• In exceptional cases in adults when psychologically oriented interventions are not feasible, short-term treatment (3-7 days) with benzodiazepines (e.g., diazepam 2-5 mg/day, lorazepam 0.5-2mg/day) may be considered for insomnia that severely interferes with daily functioning.
• Precautions:
  
  • Risk of dependence. Only prescribe benzodiazepines for insomnia for a very short time and in exceptional cases.
  • In the elderly, use lower doses (e.g., half of adult doses).
  • Do not prescribe benzodiazepines for insomnia during pregnancy and breastfeeding or in children and adolescents.

Note that the suggested duration is short and the suggested dose is low, and that these should prescribed in exceptional cases.
The named medicines are on the WHO Model List of Essential Medicines.

Question 148

Bed-wetting as a symptom of acute stress in children

Answer 148

• Apply general management strategies for symptoms of acute stress. In addition:
  
  • Obtain history of bedwetting (to confirm whether the problem started only after the event). Rule out and manage possible physical causes.
  • Manage carers’ mental disorders and psychosocial stressors.
  • Educate carers. Explain that they should not punish the child for bedwetting. It may make the symptoms worse.
  • Consider training parents in the use of simple behavioral interventions (e.g., rewarding avoidance of excessive fluid intake before sleep, rewarding toileting before sleep). The rewards can be extra play time, stars on a chart, etc.
• If the problem persists after one month, re-assess for and treat any concurrent mental or physical disorder.

Bed-wetting is one of the classic features associated with conditions specifically related to stress.
If the problem persists after one month, re-assess for and treat any concurrent mental or physical disorder. CONSULT A SPECIALIST if there is no concurrent mental disorder or if there is no response to treatment of a concurrent mental disorder.

Question 149

Management of PTSD

Answer 149

• Assess for and address current stressors
• Psycho-education for PTSD
• Stress management
• Referral for CBT or EMDR
• DEP 3 Anti-depressants
• Strengthen coping and social supports.

Question 150

INT referral for CBT or EMDR

Answer 150

• Cognitive-behavioural therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are 2 psychotherapeutic techniques that have good evidence for PTSD.
• Other therapies (whether psychotherapeutic or pharmacological) do not have such evidence basis for PTSD.
• Refer for CBT or EMDR, if competent (trained and supervised) CBT or EMDR therapists are available. Are they available here?

CBT and EMDR should be considered when the person is within a safe environment, i.e. there are no ongoing traumatic events and the person is not at imminent risk of further exposure to traumatic events. Expert opinion is divided about their appropriate use in unsafe environments.
Unfortunately, there is no time to discuss in detail what is involved in CBT and EMDR. Dedicated training and supervision is needed to learn these interventions.

Question 151

DEP 3 antidepressants

Answer 151

• Research shows that antidepressants in most people with PTSD only have a small effect (they tend to work on average a bit better than placebo).
• In adults, only consider antidepressants when CBT, EMDR, or stress management prove ineffective or are unavailable.
• In children and adolescents, NEVER offer antidepressants to manage PTSD.

It is assumed that the workshop participants have previously learned how to prescribe anti-depressants (through training of the mhGAP –IG Depression module)

Question 152

Frequency of follow up after traumatic events

Answer 152

• For symptoms of acute stress (i.e within 1 month of event)
  
  • Follow up is needed after 1 month in case person is not improving.
  • At follow up, assess for a range of conditions, incl. PTSD.
• For PTSD
  
  • Follow is also needed after 2-4 weeks to see whether management is working.
  • Long-term follow up at regular intervals may be necessary.
• For grief
  
  • Follow-up is needed 6 month after loss to assess for prolonged grief disorder.
• Follow up may be done in different ways (e.g. in person at the clinic, by phone, or through community health worker).

Question 153

What to do at follow up after traumatic events

Answer 153

• Monitor improvement by asking the person and family
• Ask about and possibly address ongoing psychosocial stressors
• Monitor adherence, response and side effects of medications, if prescribed
• Provide more psychoeducation

Question 154

What is the definition of intelligence?

Answer 154

A hypothetical mental ability that enables people to direct their thinking, adapt to their circumstances and learn from their experiences.

Question 155

What is the theory of hereditary genius?

Answer 155

Francis Galton
Theory of Hereditary Genius (1869)
• Variation in ability within the population
• Variations are inherited
• Nature vs nurture
• First to use questionnaire assessments

Question 156

Wha si the theory of typical intelligence of age?

Answer 156

Alfred Binet and Theordore Simon
	• Identified typical intelligence for age
	• Intelligence scale (1905, 1908, 1911)
	• Developed age norms
	• 'mental age'

This was done after France opened schools to all children, so many weren’t able to read or write etc, so Binet and Simon were asked to develop assessment tools to be able to assess a child’s intelligence without them having to read or write so that they could put the children into classes. Try and see what you would expect a child to be able to achieve at each age group. Also enabled them to identify children that might be struggling and might need extra help - a way of supporting children in education and also developing an efficient education system.

Question 157

What is general intelligence?

Answer 157

Charles Spearman (1904) notion of underlying general intelligence (g)
• Two factor theory of intelligence
• Special factors/abilities (s)
Performance on all tests comprise of g + s

Question 158

What is crystallised intelligence?

Answer 158

Raymond Catell (1971)
	• Crystallised intelligence (gs) - retain facts, develop experience and skills, a solid factual type of knowledge, eg vocabulary
	• Fluid intelligence (gf) - identify patterns, solve complex problems, see order in chaos

Question 159

How did intelligence used to be explained?

Answer 159

Spearman used s factors to explain individual variability/variation. This was a very dominant theory and still is. It has developed over the years.

Catell supported the idea of an underlying level of g, and developed this further. He thought there were two types of intelligence - crystallised and fluid.

In 1960s cognitive intelligence started to be researched more widely - eg memory, perception, processing, problem solving. A shift in ways of assessing intelligence.

Question 160

What is the theory of multiple intelligences?

Answer 160

Modern theorie  - Howard Gardner (1993)
Multiple intelligences - potentials rather than a general underlying intelligence
	1. Linguistic
	2. Musical
	3. Logical/mathematical
	4. Spatial
	5. Bodily-kinesthetic
	6. Intrapersonal
	7. Interpersonal

No longer bound to these seven - there have been more forms of intelligence which have been added eg moral intelligence, environmental intelligence

….ski - social inteligence - look up
Peargy??? - developmental intelligence

We have a number of different potentials which give us access to different ways of thinking. The 7 given are distinctive and don’t necessarily have overlap.

Evidence provided for this is people who have brain damage are sometimes very impaired in some areas but completely fine in other eg maths vs language. Also in people who may be classified as retarded in one way but may have huge musical or artistic ability, or in individuals who have savant (?) syndrome but are hugely talented.

People withbodily/kinestheticintelligence are skilled at using theirbodyto convey feelings and ideas. They have good hand-eye coordination and are very aware of their bodies. Their fine and gross motor skills are more advanced than the average person’s.

The wordintrapersonalmeans “within the self”—so, “intrapersonal intelligence” is another term for self-awareness or introspection. People who have highintrapersonal intelligenceare aware of their emotions, motivations, beliefs, and goals.

Interpersonal intelligenceis the ability to understand and interact effectively with others. It involves effective verbal and nonverbal communication, the ability to note distinctions among others, sensitivity to the moods and temperaments of others, and the ability to entertainmultipleperspectives.

Question 161

About intelligence tests

Answer 161

• Valid and reliable psychological tests
• Performance on intellectual tasks: correlates with performance on other tasks - is stable over time
• Consistency between tests infers an underlying level of general intelligence - g factor

Different tests using different components. Find that people that score well in one test, tend to do well in others too.

Some of the most reliable tests in psychology.

Intelligence grows with age, but at around age 11 you can get a good idea of how ones intelligence is likely to sit for the rest of life.

Question 162

What is IQ?

Answer 162

Intelligence Quotent - Index of intelligence derived from scoring intelligence tests (Stern 1912)

Originally calculated as:
(mental age/chronological age)x100

In modern times, calculated used percentile rankings which are the converted to equivalent IQ scores and projected onto a normal distribution curve

IQ is a scoring system, rather than a particular measure. Less broad than intelligence as a whole.

Was originally calculated by taking m

Question 163

What are intelligence (IQ) tests typically subdivided into?

Answer 163

Typically subdivided into:

- Performance tasks: ie picture completion (fill in missing part of picture), block design (recreate pattern with blocks without instructions), matrix reasoning (number sin a grid or symbols and have to say which one is missing to complete the pattern), object assembly (like flat pack furniture, without instructions)
- Verbal tasks: ie verbal reasoning, comprehension, arithmetic, digit span (measure of memory), letter-number sequencing

Question 164

About the bell shaped IQ curve…

Answer 164

95% of population lie wit +/- 2SDs of the mean (ie IQ 70 to 130)

68% (2/3) of the population have an IQ within 1SD of the mean. Average is considered to be within +/- 1SD of the mean (85-115)

Question 165

What are the scores of intellectual ability?

Answer 165

Very superior: >130
Superior: 120-129
High average: 110-119
Average: 90-109
Low average: 80-89
Borderline: 70-79
----------------------------------------
*learning disability: <70 *
Mild: 55-70
Moderate: 40-54
Severe: 25-39
Profound: <25

Question 166

About intellectual ability/disability

Answer 166

Often concerned with people who are in the borderline range, as access to services and support then people get this if have an IQ score of less than 70. Others very borderline may not be able to have these services.

Tests often carried out by educational psychologists as there is a lot riding on them.

Double edge sword - good because can get help needed, but also can be a stigma attached to having a learning disability.

Tests get less robust at the very top end and very bottom end. Those with IQ of 130+ are generally considered to be gifted.

Question 167

What are some common IQ tests?

Answer 167

Wechsler scales
Raven's progressive matrices
Cattle's culture fair IQ tests
National adult reading test (NART)
Dementia rating scale
Bayley scales of infant and toddler development

Question 168

What are the Wechsler scales?

Answer 168

WAIS (those who cant sit through the whole thing, eg someone who is ill), WASI (adult), WISC (children between 6-10), WPPSI (preschool and primary 2.5-7) - sit in a room with an examiner and go through these tests, age dependent, use diff version depending on the age of the person, 11 types of tests, 6 verbal and 5 performance

Question 169

What are Reaven’s progressive matrices?

Answer 169

non-verbal, series of progressively more difficult matrices looking for patterns and symbols, timed, can have many people doing it at onc

Question 170

What are Cattle’s culture fair IQ tests?

Answer 170

Tries to account for different culture and reduces the confounding factors

Question 171

What is the national adult reading test (NART)?

Answer 171

strong correlations between reading and intelligence, person given a list of words to read one at a time, tricky words, asked to read and pronounce those words correctly, useful as provides reliable estimate for peoples intelligence premorbidly, reading and pronouncing is one of the skills that stays longest with illness, can’t use if damage to language area of brain or in dyslexia

Question 172

What is the dementia rating scale?

Answer 172

way of monitoring progress of people with confusion, and monitoring fluctuations in their IQ

Question 173

What are the bayley scales of infant and toddler development?

Answer 173

in young children, basic tests, looking at developmental milestones, seeing how a child’s cognitive ability is developing

Question 174

What are the clinical uses of IQ tests?

Answer 174

• Diagnosing and quantifying the extent of learning disability
• Diagnosing and characterising specific learning difficulties
- Examples: dyslexia, ADHD, dyscalculia, dysgraphia
• Assessing intellectual impairment following trauma
- Examples: head injury, stroke, poisoning, oxygen deprivation - suffocation, drowning, choking
• Assessing intellectual impairment associated with medical problems or disease processes, and monitoring these.
- Examples: alzheimers disease, dementias, multiple sclerosis, psychosis
• Assessing intellectual capabilities in genetic or developmental disorders
- Examples: downs syndrome
• Other uses: assessing the suitability for particular occupations or educational opportunities

Learning disabilities usually diagnosed in early life by an educational psychologist. Difficult understanding and retaining skills. If diagnosed this is a permanent thing. Often caused by things before or during birth. Sometimes something that happens during the first few years of life. Often the causes are unknown. Affects 1/50 people in the UK. Helps identify where people are struggling and helping them to develop ways to dealing with this.

Question 175

What are some extraneous influences on IQ test scores?

Answer 175

• Familiarity with the particular concepts and materials used (doesn’t increase your IQ, just speed of processing the questions)
• Motivation to do well
• Distraction
• The way the test is administered
• Sensory problems
• Cultural issues - language, difference in world view

The people who devise these tests say they are testing innate ability but it is clear from results that coaching and practice does make a difference.

Question 176

What are internal; influences on IQ test scores?

Answer 176

• Emotional state - anxiety, depression, bereavement
• Physical illness
• Mental illness - psychosis, schizophrenias

Question 177

What are the gender differences in IQ scores?

Answer 177

• Test scoring designed to reduce any sex differences
• Mean 100 - artefact of test construction
• Males better at performance (visual spatial), females better at verbal tasks
• Greater variation in males scores- more spread out - more males at extreme ends. Females scores tend to cluster around the mean.

Question 178

What are the changes in IQ one the lifespan?

Answer 178

Intelligence scores rise quickly and significantly up to the age of 11. IQ peaks around the age of 20-25.

Older people sometimes have a slight decline. See some decrease in fluid intelligence to do with problem solving etc, but this is probably related to processing time. Don’t tend to see any decrease in crystallised intelligence.

Question 179

How does an intelligence test predict stability in educational performance?

Answer 179

• Research conducted by Smith et al 2001
• 24000 students aged 11-12 years sat the Cognitive Abilities Test (CAT)
• Four years later their national examinations (GCSEs) were recorded
• Correlation between CAT and total GCSE performance score was 0.74

Question 180

What was found in the Scottish Mental Survey?

Answer 180

• June 1st 1932 all children born in 1921 in scotland simultaneously sat an IQ test (n=87,497) age 11 years
• Re-tested at around age 80
• Stability in scoring
• Rank scores at age 11 and 80 years very similar - low, medium, high

Lower IQ scores at age 11 were associated with:

• Mortality - shorter life span
• More likely to develop lung cancer
• More likely to experience psychiatric illness and/or dementia

Wanted to know what peoples cognitive abilities were before they developed cardiovascular disease and how this affected them after their diagnosis. See whether there is any relation between disease process and cognitive abilities.

Test results got left unused and then were found later in life. The children were then followed up in their 80s and retested. Found that peoples intelligence rankings tended to stay similar throughout their lives. Also found some relationships with health - those with higher scores were likely to live longer and les likely to develop physical and mental illness.

Question 181

Nature vs nurture - intelligence

Answer 181

• Hereditability - how much of a trait’s variation in a population can be attributed to genes
• Heritability for intelligence in UK ranges between 40 to 70%
• “The more successful we are at equalising environments, the more genes account for the differences between us.” - Prof Robert Plomin (2007)

Non genetic factors - socioeconomic class, nutrition, poverty

The more equal the environment, open and standard access to education, the more our diets improve etc, the more we standardise these factors then the differences seen between individuals in intelligence must then be due to genes.

Question 182

What IQ data was found from twin studies?

Answer 182

An example of an American twins study. Tend to show similar things - we see that people who have very similar identical genetic profiles with the same environment you see a very high correlation in IQ at about 9 which is as high as it will get.

These are people with same environmental influences growing up and same genetics.

For identical twins reared apart we see correlation of around 7, and this is still very high. There is a difference that might be put down to environment but there is still a strong correlation that may be put to genetics.

Non-identical twins also still have a high correlation.

Impact of genetics diminishes are people become less genetically similar.

Weaknesses of twin studies: studies looking at twins reared apart have probably been adopted so may have shared same environment at one point, the adoption environment itself is very regulated so those who adopt are likely to have similarities as it is a standardised process (socio-economic. Educational background, families who really want them).

Twin studies also used to have fairly small sample groups but this is less true now as they have been running for quite a long time.

Question 183

What are some environmental influences on intelligence?

Answer 183

• Socio economic status - education (years and type), nutrition, access to resources
• Poor childhood nutrition - introduction of breakfast clubs, free school dinners etc
• Exposure to environmental toxins
• Exposure to certain drugs in utero (alcohol, cocaine)
• Lack of exposure to an intellectually stimulating environment in childhood
• Neurological injury/disease (zika, cytomegalovirus)
• Genetic disorders affecting brain development (due to environmental toxins - Chernobyl, Fukushima)

Question 184

How does socioeconomic status affect intelligence?

Answer 184

• IQ scores of 7-year-old twins. Many living near or below the poverty level
• Impoverished families - 60% of the variance in IQ was accounted for by the shared environment, and the contribution of genes was close to zero
• Affluent families - the result was almost exactly the reverse

Good evidence not support the idea that there are strong environmental influences on intelligence

Question 185

What is the effect of prolonged childhood malnutrition on intelligence?

Answer 185

Pre-schoolers in 2 Guatamalan villages (where undernourishment is common) were given ad lib access to a protein dietary supplement for several years then years later, many of these children scored significantly higher on school related achievement tests than comparable controls.

Another study:
Study included 241 children. Examines effect of dietary patterns in infancy on cognitive function. Duet was assessed at 6 months and 12 months during weaning period.

At age 4 years, children who’s diet in infancy was characterised by high consumption of fruit, vegetables and home prepared foods has higher full-scale IQ, verbal IQ and better memory performance.
Southampton women’s survey - Gale CR et al (2009)

Question 186

How does exposure to environmental toxins effect intelligence?

Answer 186

Study:
Blood lead levels of children growing up near a smelting plant were substantially and negatively correlated with intelligence tests throughout childhood.

Those with higher levels of lead in blood at birth had Iqs up to 7.2 points lower than comparisons.

McMichael et al 1988
Baghurst et al 1992

Question 187

Exposure to certain drugs in utero and their effect on intelligence

Answer 187

Study:
Mothers who confsumer even small does of alcohol dialy (the equivalent of 3 table spoons) during pregnancy had children who scored 5 points lower than contorls at the age of 4
Streissguth et al 1989

Study:
2year olds whose mothers used cocaine in pregnancy scored 6 points lower than unexposed peers on IQ tests. They were also twice as likely as peers to have IQ <70
Singer et al 2004 JAMA 291 (20): 2448-2456

Question 188

What is the flynn effect?

Answer 188

Intelligence has been increasing with time

Tests have changed with intelligence over time. Things that might explain the rise in intelligence scores include technology, access to resources, opportunities, internet

Question 189

What is higher childhood IQ associated with?

Answer 189

• Fewer adult hospital admissions for injuries/assault
  
  • More likely to become vegetarian (???)
  • Less likely to some
  • Less likely to become obese
  • Lower morbidity and mortality
    PTSD, severe depression and schizophrenia are less prevalent in higher IQ bands

Question 190

What is lower IQ associated with?

Answer 190

• Lower socio-economic status
  
  • Increased change of hospitalisation due to violent assault
  • Incarceration
  • Early death

Question 191

What is the definition of emotional intelligence?

Answer 191

An ability to accurately recognise the meanings of emotions and their relationships, to reason and problem solve on the basis of them. Emotional intelligence is involve din the capacity to perceive emotion, assimilate emotion related feelings, understand the information of those emotions and manage them.

Question 192

What are the criteria for true intelligence?

Answer 192

• Conceptual - mental performance rather than preferred ways of behaving
  
  • Correlational - describe a set of closely related abilities
  • Develop with age and experience
    Mayer and Salovey 1997

Question 193

About emotional intelligence

Answer 193

• Term first used in 1960s
  
  • 1983 Howard Gardener published theory: Multiple intelligences - inter/intra personal intelligence
  • 1985 Wayne Payne’s referred to EI in his PhD thesis - a study of emotion: developing emotional intelligence
  • 1995 Reuven Bar-On - introduces the concept of an ‘EQ” (‘Emotional Quotient”) to measure ‘emotional and social competence’
  • 1989 Stanley Greenspan put forward a model to describe EI
  • 1989 Peter Salovey and John Mayer published their model
  • 1995 Daniel Goleman publishes book: emotional intelligence - why is can matter more than IQ

Question 194

What is the are the concepts of emotional intelligence (EI)?

Answer 194

2 distinct unrelated conceptualisation of EI:

ABILITY EI

- Ability to monitor and distinguish emotions and feelings of self and others
- Operationalised using maximum performance tests, such as IQ tests

TRAIT EI

- Based on lower level personality
- Operationalised using self report personality questionnaires

Question 195

What are the 3 models of emotional intelligence?

Answer 195

• Ability model
• Mixed model
• Trait model

Question 196

What is the ability model of emotional intelligence?

Answer 196

Peter Salovey and John Mayer (1990, 1995) - Yale David Caruso

The capacity to reason about emotions and emotional information, and of emotions to enhance thinking.

The ability to accurately perceive emotions, to access and generate emotions so as to assist thought, to understand emotions and emotional knowledge, and to reflectively regulate emotions so as to promote emotional and intellectual growth.

Measure: a series of tasks designed to assess ability to perceive, identify, understand and work with emotion.

MEIS (Multifactor Emotional Intelligence Scale), (MSCEIT) Mayer-Salovey-Caruse Emotional Intelligence Test

Question 197

What are the four branches of emotional intelligence?

Answer 197

1. Perceiving emotions: understanding nonverbal signals and facial expressions
2. Reasoning with emotions: using emotions to promote thinking and reactivity. Emotions help prioritise what we pay attention and react to
3. Understanding emotions: interpret meaning from emotions
4. Managing emotions effectively: regulating emotions, responding appropriately and responding to the emotions of others

Question 198

What is social and emotional learning (SEL)?

Answer 198

Evidence for SEL school programmes such as RULER and PATHS:

- Better academic performance
- Improves school climate
- Increases students emotional intelligence and social skills
- Decreases anxiety and depression
- Students are less likely to bully other students
- Students have better leadership skills and attentions
- Teacher shave better relationship wit students, less burn out, better relationships with admin, more positive about teaching

Question 199

What are criticisms of the ability model of emotional intelligence?

Answer 199

• Problems with concept - is this just a convenient way of re-describing a collection of traits measured in other ways?
• Ability EI measures might be measuring personality in addition to general intelligence
• Problems with measurement and validity
• Self report - socially desirable responding (SDR) faking goof
• Tests knowledge of emotions but not necessarily the ability to perform tasks that are related to that knowledge
• May only measure conformity - base don method of consensus-based assessment

Question 200

What are the social and emotional learning (SEL) 5 competencies?

Answer 200

• Recognising emotions in self an others
• Understanding the causes and consequences of emotions
• Labelling emotions appropriately
• Regulating emotions effectively

Question 201

What is the mixed model of emotional intelligence?

Answer 201

1985 Reuven Bar-On - uses term EQ in doctoral thesis

Measures 5 factors - the ability to:

1. Be aware of emotions, understand and express them
2. Understand how others feel and interact with them
3. To manage and control emotions
4. To manage change, adapt to and solve personal/interpersonal problems
5. To generate positive affect to enhance self-motivation, in order to facilitate emotionally and socially intelligent behaviour.

Self report measures:
1997 published Bar-On Emotional Quotient Inventory (EQ-i)
2012 EQ-I 2.0 released - recommended for use in UK schools

Combines abilities such as perceiving, assimilating, understanding and managing emotions but also motivation, non-ability dispositions and traits, global and personal and social functioning self regard, independence, problem solving, reality testing.

1995 Daniel Goleman published book: Emotional Intelligence

Popularised EI - leadership and performance

Measures:

- 1999 Emotional Competency Inventory (ECI)
- 2007 Emotional and Social Competency Inventory (ESCI)

Question 202

What are Goleman’s 5 competencies in the mixed model of emotional intelligence?

Answer 202

1. Self-awareness - knowing own emotions, strengths, weaknesses, drives, values and goals. Recognises impact on others while using gut feelings to guide decisions.
2. Self-regulation - controlling/redirecting disruptive emotions and impulses, and adapting to chaning circumstances
3. Social skills - managing relationships to move people in the desired direction
4. Empathy - considering other people’s feelings
5. Motivation - being driven to achieve for the sake of achievement

Question 203

What is the trait model of emotional intelligence?

Answer 203

• Konstantinos V Petrides (2007) UCL
• Defined as an individuals self-perceptions of their emotional abilities. The purpose of EI encompasses behavioural dispositions and self-perceived abilities.
• Equates to trait emotional self- efficacy - same construct
• A distinct compound construct and a constellation of emotional self-perceptions located at the lower levels of personality hierarchies. Trait EI should be investigated within a personality structure.
• Concerns emotion-related dispositions and self-perceptions, it is best measured via self-report
• Measured using Trait Emotional Intelligence Questionnaire (TEIQue)

Question 204

What are higher trait emotional intelligence scores associated with?

Answer 204

• lower risk for mental disorders, such as depression and anxiety.
• higher extraversion, social competence and enhanced emotion regulation abilities
• using problem-focused rather than avoidance coping strategies
• appraising situations as challenging rather than threatening
• a recurring resilience in response to life stressors
• being more creative
• Thinking and acting in ways that encourage positive and discourage negative emotional experiences
(Mikolajczak, Bodarwé et al. 2010; Petrides, Pita et al. 2007; Mikolajczak, Luminet et al. 2007: Mikolajczak, Petrides et al. 2009)

Question 205

What is memory?

Answer 205

The ability to store and retrieve information over time

Question 206

About neuronal architecture and memory…

Answer 206

• Architecture of human brain - we know that a computer stores information on a hard drive which contains previously a spinning disk, magnetic information, now a days there’s no moving parts.
• By learning something new your brain structure is being changed as new information is given and you form new axonal and neuronal connections which store the information.
• Neurones die over the course of life time, die all the time, memories not stored in one neurone for this reason otherwise they would be lost. Memory is instead stored in multiple neurones in a distributed process - neuronal network.
• Advantages of this is that you can’t lose all the information and its difficult to screw it up.
• You cant eradicate a memory by attacking a memory as you don’t know which ones its distributed within. Lose memories in illnesses such as dementia because so many have been lost, can lose up to 80% before you even notice the change. Whole sections can die and you would only notice that you’re slowing down. When someone presents with dementia they will have already lost over 50%, often whole sections.
• Neural architecture acts the same as the internet, there’s always multiple routes to the same neurone, so if one is blocked then it’ll take another one to get the information.
• Brain stores information at different levels of readiness. In Alzheimer’s and dementia lose the useless information first, and last the things you need all the time such as how to go to the toilet and the name of your partner. Your brain prioritises information based on utility and relevance to you.

Question 207

What are the types of memory?

Answer 207

Iconic memory
short term memory
working memory
immediate term memory
long term memory
episodic memory (autobiographical)
semantic memory
declarative memory
procedural memory
prospective memory

Question 208

What is iconic memory?

Answer 208

this is the after image on retina if visual, tactile feeling on skin if you have been touched by something for long enough, echoic if you still hear a sound after it has stopped. These stores are very momentary, 250ms.

Question 209

What is short term memory?

Answer 209

online storage for things that are happening now. Phone numbers originally 7 digits as can only remember 7-8 things for about 30 seconds (unless constantly sub-vocally rehearsed). 7 pieces of information +/- 2 (standard deviation) is the average limits of human memory. Short term memory is the old fashioned way of saying working memory

Question 210

What is working memory?

Answer 210

three components: phonological loop (auditory info), visuo-spatial sketchpad (visual), and something resembling consciousness and attention. As there is a consciousness part this means conscious awareness is very limited, but unconscious awareness is vast (eg hearing name across the room even though working memory is full

Question 211

What is immediate term memory?

Answer 211

a new form. This is the bit between working and long term. Stored for up to 2 days. Eg location of car in carpark

Question 212

What is long term memory?

Answer 212

potentially forever eg Paris is the capital of France. Divided into separate sorts of stores (episodic/autobiographical which is events which have happened to you, totally separate to semantic memory which is factual memory eg paris - these two are functionally separate, can lose one and not the other

Question 213

What is episodic (autobiographical) memory?

Answer 213

events which have happened to you

Question 214

What is semantic memory?

Answer 214

factual memory

Question 215

What is declarative memory?

Answer 215

things you know you know, when something is on the tip of your tongue

Question 216

What is procedural memory?

Answer 216

memory for doing things such as riding a bike, driving, swimming

Question 217

What is prospective memory?

Answer 217

ability to remember to do things in the future, e.g. important tasks you need to do late in the day/week

Question 218

What is expectation in relation to memory?

Answer 218

Expectation is a memory phenomenon when you’re doing something and your brain fills in the information its expecting, eg hearing mum shout you or jumping when you see something outside at night. Also means that if you see someone out of context when you’re not expecting it you struggle to remember who they are or where you know them from.

There is evidence that human memory is rapidly declining due to technology, in particular google.

Question 219

What are the critical concepts in neuropsychology in relation to memory?

Answer 219

• Dissociation and double dissociation
• Help to identify neural substrates of various brain functions
• Dissociation = when you know localisation of brain damage or lesion and find that one function is knocked out by other related functions are preserved eg individual loses ability to name category of animals but can name all other objects
• Double dissociation = lesion in specific brain area impairs function x but not y then demonstrate that lesion of separate brain area impairs y but not x
• Patternson and Plaut “the gold standard was always a double dissociation” 2009

Question 220

What are the three key processes in memory?

Answer 220

• Encoding - processes occurring during initial encounter with to be remembered stimulus = stage 1
  
  • Storage - storage in the memory system = stage 2
  • Retrieval - recovering stored information form the memory system = stage 3

Forgetting can result from failure of any of these stages, rather than a process in itself.

Question 221

About encoding and storing memories…

Answer 221

Encounter with initial stimulus you’re trying to remember eg a lecture, you’re trying to record it by paying attention in order to hopefully remember it.

The deeper the level you encode something to the level you remember it the better you remember it. To deepen the level of encoding you pay more attention, write notes, etc. asking questions makes you encode to a deeper level because you think about it I a deeper way as you have to search your memory for answers which activates similar structures which mean when you are told the answer you can hook it onto something. Making things personally relevant also means that you can encode things deeper.

Storage is transferred between types of memory. One of the best ways to store memory is by asking questions, doing practice questions, making it relevant to you and making notes (rehearsal not shown to have much effect). Consolidation is the transfer from short term to long term.

In retrieval the memory is reconstructed more than recollected, you are not accessing the exact same thing but just the jist of it. We reconstruct things, which we know by telling stories about things that happened - they change slightly. This tells us that human memory is not very reliable - scientific evidence from eye witness testimonies which are very inaccurate in at least 50% of cases.

What we think of as forgetting can result from failure at any of these stages.

Question 222

About memory structure

Answer 222

A basic model is the multi-store model of memory (Atkinson and Shriffin, 1974)

sensory inputs > sensory store >(encoding)> short term memory (retrieval) long term memory

When gets to long term memory, long term memory has capacity which is almost infinite if you can always lay down memories.

Have done studies to try and test the capacity of this, by showing around 10,000 faces you’ve never seen before, and then the next week they show you them and ask if you’ve seen them before, and they keep increasing the number over months and they haven’t found the capacity of limitation.

Question 223

What is sensory memory?

Answer 223

• Auditory [echoic] memory - holds information for approximately 3 seconds
• Visual [iconic] memory - holds information for approximately 250ms

Have all the other modalities too, but there is very little research on them because it is very rare. 50% of brain is vision so 90% research on vision, 10% on auditory, very little on olfaction. Smells are weirdly one of the most infallible sources of memory however.

Question 224

About short term memory

Answer 224

• STM - now termed Working Memory (Baddeley and Hitch, 1974)
• This consists of three components:
- Central executive: this resembles what we would call ‘attention’
- Phonological loop: holding information in a speech-based form
- Visuo-spatial sketchpad: specialised for holding cisual and spatial information

Older form, more historical but still know it.

Central executive - this is almost a representation of consciousness/attention. Attention is a way of deepening the level of encoding. The brain pays most attention to information that is relevant to you. This biases us in terms of attention, means that what we see in the world is not what’s there but is what is interesting to us. If you change who you are as a person, you have trouble remembering things you learnt as your old self - this is called state dependent memory. Best example is locational memory - what you learn in this class, if you took the exam in the same room as the lesson then you would get about 5% more on the paper.

Question 225

About working memory…

Answer 225

• WM is a much more dynamic store than a unitary STM
• Working memory has a limited capacity (LTM is theoretically without limit, in both capacity and duration of storage)
- It is usually found that we can only store around 7 ± 2 pieces of information in memory (Miller, 1956)
- Be beware of chunking - grouping bits of information to make remembering easier

Chunking is how you group bits of information, for example not remembering each number in a phone number, but putting parts of the number together.

Question 226

What is double dissociation in memory?

Answer 226

• Are short term memory and long term memory distinct?
• If they are we would presumably see patients with impaired STM and preserved LTM? If we also saw the reverse pattern preserved STM and impaired LTM this would be an example of a double dissociation
• Researchers and clinicians have found this pattern to be supported
• Eg. KF = patient with impaired STM but fine LTM (Shallice and Warrington, 1970)

No short term memory means no really attention span

Question 227

Inference in memory recall

Answer 227

Inference in WM

- Traces only remain in WM with repeated rehearsal (ie attending to the information)
- They are therefore prone to interference
- Retroactive interference: new information interferes with the retention of old information in WM (trying to remember your old phone number, having used your new number for a few months; finding it difficult to revert back to manual gear changes having recently been shown how to use an automatic)
- Proactive interference: old information interferes with the recall of new information (mistakenly giving your old phone number instead of your new one; attempting to change gears manually in a newly bought automatic)

An example of interference is making the person think about something completely different when trying to remember something else - when new information interferes with old (retroactive) and when old information interferes with new information (proactive)

Question 228

What is the primary-recency effect?

Answer 228

Primacy-Recency or the Serial Position Effect
When presented information in serial order, we remember more form the beginning and end of the list, at the expense of intermediate items.

• 4000-5000 studies on this effect, never really not found.
• We are always presented with information in a serial order as its over time.
• Means that the first 20 mins of a lecture you’ll remember a lot, last 20 mins you’ll remember a lot but in the middle you’ll remember less. The same happens with films, books, experiences, etc. this is a really strong effect.

Question 229

What are the levels of processing (Craik and Lockhart 1972)?

Answer 229

Craik and Lockhart - 1972

- Depth o encoding determines later memory for information
- Processing at encoding can be shallow or deep. The greater the processing the meaning of stimuli at encoding the deeper the level of processing and greater likelihood of later storage and retrieval
- Importantly Craik and Lockhart disagree that rehearsal will improve LTM as it just repeats previous operation. BUT rehearsal has beneficial effects but they are small and nor for every type of memory eg prospective memory may not benefit

Question 230

About long-term memory

Answer 230

Craik and Lockhart - 1972

- Depth o encoding determines later memory for information
- Processing at encoding can be shallow or deep. The greater the processing the meaning of stimuli at encoding the deeper the level of processing and greater likelihood of later storage and retrieval
- Importantly Craik and Lockhart disagree that rehearsal will improve LTM as it just repeats previous operation. BUT rehearsal has beneficial effects but they are small and nor for every type of memory eg prospective memory may not benefit

Question 231

What is consolidation?

Answer 231

Involves structural change: the pattern of neural pathways are changed

- Long term potentiation: strengthening of synapses, believed to be the cellular foundation for memory
- Research into how to induce LTP useful for dementia treatment - rats given NMDA receptor antagonists display memory deficits. Mice bred with enhanced NMDA function show greater LTP and better memory

Requires metabolic activity for minutes/hours after the stimulus has been presented.

Believed that the hippocampus plays a vital role in consolidation.

Human memory has got significantly worse over the last 20 years due to this process being weakened by the advent of google. Hippocampi are getting smaller as we are externalising memory to smart phones etc.

Question 232

What is retrieval (memory)?

Answer 232

• Cue required (eg prompt, reminder, question)
• Original stimulus reconstructed using information from cue
• The more information available, the easier the retrieval
• A good ‘filing system’ also aids retrieval - eg mnemonics (memory aids, Method of Loci), make something personally relevant to you and you’re more likely to remember it
• Retrieval can be affected by interference - proactive (new phone number replaces old number), retroactive (old routine home blocks new route home)
• Tip of the tongue phenomenon

We know that memory isn’t just recalling what you laid down - it is reconstructive.

Retrieval even from long term memory can be interfered with by the same processes as in short term memory.

Question 233

What are factors affecting retrieval?

Answer 233

• Levels of processing
- The more something is elaborated at the time of encoding, the easier it will be to retrieve
• Organisation
- Of concepts in memory (also, associations between concepts stored in LTM may facilitate recall)
• Context
- Being in the same place/emotional state as the time of encoding facilitates recall - State Dependent Memory

Organisation of concepts in memory affects how you retrieve them. The hardest thing you could be asked to remember is information that you have nothing similar to in the past (similar to if you don’t have visual stimuli from birth you cant see even when given sight back later in life). This is why there is some evidence that if your critical period during childhood is more varied and exciting you will do better in life as - has been seen in rat studies where brains bigger, denser, more neuronal connectivity. This tells us that you can make your brain better than biology gave you through environmental use.

State dependent information also important for mood - if taught something drunk you wont remember it sober, but drunk you will - also works with drugs.

Question 234

What is state/emotion dependent recall?

Answer 234

Organisation of concepts in memory affects how you retrieve them. The hardest thing you could be asked to remember is information that you have nothing similar to in the past (similar to if you don’t have visual stimuli from birth you cant see even when given sight back later in life). This is why there is some evidence that if your critical period during childhood is more varied and exciting you will do better in life as - has been seen in rat studies where brains bigger, denser, more neuronal connectivity. This tells us that you can make your brain better than biology gave you through environmental use.

State dependent information also important for mood - if taught something drunk you wont remember it sober, but drunk you will - also works with drugs.

Works with biological environment with chemicals in blood stream, mood, mental state and locational environment.

Question 235

What is declarative and non-declarative knowledge?

Answer 235

Declarative knowledge (sometimes known as explicit memory):

- Memory for facts, for information that can be conveyed by statements
- Involved conscious recollection of events/facts
- Encompasses semantic and episodic memories
- Eg your birthday

Non-declarative:

- Generally doesn’t involve conscious recollection eg procedural memory
- Implicit memory
- Priming 

Implicit memory: one of the two main types oflong-term human memory. It is acquired and used unconsciously, and can affect thoughts and behaviours. One of its most common forms isprocedural memory, which helps people performing certain tasks without conscious awareness of these previous experiences. Can work out if implicitly racist using this by looking at speed of processing these things,

Priming: where one concept being active in your mind leads to another concept being active eg bread = butter, doctor = nurse. One concept primes another. You self-prime yourself by your interests, if your really love football you will prime yourself to notice all things football in the environment.

Question 236

About procedural memory

Answer 236

Procedural knowledge
- Memory for how to do things/skills
- Often in the absence of conscious recollection
Eg how do you tie your shoelaces, driving, riding a bike, playing chess

This form of memory is also dissociated from the others. Can lose all other forms of memory but still be able to do things using this form of memory.

Chess is interesting because they can see it and don’t think they know how to play as don’t think they ever have before, but if you tell them to guess then they can do it perfectly.

This is an unconscious form of memory and it can’t access conscious.

Question 237

About semantic and episodic memory

Answer 237

This form of memory is also dissociated from the others. Can lose all other forms of memory but still be able to do things using this form of memory.

Chess is interesting because they can see it and don’t think they know how to play as don’t think they ever have before, but if you tell them to guess then they can do it perfectly.

This is an unconscious form of memory and it can’t access conscious.

Question 238

About episodic/autobiographical memory

Answer 238

• Most episodic memory decline over time however decline is not uniform over all memories eg
• Behrick et al 1975 - memories of student days showed remarkable preservation - reminiscence bump = surprising perseverance of memories occurring between ages of 10 and 30. why?

Most episodic memories decline over time but not uniform over all memories.

Memory across human lifespan interesting as if get someone at 80 to recount the whole life they get reminiscence bump and get a lot of information between the age of 10 and 30. partly primacy effect as before 10 structures for laying down memories aren’t properly developed, and because the time in this period is an important transitional time, and should make this time a good part of your life as will remember it forever, this is also because during this time you’re exposed to a lot of new experiences. These are emotionally significant events. If they are new experiences then there cant be proactive interference as you have never done it before. Also have a bias towards positive rather than negative memories. Brain has some process where it rewrites your own history as you age - selectively forgets negative things and then you remember your past better than it actually was.

Question 239

What is the reminiscence bump?

Answer 239

• Stability of early adulthood memories is remarkable
• Why
• Majority of first time experiences. Novelty is memorable because of the lack of proactive interference from previous learnings
• More evidence for reminiscence bump for positive than negative memories (Bertsen and Ruben, 2002)

Facebook and social media exacerbates this as we mostly tend to post positive things, biasing ourselves. Facebook is like a selectively positive diary, if compared with actual diaries we see that this fully positive life is fake.

Question 240

What are flashbulb memories?

Answer 240

• Flashbulb memory = detailed and extremely vivid memories regarding circumstances surrounding very shocking event eg September 11th
• Only occur with shocking and emotionally significant events. Evolutionarily adaptive?
• Emotional arousal during encoding enhances retention
• Also frequently rehearsed and talked about

Memories where something happens with such great significance that you can’t ever forget it - eg 9/11

Happens with things that are usually negative and very different and are encoded very rapidly because there is emotion associated with (amygdala, limbic system) and this encodes it in a different way with memory and emotion. This is evolutionary for survival, useful to remember this information so as to avoid it as well. Can have personal versions of this as well not just famous things for all people, eg first real breakup. This is also partly how trauma memory works.

You never forget flashbulb memories, and it is one instance memories.

Question 241

What is recognition?

Answer 241

• Sensing that a stimulus has been previously encountered, sense of familiarity
  
  • Generally easier than recall, as information is contained in the cue
    Recognition can be direct from a set stimuli or from a mental search of LTM store

Question 242

What is recall?

Answer 242

• Reconstruction of a stimulus using the information available from the cue and information from LTM
  
  • Checked by the process of recognition
  • Greater ‘cognitive demand’ than recognition
    Recall can be direct from the cue or arise after problem-solving strategies have been employed

Question 243

About recognition and recall being inaccurate…

Answer 243

Memory is not entirely ‘stable’ and recall and recognition can be inaccurate

- Eye witness reports (Loftus 1979)
- Participants watch a film of an accident, one includes a STOP sign, the other a YIELD sign. Using specific working, you can change people's memory:
- "How big was the sign by the road?" the participant wont remember the fact that they saw a yield sign
- "how fast were the cars going when they smashed into each other?" participants will recall the cars were going faster than they actually were

Loftus looked at actual eye witness testimonies. Showed a video then asked about speeds varying use of ‘smashed’ and ‘hit’ and found when used the world smashed people said on average 10mph faster than when said hit each other.

Police interviews are now recorded, 2-3 people present, lawyer present and wording is now thoroughly checked. This study influenced this.

Question 244

About forgetting…

Answer 244

The main causes of forgetting from either working memory or long-term memory:

Passage of time:

- Rapid decay of information from WM
- Cell death leads to loss of LTM (can be accelerated eg dementia)

Interference:

- Interference to storage in WM eg pro/retroactive
- Connections are remolded over time in LTM, influenced by pro- and retroactive interference of information

Question 245

What is the relationship between age and memory?

Answer 245

Phenomena

- Infantile amnesia = inability to remember events from early childhood
- Generally people can not remember anything before 2 years. First memories usually occur between 2 and 5 years. Probably because brain regions responsible for episodic memory are nor sufficiently developed
- Reminiscence bump = preserved memories for 10 to 30 years (many first time occurrences)

Normative aging:

- Speed of processing declines (perfect 1994)
- Memory declines and forgetfulness increases but shouldn't interfere with ongoing functioning

Everyone has infantile amnesia
30-60 age period kind of gets lost, as opposed to the 10-30 gap

Question 246

About memory repression

Answer 246

• Freud 1915 – suggested threatening information is often blocked from conscious awareness
• Most evidence based on adult patients that often spontaneously retrieve memories of being abused as children that they report no previous memory of.
• Clancy et al 2000 – Experiment
• Butter, food, eat, sandwich, rye, jam, milk, flour, jelly, dough, crust, slice, wine, loaf, toast
• Nurse, sick, lawyer, medicine, health, hospital, dentist, physician, ill, patient, office, stethoscope, surgeon, clinic, cure
• Bread? Doctor?
• Clancy et al 2000 compared women with recovered memories of childhood sexual abuse, with women who believed they were abused but could not recall it and women who had always remembered abuse and controls.
• Also issue of prompting – subsequent studies have shown that adult patients that admit to reporting false recovered memories had clinicians that categorically suggested they had been abused as children
• This finding relates to the literature of eyewitness testimony and its unreliability.

Block things out so that we don’t have to keep reliving it. The evidence is very mixed on whether this exists at all.

Confabulation is when you remember things in a different way but that is plausible. Remember things that weren’t there for example.

Something worse about the peoples memories in the results to make them unsure if something happened or not.

Suggestibility factor - eg from therapists etc suggestion of abuse

Question 247

About dissociating function in WM and LTM

Answer 247

• The case of HM (Milner, 1978)
  
  • Had surgery to cure severe epilepsy
  • After operation had near normal memory for events prior to surgery, and STM normal (approx 15 s)
  • But severe deficit for new memory of facts or of events occurring after surgery (encoding from STM to LTM).
  • Since operation he forgets the events of his life as they occur
  • Able to learn motor skills but could not remember which skills he had learned (Short term declarative)
  • Hand buzzer example

Can remember anything that happened from then on - semantic and episodic. However could learn chess which is procedural but has to guess the moves having been taught after the accident.

Every time the doctor would go in he would say hello doctor who are you and he would say I’ve never seen you before in my life and come back in 30 seconds later would say the same thing again. Doctor then used electric shock hand shake thingy after meeting about 100 times and then went out and came back and then he still says he’s never seen him before and doesn’t recognise him BUT refuses to shake hands, and said he just didn’t feel like it so he had partial awareness.

Question 248

About dissociating function in procedural and declarative memory

Answer 248

• Temporal Lobe Amnesia (e.g. Korsakoffs)
• Patients are able to learn skills
○ Procedural
• Patients are unable to learn new facts
○ Declarative
• E.g. a patient may show improved performance on a simple task over time, but each time they will show no recognition or memory of ever having performed the task before (despite obvious improvements)

Irreversible when gets to Korsakoffs
Able to learn new skills but not new facts - so declarative and semantic mainly damaged. Can have functioning episodic memory though

Question 249

About dissociating function in semantic and episodic memory

Answer 249

• The case of KC (Tulving, 1989)
• Damage to specific brain regions, (left frontal-parietal and right parieto-occipital lobes) following a traffic accident
• Can no longer retrieve any personal memory of his past (autobiographical memory) but general knowledge remains good
• Plays chess well but does not remember where he learned to play
• Can learn semantic knowledge when care is taken but cannot acquire episodic knowledge
○ E.g. will claim never to have met people met recently, but will be more friendly towards them than people he really hasn’t met

Question 250

Amnesia

Answer 250

• Amnesia can be brought about by:
• Damage
○ Head injury, stroke
• Chronic alcohol abuse
○ e.g. Korsakoff’s syndrome, affecting storage and retrieval processes
• Disease
○ e.g. Alzheimer’s: extensive damage to cortex, progressive deterioration from some impaired memory skills (esp. episodic memory) à more general cognitive impairment
• Reversible brain disease
○ Tumours, hydrocephalus, subdural haematoma, deficiencies in B1, B6, B12, endocrine disease, syphilis
• Psychogenic Memory Loss
○ Abuse, war
• Anterograde amnesia (as in patient HM)
• Inability to store new information
• Inability to transfer information from STM to LTM
• Retrograde amnesia (rarer)
• Inability to recall information prior to trauma
• Often following closed head injury, can be relatively short duration

Most depictions of amnesia in films is someone hits their head and they lose the ability to remember who they are from the past - this is very rare and is called retrograde amnesia. The much more common form is anterograde amnesia which is where you can’t make new memories.

Also need to clinically separate into semantic and episodic to see which system is damaged.

Semantic is rarer.

Trauma could be so great that some kind of regressive mechanism is acting - people forget things because it is too traumatic.
Could also just be lying.

Common denominator of PML is that you never lose a nice memory, always traumatic things.

Following a stroke you gradually get function back, get memories back, but if a whole brain region is killed that wont recover. However we know that another area can learn and adapt to what you’ve lost, so areas around the dead area can take on some of the function. Get a slow, gradual recovery.

Question 251

About HM and the hippocampal region

Answer 251

• HM had both hoppocampi surgically removed yet retained information from the past.
• Therefore suggests this is not the actual repository
• Memories are stored in various regions of the cortex

Question 252

Biology of memory storage

Answer 252

Frontal lobe - stores certain semantic and episodic memories
Prefrontal cortex - involved in storage of STM
Motor cortex - procedural memory
Temporal lobe - formation and storage of LT semantic and episodic and also new STM
Amygdala - emotions, emotional response, emotional memories
Hippocampus - new LT semantic and episodic memories, not the repository but where theyre formed - amygdala on the end of it, close biologically as get bang for buck as it stores the memories, both lighting up saying to store quickly, perhaps one time learning
Cerebellum - storage of procedural memories and also for balance. If drink enough for long enough you permanently damage it and you get a permanent alcoholic gate

Green one - occipital lobe but this is all visual, but it does have to be interrelated to all the rest as most of what you learn comes in the visual format. Encoding it visually as well as audition.

We don’t know where all of this stuff is integrated in the brain. Looks more like the whole brain integrates it. Couldn’t just be one integrated region because this would be dangerous as if that area got damaged then there would be major consequences. The brain can make up the differences and fill in gaps of hearing and also vision.

Question 253

What is hippocampal function

Answer 253

• Memories are stored in a distributed fashion throughout the cortex
• Therefore something has to integrate these into coherent memories
• That something is probably the hippocampal region (Schacter, 1996)

Not only the hippocampus because can remove it and there’s still function - likely to be the regions around the hippocampus more than others.

Question 254

About temporary amnesia

Answer 254

• Can result from head injuries, psychological states or drugs
• Concussion often associated with memory loss
• Cinema experience
• Usually retrograde amnesia for events immediately preceding the cause
• Fugue states (Schacter et al. 1982)
• Occur with extreme psychological trauma often loss of previous experience and identity
• Drugs
Date rape drugs such as rohypnol can cause amnesic effects for events occurring while under the influence

Rohypnol, alcohol

Fugue states - when you have a big psychological trauma, do something horrific (eg kill someone) and then forget what you’ve done and are found wandering. Unaware of what you’re doing.

Question 255

About ageing and memory

Answer 255

• Memory across the lifespan is unequally distributed as we have seen (Rubin, Wetzler & Nebes, 1986).
• If we ask an older adult to recall their lives the following general pattern would emerge
• Infantile amnesia – failure to recall anything from first 3 years often first 5 years
• Reminiscence Bump – better memory for period 10 to 30 but strongest for positive information
• Alternative theory
• Conway & Pleydell Pearce (2000)
• Knowledge base
○ Lifetime periods – vast swathes of time defined in terms of ongoing situations
○ General Events – often repeated but related to each other
○ Specific knowledge of events
• Working self
○ Concerned with goal attainment frames knowledge in terms of progress or lack of progress towards important goals

As opposed to being because of new experiences, might be because of the Conway and Pleydell Pearce theory - the things you remember are discrete normative events, so average life would look like birth, school, university, work, tv, marriage, children, divorce??, death. This theory argues that these are the structures that we hang memories on.

Working self - anything related to you is better remembered, cognitive bias to things you’re interested in, also cognitive bias if set a goal for your life then you have a cognitive bias to anything related to that goal. This means that you notice some things more that you didn’t notice before or wouldn’t usually.

• At advanced age memory starts to decline
• Speed of processing slows with age (Perfect, 1994)
• Generally normative age related decline should not interfere with daily functioning
• Where it does its more likely to indicate a pathological process
• Working memory declines more

Average life expectancy is 80 (M) and 81 (F), and 80 is where we class as starting to see advanced old age.

Older adults used to refer to 60-80 and after 80 were referred to as either advanced old or old-old, but have now had to create new terminology as people are living longer now.

Question 256

About amnesia research

Answer 256

• Brain damage studies are broadly supportive of the 3 types of autobiographical knowledge
○ Generally event specific knowledge is more compromised than general events or lifetime periods
○ Confabulation on basis of plausibility is common

General event autobiographical knowledge is every time you’ve been to uni - repeatedly go, similar to dating etc

Question 257

About dementia

Answer 257

• Affects roughly 800,000 people in the UK
• Increases with age
• Is a syndrome associated with multiple losses
  
  • Memory loss
  • Speed of processing
  • Language ability
  • Understanding
  • Emotional ability
• Alzheimers is most common form representing the majority of cases
• 10% of individuals develop dementia at some point
• Cure is impossible because of neurodegeneration but slowing is possible

Massive cause of memory loss.
800,000 is going up, significantly higher than schizophrenia rates, going up because living longer and lifestyle factors such as alcohol use, using your brain/lack of use.

Not just memory loss - also speed of processing, language, comprehending, emotional, personality change.

An almost certainty if live long enough is the lens of the eye wears out and get cataracts, prostate cancer, also memory loss is another certainty.

Rest of us (90% not with dementia) wont escape memory loss.

Memory loss with dementia is problematic because cure is impossible because it is caused by neuronal death. Drugs can slow it but not stop it. Slowing it is a problem though because by the time someone presents with dementia they can have lost 50% of the neurones already.

Looking currently at transplanting parts of brains, just the regions which are damaged not the whole brain. Could be taken from elsewhere or grown.

Other treatment possibilities include encouraging neurone regeneration/regrowth. They are looking at this by using certain animal species and looking at how they regenerate eg starfish.

Question 258

What is attention?

Answer 258

• The human information processing system is limited in terms of allocation of resources to sensory and perceptual information
• The term attention s sued to refer to this allocation of processing resources
• Attention acts as a filter (Broadbent) or an attenuator (Triesman), to prevent this limited set of resources from being overloaded
• It can act as a ‘bender’ of object features and as a ‘binder’ of related information from different sensory modalities.

Question 259

What is the special problem of auditory attention?

Answer 259

Auditory system has a special problem: it requires processes that permit a listener to attend to the specific set of sounds without being confused by the overlap of other, irrelevant noises.

Auditory system is able to separate different, superimposed sounds on the basis of their different source directions.

Uncertainty remains over the fate of the unattended material.

Ears are positioned in a way that we cant direct them to avoid certain stimuli, unlike the eyes where you can just look away.

If the way we hear so much auditory stimuli would be like seeing loads of sentences superimposed on each other if you cold see it.

We have two ears which focus on long wavelengths, so we can focus on some stimuli over others.

Question 260

What is the dichotic/shadowing procedure?

Answer 260

(Broadbent, 1952, 1954; Treisman, 1960)
- Subjects wear a set of headphones and made to hear two messages at the same time, one entering each ear, and asked to shadow (repeat back the words from one message only)
- A typical shadowing task:
· Left ear: and then John turned rapidly toward
· Right ear: a series of words - ran,house,ox,cat
Ask to repeat back the left ear material

Shadowing procedure was the first wave of research. Subjects wear headphones, hear one in each ear and told to only repeat the words from one ear only.

Typically one is asked to repeat the prose not the random works.

Question 261

What was found from the dichotic listening/shadowing procedure?

Answer 261

• Unattended material appears not to be processed in a shadowing tasks; only most recent unattended material is available, while still preserved in the echoic memory
• The listener is normally unable to report significant details concerning the unattended information: can only tell whether the unattended message is a human voice or a noise, or if human, whether male or female and the language used by the voice
• These results suggest parallel acquisition of all available information, followed by serial processing to determine meaning for one attended message

Found people couldn’t really repeat the unattended words except possibly the last 3 words. Beyond that it would fade away incredibly quickly, only in very short term memory.

However, were able to register sensory aspects of it, such as pitch, language, male or female voice etc. Just cant get semantic value from it.

Question 262

What is broad bent’s 1958 filter theory?

Answer 262

The basic claims of the model:
• Sensory channels have an unlimited capacity
• There is a bottleneck allowing only one piece of information into working memory at a time
• A selective filter allows in information from only one channel at a time based on the physical characteristics of the message (ear, pitch, etc)
• Information from unattended channel is completely blocked

Take information in via sensory organs and then there’s a gate at which point we decide which message we are going to receive. After that choice is made only one stream of information will go through. Then goes onto short term memory.Biggest mistake is that the filter could only be done on superficial sensory aspects (Eg pitch)

Question 263

What are the problems with the bottleneck theory?

Answer 263

• Although there is little conscious awareness of unattended material, it may receive more processing than the above results imply
• Sometimes selected messages are processed on the basis of their semantic content rather than their physical characteristics (eg cocktail party phenomenon)
• Words presented to the unattended ear can produce priming and physiological effects (eg ‘ignored’ shock words give rise to galvanic skin responses; Corteen and Wood, 1972)
• Trying to ‘shadow’ one ear will follow the message to the other ear (Treisman, 1960)

Wasn’t true. Found that although there wasn’t much awareness of the unattenuated information, it was actually processed at a further level than initially thought.

Eg cocktail party phenomenon - shows it must be in some way

Can measure physiological aspects eg simple word association task in one ear and critical words every 5 or 6 words are followed by an electric shock and this is repeated a lot of times. After that dichotic listening task where have to shadow one ear, but in the other year every time the signal word is said their skin responds and this suggests there was some processing to the stimuli in the first part.

Question 264

What is evidence for parallel processing (Treisman)?

Answer 264

• Treisman instructed subjects to shadow a particular ear into which was played a meaningful message
• The nonshadowed ear received a random string of words
• At some point in delivery, the meaningful message switched ears and the random words were switched into the nonshadowed ear
• left ear: In the picnic basket she had peanut butter book, leaf, roof, sample, always
• right ear: cat, large, day, apple, friend, every, select, sandwiches and chocolate brownies
• Although instructed to shadow a certain ear, many ignored this and followed the meaningful message instead (temporary sensitisation?)
Results imply that processing takes place in parallel, to the extent that meaning is extracted even from unattended material

Start sentence in one ear and then switch to the other and people will follow it seamlessly. Treisman said this is because you are primed to hear the next words in the sentence, as stimuli around us prime us. When you hear your name you have a very low threshold to recognise your name, very few processing resources needed for it as it is naturally primed. Similar with the sentences.

Some semantic value in the other information.

Question 265

What is visual attention?

Answer 265

• Attention can be directed selectively towards different areas of the visual field, without the need to re-focus
• Visual attention linked to specific objects rather than to general regions of space
• Unlike hearing, seeing is typically extended over space (and not time), although seeing does require some finite time to capture and analyse information – this process has been the focus of much research

Similar message but a little more complex. With visual attention we are changing the focus. In auditory it’s the info available to us but we choose to ignore it, in visual its on information that’s there are we really want to process, but might not have time to do so because of its brief duration.

We an read a sentence, take visual imagery of a split second as opposed to auditory which takes longer to understand a sentence.

Question 266

What are the ways of testing iconic memory (visual)?

Answer 266

• Presented an array of letters for 50 ms
X M R J
C N K P
V F L B

• Whole-report method: recall as much as possible from array
• People recall 3-6 letters; report that the letters “fade away” before they can report them all
• Part-report method: only certain elements from array
• Employs a tone (high, medium, or low) to cue subjects to report a particular row (top, middle, or bottom)
• Recall a higher proportion of letters: labelled the ‘partial report superiority effect’
All material captured in parallel, some selected for further, serial processing on the basis of position or colour

How long is long enough to process something?

1/20 of a second was shown letters and asked to repeat as many as possible. Found that generally get between 3-6 letters and say saw all the other letters but they faded away while repeating the ones did remember.

Part report method - straight after the letters shown a tone is sounded. Only have to repeat one row and found people pretty good at this suggesting that have taken on the whole thing but only need to say some so can manage it.

Question 267

What was the backwards masking technique?

Answer 267

• Backwards masking procedure (Evett & Humphreys, 1981; Pecher et al., 2002)
• the mask is presented after the target, usually appearing in the order of 10-50ms after target first appeared
• time between onset of target display and onset of mask is called the stimulus onset asynchrony (SOA)
Experiments using this technique have provided persuasive evidence (e.g., significant priming effects) that meaning can be extracted from material of which participant is unaware
Seemed too simple. Became a more complex system.

Backwards masking - generally where a stimulus is shown and then something immediately replaces it. Can be done now digitally to the point where people don’t know what the initial stimulus was or can do it so fast they don’t even know there was an initial stimulus.

Normally around 40ms after.

There is persuasive evidence that even though people cant necessarily say the initial stimulus, it has subsequently affected their perception of something else.

Question 268

What evidence was found from backwards masking studies?

Answer 268

• Participants say they cannot see masked words but often do better than chance when forced to guess whether or not one had actually been presented (Cheesman et al, 1984)
• Evett & Humphrey (1981) used a perceptual identification task - stimulus sequences containing 2 words, both of which masked (SOA = 40ms) – when second word related to first, it was more likely to be reported accurately
• Pecher et al. (2002)
  
  • perceptual identification study using a potential prime (lion) followed by hard-to-see masked target which was related (tiger) or unrelated (dice)
  • manipulated priming word duration (short vs long) and proportion of related target words (10% vs 90%)

If people say they didn’t see it but then get a 50/50 choice of words they do better than chance.

Experiments where they use words such as lion and the second will be tiger or dice, where it is related people are much better at identifying the words. Cant report the first word but much more able to get the second word if they’ve been primed for it, even though cant recall seeing lion. Both words shown very briefly.

They looked at the priming word duration. Where you have a 1 second prime you can prepare much easier for the second word and see much higher percentages well above chance (50%). People then are good at picking up on what’s going on and see how it works and get a massive priming advantage.

One is called a strategic prime, and one is called a hope for the best prime.

The 40ms is enough to get a small priming advantage.

Some of the time people are taking the semantic value of the words without being able to consciously report it, some of the time.

Question 269

What results were found be Pecher et al?

Answer 269

2002

At 1 sec, benefit of related prime when targets more likely to be related to preceding prime (participants spot connection)

At short duration, priming advantages are far more modest – do not produce large increase in priming effect

Participants presumably unable to guess in brief condition but did produce a small priming effect – must have received sufficient analysis to activate their meaning

Automatic priming effects are caused by spreading activation between nodes at level of representation.

Question 270

What is the test of of RSVP (rapid serial visual presentation) technique?

Answer 270

The sequence of stimuli, shown in the same location on a computer screen, in which the participant has to identify a white letter, then decide whether an X was also present

Number of stimuli occurring rapidly one after the other. Done so guessing wont help.

How spaced to they need to be before they are frequently seen

Typical results, showing the likelihood of detecting the X, when presented in the first and subsequent positions following the white target - the attentional blink

(a) Target 2 is seen more easily when Target 1 is made easier to see by removing the following item
(b) Target 2 is also seen easily when items following it are omitted

Found that if follows straight after people are pretty good, thought that they just put them together as they came so closely.

If have a lag of 2/3/4 then get pretty bad at seeing it. 6/7 later then people have recovered from first letter and start seeing it more frequently again.

Why is the lag of 2/3/4 so bad? Found that in effect after target one, have a bit of a gap then can remove the intentional blink then people are much better. If put at the very end irrespective if straight after or not then people are much better.

Question 271

What was the Giesbrecht and Di Lollo model (1998)?

Answer 271

Two-stage model of visual processing to account for RSVP findings
• Stage 1: a range of info about target characteristics is captured in parallel (identity, size, colour, position)
• Stage 2: serial processes act upon information preparing it for awareness and report
• While Stage 2 is engaged, later info cannot be processed so has to remain at Stage 1
• Disruption to Stage 1 (masking) increases processing difficulty, so info from T2 is kept waiting longer
• If T2 masked by following stimulus, then run risk of overwriting it
• Damaging to episodic information; semantics info may be able to survive (revealed through priming effects, EEG)
Individual differences in RSVP: personality traits important to distinguish blinkers from non-blinkers (Morrison et al., 2016)?

First trying to get target one which you capture, taking in colour and identity of the letter which takes resources. People are good at doing this. However while doing this don’t have control over resource allocation to do something else to onto stage 2. serial processes are needed, preparing it for conscious awareness, and while still doing that you cant really process other information coming later. Disruption to this stage increases the difficulty.

If target 2 is then masked you have lost the change of carrying on doing it. But if its not masked, eg comes at the end, then you can do it. It is the damage to episodic information that is bad. Lose the ability to consciously report on the event, that is what attention is, the ability to take on the semantics of what’s in front of you and being able to report on it.

Question 272

What is the visual awareness and attention model?

Answer 272

• Inability to report detail from brief, masked visual displays is linked to need to assemble various information components
• The visual information is captured in parallel, but assembly is a serial process
• Episodic detail (e.g. colour, position) is vulnerable to the passage of time, or to ‘overwriting’ by a mask
• Semantic information (i.e. identity/meaning) is relatively enduring, but does not reach conscious awareness unless bound to the episodic information(Coltheart, 1980)
• Attention, in this context, is the process of binding the information about an item’s identity to its particular episodic characteristics
• ‘Unbound’ semantic activation can be detected by priming and electrophysiological techniques

Many inputs are unconscious. This comes at a later stage, not the same as consciousness. There is a difference between consciousness and being consciously aware (being able to report).

Blinkers and non-blinkers in the RSVP task. People who are particularly prone to blinkers is more likely to be in people who: lack of sleep, depression and autism - but not anxiety (don’t really know why though).

Question 273

What is subliminal messaging?

Answer 273

• Registration of sensory input without ‘conscious awareness’
• Limen is another word for Threshold - so subliminal means “below the threshold”
• Controversy began in 1957 when hidden messages such as “Eat Popcorn” were placed in films
• James Vicary claimed to have flashed the words “eat popcorn” and “Drink Coca-Cola” on a movie screen for 1/200th of a second, every 5 seconds during the movie Picnic
• He claimed popcorn sales increased 58% and Coke sales 18%
• Vicary’s experiment was never successfully replicated
• He later acknowledged the study was a fraud (Advertising Age ,1962)

Even though cant consciously report something can take some semantic value from the stimulus.

Hard to accept that there are things there that we aren’t aware of but are affecting our actions.

Question 274

What are the types of subliminals?

Answer 274

1. Embedded images: pictures or words that are hidden or flashed quickly (in 100ths of a second)
2. Sub-audible messages: sounds or words that are too faint to be heard, or are played at extremely high frequencies
3. Electronically altered signals: backward masking and other voice alterations

Can messages lead to priming, the activation of various mental constructs unbeknownst to individuals via perception of external stimuli, which not only alters beliefs or perception, but instead reaches the domain of action?

People are very interested in very quick images being flashed up.

Backmasking different to backwards masking. Beatles first to do it. Its where you play something backwards, record that, and then put it in the album.

Question is can this lead to priming?

Question 275

What is public belief in the power of subliminals?

Answer 275

• 75% of Americans believe that subliminal messages are omnipresent in advertising, and that they work (Rogers & Seiler, 1994)
• Why?
  
  • Vicary’s purported movie theater experiment in 1957
  • Wilson Brian Keys claims of planted images in advertising
  • Claims of subliminals in Disney movies and other media
  • Media spoofs: In a Simpson’s episode, Homer receives a subliminal self-help tape which increases vocabulary instead of weight loss. He begins talking like Shakespeare

People do believe in this - they believe they occur and are very powerful despite advertising companies saying they don’t bother etc.

There is a belief that musicians etc are backmasking and putting in messages.

Question 276

What is evidence for the power of subliminals?

Answer 276

• Meta-analysis assessed behavioural impact of and psychological processes associated with presenting words - revealed a small behavioural priming effect which was robust across methodological procedures (Weingarten et al., 2016)

Priming words, put a criteria for where awareness was there the study didn’t count. Controlled studies that may not extend outside the lab, but found some effects.

Betting where on fruit machines had the same 20 spins, for those who they displayed $$$ signs very briefly they tended to bet more.

Question 277

What is the Stroop Effect?

Answer 277

• The effect was first demonstrated by J. R. Stroop (1935), who found that people required an average of 110 seconds to name the ink color of 100 words that were incongruent color names (eg, blue ink used in writing the word red). In contrast, people required an average of only 63 seconds to name the ink color of 100 solid color squares
• Since the original experiment, more than 400 additional studies have examined variations of the Stroop effect (e.g., MacLeod, 1991; Richards et al., 1992)
Older adult find the Stroop task to be even more difficult than do younger adults (Hartley, 1993)

People have to name the ink colour of words as quickly as possible.

• The effect was first demonstrated by J. R. Stroop (1935), who found that people required an average of 110 seconds to name the ink color of 100 words that were incongruent color names (eg, blue ink used in writing the word red). In contrast, people required an average of only 63 seconds to name the ink color of 100 solid color squares
• Since the original experiment, more than 400 additional studies have examined variations of the Stroop effect (e.g., MacLeod, 1991; Richards et al., 1992)
Older adult find the Stroop task to be even more difficult than do younger adults (Hartley, 1993)

Question 278

How do we explain the Stroop Effect?

Answer 278

• Most promising account is provided by a parallel distributed processing approach (e.g., Cohen et al., 1990): Stroop task activates two pathways at the same time. One pathway is activated by the task naming the ink color, and the other pathway is activated by the task of reading the word. Interference occurs when two competing pathways are active at the same time. As a result, task performance suffers.
• Usually find significant effect in reverse Stroop (identify word; ignore colour) although weaker; account for that with parallel processing, but with faster accumulation of evidence for word recognition

Two pathways interfering. There seems to be interference. Slight slowing.

Question 279

What is modified (emotional) Stroop?

Answer 279

• Participants must name the colour of ink of ordinary words, or threat words related to the source of their anxiety
• High levels of anxiety impair goal-directed attentional system (Attentional Control Theory)
• Foa et al. (1991): people with PTSD colour name words related to source of trauma - Slowed more to trauma-related words
- Those who coped better showed less interference

People have started to look at people with clinical conditions, and how their attention doesn’t seem completely normal. This was done with stroop in people with fibromyalgia for example, people with pain do they slow down reading the colour of words which are very relevant to them and their condition. Lose some of ability to direct attention to certain stimuli and becomes stimuli driven rather than self-driven.

Has been seen in PTSD as well, words related to the source of the trauma. Much more interfering effect on the behaviour.

Healthy people seen to tend to avoid negative words and are quicker at naming the colours for these words.

The Amygdala initiates fast (automatic/unconscious?) “affective” responses through efferent pathways to the hypothalamus and other lower brain regions.
The Amygdala also relays info to the frontal lobes where deliberate response processing may be influenced unconsciously ( cognitive bias?)

Question 280

What is the dot-probe task?

Answer 280

Idea of the dot-probe task (or Visual Probe Task; MacLeod et al., 1986) is to measure how strongly your attention is drawn toward and held by specific types of stimuli. Participants’ task is to identify location of dot(s) as quickly as they can.

Focus on fixation point and press up and down of where the stimulus appears. 2 words appear very briefly. Depressed people go to the negative word so quicker when the stimulus is in that direction.

(Distinguishing depression from dementia in later life: a pilot study employing the emotional stroop task.)

Question 281

How is short term memory traditionally measured?

Answer 281

• Memory-span procedures:
• participant presented a sequence of items, required to repeat them back; start with 1 item, increasing number of items by 1 until participant make mistakes
• point at which the participant is able to recall all items correctly 50% of the time is designated as her/his memory span
Reading span task: originally developed by Daneman and Carpenter (1980). Task requires participants to read a series of sentences aloud and recall the final words

Question 282

What are the various views on short term working memory?

Answer 282

• John Locke (1690) explicitly distinguished between temporary workspace for the “idea in view” and more permanent “storehouse of ideas”
• William James (1905) coined the expression “primary memory” as distinct from the storehouse of “secondary memory“
• Atkinson & Shiffrin (1968) referred to short-term memory as combination of storage and control processes
• Craik & Lockhart (1972) emphasised processing rather than structure in memory; nature or level of initial processing determines recall. Thus, memory was seen as a byproduct of cognitive processing rather than as a separate entity.
• working memory as multiple components: Baddeley (1992) refers to a brain system that provides temporary storage and manipulation of the information necessary for such complex cognitive tasks as language comprehension, learning and reasoning

Question 283

What is the ‘Brown-Peterson” paradigm of short term memory (1959)

Answer 283

• participants had to recall trigrams (strings of three letters) at intervals of 3, 6, 9, 12, 15, or 18 seconds after the presentation of the last letter
after oral presentation of each trigram, participants asked to count backward by threes from a three-digit number spoken immediately after the trigram

Question 284

What factors affect memory span?

Answer 284

• auditory presentation leads to larger memory span estimates than visual presentation
• rhythmic presentation is better than non-rhythmic presentation
recoding or chunking information; George Miller showed in his classic paper (1956) that memory span is determined by the number of ‘chunks’ or integrated items you need to recall, not the number of items presented

Question 285

What is the model memory model?

Answer 285

Atkinson and Shiffrin (1968)

1. Short-Term Store
	Information maintained in an active state
	Verbal rehearsal (capacity = 7 ± 2)**
	Phonemic encoding
2. Long-Term Store
	More permanent record of experience
	Semantic encoding
	Cue-dependent
	Information is transferred from STS to LTS**

Goes through organs, once attended to goes into short term store.

Critical aspect of this model is the implication that the short term store is an anti chamber for memory proper. Must go through short term store in order to go into the long term model. Can only get into long term is stays in short term long enough and is rehearsed - this is critical aspect of their model.

Sensory stores decay rapidly. Short term store is forgetting via displacement. Capacity assumed to be very limited but unlimited in long term store and eventually becomes permanent.

Question 286

What is evidence of the short term memory model?

Answer 286

• coding differences in long-term & short-term storage (Baddeley, 1964)
• brain-damaged (amnesic) patients:
1. had severe difficulty in learning new information but could recall information that they had learned prior to their injury
2. short-term buffer appeared to be intact but their long-term storage was grossly impaired (Teuber et al., 1968)
• different components of the serial-position curve in verbal free recall:
1. Immediate vs. Delayed Recall (decreased recency effect)
2. Speeded Lists (decreased primacy effect)
3. Incidental Learning (decreased primacy effect)

Had 3 lines of evidence supporting their models. Long term memory semantic coding.

Neuropsychology of brain damaged patients both ways. One incredibly short memory span (1 word eg) but long term memory still accessible as can remember things before the accident for example.

Others could never get things into long term memory - normal digit span in short term memory while rehearsing, but cant keep it once stop.

Their short-term buffer also appeared to be unimpaired in that they could store sequences of digits and maintain the sequence by verbal rehearsal. However, as soon as rehearsal stopped or was prevented, the sequence was forgotten. Short-term buffer also appeared to be unimpaired in that they could store sequences of digits and maintain the sequence by verbal rehearsal

Question 287

What is recall performance?

Answer 287

Postman and Phillip (1965)

1. Immediate vs. Delayed Recall
   No distractor task after last item à Strong recency effect
   15-s distractor task after last item à No recency effect
2. Final Free Recall
   Recall all words from all lists
   Plot # recalled from each serial position
   “Negative recency” effect

Found in general task with immediate recall people good at first and last few words. First as rehearsed long enough having commanded attention from the start, and last few because recency effect still in short term store haven’t been displaced yet. If delay the recall, give distractive task for 30 seconds, get rid of their recently effect of those in short term store but still got those in the long term memory.

Question 288

What were the three outcomes of free recall performance (Craik 1970)?

Answer 288

1. Overt Rehearsal
   Subjects asked to rehearse out loud
   First few items receive the most rehearsal
2. Incidental Learning
   Subjects unaware of impending memory test
   No primacy effect
3. Speeded Lists
   Less opportunity to rehearse
   Primacy reduced, recency unaffected

Question 289

What are the failures of the modal model?

Answer 289

• under this model, multiple working memory tasks should limit working memory capacity
• not the case; tasks having to do with lexical information do not limit the capacity to perform visualization tasks
• numerous other studies have shown that normal adult subjects can simultaneously carry out two tasks, each of which would apparently place heavy demands on a single flexible working memory system
• several studies have shown that estimates of the difficulty of performing tasks are on their own poor predictors of how readily those tasks can be performed concurrently
• K.F.: Suffered injury to the left parieto-occipital regions and showed severe limitations in verbal STM (digit span of 2)
• but K.F. could get information into LTM and retrieve info. How?
• information had to be presented visually; auditory information was not encoded
• thus, likely there are must be “multiple-components” to WM
• K.F. had an alternative route into long-term memory
(a) that did not involve working memory and/or
(b) there are several working memory subsystems, not all of which are damaged in patients such as K.F.

Too much focus on cognitive structures and not enough on processing information. People get good at certain types of tasks. Impossible with one short term store - either got to capacity or didn’t, cant use different modalities according to this model.

Can have incredibly localised lesions - eg oliver sachs

Seemed that there must be multiple components to the working memory and the model was far too simple.

Second, I shall argue that working memory is better thought of as a system that operates after access to long-term memory has taken place, rather than acting as a means of transport for sensory input to long-term memory. On this view, working memory is seen as a workspace rather than a gateway, and sensory input reaches working memory via long-term memory, not the other way around.

Suffered injury to the left parieto-occipital regions and showed severe limitations in verbal STM (digit span of 2)
K.F. could get information into LTM. How?
Information had to be presented visually Auditory information was not encoded Thus, there must be “multiple-components” to working memory
Despite having a digit span of just two items, K. F.
appeared to have normal long-term learning and retrieval.

Question 290

How can we assess working memory?

Answer 290

Dual-task methodology
Participants perform 2 tasks at once with two assumptions
• if tasks use same component, they cannot be performed successfully together
• if two tasks use different components, it should be possible to perform them as well together as separately
Common results
• visual tasks interfere with visual retention (eg, football/driving)
• verbal tasks interfere with verbal retention (eg, articulatory suppression)
• demanding verbal/visual tasks interfere with reasoning (tap executive function)
Implications:
• multiple short-term memory systems
• articulatory loop vs. visuo-spatial scratchpad (VSSP)

Question 291

About Baddeley’s working memory model

Answer 291

The original model of Baddeley & Hitch was composed of three main components; the central executive which acts as supervisory system and controls the flow of information from and to its slave systems: the phonological loop and the visuo-spatial sketchpad. The phonological loop stores verbal content, whereas the visuo-spatial sketchpad caters to visuo-spatial data. Both the slave systems only function as short-term storage centers. In 2000 Baddeley added a third slave system to his model, the episodic buffer.

Question 292

What is the phonological loop?

Answer 292

• responsible for speech coding
• consists of two components: Phonological store and articulatory control process

Idea that the distinction between speech inputs and non speech inputs. Serial recall of verbal information. Get preferential putting away to short term store. This is about a 2 second store of memory and only way can keep it there is by subvocally rehearsing the information.

Assumed somehow important in language learning particularly developmentally. Sequential information is good - not good for seeing array of objects, just visual or speech input

Question 293

How does the phonological loop work?

Answer 293

• lexical information is coded and stored in the phonological store for about 2 seconds
• the stored information is refreshed by means of sub-vocal rehearsal
• the sub-vocal rehearsal is the articulatory loop
• assumed to have developed on the basis of processes initially evolved for speech perception and production
• suited to retention of sequential information (memory span)

Determined jointly by durability of memory trace and time required to refresh trace by subvocal rehearsal

Question 294

What are the limits of the phonological loop?

Answer 294

• capacity (items): Seven plus or minus 2?
• not necessarily
• Miller’s magic number does seem to hold (even with chunking), however…
• rehearsal rate is the main determinant of capacity
• capacity (time): about 2 seconds

Some people are better at chunking information. Large literature, is it decay or interference that limit ability to short term shore. Rehearsal rates is what keeps it going, quicker can get through the list of words, the better you can recall. If the words all sound the same people don’t tend to recall them as easily as get mixed up and the phonemics are too similar - letters or words. Hard words take time - both to articulate and store.

Preventing people from rehearsing, eg saying ‘the’ over and over again while visually presenting the words. Stops linking as cant rehearse any more and this disrupts the memory of works enormously.

Question 295

What is evidence for the phonological loop?

Answer 295

• the Phonological Similarity Effect (GPVT harder than RHXK)
• the Word-Length Effect (More monosyllabic than polysyllable words remembered)
• Articulatory Suppression (Overt or covert inner speech disrupts lexical memory)
• the Unattended Speech Effect (Lexical-based sounds disrupts lexical based tasks)

Speech inputs preferentially access the store and can disrupt the memory

Question 296

What is the visuospatial sketchpad (VSSP)?

Answer 296

• maintaining and manipulating visuo-spatial information
  
  • spatial orientation
  • solution of visuo-spatial problems
• interface between visual and spatial information (from senses or LTM)
  
  • bind visual information with motor/haptic/tactile information

Memory with spatial component, about remembering something that we visually see.
• Information can enter the sketchpad visually or through the generation of a visual image
• access to this store by visual information is obligatory
• the information in this store may be visual or spatial or both
• Not ideal for serial recall

Question 297

What is evidence for the visual-spatial sketchpad?

Answer 297

• sketchpad disrupted by requiring participants to tap repeatedly a specified pattern of keys or locations, a procedure that impairs the use of visuospatial imagery (Baddeley & Lieberman, 1980)
• unattended patterns or visual noise may disrupt the visual component of the system (Logie, 1986)
• Corsi span (test in which task is to reproduce visuo-spatial sequences using set of 9 identical cubes mounted at locations on board) and auditory digit span impaired independently in patients with different lesions

Found that when people have to remember images of items, if have to follow a specified order they do much worse as disrupts ability to spatially remember sequences.

People who had parietal lobe problems, they tend to be good at auditory digit span but very bad at spatial memory.

Participants were given a visual tracking task: track a moving line with a pointer at the same they were given one of two tasks:

1. To describe the angle of the letter F (which system did this task involve?)
2. To perform a verbal task (which system did this task involve?)
   They performed better in the second task Why?

Question 298

What did Logie (1995) say about the visuo-spatial sketchpad?

Answer 298

• Logie (1995) argues that VSSP can be subdivided:
1. visual cache: stores info about visual form and colour
2. inner scribe: deals with spatial and movement information (and basic mechanism for rehearsal)
• stroke victim LH performed much better on memory tasks involving spatial processing than on tasks involving the visual aspects of imagery (eg, judging animal sizes)

Stroke victims are able to dissociate these two

Question 299

What is the central executive?

Answer 299

• the ‘black box’
• drives the system; allocates the resources
• timesharing in dual task studies
• modality free: can manage information in any sense modality
• has no storage capacity
• limited capacity so cannot attend to many things at once
• temporary activation of long-term memory

Baddeley (1996) assumed four main functions of the central executive:

1. the coordination of simultaneous tasks and task switching
2. the control of encoding and retrieval strategies of temporarily stored information (also when retrieved from the long-term store)
3. the selection of attention and inhibitory processes
4. the retrieval and manipulation of long-term stored information

Model proposed as the governor - source of intentional control. Some temporary work space which is our consciousness that governs everything.

Like prefrontal cortex functioning - problem solving, manipulating. Modality free, not a storage model. But can easily load this part of the system.

Pulling information out of long term memory that might be useful. Selecting what to attend to and what not to be distracted by.

The central executive plays an important role in controlling attention. Our discussion of the central executive will begin with a discussion of the interplay of attention and memory
Takes decisions on how subsystems should be used

Question 300

What was a study done on the central executive?

Answer 300

Baddeley (1996)
• asked participants to think of random digits that bore no connection to each other (by tapping in numbers on a keyboard) Either carried out on its own, or with one of the following tasks:
1. Reciting the alphabet
2. Counting from 1
3. Alternating between letters and numbers e.g. A1 b2 c3
• generated number stream was much less random in condition 3 – Baddeley said they were competing for the same central executive resources

One good way of loading central executive - ask someone to keep producing random numbers and after a while it gets very hard and to not get redundancy which is pairs which keep going together.

Verbally alternating between words and numbers puts more stress on and fail at one of the tasks.

Similarly when load extended memory span start putting pressure of central executive, higher order of brain gets pressure. Redundancy goes up when trying to generate random numbers and trying to do two tasks at once.

Question 301

What is evidence of the central executive?

Answer 301

Randomness of digit generation (greater redundancy means reduced randomness) as function of concurrent digit memory load (Baddeley, 1996)

Question 302

What are the neural structures of working memory?

Answer 302

• executive part of Working Memory involves the prefrontal lobe
• verbal part - such as rehearsing words or numbers silently - involves speech areas of the cortex (especially dominant hemisphere; eg Broca & Wernicke’s areas)
• visual part — such as visual imagery to think about how to walk from one place to another — seems to involve visual regions, including the occipital lobe

But across neuroimaging studies, STM/WM tasks often activate areas of the brain that also are involved in LTM (Jonides et al., 2008)

Pre frontal cortex basis for a lot of executive function. Verbal part really hard - is a functional loop, Brocas and Wernickes.

Some argue that long term memory activated by short term memory.

Question 303

What are the problems with the 3-component model?

Answer 303

• Articulatory suppression
○ saying ‘the’ repetitively (occupying the phonological loop) does not have a devastating effect on recall of visually presented numbers
○ recall drops from 7 to 5 digits
○ one might expect recall to drop dramatically because Phonological loop is occupied and VSSP is not very good at storing this type of information
• patients with grossly impaired short-term phonological memory with auditory span of only one digit can typically recall about 4 digits with visual presentation
• prose recall of a patient (PV) with word-span of 1 word is 5 words. This is less than the span of 15 words, but much more than 1 word
○ are sentences stored in PV’s LTM? Implausible because PV has normal LTM

Question 304

What is the binding problem of working memory?

Answer 304

• Binding problem
  
  • information that is processed independently by separate cognitive processes must be bound together because our experience of the world (and our memory of it) is coherent
  • people can also retrieve information about an episode when given part of an episode (e.g., given a spatial cue, state what object was stored there)
  • episodic buffer is one way in which the binding problem can be solved

Question 305

What are the properties of the episodic buffer?

Answer 305

• Episodic buffer
  
  • integrates info across modalities and from different sources
  • limited storage capacity
  • buffer retrieval through conscious awareness
  • originally thought to be capable of manipulating information; but now thought to be a passive structure on which bindings achieved elsewhere can be displayed

Question 306

What is the episodic buffer of working memory?

Answer 306

• accounts for finding that amnesics can retain relatively large amounts of complex information briefly (e.g., sentence span)
• allows executive processes to carry out further manipulation
• attention useful for maintaining:
○ visual bindings (eg, objects’ colour & shape)
○ verbal bindings (eg,words into chunks)
but binding process itself largely unaffected by attentional load
• although concurrent tasks (including those with executive components) impair overall memory performance, they do not interfere with the binding process itself (for a review see Baddeley, 2012)

Question 307

What are the ongoing controversies of working memory?

Answer 307

Linking long-term and working memory
• limited links with LTM in early multicomponent models
• Ericsson & Kintsch (1995): people utilize previously developed structures in LTM as a means of boosting WM performance
• number of approaches describe working memory as activated LTM (e.g., Cowan’s Embedded Process Model; Cowan, 2005)
• phonological loop likely to depend on phonological/lexical representations within LTM as well as procedurally based language habits for rehearsal
• Baddeley (2012): argues these studies clear example of way in which WM and LTM interact rather than a separate LTM system

Question 308

What are outstanding issues of working memory?

Answer 308

• Episodic buffer: how to measure capacity? What extent is the buffer limited by number of and similarity between chunks? How is rehearsal maintained?
• Baddeley assumes that the buffer provides access to conscious awareness; does this mean that we are not directly aware of the other subsystems?
• are there separate subsystems for smell and taste?
• VSSP: visual and spatial aspects appear to be clearly separable but linked within the sketchpad; is this true of haptic, tactile, and kinesthetic memory?
• to what extent is the phonological loop used for remembering nonverbal material such as music or environmental?

Question 309

About working memory and fluid intelligence…

Answer 309

• Fluid intelligence: “Gf reasoning abilities consist of strategies, heuristics, and automatized systems that must be used in dealing with novel problems, educing relations, and solving inductive, deductive, and conjunctive reasoning tasks” (Horn & Hofer, 1992)
commonly stated that approximately 50% of the true score variance between WM Capacity and Gf is shared
WM training programs; claims of profound beneficial effects on children’s academic and intellectual attainment
WM training produces limited benefits in terms of specific gains on short-term and working memory tasks that are similar to training programs, but advantages for academic-based reading and arithmetic outcomes less clear (Au et al., 2015; Redick et al., 2015)

Question 310

Can we train working memory?

Answer 310

• Performance task on WM task predicts performance on other cognitive tasks
e.g. performance on reading span task correlates well with reading comprehension
Working memory refers to a brain system that provides temporary storage and manipulation of the information necessary for such complex cognitive tasks as language comprehension, learning and reasoning.
(Baddeley, 1992)
Associated with reading (Gathercole & Pickering, 2000) and mathematic (Geary et al., 2004) ability
10-15% of all students have working memory deficits
(Alloway et al., 2009)
Children with poor working memory make poor academic progress
Of 300 children with poor working memory (Gathercole & Alloway, 2008):
83% scored poorly on either reading or maths tests
the vast majority of these scored poorly in both areas

Question 311

What is the definition of personality disorder?

Answer 311

• ICD-10 (WHO, 1992)
  
  • Enduring and deeply ingrained ways of behaving, thinking, feeling and relating
  • Deviate significantly from the norm
  • Sufficient to cause significant personal and social distress and disruption
  • Usually present since adolescence or childhood and persists throughout most of adult life.

Effects every domain of function - really pervasive.

A lot of people have bizarre personality traits but they find their place in society, jobs etc - with PD it must cause some of personal distress of hindrance. If weird but fine then don’t have PD.

Also needs to be clear that the disorder was present at some point during adolescence. Been going on for a while.

Question 312

How do ICD and DSM cluster personality disorders into groups?

Answer 312

Cluster A = odd
Cluster B = difficult
Cluster C = anxious

Might consider cluster first then work back to the specific PDs after that during diagnosis.

Question 313

What are the problems with classification of personality disorder?

Answer 313

• Most patients meet criteria for >1 PD
• Extreme heterogeneity within PD diagnoses
• Arbitrary diagnostic thresholds
• Poor coverage (PD NOS the most common)
• Poor convergent validity
• Longitudinal course more like Axis 1 than previously realised
• Problems communicating about dimensions to other clinicians.

Question 314

What does the DSM 5 say about personality disorder?

Answer 314

• PPDWG Proposal
  
  • Hybrid categorical dimensional model
  • Evaluation of impairments in personality functioning
  • Six specific patterns of traits: borderline; obsessive-compulsive; avoidant; schizotypal; antisocial; narcissistic
  • “PD – Trait specified” if fail to meet criteria for specific PD
• Rejected at last minute by the APA Board of Trustees
  
  • Placed in Section III, “Emerging Measures and Models”
  • Retains DSM-IV diagnostic criteria
  • Single axis system

Tried to think about a combination of a dimensional approach with some categories, but it was rubbish

Question 315

What was the McLean study of adult development?

Answer 315

• McLean Study of Adult Development Zanarini et al. (2006)
• Prospective study of borderline PD
• 70% meet remission criteria at 8 years
• ~6% of remissions experience recurrence within 8 years
• Different symptoms resolve at different rates
○ Impulsivity resolves most quickly, followed by interpersonal, cognitive and then affective symptoms.

This contradicts the idea that it is a diagnosis for life. Behavioural symptoms seem to resolve early on, but emotional issues are more enduring.

Question 316

What is the prevalence of personality disorder?

Answer 316

• Community
  
  • 10-13% (2% antisocial PD) De Girolama and Dotto (2000)
• Primary care
  
  • 10-30% (Cluster C most common) Moran et al. (1999)
• Inpatients
  
  • 36% Pilgrim and Mann (1990)
• Drug and alcohol services
  
  • 78% of alcohol inpatients De Jong et al. (1993)
• Prison
  
  • 60-70% Singleton et al. (1998)

Question 317

What sit eh border of personality disorder?

Answer 317

• Mortality and accidents
• Mental illness
• Poor treatment outcome
• Increased service utilisation
• Antisocial behaviour
• Deliberate self-harm
• Suicide

Outcome of any other disorders is made worse by PD - not go to appointments, into take medications properly, self harm, etc.

Tend to use services more, don’t go to monthly appointments but go to A+E, police etc - use all the services they shouldn’t be

Self harm more common in some forms of PD than others, in particular borderline PD.

Question 318

About personality disorder and violence…

Answer 318

• Personality disorder in high risk populations
• Mean 3.6 in high secure hospital/prison sample.
• Violence in epidemiological samples
• Cluster B: x10 criminal convictions; x8 time in prison.
• Any PD + substance dependence – 52% violent in previous 5 years.
• ~1:2 ASPD not violent in previous 5 years.
• Violent vs. non-violent offenders
• ñASPD in violent offenders (23.6% vs. 14.6%)
• ASPD corr. with violent convictions in violent offenders
• Cohort studies
• Cluster A in adolescence associated with burglary and threatening behaviour.
• Cluster B (excl. ASPD) associated with any violent act, including arson, vandalism, fights, robbery.
• Role of alcohol in mediating relationship.
See Duggan and Howard (2009) in McMurran and Howard (eds.) for review.

Question 319

What specific personality disorders have a link with violence?

Answer 319

• Four dimensions operate as clinical risk factors for violence:
  
  • Impulse control
  • Affect regulation
  • Narcissism
  • Paranoid cognitive personality style
• ASPD and BPD selectively co-occur
  
  • Co-occurrence increases with security level.
• Cluster C PDs may be protective
  
  • Particularly obsessive-compulsive personality disorder

Poor impulse control, regulating emotions, rules are for other people/exploiticism/only few people understand you (narcissism), hypervigilance, thinking people will attack you so you pre-emptively attack etc.

Antisocial and borderline PD tend to co-occur, diagnostic system not very discriminative and people often have more than one kind. Increases risk of being admitted to high security hospitals.

Always look for functional impairment, don’t exclude other types etc.

Question 320

What is the assessment of personality disorder?

Answer 320

• Interview-based measures
  
  • International Personality Disorder Examination (IPDE)
  • Structured Clinical Interview for DSM-IV Axis II Personality Disorder (SCID-II)
• Self-report measures
  
  • Millon Clinical Multiaxial Inventory (MCMI)
  • Minnesota Multiphasic Personality Inventory Personality Disorder Scales (MMPI-PD)

Prompting the accurate answers, eg asking if other people think they are a certain way in which they might say yes, whereas if you asked if they thought they were they would completely disagree as they don’t see it.

Self-report measures important as in time constraints at appointments they can have sent back response before hand so got an idea beforehand. Not as systematic as interviews but still a useful tool.

Question 321

What is borderline PD?

Answer 321

• Frantic efforts to avoid abandonment
• Unstable and intense interpersonal relationships
• Identity disturbance
• Impulsivity
• Affective instability
• Chronic feelings of emptiness
• Difficulty controlling anger
• Transient psychotic or dissociative symptoms
• Recurrent self-harm and/ or suicidal behaviour

Anxiety of abandonment in relationships - can manifest through appointments also, don’t leave on time, don’t come, etc. relationships tend to be quite unstable and intense.

Anger is disproportionate.

If asking about self-harm try and figure out the meaning of it for them, could be a way of managing emotions, could be because they feel chronically empty and want to feel something, may be attempts to manipulate relationships such as the doctor seeing they need to carry on looking after them etc.

Question 322

How do we measure PD outcomes?

Answer 322

• Methodological problems
  
  • Lengthy evaluation period required
  • Treatment rejection
  • Multifaceted; comorbidity
  • Lack of consensus on outcome measures
• Outcome measures
  
  • Symptoms; personality
  • Quality of life; social functioning
  • Behaviour; recidivism
  • Service use

Some people are treatment rejecting - don’t think they’ve got a problem, actively reject, schizo don’t interact with other or seek out treatment.

Lots of different parts to the diagnosis so might get some areas really improving and others seeing no change.

Meta-analyses, only really possible is using the same kinds of outcome and that doesn’t work in PD research, looking at all sort of different outcomes only recently have they begun looking at the same things to get the results

Quality of life, relationships improving, working and jobs, other community integration measures.

Behavioural includes self harm, accidents, reoffending behaviour.

The best studies have looked at one outcome in at least 4 or 5 of these areas. Tricky but manageable and improving.

Question 323

Where is the evidence for PD?

Answer 323

• ‘What works’ literature
  
  • Behaviour focused
  • Ignores PD
• Mental health literature
  
  • Non-offenders
  • Usually borderline PD

What works literature is the prison literature form offending behaviour programmes looking at how effective they are. They are relevant because the vast majority of people engaging in them have PD and the focus is on reducing behavioural issues.

Mental health literature less on prisoners and focusses on general borderline PD.

Question 324

What is the ‘what works’ literature on PD?

Answer 324

• Behaviour focused – ignores PD diagnosis
• ~ 10% reduction in reoffending overall
• Evidence for CBT, relapse prevention and multisystemic therapy
• Evidence for DTCs if stay >18 months and high risk
• Drop outs do very badly
• Low risk offenders do worse in treatment
See Craig et al. (2013) for review

Focussing purely on behavioural.
Most people in prison have PD - exceptionally high prevalence
Underwhelming results - 10% reduction - might expect a lot more.
Therapeutic communities - residential treatment programmes. Daily community meetings, real effort in giving residents responsibility and making them accountable of their behaviour. There are 3 or 4 now which are based in prisons, previously just in general community.
Those who drop out often do worse than those who don’t have any treatment at all, this is why it is important to consider what treatment methods might be best for each individual.
Can be destabilising, if someone is low risk might have less of an impact.

Question 325

What is the mental health literature on PD?

Answer 325

• Non-offenders; usually borderline PD
• Evidence supports the following manualised treatment models:
  
  • Mentalisation-based treatment
  • Transference-focused psychotherapy
  • Schema-focused therapy
  • Dialectical Behaviour therapy
  • Cognitive therapy
  • Cognitive analytic therapy
  • Systems training for predictability and problem solving
• Evidence from cohort studies for therapeutic community treatment

Whole range of model based on a rang elf things

Question 326

What is mentalisation based treatment (MBT) for PD?

Answer 326

MBT - mentalisation based treatment

• Borderline PD (?antisocial PD)
• Enhancing mentalisation will promote emotion regulation and more adaptive cognitive functioning
• RCT MBT vs. treatment as usual (5 year follow-up):
• Suicide attempts (23% vs. 74%)
• Reduced A&E visits, hospitalisation and OPD
• Reduced medication use(0.02 vs. 1.9 using 3+)
• BPD diagnosis (13% vs. 87%)
• Global functioning (45% vs. 10% GAF >60)
• Vocational status (3.2 vs. 1.2 years employed/in education)
Bateman and Fonagy (2009)

Mentalisation is relatively new therapy model based on attachment theory formed by psychodynamic thinking. Try and understand own and other peoples minds through what they’re thinking/feeling/their intentions/what’s going on in their mind.
Evidence that its really effective in BPD, trail in antisocial PD
About trying to get people to identify when they’ve stopped mentalising and need to start improving this.
Outcomes are quite pervasive - reduced suicide attempts, medication use, symptoms, improved function, more likely to be in employment.

Been followed up for 8 years now - works and persists.
Quite often know when not mentalising as something comes unexpectedly from an interaction - haven’t kept and open mind and curiosity about their intent and how they might feel.

Question 327

What are definitions of metallisation?

Answer 327

• The mental process by which an individual implicitly and explicitly interprets the actions of himself and others as meaningful on the basis of intentional mental states such as personal desires, needs feelings, belief, and reasons.
  
  • To see ourselves from the outside and others from the inside
  • Understanding misunderstanding
  • Having mind in mind
  • Introspection for subjective self-construction – know yourself as others know you but also know you subjective self (your experience)

Question 328

What is SFT?

Answer 328

• Borderline PD
• Modifying dysfunctional schema modes will reduce dysfunctional beliefs and maladaptive thinking
• Detached protector; punitive parent; abandoned/abuse child; angry/impulsive child
• RCT SFT vs. TFP: both work, but SFT:
• Reduce BPD severity index
• Improved “general psychopathologic function”
• Improved measures of SFT
• Improved quality of life
Giesen-Bloo et al. (2006)

Schema focussed therapy

Depending on the environment you’re in you develop beliefs
about the world which are protective and adaptive helping you survive that environment

Schema are a set of beliefs that go together

Can develop a protective schema by not trusting people, suspicious of help etc if been abused for example and wouldn’t survive with out this - if continue it in adults life etc it makes it really DIFFICULT for you to survive as it is no longer adaptive. Makes v difficult to regulate emotions, relationships etc

Attempts to get modification of individuals schemas, challenging them and trying to move them into a healthy adult mode.

People really like this because instead of saying have made a mistake or done something wrong, theyre able to valdiate that their early beliefs make sense and without them wouldn’t be around, but to understand that they are no longer valid and adaptive and helpful. This is a non-threatening way to get people to adapt from this.

Question 329

What is DBT?

Answer 329

• Borderline PD
• Development of emotion regulation skills improves affect regulation
• RCT DBT vs. expert treatment – 1 year follow-up
• Half as likely to make suicide attempt
• No difference in non-suicidal self-injurious behaviour (cf. previous trials)
• Reduce A&E attendance and hospitalisation
• Half as likely to drop out of treatment
• Improved outcome not attributable to general factors associated with expert psychotherapy
Linehan et al. (2006)

Based mainly on CBT, but includes zen beliefs, radical things - an eclectic mix of beliefs

Challenging these and understanding skill to manage difficult emotions/impulsivity/”a shit life” - can either decide your life is rubbish and dwell on it, or radically accept that is the case, bad tings happen to people and this is a part of life but you get on with it.

Particularly reduces self-harm attempts, mainly in women, but also other aspects too.

Question 330

What are the common factors of SFT and DBT?

Answer 330

• Structure
• Consistent, transparent model of treatment (+/- contract)
• Treatment alliance
• Establish/maintain collaborative treatment alliance
• Consistency
Adherence to treatment model/contract; containment
• Validation
• Recognition/affirmation of patient’s experience as legitimate
• Motivation
• Build motivation and commitment to change; risk-need-responsivity
• Metacognition
• Promote reflective function; culture of curiosity
• Treatment may make patients worse (?10%)

If people develop a therapeutic model they are very invested in it and want it to go the furthest.

Have been comparisons of models and there’s not much evidence for one being better than others.

The key thing is having structure - communicating to the patient what the model is so they understand it, transparency and consistency - can even have a contract with it with what expect to achieve etc.

Important to have some treatment alliance with the patients, some will really struggle and important that an active part of treatment is a stable relationship underlying it

Consistency, need to stick to it not be ruled of fit by unpredictable patients - often like there being boundaries and nothing shifting

Validation is saying that their experience is understandable in the context of their experience

Motivation for treatment as it can be hard - making sure maintain motivation and engagement, avoid at all costs people dropping out.

Metacognition - peoples minds, how you feel, internal curiosity etc this is very important. Getting the sense that talking about feelings is normal and not weird.

Some treatment can make people worse if the timing is wrong for example, not ready to engage or talk about things, may have mismatched the model, may feel coerced to engage in treatment for their sentence for example, really need to match the treatment to the person depending on how risky they are, to their particular needs and responsivity factors - if delivering treatment with someone with literacy problems need to adapt to that and minimise the issues this may have to their engagement.

Question 331

What is risk-need-responsibility (PD)?

Answer 331

• Risk principle
• Intensity of treatment must match risk level
• Need principle
• Treatment must target needs linked to violence risk (criminogenic needs).
• Responsivity principle
• Treatment delivery must accommodate the patients idiosyncratic characteristics (e.g., cognitive abilities, level of motivation)
Andrews and Bonta (2006)

Another set of principles underpinning effective treatments for PS
Must target something that’s a problem and related to need
May be treatment obstacles for that individual and need to address these

Question 332

What are the treatment delivery methods in PD?

Answer 332

• “What will once a week in the community do? I need inpatient treatment.”
  
  • ‘Step-down’ programme more effective than long-term admission or standard psychiatric care
• “I’m not doing a group. I need individual treatment.”
  
  • Equivalent outcomes in RCT of group and individual interpersonal therapy
• “You need to admit me to hospital.”
  
  • Avoid admission of >72 hours
  • Planned; clear aims; avoid sudden discharge

Intensive period of treatment in beginning building motivation, engagement, trust etc
Then some treatment
Then to avoid dependence and too much attachment, and also encouraging them to form other attachments to others, need to do a step down…

People with relationship difficulties a group is a good place to start then go on to individual treatment.

Individual treatment is NOT the gold standard - all about the individuals needs

There is no evidence that admission to hospital is helpful and a lot of evidence that it could be unhelpful. If they need to go in, the best admission route would be for it to be planned with a plan of what will happen during that time, setting goals and knowing when will be discharged. They know what’s coming and then they can leave etc.

Question 333

What are the NICE guidelines for ASPD?

Answer 333

• Develop an optimistic and trusting relationship
  
  • Emphasise that recovery is attainable
  • Open, engaging, non-judgmental, consistent and reliable
• Cognitive behavioural interventions for children aged ≥ 8 years with conduct problems
  
  • If unable to engage in parent training programme or if additional factors e.g., callous unemotional traits
• Use standardised severity and risk measures
  
  • E.g., PCL-SV, HCR-20
• Group-based cognitive behavioural interventions for those in the community or institutional care with history of offending
• Multi agency care
  
  • Pathways; specific interventions at each point; networks

Question 334

What is drug treatment rationale for PD?

Answer 334

• Subsyndrome or spectrum
• Neurotransmitter
• Lack of resources
Panic

There is no evidence base for drug treatment in PD at all.

People think that its like mini-bipolar so should use mood stabiliser, bit like schizophrenia use antipsychotic etc…. But no evidence at all.

Some patients are drug seeking, responsibility of professional is to give best treatment and drugs is not that as no evidence base.

Find that give someone a drug, doesn’t work, and keep on upping it and nothing works and then they end up on loads of unnecessary drugs and then have to stop them and that’s a challenge and not taken well. Much better to not start them - spend a lot more time stopping treatment rather than starting.

Question 335

What are the guidelines for drug treatment of PD?

Answer 335

do not use drug treatment specifically for BPD/ASPD or individual symptoms associated with them (NICE, 2013)

Question 336

What actually happens with drug treatment of PD?

Answer 336

• Patients frequently on 3+ classes of drug

* Stopping/changing medication is perceived as punishment or lack of care

Question 337

In practice what is done with drug treatment of PD?

Answer 337

• Be explicit – best practice; NICE guidelines; there is nor drug treatment for this disorder.
  
  • Think about context/meaning – both of the request and impulse to prescribe (anger, hopelessness)
  • Short-term use of hypnotic (antihistamine)
  • Short-term use of antipsychotics in problematic paranoia
  • Review and stop

Question 338

What is the future of drug treatment of PD?

Answer 338

• Multiple RCTs underway

* LABILE – placebo-controlled randomised trial of lamotrigine in BPD

Question 339

What are the future directions of PD?

Answer 339

• Integrated modular treatment (Livesley et al., 2015)
  
  • Lack of evidence of clinically significant differences between therapy models
  • Lack of substantial differences between specialised models and well-specified, manualised general psychiatric care
  • However, some therapies are better than others in treating specific domains
• General approach + technical eclecticism - i.e. common factors plus methods from diverse models for specific domains (without adopting their associated theories).

Integrated modular treatment - no evidence that any of the 3 letter treatments are better than others. Also if use common factors to them all (good psychiatric practice) and deliver that and compare it to one of them alone no evidence of it being better. Worrying in some ways but good in others.

Mentalisation treatment has some evidence of being better for some domains of PD for example - specifics for specific domains. Focussing on little domains and using bits of the models in the context of good psychiatric care is the probably the best approach.

Question 340

What is an early model of the visual system and perception?

Answer 340

The principal driving force for this work was the development of the digital computer and concentration on the information processing approach e.g. BROADBAND 1958

Stimulus perception > basic perception > attention > short term memory (> rehearsal) > long term memory

Question 341

What is meant by top down vs bottom up information flow in perception?

Answer 341

• There is a tacit assumption in Broadbent’s model that stimuli arrive in the absence of expectations. This is sometimes called bottom-up processing.
• Bottom up processing - schema driven/conceptually driven affected by expectation and past experience (knowledge, memory, information)
• During the 1970s theorists such as Neisser came to see cognition as being a complex interaction between so-called “top-down” and “bottom-up” processes

Question 342

What is cognition?

Answer 342

• How information is:
- Acquired
- Stored
- Transformed
- Used
- Communicated
Investigation and understanding of mental events, activities, representations

Includes: memory, thinking and reasoning, visual perception and attention, language, disturber cognition, emotion, cognitive abilities, meta-cognition, consciousness and the unconscious

Question 343

What types of cognitive psychology are there?

Answer 343

Eysenck and Keane’s approximate partitioning of current cognitive psychology:
- Experimental cognitive psychology
- Computational cognitive science
- Cognitive neuropsychology
Cognitive neuroscience (eg fMRI, PET, TMS)

Question 344

What is the definition of attention?

Answer 344

William James in 1890:

“Everyone knows what attention is. It is the taking possession of the mind, in clear and vivid form, of one out of what seem several possible objects or trains of thought. Focalisation, concentration, of consciousness are of its essence.”

Question 345

What are the two types of attention we look at?

Answer 345

Focussed attention (aka selective attention) involves attending to one stimulus in the presence of one or more others

Divided attention involves attending to more than one stimulus at the same time

Question 346

What is mean by active and passive attention?

Answer 346

• Attention is active (top-down) when it is directed by the person’s goals or expectations
• Attention is passive (bottom-up) when it is directed by the external environment eg a loud bang

Question 347

What is focussed auditory attention?

Answer 347

• Cocktail party effect
• Orchestral concert can follow just the violin for instance
• Cherry (1953) found that a number of factors were important in the former example: the sex of the speaker (probably mostly the pitch of their voice); speaker location; speaker intensity
• It was very difficult to sue meaning as a way of attending to a single speaker

Question 348

What was Cherry’s 1953 study on attention?

Answer 348

• Cherry also carried out studies in which participants had to repeat what they heard in one of their ears, while another message was played to the other ear
• Cherry found that there was very little processing of higher-level information (eg meaning, language) coming from unattended sources
• Gross changes in physical attributes of the unattended stimulus, like location, type of stimulus (speech vs music), loudness, etc, could be reported. But poor memory of content, what can account for this?

Question 349

What is Broadbent’s filter theory?

Answer 349

• Broadbent (1958) used a dichotic listening task (dichotic = different things presented simultaneously to each ear) in which subjects heard three digits in one ear interleaved with three digits in the other ear
• He found that when subjects recalled the digits, they reported them by ear (the digits from one ear first, eg 496, then 852 from other ear, instead of 489562)
• His filter theory of attention hypothesized that:
- Two stimuli presented simultaneously both access a sensory buffer
- One of the stimuli is allowed through on the basis of physical characteristics (eg location) while the other is kept in the store for later processing
- The filter prevents overloading of subsequent stages (eg meaning)

Question 350

What is the evidence on attention and broadbent’s filter theory?

Answer 350

• Broadbent’s theory suggests a block on the unattended stimulus. In fact, the extent to which the stimulus is blocked depends strongly on the similarity between the two stimuli
• Allport, Antonis and Reynolds (1972) found that if both stimuli are verbal then the degree of processing of the unattended stimulus, as assessed using a memory measure, is low. However, attending to a verbal stimulus does not block memory for simultaneously presented pictures.
• There is other evidence that unattended stimuli can be processed for meaning…

Question 351

What are the problems with Broadbent’s filter theory?

Answer 351

Von Wright, Anderson and Stenman (1975) associated a word with an electric shock. The then presented that word (or something similar in sound or meaning) in an unattended channel. All conditions produced a skin response suggesting that people had accessed the meaning of the unattended stimulus.

Moore and Egeth (1997) asked people to judge which of two lines was the longer. The lines were surrounded by black and white dots which were unattended. When the dots formed a pattern like that in the Mueller-Lyer illusion, subjects claimed not to have noticed the pattern (and couldn’t pick it out of four possibilities), even though it strongly influenced their decision regarding line length.

Broadbent’s filter theory seems to inflexible to account for all the findings even though it can account for Cherry’s original findings.

Question 352

What was Treisman’s breakthrough on attention?

Answer 352

• Similarly, Treisman (1960) found that if a word from the unattended stimulus was a good fit with the attended stimulus, then it would sometimes intrude into subjects; shadoring reports - Breakthrough (reported words are underlined below:
- Left ear (attended): sitting at the mahogany three possibilities.
- Right ear (unattended): let us look at these table with her head.
· Other stimuli that are particularly meaningful, like your own name, are also able to “catch” your attention like this, even though they are in unattended stimuli

Question 353

What was Treisman’s attenuation theory?

Answer 353

Treisman (1964) therefore proposed a more flexible system than Broadbent’s, in which the attentional filter only reduces (attenuates) the processing of the unattended stimulus without blocking it entirely

She proposed that unattended information could be processed in stages, up to a level depending on the current attentional demand and the fit of the unattended stimuli

Treisman also suggested that other stimuli consistent with current expectations have a lower threshold for awareness - this would explain why highly relevant words in an unattended speech stream, or your name, will sometimes break through into awareness.

Question 354

What is late selection theory?

Answer 354

Deutsch and Deutsch (1963) went further and suggested that all stimuli were fully analysed, with only the most important stimulus controling the response.

Evidence supportive of this late selection theory included Mackay (1973) who presented a sentence like ‘they were standing near the bank’ in the attended ear, and either ‘river’ or ‘money’ in the other unattended ear. The unattended work was found to influence the interpretation of the ambiguous word ‘bank’.

But, contrary to late-selection theory, Treisman and Riley (1969) found that when Ss shadowed one of two auditory stimuli, and were told both to stop shadowing and to make a tap when they detected a target word in either stimulus, they detected many more targets in the attended stimulus.

Question 355

What is neurophysiological evidence for attenuation?

Answer 355

Woldorff et al (1993) found stronger event related potentials (EEG) to stimuli presented in the ear to which subjects were attending so as to detect targets.

Rees, Russell, Frith and Driver (1999) found that attended letter strings (in a tast involving letter-strings superimposed over pictures) gave different activity patterns on an fMRI scan depending on whether they formed real words or not. There was no difference between activity patterns in response to words and nonwords when it was the pictures that were attended rather than the letter-strings.

Both are more consistent with earlier selection and cannot be artefacts of memory processes.

Question 356

What is the current view on what we know about attenuation?

Answer 356

• Most of the evidence suggests that there is limited processing of unattended information
• Finding out where attention takes place (early vs late) may not help explain fully why or how attention works
• It could be possible that both early and late selection occurs depending on the task
• A return to Broadbent Lachter et al (2004). Slippage - allocation of attention to irrelevant items, perhaps unintentionally. Rather then Treisman’s leakage account.

Question 357

What is the perceptual load framework?

Answer 357

This is a confusing state of affairs. There seems to be evidence for both early selection and late selection. This is partly due to the fact that some of these studies suggest strongly that unattended stimuli (eg words) can be processed up to and including the level of meaning, without subjected being aware of their presence.

This debate is ongoing, but one useful ‘compromise’ position is represented by the perceptual load framework of Lavie and Tsal (1994).

Question 358

What are the assumptions of the perceptual load framework?

Answer 358

• That attention is limited in capacity
• That the amount of attention applied to any one task is related to its perceptual demands/load
• That one cannot allocate less than the total amount of capacity at any one time.
• That surplus attentional capacity ‘spills over’ onto what wold otherwise be unattended stimuli.

Question 359

What does the perceptual load framework suggest results will look like?

Answer 359

• Early selection when the attended task is perceptually (as opposed to cognitively) demanding
  
  • No surplus attention spills over to ‘unattended’ material
  • Late selection when the attended task isn’t so demanding
  • Surplus attention spills over to ‘unattended’ material

Question 360

What did Lavie do on attenuation (1995)?

Answer 360

• Participants had to response to a letter in one of six positions that was either an x or a z
  
  • There either were (high-load) or were not (low-load) letters in the other five positions
  • A large distractor letter was presented that was either incompatible (eg it was x when z was presented) or neutral (eg a p when z was presented)
  • The distracting effect of the incompatible letter was only evident in the low load condition - this was because some attention had spilled over to the distracting letter.

Question 361

What is selected by selective visual attention?

Answer 361

• A location in space
  
  • A spotlight eg Posner (1980)
  • Multiple spotlights eg Awh and Pashlet (2000)
  • Concentric circles eg Juola, Bowhuis, Cooper and Warner (1991)
  • A zoom lens eg Eriksen and St James (1986) and La Berge
  • An object
  • An object and a location
  • More likely that attention is object based, but can be location based when needed

Question 362

What is divided attention?

Answer 362

• The debate about location vs object based attention tells us something about the way that attention operates but does not tell s about how resources are allocated. What is its capacity?
• Dual task performance. What happens when we try to do more than one thing at the same time - multitasking. As you might have guessed it depends on what the tasks are. Let’s look at some of the factors that affect this ability.
• Similarity: Wickens (1984) concluded a review of the available evidence by suggesting that two tasks interfere with each other to the extent that…
- They share the same modality (visual, auditory, etc)
- They make use of the same stages of processing (eg input, output)
- They rely on related memory codes
• For instance, Brooks (1968) gave subjects two tasks: one was a visual task, tracing round the shape of a block letter, indicating at each corner whether it was at the top/bottom or not; or a verbal task, going through a learned phrase word-by-word saying whether each was a noun or not.
• The response was either verbal (saying ‘yes’ ‘no’) or visual (pointing to a Y or a N). Verbal responding was difficult with the verbal task and easier with the spatial task; whereas pointing responding was more difficult with the spatial task than with the verbal task.

Question 363

What did Brooks do in 1968 on divided attention?

Answer 363

For instance, Brooks (1968) gave subjects two tasks: one was a visual task, tracing round the shape of a block letter, indicating at each corner whether it was at the top/bottom or not; or a verbal task, going through a learned phrase word-by-word saying whether each was a noun or not.

The response was either verbal (saying ‘yes’ ‘no’) or visual (pointing to a Y or a N). Verbal responding was difficult with the verbal task and easier with the spatial task; whereas pointing responding was more difficult with the spatial task than with the verbal task.

Results:

- Verbal responding was difficult with the verbal task and easier with the spatial task
- Pointing responding was more difficult with the spatial task than with the verbal task

Question 364

How was the relationship between video gaming and spatial attention tested?

Answer 364

Green and Bavelier (2003)

- Flanker test
- Participants asked to decide whether a square or a diamond appeared within one of the six rings (target task), while ignoring a distractor shape presented outside the rings
- Left over spatial attention can spill over on to the distractor
- Video game players show increased visual spatial attentional capacity
- Also higher number of subitized items for video game players

Question 365

What are the cognitive benefits of video gaming on attention?

Answer 365

Meta-analysis by Uttal et al. (2013) showed improvements:

- In spatial skills
- Can be trained with video games in a relatively short period of times
- Training benefits last long term
- Benefits transfer to other spatial tasks outside of the video game context

Question 366

What are practical applications of research on attention?

Answer 366

• Videogaming has been shown to improve spatial attention (Green and Bavelier 2006 and 2007) through the practicing of processing multiple items simultaneously
• Could it help medical students
• Schlickum et a (2009) found that medical students that played 3D 1st person (Halflife) shooting games vs 2D (chessmaster) and no gaming performed (control).
• Results showed that the group who player 3D video game performed better (pre to post) in two virtual reality endoscopic surgical simulators (MIST-VR and GI Mentor II). 2D group only showed improvement in one test. No differences found for control group.

Question 367

How was it tested whether brain training games work?

Answer 367

Owen et al (2010)

• 6 week study using the BBC website
• All participants tested pre and post training
• N = 11,430
• 3 groups
- Experimental 1, 2 and control
- 2 experimental groups given 6 different brain training games
- Several times a week Ps did computer based cognitive tasks designed to improve reasoning, memory, planning, visuospatial skills and attention
- Control no brain training tasks, just answered questions
• All experimental groups did better on all the trained tasks after the 6 weeks training
• However, no improvement on general cognitive functioning of reasoning, verbal short-term memory, spatial working memory, and paired-associates learning
• Therefore, no evidence was found for transfer effects to untrained tasks, even when those tasks were cognitively closely related

Conclusions:
• Increase in performance on the task that has received training in comparison to control group
• No evidence of changes to general cognitive function
• Therefore no transfer effects
• However, there could be benefits to multitasking for older adults eg over 60+, as shown by Anguera et al. (2013) with their ‘NeuroRacer’ game

Question 368

What did Spelke, Hirst and Neisser (1976) find about divided attention?

Answer 368

Provided experimental support for it being easier to do two things at once is one if highly practiced (e.g. driving and talking)

They gave two subjects considerable practice (five hours a week over four months) in reading for comprehension while writing dictated words at the same time

Initially they found this very difficult. After six weeks of practice, however, they could read just as well when writing to dictation as they could when not (though we should be a bit cautious in our interpretation)

Question 369

What is automacity?

Answer 369

What can influence how two tasks are performed is whether one of those tasks has become automatised. Some tasks are so well practiced that they are said to be automatic. Criteria typically include that these processes:

- Are fast
- Operate without occupying other resources
- Operate in the absence of awareness
- Operate in the absence of intention

One example is the very well known Stroop effect…

Question 370

What is Logan’s 1988 instance theory?

Answer 370

Logan (1988) suggested that automaticity was essentially a memory phenomenon. Suppose you’re given some alphabet arithmetic such as A+2=C etc, try it.

B+3=?
H+4=?
K+1=?
R+2=?
B+3=?

Notice that there’s two ways of doing the last one.

Logan suggested that automaticity consisted of a build up of memorised ‘instances’ of previously solved problems, which could be used later as a direct ‘look up’ process rather than going through the sequence of steps that are needed the first time.

Logan also showed how the more times you’d seen a particular problem, the faster you’d be to answer correctly.

* Logan's theory explains why automatic knowledge is fast and accurate but not good if you want to generalise
* Put simply, seeing several times that
* B+3-E
* Does not help deal with
* F+4=?
* It turns out that as long as the memory that you stored has at least the information that you require at test, then automaticity will be seen - you can, however, encode more information than is needed.

Question 371

What is the physiology of the eye?

Answer 371

• Light enters the eye via the cornea
• If then passes through the pupil (a hole in the centre of the iris)
- When light is bright the iris causes the pupil to constrict to limit the amount of light entering the eye
• It then passes through the interior lens
• It’s then focussed on the retina (a network of neurones/cells)
• Layers of cells in the retina - ganglion, amacrine, bipolar, horizontal and photoreceptors
• Photoreceptors turn light into neural impulses to send to the brain. Two types:
- RODS (dim light vision, motion)
- CONES (bright light and colour vision)

Question 372

About perception and the brain…

Answer 372

• Sensation is not the same as perception
• Retina
• Rods and cones
• Optic disk (blind spot)
• Optic chiasma (right field of each eye to right hemisphere and left field of each eye to left hemisphere)
• Lateral geniculate nucleus (LGN)
- Carries different information in the magnocellular and parvocellular layers from rods and cones

We have a blind spot because of the entry point of the optic nerve.

• Visual cortex, V1 (striate cortex) then V2, V3, V4, MT
• The visual system separates the visual features (form, motion, colour etc) of the visual scene but combines them to form a coherent
• Ventral - what pathway
• Dorsal - where pathway - specialised for object recognition or thought of by ohters (Milner and Goodale, 1995 as the how pathway - for visually guided action)

Question 373

What is the Gestalt approach to perception?

Answer 373

• Assumes that the simplest and most stable interpretations of visual stimulus are favoured (Principle of Pragnanz)
• Gestaltists looked at the configuration of visual scenes. Favour hollistics processing (whole is greater than sum of its parts). It is the relations between parts, and their arrangement that determines perception. Eg spatial rules - bottom up
• Proposed principles that govern how the perceptual input is organised into chunks to provide the ‘best guess’ as to what it is that we are looking at. The perceptual system is considered to have ‘preferences’ for interpreting certain arrangements.

Question 374

What is form perception?

Answer 374

• Principles of form perception
• Principles are innate so we can’t choose how we see things
• The figure-ground concept - some things stand out (figure)and others fade into background (ground)
• Figure has distinct from and the ground doesn’t
• Figure seen as being in front of the ground

Question 375

What are some principles of visual perception?

Answer 375

• principle of proximity
• principle of similarity
• principle of good continuity (smoothness)
• principle of closure

Question 376

What is a summary of Gestalt’s theory of visual perception?

Answer 376

1. Proximity - objects close together are perceived as forming a group
2. Similarity - group ojects on the basis of similarity
3. Continuity - perceive smoothly flowing forms rather than disrupted ones
4. Closure - complete objects that are not complete
   • BUT - the theory is purely descriptive
   • How does this phenomenon occur?
   • These principles can be demonstrated very well with 2D designs - but how applicable are they to the real world?

Question 377

What did Bruner say about visual perception?

Answer 377

Bruner (1957) “all perceptual experience is necessarily the end product of a categorisation process”

Question 378

What happens to form out visual experience?

Answer 378

the detection of sense ‘information’&raquo_space;> formation of perceptual representation&raquo_space;> interpretation of the perceptual representation

Question 379

What is perception?

Answer 379

• We experience the world through our sense which receive information from the environment
• Sensory receptors stimulated by physical energy (eg for vision the energy is light reflected off object)
• The sense organs receive these sensory inputs and transmit sensory info to the brain
• How is the physical energy received by the sense organs converted into perceptions?

Question 380

What is constructivist perception?

Answer 380

Constructivist perception - top-down processing

- Helmholtz (1909); Rock (1983); Gregory (1997)
- We construct the perceived stimulus using sensory info as the base but it's our thinking processes that make sense of the info ie we need prior experience to interpret the input

Question 381

What is direct perception?

Answer 381

Direct perception - bottom-up processing

- Gibson - ecological (1979) and Marr - computational (1982)
- The info received by our sensory receptors is all we need in order to perceive (don't need prior knowledge to mediate between sensory input and perception)
- We are bon with all we need to make sense of what we see

Question 382

What are assumptions of constructivist theories?

Answer 382

• Bruner, 1957; Neisser, 1967; and Gregory, 1972, 1980 tend to make the following assumptions:
• Perception is an active and constructive process; ‘something more than the direct registration of sensations…other events intervene between stimulation and experience’. (Gordon, 1989)
• The visual image is ambiguous and needs interpretation
• Perception is not directly given by the stimulus input, but occurs as the end-product of the interactive influences of the presented stimulus and internal hypotheses, expectations and knowledge, as well as motivational and emotional factors (top-down).
• Perception is an active and constructive process; ‘something more than the direct registration of sensations… other events intervene between stimulation and experience (Gordon, 1989)
• Perception is not directly given by the stimulus input, but occurs as the end-product of the interactive influences of the presented stimulus and internal hypotheses, expectations and knowledge, as well as motivational and emotional factors
• Perception is influenced by expectations that are sometimes incorrect, and so it is prone to error. Hence visual illusions.
• Perception is influenced by hypotheses and expectations that are sometimes incorrect, and so it is prone to error
• When information from memory is being used to guide expectations about the information that is being received from the environment, this is referred to as top-down processing
• Gregory talks of ‘perceptual hypotheses’ being generated

Question 383

What is direct perception?

Answer 383

• Sensations received by the visual system are highly organised and rich in information that we do not need to interpret them to make them meaningful perceptions
• We can perceive them directly
• This means that there are no intermediate stages between light reaching the retina and our response to it
• No need to make use of internal hypotheses or thought processes - perception is automatic. Because of the emphasis on environmental stimuli, Gibson’s theory is also ecological perception
• Characterised best by Gibson’s (1979) ecological approach
• A ‘pattern of light’ reaching the eye is an optic array; this structured light contains all the visual information from the environment striking the eye
• This optic array contains unambiguous information about the layout of objects in space, in the form of texture gradients, optic flow patterns etc
• Perception involves ‘picking up’ the rick information provided by the optic array directly via ‘resonance’, with little or no information processing
• For instance, when thinking of a pilot approaching a landing strip, there is a point in their visual field that appears to remain stationary, with all other points flowing away from it. This gives direct information regarding the point towards which the pilot is currently heading, without any model or internal representation of the environment
• What about meaning? Gibson introduced the notion of direct perception of the affordances of an object, eg a chair “affords” sitting on
• This has proved a useful idea in the context of object design, but is very incomplete as a theory of meaning in general. The idea of ‘resonance’ is also rather difficult to pin down.

Question 384

What are the successes of Gibson’s perspective?

Answer 384

• More about ‘seeing’ rather than ‘seeing as’
• A proper acknowledgement of the environmental and ecological grounding of perception. What is perception for, if not to allow interaction with the environment?
• The transparency of some illusions with regard to action
• A highlighting of the richness of information present in the visual signal
• An anticipation of theories relating to the so-called ‘dorsal stream’ of brain processing

Question 385

What are the weaknesses of Gibson’s approach?

Answer 385

• By not specifying exactly what constitutes resonance and invariance detection, Gibson avoids the exact problem that information processing accounts sought to address. He underestimates the amount of processing that must be performed even to detect the invariances that he proposes
• The denial of the role of stored knowledge (memories) in perception is highly questionable eg seeing that a tree has been cut down
• Even the topics Gibson discusses (eg motion towards) are more complex than he assumes

Question 386

What did Palmer show about visual perception?

Answer 386

Palmer (1975) showed that a preceding picture of a kitchen would facilitate the recognition of a rapidly presented appropriate object(eg a loaf) but would actually slow identification of an inappropriate object (eg a mailbox), both relative to a no-context condition

Question 387

What are the context effects in object recognition?

Answer 387

• One of the ways in which to look at the interaction of bottom-up and top-down processing is to consider the effects of context
• Experimental data support an influence of context on perception
• Palmer (1975)
• Ps viewed a scene for 2 seconds. After 1.3 seconds delay they were shown a picture of an object for either 20, 40, 60 or 120ms. Their task was to name the object. (line drawings)
• There were 4 types of relationships between the scene and the object:

Question 388

What did Palmer find in 1975?

Answer 388

1. Related context - eg a kitchen followed by a picture of bread
2. Misleading context - eg a kitchen followed by a picture of a mailbox (same shape as bread)
3. Unrelated context - eg a kitchen followed by a picture of a muscal instrument
4. No context (baseline performance measure)

• Measure (DV) was probability of item being correctly identified
• Performance improved with increased viewing exposure (more bottom-up information)
• Performance was best for related condition - better than no context but performance on misleading and unrelated was worse than no context at all (effect on top down processing)

Question 389

Is visual perception top down or bottom up?

Answer 389

• Top-down or bottom-up
• Most visual experience probably involves combination of bottom-up and top-down processing Neisser (1976)
• Broadbent (1977) and Navon (1981)
• Bottom-up sensory data ‘suggests’ whilst top down information ‘inquires’ or ‘interrogates’ the perceptual representation - guides the final visual experience by selecting that which matches experience/expectations/beliefs
• Under good visual condition bottom-up processing is more prevalent
• Under poor visual conditions, brief exposure top-down processing become more important

Question 390

How has constructivist approach sought to explain visual illusions?

Answer 390

For example, Gregory’s explanation of the Mueller-Lyer illusion: that the figure on the left looks like the inside corner of the room with the corner therefore far away; that the figure on the right looks like an outside corner, with the corner near. If they look the same size but they are at different distances from the observer then the left one must really be longer than the right one (misapplied size constancy).

Question 391

What is the Ebbinghaus illusion?

Answer 391

Note: Gregory’s explanation is far from unchallenged. Nevertheless it is a good example of constructivist thinking

Note also: that many perceptual illusions fail to affect actions.

For example, in a three dimensional version of the Ebbinghaus illusion, hand grip aperture was the same for picking up the central object in each case, even thought the objects are perceived as being different sizes

Question 392

What are some problems with the constructivist approach?

Answer 392

• Illusions are the exception rather than the rule
• Many experimental stimuli are unnatural eg odd designs, brief presentations
• Many illusions remain unaccounted for

Question 393

About illusions…

Answer 393

• Gregory (1972) - visual information derived form the retinal image is ambiguous
• When perceptual cues conflict, the visual system has to chose the best option based on retinal size, distance cues and expectations
• It formulates a perceptual hypothesis which in the case of illusions is incorrect
• Illusions may be able to help us understand visual perception
• How does the bottom-up approach deal with visual illusions?
• There is no single definitive theory of illusions but they remind us of the different factors which can enter into visual perception eg physiology, depth cues and expectations

Question 394

What is perceptual constancy?

Answer 394

Even though the retinal image for objects may be different, we still perceive the object in a certain way. There is constancy in what we see even though the retinal image is different, due to different viewpoints or distance. Perceive round table, but retinal image is elliptical.

Perceptual Constancy or Invariance refers to the phenomenon whereby our perception of an object does not change even though the sensory information/image has changed - recall the distinction between perception and sensory experience.

- Size
- Colour
- Shape

Question 395

What is size constancy (visual perception)?

Answer 395

• We show size constancy because we take account of the distance when judging the object’s size
• Retinal image changes with movement and distance but the size we perceive does not change
• Imagine someone walking towards you. We perceive them getting closer but we do not perceive someone growing in size
• The retinal image of an object varies with distance of the object from the retina
• Hold finger quite close to eyes then move away to arm’s length - your perception is NOT that is becomes smaller
• When our perception of an object remains the same but our sensation of the object changes
- Eg as you walk towards a person they become larger but you know they’re really the same size - why?
1. We know this from experience which affects our interpretation of the person - ie top-down processing
2. The retinal image and the perceived distance cancel each other out
• Therefore no size constancy when perceived distance of an object is very different form its actual distance
- Eg the Ames room - perceive impossible relative sizes but this is because the shape of the room is distorted

Question 396

What is colour constancy (visual perception)?

Answer 396

• Colour is a psychological construction
• Hugh, brightness, saturation
• Knowledge of the object’s colour
• Lighting
• Reflective nature of the object
• Surrounding colours
• Shadows

Question 397

About depth in visual perception…

Answer 397

To know where objects are we need to be able to:

- Segregate objects from each other and from background
- Determine distance (depth), and movement. This is done through depth cues

Question 398

What are depth cues in visual perception?

Answer 398

Monocular (one eye)

- Perspective, things converge in distnace
- Texture, gets finer as things get further away
- Occluding edges
- Motion parallax

Binocular (two eyes)

- Stereopsis
- Retinal disparity
- Binocular convergence

Question 399

About monocular cues (visual perception)…

Answer 399

Relative and familiar size
- In a visual scene of different sized objects, smaller ones are usually seen as more distant but we can be fooled

A number of illusions are based on the relationship between size and depth - eg Ponzi illusion

Question 400

About occlusion and shadows in visual perception…

Answer 400

Near objects will occlude more distant objects. If you cant see all of one object because of another, it is due to the fully visible object being nearer to you than the occluded object.

Other monocular clues to depth such as shadows and shading.

Question 401

About texture in visual perception…

Answer 401

Another invariant is the texture gradient. The appearance of the surface of objects will change with distance (think about how grass looks close to you and distant from you). As we assume that the texture itself hasn’t changed we take the change in appearance to indicate distance (roads, grass, etc).

Question 402

What are other monocular cues to depth in visual perception?

Answer 402

• Relative size
- In a visual scene of different sized objects, smaller ones are usually seen as more distant
• Relative brightness
- Brighter objects normally appear closer
• Aerial perspective
- Objects at a greater distance have a different colour (light filtered from atmosphere) blue tint
• Height in the horizontal place
- Distant objects seem higher (closer to the horizon)

Question 403

What is the motion parallax?

Answer 403

Motion parallax
• Motion also provides important information about the position of items in the world
• Motion parallax describes the phenomenon whereby if the observer is moving - nearby items will appear to move faster than items in the distance (think of looking out of a window of a train or bus)
• Also - more distant objects will appear to ‘move’ more slowly

Question 404

About binocular cues…

Answer 404

• Stereopsis refers to the way that we are able to perceive distance as a result of having two eyes, each in a different position
• The difference in position means that they receive a slightly different image (retinal disparity).

Question 405

What is multisensory integration?

Answer 405

• At many times the perceptual system has to deal with integrating and potentially competing sensory information across modalities
• What you hear depends on whether your eyes are opened or closed
• Multisensory integration raises the question of how unisensory and multisensory cognitive systems and brain regions operate.

Question 406

What is the McGurk effect?

Answer 406

The McGurk effect is a perceptual phenomenon that demonstrates an interaction between hearing and vision in speech perception. The illusion occurs when the auditory component of one sound is paired with the visual component of another sound, leading to the perception of a third sound.[1] The visual information a person gets from seeing a person speak changes the way they hear the sound.[2][3] If a person is getting poor quality auditory information but good quality visual information, they may be more likely to experience the McGurk effect.[4] Integration abilities for audio and visual information may also influence whether a person will experience the effect. People who are better at sensory integration have been shown to be more susceptible to the effect.[2] Many people are affected differently by the McGurk effect based on many factors, including brain damage and other disorders.

Question 407

What is Marr’s levels of representation?

Answer 407

• The grey-level description: gives the intensity of light at each point in the image (cf the retina)
• The raw primal sketch: a description of the main changes in light intensity in the image, generated by ‘smoothing’ the intensity changes in the input. This shows edges, blobs, textures etc…
• The full primal sketch: indicated which aspects of the raw sketch ‘go together’ to form larger structures in the image eg the outline shapes of objects (cf Gestalt)
• The 2 1/2 -D sketch: this adds information about depth and orientation of visible surfaces, by using texture, motion, etc. This details how surfaces and edges in the scene relate to each other

(This and all previous stages are represented from the viewpoint of the observer - they are ‘view depended’. This is an important point.)

• 3-D model: takes the 2 1/2 -D surfaces etc. and groups them into viewpoint-independent descriptions of basic perceptual elements.
• Marr and Nishihara (1978) suggested using cylinders as basic elements in these descriptions, where each cylinder’s major axis is appropriately aligned.

Question 408

What is Biederman’s recognition-by-components model?

Answer 408

• Biederman’s (1987, 1990) model is a development of Marr and Nishihara’s (1978) theory
• Biederman proposed a more general set of basic elements of ‘primitives’ which he called ‘geons’ (from geometric ions). He proposed about 36 geons including wedges, blocks, cylinders and spheres
• Images are broken down into geon components. The breaks tend to be made at sharply concave parts of something like the 2 1/2-D sketc

Question 409

What are Biederman’s non-accidental properties?

Answer 409

• Points in a straight line in sketch strongly suggest that those points on object also lie in a straight line
• Points or segments in a curve strongly imply a curve on the object
• Symmetrical parts of the sketch are highly likely to be symmetrical parts of the 3D object
• Parallel parts of the sketch strongly imply that the corresponding parts of the object are parallel
• Two lines in the sketch ending at the same point strongly suggests two edges of the object ending at the corresponding point.
• These five properties of parts of a sketch can be used to determine which geons can be used to determine which geons can be found where, the geons being invariant across all non-accidental viewpoints
• These properties are also detectable when only parts of given edges are visible
• Providing joining (particularly concavities) are visible, then missing parts of an image can be reconstructed.

Question 410

What are the structural relationships found by Biederman?

Answer 410

Once the geons have been determined, Biederman specifies a number of structural relationships between them. Some major relationships are:

- Relative size
- Verticality: above, below, to the side of
- Centering
- Relative surface size at join

Question 411

What is experimental evidence done by Biederman?

Answer 411

Biederman, Ju and Clapper (1985) showed that participants could recognise rapidly presented complex objects even when more than half of their features were missing.

Biederman (1987) showed that it was much easier to identify degraded drawing that still showed the concave parts, supporting his view that these are important points of reference.

Biederman and Ju (1988) also found that line drawings were just as effective cues to recognition as were full colour photographs, though Sancki, Bowyer, Heath and Sarkar (1998) showed that this was only the case when ‘idealised’ line drawings were used ie those with only and all the relevant edges

Bogels, Biederman, Bar and Lorincz (2001) also found some neurons in inferior temporal cortex that seemed sensitive to the presence of particular geons, but insensitive to changes in size.

Question 412

What is some criticisms of Biederman’s models?

Answer 412

• It is really dedicated towards the recognition of different classes of object (eg cup vs bicycle) rather than the discrimination of objects within a class (eg my cup vs your cup)
• It does not account for contextual effects (the example given earlier with the letter H in EAT and THE), though this might be incorporated at a fairly late stage of processing
• It clearly favours a viewpoint-invariant (independent) description as the target for perceptual analysis. However…

Question 413

What is viewpoint-specific representation?

Answer 413

Tarr and colleagues (eg Gauthier and Tarr, 2002; Tarr, 1995; Tarr and Bülthoff, 1995) have found some evidence that object recognition depends on storing a number of specific views of an object, with recognition time for a given viewpoint depending on the distance between that new viewpoint and the closest learned viewpoint (E&K, p.88)

It may well be that both viewpoint-invariant and view specific representations exist, with the former being used for broad class distinctions and the latter being used for fine within-category distinctions.

Question 414

What is viewpoint dependence?

Answer 414

• An interesting contribution has been made by Vanrie et al. (2002) who suggested that viewpoint dependency will also be likely to be seen when dorsal-stream processing (processing for action) is involved
• This issue has led to a fierce argument in recent years between the Biederman and Tarr camps

Question 415

About face recognition

Answer 415

• Faces plat a special role in the field of object recognition, and as such there is a good deal of work dedicated to a description of the human face processing system
• A lot of work (some reviewed below) suggests that faces are processed somewhat separately form other objects, reflecting the great importance they have for members of a social species like ours
• These is also evidence that different aspects of the face eg expression and identify, are processed separately. E & K chapter 3 review some relevant literature and point to further reading.

Question 416

How are faces processed?

Answer 416

Congfigurally (ie as a whole) or elementally (as a series of parts)? Most evidence suggests the former:

Young, Hellawell and Hay (1987) - identification of halves of split-faces better if the two halves are not aligned.

Question 417

What did Tanaka and Farah do to investigate facial recognition (1993)?

Answer 417

Tanaka and Farah (1993) taught people the names of some normal faces and some scrambled faces (with features moved around)

When an intact face had been learned, the choice of the correct whole face was better than the choice of the correct part. When a scrambled face had been learned, the choice of the correct part was actually better than the choice of the correct scrambled face. For the scrambled face, it is learnt as a series of parts and therefore part identification is better.

Question 418

What are invention effects on facial recognition?

Answer 418

• There is evidence, however, that configural processing is only use for faces that are presented the right way up:
• Bartlett and Searcy (1993; and S & B, 1996) - grotesque expression unaffected by inversion, but distortions induced by feature movement are less noticeable when the face is inverted.
• Thompson (1980) - the Thatcher Illusion

Holistic processing is used more with faces than other objects. That is why it is harder to identify faces that have been inverted.

Question 419

Are inversion effects only found with faces?

Answer 419

• No. Diamond and Carey (1986) found that expert dog breeders were disproportionately affected by inversion of pictures in dogs in a dog-recognition task.
• This suggests that configural (and viewpoint dependent) processing is used in making fine-grained within-category distinctions of several different types. This is consistent with the observations of Tarr and colleagues (see earlier).
• Other data suggest that faces are not processed as viewpoint-invariant structural encodings.

Question 420

How are faces stored?

Answer 420

• Faces are stored as images rather than structural descriptions
• Photographic negative images of faces are very hard to identify (Bruce and Langton, 1994)
• Line drawings with no shading are also difficult to identify, (Bruce et al., 1992; Davis et al. 1978), though as soon as basic threshold shading is added, the image becomes much more recognisable. The same pattern is not found for other objects.
• Remember that in Marr/Biederman-type models, texture and shading plays little role in object identification. These results suggest that faces are processed in a more image-like manner.

Question 421

What is the fusiform ‘face’ area?

Answer 421

• Kanwisher and Yovel (2006) reviewed evidence (eg from fMRI scans) showing that intact faces were processed in a particular different brain area, consequently called the ‘fusiform face area’ (FFA)
• There are other areas of the brain associated with face processing eg the occipital face area
• However, Grill-Spector et al. (2006) also found variation in the FFA, with some parts sensitive to animals, cars and sculptures.

Question 422

Is FFA sensitive to expert categories?

Answer 422

• But: gunther et al (1999) have found that fusiform ‘face’ area activates when participants are trained for several hours on recognition of members of a fine-grained category (eg Greebles).
• Gauthier et al (2000) found that FFA activated more to cars for car experts than bird experts, and vice versa for birds (though it’s possible that they paid differential attention).
• McKone et al (2007) reviewed various studies but didn’t properly support the expertise hypothesis (see E&K, p.106, for details)

Question 423

Generally about face recognition…

Answer 423

• But: gunther et al (1999) have found that fusiform ‘face’ area activates when participants are trained for several hours on recognition of members of a fine-grained category (eg Greebles).
• Gauthier et al (2000) found that FFA activated more to cars for car experts than bird experts, and vice versa for birds (though it’s possible that they paid differential attention).
• McKone et al (2007) reviewed various studies but didn’t properly support the expertise hypothesis (see E&K, p.106, for details)

Question 424

Generally about object recognition…

Answer 424

• Most models of object recognition are of the constructivist type (eg Marr, Biederman)
• Recognition proceeds via a series of hierarchically arranged stages, form grey-level description to viewpoint-specific image based representation
• This might be important of expert discrimination within fine-grained categories, and for recognition-for-action (Gibson)
• Faces appear to constitute such a fine-grained category
• Faces are unlikely to be accessed as structural descriptions
• Nonetheless, this image-based style of processing is unlikely to be restricted to faces alone
• Face processing may involve the fusiform face area (FFA)

Question 425

What is neglect?

Answer 425

• Neglect: “A failure to report, respond, or orient to novel or meaningful stimuli presented to the side opposite a brain lesion, when this failure cannot be attributed to either sensory or motor defects (Heilman, 1979).
• Also referred to as hemi-neglect, visual neglect, visuo-spatial neglect and unilateral neglect.
• EXTREMELY heterogeneous condition!

Question 426

What are different types of neglect?

Answer 426

• The neglect literature is littered with different subtypes:
• Sensory
• Motor
• Spatial
• Personal
• Representational
• Neglect dyslexia
• Neglect dysgraphia
• Facial neglect
• Auditory neglect
• Tactile neglect
• Personal
• Extrapersonal

Question 427

What are everyday examples of neglect?

Answer 427

• Patients behave as though one half of the world does not exist (they aren’t aware of the missing half).
• In everyday life patients with neglect may fail to:
  
  • draw portions of a picture
  • shave / apply make-up to only half their face
  • dress only one side of their body
  • eat food on only one side of their plate
  • read part of a word or sentence

Question 428

What is personal neglect?

Answer 428

A lack of orientation or exploration of the side of the body contralateral to the injured hemisphere (Beschin and Robertson 1997)

Question 429

What is extrapersonal neglect?

Answer 429

A failure to detect visual and auditory stimuli on the contralesional side (Peru and Pinna, 1997)

Question 430

How can we assess neglect?

Answer 430

• Cancellation tasks.
  
  • Line bisection.
  • Copy drawing or draw from memory.
  • One-touch test (aka The Personal Neglect Test)

Question 431

What is the personal neglect test?

Answer 431

• Requires the patient to touch their contralesional hand using their ipsilesional hand.
• 0 = the patient promptly reaches for the target.
• 1 = the target is reached with hesitation and search.
• 2 = the search is interrupted before the target is reached.
• 3 = no movement towards the target is performed.

Question 432

What is the neuroanatomy of neglect?

Answer 432

• Strong association with right hemisphere lesions.
• Particularly the parietal lobe (most common)
• But also:
  
  • Frontal lobe
  • Sub-cortical regions (basal ganglia, thalamus)
• Different damage linked to different neglect subtypes (Mesulam, 1999)

Question 433

What insight do we have form neglect patients?

Answer 433

• Studies of neglect have revealed a great deal about how attention and space are processed in the brain.
• For example, neglect is far more frequent following damage to the right-hemisphere, resulting in failure to attend to the left.
• This suggests that there is likely to be a hemispheric asymmetry such that the right hemisphere is more specialised for attention than the left (see also Posner & Petersen, 1990).
• When a brief cue is flashed to either the left or right side, neglect patients may engage attention and move their eyes to the side normally.
• However, if the cue orients them to the right and then the target appears on the left (the neglected side), they may fail to detect this.
• The fact that patients can detect targets on the left when cued to the left suggests that the deficit is related to shifting attention rather than a problem of initial perception.
• Posner & Petersen (1990) therefore suggest that the parietal lobes are not critical for the initial orienting of the cue but are necessary to disengage attention.

Question 434

Representation account of neglect?

Answer 434

• Neglect is NOT just a visual field defect
• Bisiach and Luzzatti (1978) suggest that the parietal loves contain an elaborate representation of the world

Patients asked to imagine and describe the landscape from two different vantage points. Since the descriptions were not contingent on direct sensory input the findings are interpreted to imply that the patients internal representation of the world was impaired.

• Parietal cortex on each side of the brain contains an elaborate spatial representation of the external world. Ergo, damage to parietal on one side of brain causes loss of half the spatial representation of the world.
• Data from the Piazza del Duomo experiment (and other similar experiments) appear fairly convincing.
• However, it remains unclear in this explanation exactly how neglect is brought about.
1. Is the representation of space itself impaired?
2. Is the representation preserved but the ability to scan it lost?

Question 435

What did Bisiach and Luzzatti do on neglect in 1978?

Answer 435

• Bisiach & Luzzatti (1978) asked two neglect patients to imagine being in the Piazza Del Duomo. A well known square in Milan and the patients’ native city.
• Describe the buildings and other features around the square.
• When asked to imagine standing on the steps of the cathedral at one end of the Piazza, nearly all of the features mentioned were ones that would have been to their right from that viewpoint
• Very few things on the left were recalled.
• When asked to imagine standing at the opposite end of the square (facing the cathedral) most of the features mentioned were ones on the previously neglected, which was now to their right.
• The patients were forming a mental image of the Piazza, as viewed from the specified location, and attempting to read off the features around it from their imagery.
• Knowledge of features on both sides was in their memory, but they were unable to access all of it normally from their imagery.
• Representational neglect has since been studied in numerous other patients using other locations and various other stimuli (e.g., Rode et al., 1998, 2004).

Question 436

What are attentional accounts of neglect?

Answer 436

• Impaired orienting of attention to neglected side. (Heilman, 1979; Riddoch & Humphreys,1983).
• Overly strong orienting of attention to non-neglected (intact) side. (Kinsbourne, 1978; Ladavas, 1990).
• Impaired disengagement of attention once it is oriented to the non-neglected (intact) side. (Posner et al, 1982).

Question 437

What did Marshall and Halligan do on neglect? (1988)

Answer 437

• The left side differed such that one of the two houses had flames coming from a left window.
• Although the patient claimed not to be able to perceive the difference between them, he/she stated a preference to live in the house on the right (i.e. without the flames).
• This points to the fact that neglected information is implicitly coded to a level that supports meaningful judgments to be made.
• Suggests that the information is being processed at an early stage (bottom-up) but there is a problem with selective attention at a higher stage of processing (top-down).

Question 438

What can we learn about awareness from neglect?

Answer 438

• In addition to the importance of the right-hemisphere in attention…
• Evidence from patients with neglect demonstrate that our awareness is not derived directly from incoming sensory information.
• Mental representations and attentional mechanisms are key factors in awareness.
• Different levels of awareness / information processing occur – such that it is possible to be influenced by something we are not consciously aware of having seen.

Question 439

About visual pathways…

Answer 439

• The largest contribution to human visual perception is made via the retinal-geniculate-striatal pathway.
• I.e. the pathway that goes from the retina to the Lateral Geniculate Nucleus (LGN) of the thalamus and on to V1…
• Gives rise to (subjective) conscious visual perception.

Question 440

What are the non-cortical (subcortical) routes to seeing?

Answer 440

• However, this main pathway from the retina to the cortex is not the only visual pathway in the brain.
• Around 10% of retinal ganglion cells branch away from the optic nerve before reaching the LGN.
• These cells pass to subcortical regions, making up several (around 10) different pathways.

Question 441

What are subcortical visual pathways?

Answer 441

• These subcortical pathways are evolutionarily more ancient (and unconscious).
• Evolution appears to have replaced these old routes with new (better / conscious) ones, but has retained them and added new routes that enable finer levels of processing.
• One route goes via the superior colliculus…
• The superior colliculus (SC) is involved in the control of automatic reflexes and orienting movements of the head and eyes – especially when new stimuli appear in the visual field.
• These pathways are faster than the V1 route, and can therefore provide an early warning sign to potentially threatening stimuli.
• This can explain how it is possible to unconsciously turn to look at something without realising its importance until after orienting.

Evidence that this pathway makes an important contribution to human vision has come form the phenomenon of blindsight.

Question 442

What is cortical blindness?

Answer 442

• A condition in which a patient sustains damage to the primary visual cortex and loss of (at least part of) the visual field.
• What would happen if V1 were entirely damaged?
From Ward (2010)

Question 443

What is blindsight?

Answer 443

Blindsight: a symptom in which the patient reports not being able to consciously sees stimuli in a particular region but can nevertheless perform visual discriminations (e.g. long, short) accurately.

Question 444

What is patient DB (blindsight)?

Answer 444

• Patient DB had part of his primary visual cortex (V1) removed to cure a chronic and severe migraine (Weiskrantz, 1986).
• DB reported seeing nothing when stimuli were presented to his blind visual field.
• However, if asked to point or move his eyes to the stimulus he could do so accurately, while maintaining that he saw nothing.
• He was also able to perform a number of other discriminations: orientation (horizontal/vertical/diagonal), motion detection (static/moving), and contrast discrimination (gray on black vs. gray on white).
• In all tasks DB reported guessing – but he clearly was not.

Question 445

Critiques of blindsight

Answer 445

• The existence of blindsight remains controversial.
• Some researchers claim that blindsight is the result of islands of spared cortex within the supposedly damaged region (Campion et al., 1983).
• However, many patients have undergone structural and functional MRI. These have established that no cortical activity remains in the region corresponding to the ‘blind’ field (Cowey, 2004; Storeig et al., 1998).
• This evidence suggests that the spared striate cortex explanation is weak.
• Another explanation is that stray light from the stimulus is scattered onto intact parts of the visual field and is detected by intact parts of area V1 (Campion et al., 1983).
• However, the stray light hypothesis seems to be an unlikely explanation for several reasons…(see Cowey, 2004).
  
  • DB is still able to make perceptual decisions in the presence of strong ambient light, which reduces the amount of stray light.
  • This theory cannot explain how DB can still make decisions about the spatial dimensions of objects.
• The most satisfactory explanation of blindsight (at present) is that it reflects the operation of other visual routes from the eye to the brain.

Question 446

What can we learn about visual perception form blindsight?

Answer 446

• Evidence from patients supports the proposal that we have visual systems that operate both within and outside our conscious awareness.
• Blindsight provides evidence for the existence of unconscious (subcortical) routes to vision – but remains controversial.

Question 447

Why are faces important?

Answer 447

• Faces are subject of intense research.
• Apparently effortless. No formal training.
• No limit to number of faces recognised.
• Great social significance.

Question 448

What is prosopagnosia?

Answer 448

• Inability to recognise previously familiar faces.
• Includes famous faces, friends, family – even own face!
• Apperceptive.
  
  • Cannot perceive faces.
• Associative.
  
  • Cannot recognise faces they perceive.

Unlikely to resolve whether or not the model is adequate from looking at normal people’s intact face processing. More insightful to look at face recognition impairments.
Face processing system can be fractionated into its components and relationships by looking at the patterns of impaired and intact performance of patients with face processing problems.
Vast majority of this work has been done by examining patients with prosopagnosia.

• A specific disorder of the face recognition system OR a problem making fine within-category discriminations?
• Possible that patients with prosopagnosia can make between-category discriminations (e.g., face, car, house) but not within-category discriminations.

Question 449

What brain areas are involved in face processing?

Answer 449

• Impaired face recognition (prosopagnosia) Usually associated with bilateral damage fusiform gyrus, located in inferior aspect of temporal cortex (BA 37).
• Unilateral RH damage to same area sufficient to produce prosopagnosia whilst sparing object recognition of equal difficulty.
• Impaired object recognition (agnosia) with relatively spared face recognition (without prosopagnosia) observed following unilateral LH inferiotemporal cortex damage.

Question 450

What is the functional neuroanatomy of object and face processing?

Answer 450

• Kanwisher and colleagues argue that the fusiform gyrus is specialised for the detection and identification of faces.
• Gauthier and colleagues argue that face recognition involves expert discrimination of visually similar objects, with fusiform gyrus being specialised at this general function.

Question 451

What is the face inversion effect?

Answer 451

• If faces are show upside-down, the speed and accuracy of recognition is reduced.
• Interpreted as evidence that inverted faces are processed differently from upright faces.
• Upright faces processed as a unique pattern, rather than as components.
• Same effect NOT found for general objects.

Question 452

What is object agnosia?

Answer 452

Cant recognise objects

Question 453

What was the WJ study of prosopagnosia?

Answer 453

• 51-year-old right handed professional man became severely prosopagnosic following a stroke.
• Unable to identify 10/12 famous faces (and appeared to identify other 2 by deduction rather than identification).
• Unable to judge age, sex, or facial expression of faces & impaired at face matching task.
• Became sheep farmer (flock of 36) post-stroke.

Prediction:
If prosopagnosia is a face specific disorder, patients should be able to perform within-category discriminations for other visually difficult categories, but not human faces.

Results:
• Able to recognise own sheep (i.e., identify sheep by ID number) & claimed to recognise them more easily than human faces.
• Recognition memory for sheep better than that of healthy age-matched controls.
• Cannot be attributed to sheep task being easier than faces – controls found sheep difficult to recognise (‘they all look the same’).
• WJ suffers face-specific problem whilst remaining able to recognise other visually difficult and confusable stimuli.

Question 454

What is Bayes’ theorem?

Answer 454

Everyday life is full of cases in which the strength of our beliefs is increased or decreased by fresh or new information.

This process was formalised by the Reverend Thomas Bayes in his famous theorem:

Need to know prior ratio (probability before data is collected) –> p(HA) / p(HB)

And the likelihood ratio (relative probability of collecting the observed data) –> p(D/HA) / p(D/HB)

Bayes developed a way of conceiving about judgements. Many things increase or decrease our inference of something, and Bayes came up with the formula.

Odds of something happening or not, observation, ability to detect when this thing is happening. Prior odds and posterior odds.

Question 455

What is the Bayes illustration: Tversky and Kahneman (1972)?

Answer 455

• A taxi-cab was involved in a hit-and-run accident one night
• Of he taxi-cabs in the city, 85% belonged to the Green company and 15% to the Blue company
• An eyewitness identified the cab as a Blue cab
• However, when her ability to identify cabs under appropriate visibility conditions was tested, she was wrong 20% of the time and correct in 80% of cases
• The participant had to decide the probability that the cab involved in the accident was blue

Mustn’t ignore the ‘base rate’ probability, the prior ratio.

Question 456

What is base rate neglect?

Answer 456

If people make snap judgements they focus on the posterior odds, we are biased to observing the data rather than getting the data in the first place.

People are not as good as understanding probabilities etc in base rate information in judgements, better at natural frequencies. This is because these are the types of figures we deal with in the natural world. More psychologically digestible.

Question 457

About neglecting base rates…

Answer 457

Koehler (1996, p1) defined base-rate information as ‘the relative frequency with which an event occurs or an attribute is present in the population’

People often fail to take base rates fully into account. Why?

Tversky and Kahneman (1972): Taxi cab problem: participants said there was an 80% likelihood that the taxi was blue.

Tversky and Kahneman (1982) repeated study.

In the ‘causal’ condition, the problem was rephrased: Ps were told that although taxi firms were equal in size, 85% of the accidents involved green cabs

Estimated probabilities that a blue cab was responsible for the accident in causal and control conditions are shown below. Base rates are not so neglected in this example.

Question 458

About heuristics and biases…

Answer 458

• Kahneman and Tversky suggest that we are prone to errors because we rely on simple heuristics
• Heuristics are simple, efficient rules, and can be hard-coded by evolutionary processes or learned
• Heuristics work well under most circumstances, but in certain cases lead to systematic errors or biases.

In both judgement and decision making literature there’s an emphasis and focus on heuristics. This is a simple, fast, effective rule of thumb.

In psychological terms if we were trying to design a robot that we wanted to be able to navigate from one side of the room to another. One way is of programming everything about the space into the robot, a lot of programming involved. However this means that the robot it inflexible - if move a chair then it wont be able to do it. Alternatively, give it rules of thumb, chairs are of what size etc, then it knows what the things it comes to are like and can go around them. Not hard criteria about its environment, just rules of thumb.

This is what we do in life - use rules of thumb. Smart, efficient psychological processes which enable us to be flexible in our environment.

Fast, usually quite simple. Allow us to be successful, but because they are rules of thumb they throw up systematic biases.

Question 459

What is the representative heuristic?

Answer 459

Why do we fail to make proper use of base rate information?

Kahneman and Tversky suggested that people often use a representativeness heuristic (rule of thumb):
"events that are representative or typical of a class are assigned a high probability of occurrence. If an event is highly similar to most of the others in a population or class of events, then it is considered representative" Kellogg, 1995

People judge the probability that an object A belongs to certain class of objects B.

For example in the Jack (lawyer/engineer) example or judge the likelihood of him being an engineer based on the similarity between the description of your stereotype of the job.

Question 460

What is conjunction fallacy?

Answer 460

Further evidence of the representativeness heuristic is the conjunction fallacy (Kahneman and Tversky, 1983).

Linda is 31 years old, single, outspoken and very bright, she majored in philosophy. As a student, she was deeply concerned with issues of discrimination and social justice, and also participated in anti-nuclear demonstrations.

How likely is it that:

- Linda is a bank teller
- Linda is active in the feminist movement
- Linda is a bank teller and active in the feminist movement

Almost 90% rated bank teller and active in the feminist movement as being more probably than single outcomes, even though it is logically incorrect.

Mistaken belief that the probability of the conjunction of two events (A and B) is greater (ie more likely) than one of the two events separately (A or B)

Most Ps ranked feminist bank teller as more probable than either bank teller or feminist on their own. This is incorrect as ALL feminist bank tellers belong to the larger categories of bank tellers AND of feminists (and are therefore more probable).

A form of representativeness - a bias.

The conjunction fallacy tells us that it is less likely to be a combination of two things than to just be one.

Wrong to think that the conjunction of the two things together is greater than each of the single things. This is because of the representativeness.

Question 461

What is the availability heuristic?

Answer 461

Estimating the frequencies of events on the basis of how easy or difficult it is to retrieve relevant information from long-term memory eg Tversky and Kahneman (1974)

If a word of three letters or more is sampled at random from an English text, it is more likely that the word random starts with ‘r’ or has ‘r’ as its third letter?

People tackle this question by comparing how easy it is to think of words form each category. Starting letters usually provide the best cues for word retrieval people think that there are more words that start with the letter r but there are actually more words that have r as the 3rd letter.

Differences in availability (retrieval ability or fluency of examples) lead people to misjudge the relative frequency of the two categories of words.

(confirmation bias: orientated towards information that confirms our judgements and beliefs. Will orientate to ones that confirm our belief and ignore the ones that don’t. in todays day when we tell the news the things were interested in it pushes things our way and we ignore the things we don’t know or believe).

How available information is to you psychologically biases your judgement. Trying to rationalise a judgement.

Question 462

What is the numerosity heuristic?

Answer 462

• Pelham, Sumarta, and Myaskovsky (1994) proposed a numerosity heuristic. This involves over-inferring quantity or amount from numerosity or number of units into which something is divided. For instance:
• People generally eat less when food is divided into small pieces
• Participants who were asked to estimate the value of sets of coins gave higher estimates when there were many coins
• High self-esteem seems to be enhanced if a single belief (eg I am creative, analytical, and verbal) about oneself is divided into several distinct statements (eg I am creative, I am analytical, I am verbal) (Showers, 1992).

We change our impression/inference of what’s going on based on the number of units that exist.

Question 463

What is support theory?

Answer 463

Tversky and Koehler (1994) proposed their support theory:

- Any given event will appear more or less likely depending on how it is described. Need to distinguish between events themselves and the descriptions of those events.
- A more explicit description of an event will typically be regarded as having greater subjective probability when it is mentioned explicitly compared to the same event described in less explicit terms. An explicitly description may draw attention to aspects of the event that are less obvious in the non-explicit description.
- Memory limitations - people do not remember all the information (or possibilities) if it is not supplied - related to representativeness heuristic.

What is critical to making judgements is the assessment of how likely something is to occur, based on how its described. A more explicit description changes the subjective probability of the judgement.

More detail provided could mean that we think more likely, when actually not as less specific description encompasses more scenarios. Biases our judgement. This is seen in terms of insurance - ‘we cover everything’ or ‘we cover x, y, z, a, b, c…..’ and people will go for the second one.

Question 464

What is evidence relating to support theory?

Answer 464

Johnson et al (1993) found supportive evidence in that Ps offered to pay more for insurance policies that covered a detailed range of illnesses than for one that covered all illnesses in general.

Support theory in conjunction with the discussed heuristics demonstrates when errors in judgements are made.

Insurance policy example.

Support theory tries to encompass why representativeness is so important and the detail.

Question 465

What is a summary of heuristics?

Answer 465

• Heuristics are rules of thumb that we use to simplify decision making
• Overall, heuristics result in good decisions
• The loss in quality of decision is made up by the time saved
• However, heuristics can cause systematic biases or errors in decision even in experts
• There are some limitations however:
- Heuristic theory has failed to provide process models
- Some errors are made because participants misunderstand parts of the problem
- The research is detached from everyday life
- Individual differences are under-researched

Even though there is support theory, there are some limitations of looking at judgements just is that way. They are not a model - don’t provide a process model. Support theory goes some way to do that but doesn’t provide everything.

A lot of the time people misunderstand the question and this can lead to a number of errors being made. Using natural frequencies helps in this.

Individual differences: age, gender, personality, IQ, etc… means that we are unsure if these hold for all groups. So in this sense they are descriptive rather than predictive.

Question 466

About fast and fugal heuristics…

Answer 466

• Gigerenzer and colleagues tried to enumerate some ‘simple heuristics that male us smart’
• Rapid processing of relatively little information
• One example was the so-called ‘recognition heuristic’
• A specific examples of the so-called ‘take the best heuristic’ - take the best ignore the rest
• Goldstein and Gigerenzer (2002) in their city recognition/population size example (Herne vs Cologne). Which has the larger population, Cologne or Herne?
• Which has the larger population, Herne or Cologne?
• Start by which city name you recognise: more likely this is a larger city
• Lets say you recognise both names
• What may be another clue
• Cathedral/football stadiums - cities with cathedrals/football stadiums usually have larger populations
• Because you know that cologne has a cathedral your answer is cologne
• Therefore you take the best heuristic. You search cues, stop after you find something that can discriminate between the options, then choose the outcome.
• However, Newell and Shanks (2003) found that the take-the-best is not always used. In particular, more information is considered (ie. Weighed) when the decision is important, for instance when you decide to marry someone. More complex decision making.
• We need to organise the cues hierarchically and this is not a fast or easy task.
• More research is needed to explain how and why certain heuristics are used over others.

With very little information idea of fast mapping. Show things in contrast to one another can get people very quickly to learn, through them discounting the rest of the information. Very successful way of learning - learning things in contrast to what they’re not.

With very little information can cascade to make a decision about something with very little knowledge.

You take the best heuristic having searched for cues. Once done that you make the decision - very fast.

However, wouldn’t use a fast and frugal heuristic in huge decisions like marriage etc. for more complex decision making/judgement don’t use something so fast and frugal.

Question 467

What are causal models of judgement?

Answer 467

• If we’re so dumb, how come we’re so smart
  
  • People are generally accurate in real life decisions, which is not reflected in artificial problems
  • Easy to persuade people to take base rates into account when causal relationships are more explicit

Question 468

What are the dual process models of judgement?

Answer 468

• Use of complex processes as well as heuristics
  
  • System 1 - fast, automatic, associative, difficult to change, emotionally charges - most heuristics
  • System 2 - analytical, slower, consciously monitored, flexible, effortful

Question 469

What are normative theories of decision making?

Answer 469

• Focusses on how people should make decisions (best decisions/ideals) while de-emphasising how they actually make them. Typically developed by economists.
• Von Neumann and Morgenstern’s (1947) Utility Theory suggests that Ps treat decisions like gambles and that they seek to maximise utility.
• This was later modified to take into account subjective utility

How people should be making decisions. Came up with utility theory. We treat decisions like gambles and maximise the utility/benefit. Estimate the benefit vs the cost.benefit of the cost is going to be subjective to the individual.argue that we simply calculate the utility and cost.

Question 470

What is expected utility theory?

Answer 470

• Expected utility = (probability of an given outcome) x (utility of the outcome)
• Eg lottery ticket had an 85% chance of winning £100. therefore the average over many weeks of lottery tickets would be £85. some weeks (15%) you would get nothing and a lot of the weeks 85% you would get £100. Therefore people should be willing to buy the ticket for anything up to £85
• They way the problem is described should not affect the decision
• However, people are not rational decision makers inline wit utility theory
• It does not seem that people make decisions in this way. Psychologists found big departures from the expected utility theory in how people make decisions

Rather than just cost vs benefit, also look at the probability of getting that.

What’s the benefit and how likely is it?

People do not make decisions on this basis - they are not rational. This model of decision making shows that this is how people should make decisions, but they don’t. the description of the decision problem should not influence the outcome. Should just be cost vs utility.

Question 471

What are descriptive theories of decision making?

Answer 471

Focusses on and describes how people actually make decisions. Typically put forward by psychologists.

Prospect theory.

This approach considers how people decide amongst games (prospects).

Normative theories might be better in that they are how we should make decisions and make better choices, descriptive theories focus on how we actually make decisions.

The most developed of these is prospect theory.

Question 472

What is prospect theory?

Answer 472

Kahneman and Tversky (1979, 1984) proposed a development of subjective expected utility hteory called prospect theory. This can be summarised sing the following graph.

Eg a loss of £10 has greater negative utility than the gain of £10 has positive utility.

Losses of any kind are weighted disproportionately to gains of the same amount. That is why the line is not linear. Steeper slope for loses.

Explains why there is risk seeking for loses and risk aversion for gains.

Show that they developed subjective utility theory and showed that we have the value of something and whether it’s a gain or a loss. Prospect theory predicts that it’s not linear. We have gains of certain values, where its not symmetrical, losses are worth more than gains. We are a lot more sensitive to losses than we are to gains - loss aversive. The slop is steeper for losses than it is for gains. We want to avoid losses.

This proposes that a loss of £10 has greater negative utility than a gain of £10 has a positive utility.

Risk seeking for loses, the loss may not come about. Happy to be risk aversive for gains. This changes how people make decisions.

In addition, people give too much weight to very small probabilities. Most refused this bet: $20 if a tosses coin came up heads and a loss of $10 if it came up tails. The bet provides an average expected fain of $5 per toss.

K and T also identified risk aversion in securing a gain and risk seeking in attempting to avoid a loss.

Dawes (1988) also identified the sunk-cost effect: extra resources are committed to support a previously unsuccessful decision.

Question 473

What is risk seeking and risk averse decisions making?

Answer 473

In making choices, people are sensitive to outcomes and to degrees of risk.

However, people are also heavily influenced by how a decision is frames.

- When cast in terms of gains, people tend to avoid any risk
- When cast in terms of losses, people seek out risk, presumably in hopes of avoiding it

This has also been shown to be the case with studies on surgical survival rates Edwards et al. (2001) 90% survival rate vs 10% death rate.

One of the things demonstrated nicely is framing effects. Framing effects are the way you cast information about the gains and the losses showing if people are risk averse or risk seeking.

People change their decisions dependent on the frame.

Question 474

What are framing effects?

Answer 474

Decisions are influence by irrelevant aspects of the situation. For instance, in relation to Tversky and Kahneman’s (1987) Asian disease problem has shown the powerful effect of the framing of the decision.

Imagine that the UK is preparing for the outbreak of an unusual Asian disease, which is expected to kill 600 people. Two alternative programs to combat the disease have been proposed. Assume that the exact scientific estimate of the consequences of the programs are as follows:

Problem 1

- If program A is adopted, 200 people will be saved. (72%) positive - risk averse
- If program B is adopted, there is 1/3 probability that 600 people will be saved, and 2/3 probability that no people will be saved
- Which of the two programs would you favour?

Problem 2

- If program C is adopted 400 people will die
- If program D is adopted there is 1/3 probability that nobody will die, and 2/3 probability that 600 people will die (78%) negative - risk seeking
- Which of the two programs would you favour?
- What can account for the difference in the decision making

· Participants frame the problems in different ways
· Participants in problem 1 working in a gain frame - lives saved. Therefore they are risk averse.
· Participants in problem 2 are working in a losses frame - lives lost. Therefore they are risk seeking
· Utility theories can not account for these findings

Even though both options mean the same thing, people are risk averse so choose the first program.

When done the other way round, will choose the other option. When its negative they go for the risk seeking option as this its less certain about the people dying.

Powerful in the way that is shows that people make decisions on the basis of risk seeking and risk aversion when they’re thinking about gains and losses. Also that the gains and losses are not equally weighted.

Question 475

What is omission bias and decision avoidance?

Answer 475

Sometimes people prefer to do nothing rather than to do something that might have negative consequences, even if this is irrational. This is called an omission bias.

Ritov and Baron (1990) found that people overrated the risk of having a vaccine relative to the risk of the disease.

Samuelson and Zeckhauser (1988) also identified a status quo bias.

Both biases can result form both fear and anticipated regret as captured in Anderson’s (2003) rational emotional framework.

Status quo bias in which you just want to keep things as they are.

Omission bias where you leave something out

Question 476

What is the rational-emotional model?

Answer 476

Anderson’s (2003) rational-emotional model identifying factors associated with decision avoidance.

What drives decisions making is really the avoidance of experiences regret and fear regulation. Want to minimise these consequences most importantly.

Question 477

What is the social functionalist approach?

Answer 477

• Tetlock (2002) criticised isolated laboratory experiments:
• People sometimes behave like intuitive politicians, with a need to be able to justify their decisions to other people
• People sometimes behave like intuitive theologians, and feel themselves obliged to a higher authority
• People sometimes behave like intuitive prosecutors, who place obligations on other to ‘play fair’

Weren’t really real world, were lab based. Said that decision making largely depends on how well we believe we can justify our decisions to ourselves and to others. It is in the justification of the decision which drives which decision we take.

Question 478

What is evidence for the social functional approach?

Answer 478

Tversky and Shafir (1992) found that people chose to justify taking a cheap holiday if they had either failed or passed an exam, but deferred the decision (at some expense) when the result was as yet unknown.

Look for justification for making decisions. This adds a dimension to the previous models discussed that they don’t take into account.

Question 479

What is bounded rationality of complex decisions?

Answer 479

• Finally, we draw attention to the way in which people make decisions in the real world in response to complex situations.
• Simon (1957) proposed that peple employ bounded rationality: they produce reasonable or workable solutions to problems by using various short-cut strategies. Simon (1978) identified satisficing as one particular strategy. When satisficing, people choose the first option that meets their minimum requirements.
• Schwarts et al. (2002) found that satisficers are happier and more optimistic than maximisers (or perfectionists), and they experience less regret and self-blame.
• “The best is the enemy of the good enough”

Say that satisficing is better - as long as it satisfies a condition they make the decision. Tend to be happier and more optimistic than maximisers. Experience less regret and self-blame, which are the things people are trying to avoid.

Decision making can be thought of in a really good way, as satisfisers are happier. Doesn’t have to be the best, just has to be good enough which tips you into that decision.

Given the impression that small decisions don’t matter. But potentially every decision we make can be as impactful as any other that we make. Every decision could lead to devastating or brilliant outcomes, we don’t know.

We don’t see the things that don’t happen every day. Bias to look at the things we decided to do in case they have a big impact.

Question 480

What is unconscious decision making?

Answer 480

• Dijksterhuis (2004) and Dijksterhius and Nordgren (2006) unconscious thought theory
• Better for complex decision making
• Poor processing capacity of conscious thought
• Decision making on apartments based on positive/negative attributes
• Asked to make a decision about which apartment was the most attractive
• Either immediately, after conscious deliberation, after unconscious thought
• Unconscious group made better decisions compared to the conscious and immediate groups
• What are the implications of unconscious thought theory?

We know that we are making decisions that are influenced by things that were not sure of.

The power of the unconscious not just influencing our decision making but how it can inform decisions.

Argued that you get better quality decisions made when they are processes unconsciously.

75% positive attributes, 75% negative attributes and some 50:50 - a clear best, a clear worst, and some in the middle.
Flash the attributes up in a random order individually - one group make answer immediately, one group has 3 mins, and another has another task to do which is very hard for conscious processing.

They consistently find that the group given time doing another task, reliably choose the best option over the people who choose immediately or have time to consciously think about it.

Unconscious has more capacity and different constraints. Works well for more simple problems. Not bound by the same capacity constraints.

Question 481

How does decision making change throughout the day?

Answer 481

• Decision making related to self regulation theories such as Baumeister’s ego depletion theory and mental resource replensihment eg Gailliot and Baumeister (2007)
• Would like to think that judicial decision making is influenced by the facts of the case and
• Surprisingly Danzinger finds that the percentage of favourable decisions gradually drops from around 65% to nearly 0% within each decision session and then jumps back up to around 65% after a break. This suggests that decision making can be influenced by factors that should have no affected legal decisions.

Ego depletion - may be due to some kind of glucose system.

Test and regulate with the motivation to meet a certain criteria.

Found that if make someone unable to have self restraint against eating cookies, have lowered restraint in situations following after - found to be due to glucose processing (listen to recording). Glucose and what you eat may limit your self control - we try and control ourselves all day and then break this. Control is a finite resource

Nudges can help in binary decision making.

First three and last three are very different

Question 482

How can we define problem solving?

Answer 482

“cognitive processing directed at transforming a given situation into a goal situation when no obvious method of solution is available to the problem solver” (Mayer, 1990)

Therefore problem solving is the interaction between a cognitive agent, the task and the task environment. Problem solving is a cognitive process.

Problem solving is:

- Purposeful - it is goal driven
- It is not automatic but requires cognitive processes

Question 483

What is a well defined problem?

Answer 483

• A well defined problem is where the ‘initial state’ is clearly defined and the moves, restrictions and the ‘goal state’ to the problem are explicitly known

Question 484

What is an ill-defined problem?

Answer 484

• Ill-defined problems are more like the ones we experience in everyday life. We have to find out the constraints for ourselves are usually the initial and goal states are not clear.

Question 485

How are problems knowledge dependent?

Answer 485

• Knowledge dependent. A problem for one person may not be a problem for another person who has more knowledge in that area (eg mathematician with a maths problem) knowledge rich vs knowledge lean problems

Question 486

What is the behaviourist approach to problem solving?

Answer 486

• Behaviourist approach suggested by Thorndike (1898)
• Research using cats
• Trial and error learning - random search (generate and test) - learning through association and then REPRODUCED when faced with a similar problem or environment - “Law of Effect”

Reproductive thinking following trial and error

• Can explain quite a lot of animal behaviour
• Trial and error tends to be inefficient
• Seems too simplistic to think that we only learn from our mistakes

Question 487

What is the Gestalt approach to decision making?

Answer 487

In response to Thorndike the Gestaltists (1930s) made the distinction between:

- Reproductive thinking - using past experience (Thorndike)
- Productive thinking - more complex than reproductive thinking. It is a RESTRUCTURING of the problem

· Argued that not all problems could simply be solved using reproductive thinking - the re-using of previous experiences
· Introduced the notion of insight - the Aha experience
· Insight is 'any sudden comprehension, realisation, or problem solution that involves a reorganisation of the elements of a person's mental representation of a stimulus, situation, or event to yield a nonobvious or nondominant interpretation" (Kounios and Beeman, 2014, p. 74)

· Insight and non-insight problems
· Gestalt approach sees them as not the same and claim insight is from a special process
· Large debate (see Weisberg, 2015) whether insight is the result of:
	- A special process or
	- Whether it involves the same processes as other thinking tasks (the 'business-as-usual' view) or
	- A combination - a lot of problems can be seen as hybrid problems
· Therefore, do solutions to insight problems derive from special processes (eg unconscious) or 'normal' problem solving processes

· Non-insight problems - wok within initial representation
· Insight problems require change in representation of the problem
· Metcalf and Wiebe (1987) feelings of warmth in insight and non-insight problems

Very early on 1920s/30s
Thought about things like visual perception and problem solving.

As well as reproductive thinking, also productive thinking which involves restructuring of the problem.

Restructure problems in to insight problems and non-insight problems.

Need to restructure the problem in order to gain insight.

Goes from zero to insight, sudden realisation.

Aha experience requires a change in representation.

Insight is an all or nothing process. Insight problems are not based on what you know.

Question 488

What is the Aha! effect?

Answer 488

• Shows progressive feelings of warmth towards solution for non-insight task, but feeling of warmth increases dramatically from very low to high in insight task
• Does not show how insight is achieved or that it is a special process
• Only shows that it is all or nothing

Question 489

What is facilitating insight?

Answer 489

What is surprising is that even subtle hints are useful. Maier facilitated problem restructuring by accidently brushing against the rope setting it in motion (unconscious cue effect)

Knoblich and Wartenberg (1998) and Thomas and Lleras (2009) found that subtle hints that were not consciously noticed by Ps led to problem restructuring and solution.

The way we get hints of how to solve a problem that we aren’t even aware of - eg the brushing against the rope

Question 490

What are Wallas’ 4 stages of creative process (1926)

Answer 490

Preparation
Incubation
Illumination
Verification

Question 491

What is the incubation stage of problem solving?

Answer 491

Many anecdotal accounts of incubation

Explored using Convergent thinking tasks (eg RAT) and Divergent thinking tasks (eg Alternative Uses Task)

Incubation effects: the phenomenon where putting something aside and on returning there is insight or better problem solving ability after the break

What can be the explanation for this?

- Fatigue
- Conscious work
- Unconscious work
- Selective forgetting

See Gilhooly

Question 492

About blocking problem solving

Answer 492

What happens if we fail to restructure a problem? The reliance on past experience can often get in the way of restructuring a problem…

- Functional fixedness - a failure to see that an object may have alternative functions
- Mental sets - inappropriately using a previously successful strategy

Functional fixedness - fixated on a particular use fo something and cant relax that

Mental sets -

Question 493

About blocking insight in problem solving - FUNCTIONAL FIXEDNESS

Answer 493

• Dunker (1945) Canle problem
• Ps fixated on the box of nails as a container and not as a support for the candle
• More correct solution when the box of nails was empty
• Young children (5 yrs) suffer less as they have less strongly fixed association of objects to uses (Defeyter & German et al, 2003)

Young children suffer less with this kind of problem as have less functional fixity - still learning about objects and their uses.

Question 494

About blocking insight in decision making - MENTAL SET

Answer 494

• Einstellung - Luchins (1942) Luchins and Luchins (1959) - Water jug problem
• Application of a used method even though there may be a simpler solution - mental set that:
- Mechanisation of thought
- Persists over time
- B - 2C - A = Target

The method (B- 2C - A = Target) that is used for problem numbers up to 1 to 5 is also used for problems 6 and 7 even though there is a simpler method (A - C = Target). This is due to mental set.

People stick to doing one thing because they’re in a mental set rather than doing something else which might be more efficient.

Question 495

What are the conclusions of the gestalt approach to decision making?

Answer 495

• Showed that problem solving is the result of both productive and reproductive thinking
• Introduced concepts of restructuring and insight
• Showed that past experience can hinder problem solving in the form of functional fixedness
• Hard to measure concepts (eg insight)
• Descriptive theories with no explanation of the underlying processes used in insight and restructuring (no process model)

Question 496

What is the representational change theory - Ohlsson (1992)?

Answer 496

• Built on the back of Gestalt approach (Neo-Gestalt)
• Tried to explain the udnerlying process that occurs during problem solving
• Ohlsson focused on insight and saw it occurring after there is an impasse (block) to solving the problem
• Representation of the problem probes long term memory for possible actions (cue for recall)
• This is done through spreading activation
• Impasse is broken when representation is changed and insight occurs when the retrieved knowledge is sufficient to solve the problem

Ohlsson (1992) based on a Gestalt approach to problem solving - restructuring how we perceive the problem through the following steps…

1. Initial perception and retrieval of relevant information from LTM
2. A block occurs when the way the problem is represented does not permit retrieval of the necessary memory/actions
3. This block is broken when the problem representation is changed. This can be done in a number of ways…

The representation can be changed in a number of ways:

1. Elaboration or addition of new information
2. Constraint relaxation - what was thought to be not allowed is now seen as being allowed
3. Re-encoding - problem representation is reinterpreted

Question 497

What is the nine dot puzzle (problem solving)?

Answer 497

The goal of the puzzle is to link all 9 dots using four straight lines or fewer, without lifting the pen and without tracing the same line more than once.

Constraint relaxation: solution is found because inhibitions of what is regarded as permissible are removed.

Nothing tells you that you cant go outside the box.This is where the phrase ‘think outside of the box’ comes from.

Question 498

What is the checkerboard problem?

Answer 498

Suppose a standard 8x8 chessboard has two diagonally opposite corners removed, leaving 62 squares. Is it possible to place 31 dominoes of size 2x1 so as to cover all of these squares?

Question 499

What is representational change theory?

Answer 499

• Past experience of arithmetic informs us that typically we change values not operators like + or -
• Ps found it harder to relax the constraints of arithmetic and therefore did not solve as many type B problems
• Results do provide some evidence of the processes causing the difficulties (constraint relaxation and chunk decomposition)
• Knoblich et al (2001) follow up study using eye tracking found that Ps fixated more on the values than the operators as they thought only these needed changing
• Ps that did solve Type B problems showed a progressive increase in amount of time fixated on the operators
• Representational change is like restructuring (Gestalt)
• Constraint relaxation is important
• More precise about the mechanism underlying insight than Gestalt theory
• Good combination of Gestalt and information processing approaches
• Still some ambiguity regarding mechanisms - difficult to predict when or in what way the representation will change
• Unlikely to be the only factor. Kershaw and Ohlsson (2004) found that hints to encourage the relaxation of constraints only showed modest improvements on the nine dot problem
• Constraint relaxation may not be sufficient on its own to explain insight
• Ohlsson did not consider individual differences (ie intelligence, working memory capacity)
• Theory is applicable mainly to insight problems but difficult when applied to non-insight problems eg maths problem

Question 500

What is the computational approach to problem solving?

Answer 500

Newell and Simon (1972)

Problem Space Theory - Information Processing Approach

• We will now look at Newell and Simon's influential Problem Space Theory as described in their book Human Problem Solving in 1972
• Tried to produce a computer simulation of human problem solving - General Problem Solver (GPS)
• Starting assumptions of information processing in problem solving were that
	- It is a serial (one process at a time)
	- People have limited capacity of short term
	- Information can be retrieved from long term memory
• To develop the theory and the program they asked people to think aloud while solving problems to understand the general strategy they used, so they could program GPS to do the same
• They characterised problem solving as passing through a series of states between an initial state and a goal state. A move from one state to another is implemented by an action or operator (eg moves) that allows change form one state to another state
• Therefore there will be intermediate states during problem solving
• The basic problem space is the entire set of possible states between initial and goal states. There may be so-called path constraints that actually forbid passing beyond certain points in the space
• There is a parallel system of knowledge states which are those subjective states experienced by the problem solver
• Working through a move from one knowledge state to another requires a mental operator (actions you need to take to solve the problems, in TOH this would be moves)
• Because the permissible space that remains might still be very large, people use techniques to limit the time spent on problem solving
• How do people decide or select mental operators or moves as they progress through a problem
• They might use heuristics: reasonable effective "rules of thumb" which help navigate the problem space efficiently
• Hillclimbing is one very simple heuristic
• They might create sub-goals, that is, staging posts which can be achieved on the way to a full solution
• The available heuristics and the appreciation of subgoals are just two aspects of problem-solving behaviour which will be strongly affected by prior experience and knowledge
• In some ways, the generation of subgoals can be seen as part of what is more generally called a means-ends analysis. This compromises noting a difference between the current state and the goal
• Form a subgoal that will reduce the difference between current state and goal state
• Select a mental operator that will allow you to achieve the next subgoal
• Apply the operator
• Repeat earlier steps until goal state is achieved
• Another heuristic is loop-avoidance - trying not to return to previously experienced states

Introduced the idea of problem space theory - information processing approach.

The other approaches are largely focussing on insight problems - these are however on very well defined problems

They wanted to produce a computer simulation of how people solve problems called GPS - general problem solver. Using the parameters people use.

In order to develop the simulation they asked people to think out loud while solving the problems so that they could build up an algorithm for the GPS.

Question 501

What is an example of GPS problem solving?

Answer 501

• Goal state: to finish an essay
• Current conditions: the essay will require extra reading
• Rule: extra reading can be found in the library
• Operator: visit the library

How do we know which operator to apply? The choice of operator depends on the nature of the problem space and the current conditions.

Question 502

About progress monitoring in problem solving…

Answer 502

• MacGregor, Ormerod and Chronicle (2001)
• Have proposed an addition to Newell and Simon’s approach by suggesting 2 general heuristics
• Maximisation heuristic
- Make as much progress towards the goal on each move (a kind of means-end analysis)
• Progress monitoring
- Solvers assess their rate of progress towards the goal
- Criterion failure occurs if progress is too slow for what needs to be achieved

Trying to maximise our progress towards the goal on each move.

Solver is constantly assessing their progress to see how likely it is that they might fail. If they’re not making enough progress this prompts them to change what they’re doing.

Question 503

Why might a problem be considered difficult (computational approach)?

Answer 503

• Real world problems and problem space
• How might you get to the O2 centre?
• A problem might be considered difficult because:
- It has a large problem space
- Effective subgoals are difficult to identify, or
- The solution places large demands on memory processes that “keep track” of one’s position in the problem space

Question 504

What are the conclusions of the computational approach?

Answer 504

• Works well with well defined problems, but difficult to generalise to everyday, ill-defined problems
• Specifies how quickly (shortest sequence) ideal problem solution is achieved compared to participants performance
• Consistent with knowledge of information processing (eg memory limitations)
• However GPS is better at memory of previous states in a problem
• GPS is worse at planning future moves, as it only focuses on a single move. Humans often plan in sequences of moves (parallel not serial)
• Problems used by Newell and Simon are well defined problems
• How well would GPS do with ill defined problems in everyday life or insight problems that the Gestaltists used?
• Little attention paid to individual differences of problem solvers
• Insight is most likely to occur when constraint relaxation follows criterion failure
• Progress monitoring involved in the first part of solving up to impasse then representational change involved in breaking the impasse leading to insight
• Traditional input - output model focuses on internal transformations of problem representations
• Problem states are represented in working memory
• For well defined problems it seems that an input - output model does well to explain how a search in problem space, with the aid of heuristics can account for problem solving

Question 505

What is ACT-R theory?

Answer 505

Anderson, Fincham, Qin and Stocco (2008) proposed the adaptive control of thought rational (ACT-R) theory to explain how some areas of the brain deal with common/specific features of problem solving

- Retrieval module - retrieving cues from memory
- Imaginal module - transforms problem representations (see insight)
- Goal module - keeps track of intentions (reaching goal)
- Procedural module - uses production rules (see GPS) to determine the next action

Neuroimaging studies suggest:

- Retrieval module - inferior ventrolateral prefrontal cortex (Badre and Wagner, 2007)
- Imaginal module - posterior parietal cortex (Anderson, Albert and Fincham, 2005)
- Goal module  - anterior cingulate cortex (Fincham and Anderson, 2006)
- Procedural module - head of the caudate nucleus (Qin et al, 2004)

• Large theory that makes a number of predictions
• Has allowed neuroimaging approaches to focus on specific hypotheses
• Other areas such as the DLPFS are likely to be involved in Colvin, Dunbar and Grafman (2001)
• The separate functions of each area may not be so clear cut as simultaneous activation is present (Danker and Anderson, 2007)

Question 506

What is the prevalence of depression?

Answer 506

• Worldwide estimates of lifetime prevalence : 4 and 10% for depression .
• The estimated point prevalence for a depressive episode in the UK in 2000 was 2.6% (males 2.3%, females 2.8%).
• If mixed depression and anxiety was included, these figures rose dramatically to 11.4% (males 9.1%, females 13.6%) .
• Prevalence rates are 1.5 and 2.5 times higher in women than men
• Those with a depressive episode were more likely than others to be unemployed, to belong to social classes 4 and below, to have lower predicted intellectual function, to have no formal educational qualifications .
• No significant effect of ethnic status on prevalence rates

Women are more susceptible to depression, regardless of culture.

Question 507

What are the economic costs of depression?

Answer 507

• by 2020, depression is projected to become the second leading cause of disability and account for 4.4% of the global disease burden, (WHO)
• King’s Fund in 2006 to estimate mental health expenditure, including depression, in England for the next 20 years,(McCrone et al., 2008). It was estimated that there were 1.24 million people with depression in England, and this was projected to rise by 17% to 1.45 million by 2026 .
• Overall, the total cost of services for depression in England in 2007 was estimated to be £1.7 billion, while lost employment increased this total to £7.5 billion. By 2026, these figures were projected to be £3 billion and £12.2 billion, respectively

The second greatest burden on economic costs from disease.

Question 508

When does depression become a mental disorder?

Answer 508

• Establishing a valid diagnostic boundary between depressive illness versus intense normal sadness or mild adjustment disorder that generally does not require intervention has proven challenging.
• The problem is that non-pathological reactions to major losses and stressors possess many of the same general-distress symptoms as depressive disorder.

Mario Maj - how can we differentiate a depressive disorder from ‘normal’ sadness?
• The qualitative approach
This approach, endorsed by several European psychopathologists, assumes that there is always a qualitative difference between ‘true’ depression and ‘normal’ sadness.
• The contextual approach
This approach argues that depression, contrary to normal sadness, is either unrelated to a life event or disproportionate to the preceding event in intensity, duration and degree of the functional impairment it produces
• The pragmatic approach
This approach assumes that, since there is a range of severity from ordinary sadness to clinical depression, the boundary has to be fixed on pragmatic grounds (i.e. giving priority to clinical utility). This is what the DSM-IV and ICD 10 actually tries to achieve, regarding depression as a ‘disorder’ when it reaches a given threshold in terms of severity, duration and degree

Mario Maj: President of World Psychiatric Association (2008-2011)

Article - see slides

Third approach was beneficial and found evidence for that - pragmatic approach

Cluster of symptoms - when have those together, it is an illness: diagnostic threshold

Describing the prognosis is important in diagnosis.

The pragmatic approach
• Of the three approaches , the first two, which are not supported by currently available research evidence, whereas the third has some empirical support.
• An analogy seems to emerge between depression and common physical diseases such as hypertension and diabetes, which also occur a long a curve , with at least two identifiable thresholds: one for a condition deserving clinical attention and another for a state requiring pharmacological treatment.
• Diagnostic threshold ( symptoms cluster ) or ( Diagnostic Criteria )

Question 509

Classification of mood disorders…

Answer 509

• In between 1950 and 1960 , psychiatrists on both sides of the Atlantic noticed increasing difficulty in communicating their understanding of clinical depression . Depression’ is an unsatisfactory term; it is too vague and has too many meanings No common language or clear diagnostic criteria
• .The clinical practice depends on the individual clinical education and expertise.
• Diseases can be classified byaetiology (cause),pathogenesis (mechaism), or bysymptom(s).
• Cassidy et al. outlined diagnostic criteria of depression as follows: “the patient (a) had made at least one statement of mood change … and (b) had any 6 of the 10 following special symptoms: slow thinking, poor appetite, constipation, insomnia, feels tired, loss of concentration, suicidal ideas, weight loss, decreased sex interest, and wringing hands, pacing, over-talkativeness, or press of complaints.”
• Charney then located Cassidy, who was retired and living in Florida. When asked how he decided on the threshold of six out of 10 criteria, Cassidy replied, “It sounded about right.”
• Feighner and colleagues’ “Diagnostic Criteria for Use in Psychiatric Research,” which proposed criteria for 14 psychiatric disorders, was published in January 1972 (1) in theArchives of General Psychiatry.

Question 510

Development of operational definition of depression…

Answer 510

• Feighner and colleagues developed systematic descriptions of symptoms that did not rely upon theoretical assumptions or interpretations.
• These criteria were incorporated in the International Diseases Classification was the UK Glossary of Mental Disorders for ICD-8 (1967)
• ICD-8 contained the following mood disorders ; Manic-depressive psychosis, depressed type Involutional melancholia Reactive depressive psychosis Depressive neurosis .
• ICD-8 followed by the ICD-9, then by the ICD-10
• These diagnostic criteria have been Validated in different studies

Question 511

What is the ICD-10 definition of a depressive episode?

Answer 511

1-Depressed Mood
2-Marked loss of interest or pleasure
3-Decreased energy or fatigability
• (a)reduced concentration and attention;
• (b)reduced self-esteem and self-confidence;
• (c)ideas of guilt and unworthiness (even in a mild type of episode);
• (d)bleak and pessimistic views of the future;
• (e)ideas or acts of self-harm or suicide;
• (f)disturbed sleep
• (g)diminished appetite.
Duration 2 weeks

Sustained everyday for 2 weeks

Question 512

What are the difference severity levels of depressive episodes and recurrences?

Answer 512

• Mild ; one of the first 3 symptoms + total of 4 symptoms
• Moderate ; two of the first 3 symptoms + total five symptoms
• Sever ; all of the first 3 symptoms + total eight symptoms
• Recurrent Depressive Disorder ;at least more than one episode lasted for more than 2 weeks
• Persistent Mood Disorders ; duration for 2 years +insufficient symptoms to meet the criteria of depressive episode

Question 513

About melancholic and psychotic depression

Answer 513

• Some patients have a more severe and typical presentation, including morning worsening ,complete lack of reactivity of mood , weight loss, reduced sleep with a waking early in the morning . It is referred to as depressive episode with somatic symptoms in ICD–10.
• People with severe depression may also develop psychotic symptoms (hallucinations and/or delusions), most commonly thematically consistent with the negative, self-blaming cognitions , others may develop psychotic symptoms unrelated to mood (Andrews & Jenkins, 1999).

Question 514

What are the problems with the diagnostic criteria system of depression?

Answer 514

• The symptom criteria of MDD are broadly defined and include reversed conditions. For example, a change in appetite either increase or decrease ; sleep problems either , decrease or increase
• The diagnosis can be made using different combination of symptoms
• A recent study identified 1030 unique depression symptom profiles in 3703 individuals diagnosed with MD, translating into only 3.6 patients per profile (Fried and Nesse, 2015).
• Symptoms of depression overlap with the symptoms of other psychiatric disorders like anxiety and even with the symptoms of physical health problems
• All symptoms are equally good severity indicators.
• Studies showed that specific depressive symptoms like sad mood, insomnia, concentration problems, and suicidal ideation are distinct phenomena that differ from each other in underlying biology, impact on impairment.
• Jang et al. showed that 14 depression symptoms differ from each other in their degree of heritability
• Another study , revealed differential associations of symptoms with specific genetic polymorphisms; for example, the symptom ‘middle insomnia’ assessed by the HRSD was correlated with the GGCCGGGC haplotype in the first haplotype block ofTPH1.
• Furthermore, biomarker differ for different somatic symptoms such as sleep problems, appetite gain, and weight gain seem elevated in the context of inflammation .

Relying on patients giving accurate information - not hard evidence

Some of the things are on a continuum - no distinctive point at which it is classifiable.

Different combinations lead to same diagnosis, even though the different combinations can have totally different effects.

Question 515

What are the NICE guidelines depression diagnosis?

Answer 515

NICE GUIDELINE
1-Identification of major depression is based not only on its severity but also on persistence, the presence of other symptoms, and the degree of functional and social impairment. The greater the severity of depression, the greater the morbidity and adverse consequences (Lewinsohn et al., 2000; Kessing, 2007).
2-Commonly, depressive illness is unreactive to circumstance, remaining low throughout the course of each day. For some of the patients, mood may be reactive to positive experiences although these elevations in mood are not sustained, with depressive feelings re-emerging, often quickly (Andrews & Jenkins, 1999)

Question 516

What are the nice guidelines on sub-threshold depression?

Answer 516

• In recent years there has been a greater recognition of the need to consider depression that is ‘subthreshold’; that is, where the depression does not meet the full criteria for a depressive/major depressive episode.(Rowe & Rapaport, 2006)
• The following definitions of depression are used in the guideline update:
● Sub threshold depressive symptoms: fewer than five symptoms of depression

People that have some of the symptoms but not enough of them, these people shouldn’t be ignored. This is a problem.

Has recently been recognised by Nice Guidelines and has been given definition of sub threshold depression

Question 517

Sub threshold depression

Answer 517

• persons falling below the threshold are not recognized in primary care settings or community surveys and often not included in biological (imaging and genetic)
• Medline search of the literature published between January 2001 and September 2011 was conducted
• Prevalence rates for subthreshold depression ranged from 2.9% to 9.9% in primary care and from 1.4% to 17.2% in community settings

Question 518

What are screening and assessment tools for depression?

Answer 518

• NICE recommends that any patient who may have depression should be asked the following two questions
• During the last month have you been feeling down, depressed or hopeless?
• During the last month have you often been bothered by having little interest or pleasure in doing things?
• Assessing newly diagnosed patients:
• Patient Health Questionnaire (PHQ-9): this is a nine-item questionnaire which helps both to diagnose depression and to assess severity. It is based directly on the diagnostic criteria for major depressive disorder in the Diagnostic and Statistical Manual - Fourth Edition (DSM-IV.
• Hospital Anxiety and Depression (HAD) Scale:
• Beck Depression Inventory® - Second Edition (BDI-II): this also uses DSM criteria. it takes about five minutes to complete. It is an assessment of the severity of depression and is graded as minimal (0-13), mild (14-19), moderate (20-28) and severe (29-36). It consists of 21 items to assess the intensity of depression in clinical and normal patients. Each item is a list of four statements arranged in increasing severity about a particular symptom of depression. It is also not free but can be purchased from the supplier’s website

Question 519

How are symptoms of depression related to each other?

Answer 519

The analysed 27 items of the Inventory of Depressive Symptomatology, which was administered in the Netherlands Study of Depression and Anxiety
• The focus was on nodes: node strength, betweenness, and clustering coefficient .
• Node strength is a measure of the number of connections a node has,
• Betweenness measures how often a node lies on the shortest path between nodes
• The local clustering coefficient is a measure of the degree to which nodes tend to cluster together
• These measures are indicative of the potentialspreading of activitythrough the network. As activated symptoms can activate other symptoms, a more densely connected network facilitates symptom activation.

Question 520

What is the impact of individual depressive symptoms on impairment of psychosocial functioning?

Answer 520

Fried EI, Nesse RM, Gong Q, ed. PLoS ONE. 2014

• Data from 3,703 depressed outpatients in the first treatment stage of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study.
• Participants reported on the severity of 14 depressive symptoms, and stated to what degree their depression impaired psychosocial functioning (in general, and in the five domains work, home management, social activities, private activities, and close relationships).
• We tested whether symptoms differed in their associations with impairment.
• results show that symptoms varied substantially in their associations with impairment
• Furthermore, symptoms had significantly different impacts on the five impairment domains. Overall, sad mood and concentration problems had the highest unique associations with impairment and were among the most debilitating symptoms in all five domains.

Sad mood always present

About understanding how these symptoms can affect your functioning and what role that symptoms plays in the overall picture of depression.

Question 521

What is the differential diagnosis leading to depression?

Answer 521

• Bipolar Disorders
• Anxiety
• Obsessive-compulsive disorder
• Panic disorder
• Phobic disorders
• Posttraumatic stress disorder
• personality disorders
• Physical health problems
• Central nervous system diseases (eg, Parkinson disease, dementia, multiple sclerosis, neoplastic lesions)
• Endocrine disorders (eg, hyperthyroidism, hypothyroidism)
• Drug-related conditions (eg, cocaine abuse, side effects of some CNS depressants)
• Infectious disease (eg, mononucleosis)
• Sleep-related disorders

Question 522

What is the genetic cause of depression?

Answer 522

• A recent review of twin studies in MDD-RU estimated heritability at 37%.
• Family studies ; There was a twofold to fourfold increased risk of MDD-RU among the first-degree relatives of MDD-RU
• linkage studies in MDD have suggested several regions in the genome that might harbour risk alleles, findings have been inconsistent, and thus far, no established universal genetic risk factor or causative gene for depression has been identified.

Question 523

What are the recent findings of the genetic determinants of depression and future directions?

Answer 523

Some of the most commonly studied candidate genes have been those regulating serotonin (5-HT) and dopamine (DA) neurotransmission.
Unfortunately, most candidate gene studies have been underpowered and replication of findings has been rare.
More recently, the availability of DNA microarrays have enabled genome wide association studies (GWAS) that do not rely on prior hypotheses. The GWAS approach allows for the analysis of a million or more variants across the entire genome. The ultimate goal of these genetic association studies is to improve diagnosis, prevention, and treatment through a nuanced understanding of the genetic underpinnings of the disease.

Question 524

About childhood trauma and its relation to chronic depression in adulthood

Answer 524

• The aim of this study was to examine
• 75.6% of the chronically depressed patients reported clinically significant histories of childhood trauma.
• 37% of the chronically depressed patients reported multiple childhood traumatization.
• Experiences of multiple trauma also led to significantly more severe depressive symptoms.
• Stepwise multiple regression analysis suggested that childhood emotional abuse and sexual abuse were significantly associated with a higher symptom severity in chronically depressed adults.

Question 525

What is the role of stress in depression?

Answer 525

• In community samples, up to 70-80% of Major Depressive Episodes (MDEs) are preceded by major life events, particularly in the 1-3 months before MDE onset, and it has been estimated that stressors are approximately 2.5 times more frequent in the period before an MDE relative to a comparable period in controls (Hammen 2005;Mazure 1998).
• In addition, chronic stressors have been linked to poorer prognosis and more frequent relapse (e.g.Lethbridge & Allen 2008),
• (1) lack of control, (2) inability to escape or resolve the aversive situation (e.g., entrapment), or (3) loss of status (e.g., humiliation) appear to be particularly depressogenic (e.g.,Brown & Harris 1978;Kendler et al. 2003). Findings emphasizing the uncontrollability component of stressors are consistent with data indicating that perceived control over stressors is a key modulator of physiological stress responses (Dickerson & Kemeny 2004).
• stressors play a stronger role in triggering first episodes of depression than recurrences (e.g.,Daley et al. 2000), and the association between stressors and depression becomes weaker with increasing number of episodes (Kendler et al. 2000).

Question 526

What are some psychological theories of depression?

Answer 526

• One major cognitive theorist isAaron Beck.
• Beck (1967) identified three mechanisms that he thought were responsible for depression:
• The cognitive triad (of negative automatic thinking)
• Negative self schemas
• Errors in Logic (i.e. faulty information processing)
• Freud (1917) prosed that some cases of depression could be linked to loss or rejection by a parent. Depression is like grief, in that it often occurs as a reaction to the loss of an important relationship
• Freuddistinguished between actual losses (e.g. death of a loved one) and symbolic losses (e.g. loss of a job). Both kinds of losses can produce depression
• Later, Freud modified his theory stating that the tendency to internalize loss objects is normal, and that depression is simply due to an excessively severe super-ego demands
• Martin Seligman (1974) proposed a cognitive explanation of depression called learned helplessness

Question 527

What is the neurobiological hypothesis of depression?

Answer 527

Monoamine hypothesis Serotonin–norepinephrine
• Depression can be improved by agents that increase synaptic concentrations of monoamines. . However, the pathophysiology of depression itself remains unknown. Still, the monoamine hypothesis does not address key issues such as why antidepressants are also effective in other disorders such as panic disorder, obsessive-compulsive disorder, and bulimia, or why all drugs that enhance serotonergic or noradrenergic transmission are not necessarily effective in depression.
The role of corticotropin-releasing factor in determining sensitivity to stress
• Stress may activate the hypothalamus and therefore may activate the hypothalamic–pituitary–adrenal axis directly, Activation of this system is thought to increase vigilance and fear.
Stress-induced changes in the dopamine system
• Dopamine is increasingly thought to play an important role in the pathophysiology of major depressive disorder. Environmental threats perceived by the amygdala increase the levels of dopamine in the prefrontal cortex and the ventral striatum.Local inhibitory feedback ensures a return to homeostasis. However, a severe stressor may disrupt this feedback system by altering striatal levels of brain-derived neurotrophic factor.

Question 528

Serotonin

Answer 528

Small number of cells produce serotonin. Raphe nuclei - no exact function but moderate the way the whole brain works

Question 529

Dopamine

Answer 529

Also comes from small number of cells - to whole brain, modulating. Produces pleasure. Tells frontal lobe that you like whatever it is that you are enjoying.

Question 530

Anhedonia

Answer 530

• Anhedonia is a core symptom of major depressive disorder (Feighner et al., 1972)
• Along with depressed mood, anhedonia is one of the required symptoms for a diagnosis of MDD
• World Health Organization, 1992). Recent reports estimate that approximately 37% of individuals diagnosed with MDD experience clinically significant anhedonia (Pelizza and Ferrari, 2009).
• Difficult to be treated
• In this study they suggest that this problem may be resolved through a refined definition of anhedonia, which attends more closely to the distinction between deficits in the hedonic response to rewards (“consummatory anhedonia”) and a diminished motivation to pursue them (“motivational anhedonia”). reflect the multi-faceted nature of reward deficits in MDD.
• The overall goal of improving our understanding of neurobiological mechanisms is to improve treatment.
• In terms of pharmacological treatments, the exploration of tailored treatments for individuals experiencing anhedonia using DA-active pharmacotherapies is recommended. (CNS Stimulant)
• Behavioural activation (BA) provides a potential example of a specific psychotherapeutic technique that might be particularly appropriate in cases with motivational anhedonia. Initially developed as a component of Cognitive Behavioural therapy

Question 531

What is the treatment of depression?

Answer 531

• Of the 130 cases of depression (including mild cases) per 1000, only 80 will consult their GP.
• Reasons; not thinking anyone could help (28%); a problem one should be able to cope with (28%); not necessary to contact a doctor (17%); problem would get better by itself (15%); feeling too embarrassed (13%); afraid of the consequences ( 10%) (Meltzer et al., 2000).
• The stigma associated with depression cannot be ignored in this context (Priest et al., 1996).
• Of the 80 depressed people per 1000 who do consult their GP, 49 are not recognised as depressed, mainly because most of such patients are consulting for a somatic symptom and do not consider themselves mentally unwell,
• Of those that are recognised as depressed, about one in four or five are referred to secondary mental health services

SUBTHRESHOLD DEPRESSIVE SYMPTOMS OR MILD TO MODERATE DEPRESSION
1-When depression is accompanied anxiety, the first priority should be to treat the depression. When the person has an anxiety and comorbid depression treat anxiety
2-Offer people with depression advice on sleep hygiene
3-Active monitoring discuss the presenting problem(s) , provide information about the nature and course of depression, arrange a further assessment, within 2 weeks.
4-Low-intensity psychosocial interventions

Question 532

Low-intensity psychosocial interventions as treatment for depression…

Answer 532

1. Individual guided self-help based on the principles of cognitive behavioural therapy (CBT) to include the provision of written materials of an appropriate reading age , be supported by a trained practitioner, who typically facilitates the self help programme, consist of 6-8 sessions
2. Computerised cognitive behavioural therapy
3. Group cognitive behavioural therapy, consist of 10 to 12 meetings of eight to ten participants
4. Do not use antidepressants routinely , consider if; a past history of moderate or severe depression or ,present for a long period (typically at least 2 years) o persist after other interventions.
5. reviews progress and outcome

Moderate Depression
• An antidepressant (normally a selective serotonin reuptake inhibitor [SSRI])
• or
• A high-intensity psychological intervention, normally one of the following
3. – CBT
4. – interpersonal therapy (IPT)
5. – behavioural activation
6. – behavioural couples therapy for people who have a regular partner and where the relationship may contribute to the development of depression
• Severe depression, provide a combination of
antidepressant medication and a high-intensity psychological intervention

Question 533

About antidepressants

Answer 533

• 50-65% of people treated with an antidepressant for depression will see an improvement, compared to 25-30% of those taking inactive “dummy” pills (placebo).
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-noradrenaline reuptake inhibitors (SNRIs)
• Noradrenaline and specific serotonergic antidepressants (NASSAs)
• Tricyclic antidepressants (TCAs)

Question 534

Psychotherapy for mood disorders as a treatment for depression

Answer 534

• Empirically supported treatments for major depression include cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT), and to a lesser extent, short-term psychodynamic psychotherapy
• Meta-analytic evidence suggests that psychotherapy has a significant and clinically relevant, though not large, effect on chronic forms of depression.
• Psychotherapy with chronic patients should take into account several important differences ,(identification with their depressive illness, more severe social skill deficits, persistent sense of hopelessness, need of more time to adapt to better circumstances).
• The combination of psychotherapy has small but significant advantages over each treatment modality alone, and have a protective effect against depression relapse or recurrence.

Impact on the brain is through our perception of the environment and of events - changing the thought process can change the way people ting and make them able to relax, this can lead to clinical changes, similarly to how medication works.

Question 535

What are risk factors for depression treatment failure?

Answer 535

Addiction
Coexisting medical illness
Coexisting psychiatric illness
Cognitive impairment
Family history of treatment failure
Genetic polymorphisms in serotonin transporter proteins
History of physical or sexual abuse
Inadequate medications dose
Inadequate treatment duration
Incorrect diagnosis
Severity of depression
Treatment nonadherence

Question 536

About suicide (depression)

Answer 536

• About one-half to two-thirds of all suicides are by people who suffer from mood disorders;
• Lifetime risk of completed suicide is likely between 5% and 6%.
• Substance use and cluster B personality disorders also markedly increase risk of suicidal acts during mood episodes.
• Other major risk factors include hopelessness and presence of impulsive–aggressive traits. Both childhood adversity and recent adverse life events are likely to increase risk of suicide attempts, and suicidal acts are predicted by poor perceived social support. Understanding suicidal thinking and decision making is necessary for advancing treatment and prevention

Life time risk for suicide in people who suffer from depression is about 5-6%.

Question 537

Mood in general

Answer 537

Normal to have changes in mood, sometimes in response to things.

When someone has a mood disorder its not the natural variation of mood, much more stark and prolonged changes.

Question 538

What are the signs and symptoms of mania?

Answer 538

• Symptoms must be present for at least 7 days
• Marked disruption of functioning - RISKS
• Mood
• Elevated, irritable, or labile
• Disinhibition
• Engaging … insensitive
• Energy and goal directed activity
• Impulsive
• Poor judgement
• Disregard for risks
• Grandiosity
• Exaggerated
• Talents
• Sleep
• Decreased need cf insomnia
• Cognition
• Racing thoughts, Distractibility
• Flight of ideas, Poor memory
• Speech
• Loud, Rapid, Clanging
• Jokes, Gestures
• Perceptions
• Delusions, hallucinations, first rank

Mood is amazing. This must be present for more than 7 days, not just a short blip in their mood.

This impinges on all manners of your life - employment, relationships, safety

Mood is elevated, best ever, and this can persist for a long time. Can also be very irritable and disinhibited.

Can be really engaging or could be insensitive.

Not uncommon for people who are manic to be disinhibited with their money - spending and gambling. Can run up huge debts in short periods of time.

Flight of ideas is when peoples thought processes go so fast but they miss things out of speech so difficult to understand.

Clanging - when the links between thoughts become more about the sounds

Large percentage of people also have psychosis with mania. Delusions often not in keeping with the mood - look and sound happy but talking about something scary or traumatic.

Hallucinations often very positive, hear things such as angels

First rank symptoms that are very typical of schizophrenia - third person voice, running commentary, interference with thoughts.

Question 539

What are the signs and symptoms of hypomania?

Answer 539

• Symptoms must be present for at least 4 days
• Similar to mania symptoms
  
  • But milder
  • No psychotic symptoms
  • Functioning not markedly impaired
• If requires hospital admission = Mania
• If only hypomania: Bipolar Type II
• Is distinction between hypomania/mania arbitrary?

Milder than mania, no psychotic symptoms and function not as impaired.

Question 540

Bipolar affective disorder

Answer 540

• Two or more episodes of mood disturbance:
○ The disturbance consisting on some occasions of mania or hypomania and on others depression.
○ Repeated episodes of mania or hypomania only are classified as bipolar

ICD-10 has clear lists of diagnostic criteria.
Bipolar II - hypomania + hypomania or hypomania + depression

Question 541

What might be the differential diagnosis leading to bipolar disorder?

Answer 541

• Schizoaffective/Schizophrenia
• Substance misuse (stimulants)
• Organic disease (dementia, thyroid etc)
• Personality disorder (esp BPAD2 vs BPD)

Can be difficult to disentangle symptoms to see what it might be.

Bipolar patients tend to recover more fully between episodes.

Question 542

What is the epidemiology of bipolar disorder?

Answer 542

• Lifetime prevalence 2.8% (≈Hyperthyroid)
• WHO 46th / 291 greatest cause of disability
  
  • Greater than breast cancer and Alzheimer’s
• Male to Female 1:1
• Mean age of onset is 18-20 but presentation delayed for up to 10 years
• Substance misuse/anxiety disorders commonly comorbid

Can be difficult to diagnose someone quickly with bipolar as around the age where it’s common to move around different people etc might go unnoticed. Also often because people have a first depressive episode which they are treated for, and then don’t have their first manic episode for many years. Also wouldn’t really go to the doctor to complain about feeling really happy.

Question 543

What is the course of action of bipolar disorder?

Answer 543

• Most people first present with depressive episode
• Manic episode usually within 5 years
• Manic episodes shorter (6 vs. 11 weeks)
• Rapid cycling (>4/yr)
• Gap between episodes shortens
• Pregnancy (>50% chance of relapse)

Generally as get older, episodes become more frequentPregnancy one of the biggest risk factors for the mental health of women generally. Can be very difficult to treat with concerns of wellbeing for the baby.

Question 544

What is the prognosis o bipolar disorder?

Answer 544

• Chronic illness
  
  • (40 year follow up – 16% remission)
• Hard to treat (we’ll learn more about this)
• Mortality increased
  
  • SMR = 1.6 (60% higher risk of death)
  • Suicide rates much higher (SMR 15M and 22F)

Part of reason mortality increased due to lifestyle (smoking, risk taking) also partly due to the medications

Question 545

What is the biological aetiology of bipolar disorder?

Answer 545

• Genetics
	• MZ: DZ 40:5
	• 5 to 10% chance in first degree relatives
	• Overlap with Schizophrenia(!)
• Neuroanatomy
	• Early development
		○ White matter connections
		○ Pruning prefrontal cortex
		○ Leads to decreased connections between prefrontal networks and amygdala
	• Neurodegeneration
		○ Control for confounders
		○ Smaller total grey matter
• Neurotransmitters

When thousands of genes across whole genome infer an increased risk for a condition.

Question 546

What si the psycho-social aetiology of bipolar disorder?

Answer 546

• US study – link with childhood physical abuse
• New Zealand – involvement with child protection agency not linked
• Patients with BPAD
  
  • Emotional and sexual abuse lower age of onset and increase risk of suicide
• No link with obstetric complications

Question 547

What are the three phases of bipolar disorder to consider in treatment?

Answer 547

BPAD depression
Acute mania
Mood stabilisation

Question 548

About bipolar depression

Answer 548

• Difficult
• Often unopposed antidepressant = MANIA
• Medication Naïve
  
  • Fluoxetine + Olanzapine or Quetiapine (antipsychotic with mood stabilising properties)
  • Consider Lamotrigine
• Already on mood stabiliser (lithium or valproate)
  
  • Check level and increase dose as required
  • Add Fluoxetine + Olanzapine
  • Consider Lamotrigine + Lithium/Valproate
• Discontinue anti-depressant when depressive symptoms stop

Lamotrigine is an antiepileptic drug which can also be used as a mood stabiliser

Question 549

About mania

Answer 549

• Stop antidepressant
• Antipsychotic (haloperidol, olanzapine, quetiapine or risperidone)
• If antipsychotic not sufficient, consider adding Lithium then add Valproate
• ?Additional sedation - benzodiazepines

Question 550

Maintenance of health in bipolar disorder treatment

Answer 550

• Lithium – most effective long term pharmacological Rx
• Other mood stabilisers: Valproate, Lamotrigine, Carbamazepine
• Antipsychotics: Olanzapine, Quetiapine

Valporate has terrible implications for unborn children eg spina bifida

Question 551

About lithium as a treatment for bipolar disorder

Answer 551

• Narrow therapeutic index
• Exclusive renal excretion
• Side Effects:
□ Polyuria, polydipsia, weight gain, fine tremor, lethargy, GI upset, skin problems
□ Hypothyroidism, renal failure, teratogenicity (Ebstein’s anomaly), cardiac conduction problems
• Toxicity
□ Coarse tremor, marked GI upset, dehydration, lethargy, agitation, myoclonus, hypertonicity, confusion, drowsiness, arrhythmia

Lightest metal
Narrow therapeutic index
Need to have blood tests a lot for thyroid and renal function

Question 552

What are other considerations for bipolar disorder treatment?

Answer 552

HTT: home treatment techniques - struggle, manic patients often difficult and often get admitted to hospital

ECT - electroconvulsive therapy is actually one of the most effective therapies. Can be miraculous. Nowadays have general anaesthetic, muscle relaxant so don’t shake. Indicated for treatment resistant or life threatening depression and for refractory mania. Biggest risk of the treatment is the general anaesthetic and can have autobiographical memory loss.

Question 553

About the nucleus accumbens

Answer 553

Reward centre. dopamine acts on this. we have this because it allows behaviour regulation - biology way of showing what actions are good and should be repeated.

Question 554

About dopamine

Answer 554

The dose of dopamine released is relatable to your experience of the pleasure - it is titratable.
Highest release of dopamine: sex, exercise, success.
Success because an external things has rewarded you and internally your biology has reacted to that award.

Dopamine is excitatory. (GABA is inhibitory, eg alcohol)
Heroin, cocaine work on dopamine.
Brain developed so that drugs attack cortical part, which is good as means critical functions of brainstem eg breathing and heart rate are not affected.
If inhibiting critical function, eg alcohol through GABA. Ability to reason critically is turned off. All that’s left are biological urges (eat, sleep, sex).

Drugs of abuse work in three main ways - increase release of dopamine (amphetamine), block reuptake (cocaine) or bind directly to the receptors.

Question 555

Basic idea of theories of motivation

Answer 555

Most theories of motivation cite hedonism. Pleasure go towards, pain avoid - found that you avoid pain more than you seek pleasure. We hate losing more than we love winning. Means that we are set up to not be remarkably happy - hypersensitive to loss not to gain.

Question 556

Basics: classical conditioning

Answer 556

Pavlov’s dogs. Chose a behaviour which is a natural re-inforcer - eating, salivation. Noticed that if give food they salivate - this response did not have to be learned, biologically hardwired and can’t be turned off, is not under volitional control. He then took a bell which has no biological meaning to the dog and paired it with the food. He rang the bell and then gave the food. After doing this enough times then the dogs learn that the bell indicates that food is coming, and this works the same in humans. Introduces predictability. Another example of this is the seasons. Learning by association - always associating two things together.

Question 557

Basic: operant conditioning

Answer 557

learning by reward or punishment. Reward is stronger in its reinforcing properties. Punishment doesn’t really work in terms of rewarding properties - people still commit crimes and go to jail even though we know that our whole law system is based around punishment. Even death penalties don’t deter people from committing murders etc, as seen in America and Mexico. If a psychologist designed a legal system it would be very different - would be rewarded for good behaviour instead.

Question 558

What is tolerance?

Answer 558

a person’s diminished response to adrug, which occurs when thedrugis used repeatedly and the body adapts to the continued presence of thedrug.

Tolerance makes drugs of abuse very dangerous as to get the same high have to take more and more and more. These drugs are also relatively expensive. Also the environment acts on this, tolerance can be somewhat dependent on the environment, if you always drink in one place your tolerance will develop to that environment, if you had the same amount to drink elsewhere then you would experience a stronger effect. This is a problem for drugs of abuse and overdose as this often happens in a different place eg on holiday. Tolerance causes physiological changes in the brain but also changes that precede the ingestion of the drug which prepare your brain to receive it, and if you’re in a different environment these changes don’t occur so causes overdose.

Question 559

What is withdrawal?

Answer 559

negative effects in the absence of the drugs. We know that humans do more to avoid loss, so once hooked on a drug you’re in a bad position as need more and more of it to feel good, everything else in life now makes you feel less good, and if you stop taking the drug then you feel awful.

Pharmacologically, we have legalised the two most dangerous drugs - alcohol and tobacco. Historically they were easy to find and in history alcohol was safer to drink than water because of sanitation. Would water it down and the alcohol would kill bacteria in the water. Tobacco was also easy to discover as just needed to be dried.

Heroin is the most addictive, followed by nicotine, but the difference between them not even statistically significant. Rates of smoking cessation is terrible, only 3% quit. Even with every medical assistance available, only 22% quit.

Rate of alcohol quitting is around 50% with medical help, without its around 20%.

Question 560

What is operant conditioning?

Answer 560

Habit and learning
Mechanisms that don’t require conscious decisions
- Development of habitual behaviour patterns independent of conscious evaluation of pros/cons
Operant conditioning (Skinner)
· Positive reinforcement - increases probability of a behaviour occurring by presentation of reward, behaviour (take drug): reward (get high)
· Negative reinforcement - increases probability of a behaviour by removing discomfort, stimulus (withdrawal, depression): Response (take drug)

We raise children telling them not to do things that we do as parents. Not good. Eg smoking/drinking alcohol.

There is nothing in natural human life that you get immediate rewards from. In education, dating, cooking etc we build the motivation to continue through short term goals, eg continued assignments in education which you get results back for. Drugs bypass the whole thing and give much more reward than you get any other way, instantly.

Negative reinforcement studies: have small animal in cage and play a loud aversive noise to it which it dislikes. There is a level which stops the noise and the rat learns that this is what the lever does. This also operates in withdrawal - take drug regularly, then don’t take it and feel rubbish, to stop this you take the drug again.

In terms of reinforcement, the most effective is given straight after.

We see that IV give as massive initial hit with quite a rapid decline. Feels phenomenal for a short amount of time.

IM doesn’t give such a high immediate peak but the feeling is experiences for a much longer period.

Oral administration is a sustained high over time but just not as high.

Some people may naturally prefer longer lasting lower effects, but IV is likely to be the most addictive as it has such a high amount of reinforcement.

• Intermittent reinforcement strengthens a behaviour
• Animals learn to avoid as well as escape discomfort
• Cues (discriminative stimuli) are important and ties in well with classical conditioning
• Strength of learning is influenced by the nature of the reinforcer, the schedule of reinforcement and for how long the schedule is in place
• Underpinning this is the release of dopamine in the meso-limbic pathway

One of the most common examples of this is fruit machines in pubs. These give random reward of money. The possibility of winning keeps you putting money into the machine. Flashing and noise when you win is also conditioning you to want to play more when you walk past and hear the noise or see the lights.

The problem with human behaviour is that rewards are not easy to come by, we have to work for them. The problem with this is that we don’t enjoy this work for the rewards.

Cues can include walking past pubs for regular drinkers.

There are two types of reinforcers - primary (biologically reinforcing, don’t have to learn its reinforcing. The only three are food, water, sex) and secondary reinforcers (eg money which enables you to BUY food water etc).

Historically would have gone more for primary reinforcers, but now for secondary. The most rewarding thing that people want nowadays if money as it allows you to get all of the other reinforcers.

Random reinforcers that you don’t know when they’re coming often more rewarding than regular expected rewards.

Have also found that if you start paying someone to do something you already enjoy doing, then you end up hating doing the task.

Question 561

What brain parts does operant conditioning work on?

Answer 561

• Mesolimbic dopaminergic pathway
  
  • ventral midbrain, via medial forebrain bundle, to limbic region
• Limbic system
  
  • involved in emotional responses
  • Forebrain (Amgydala, nucleus accumbens, striatum)
• All dependence producing drugs appear to increase dopamine in the nucleus accumbens
• Chemical or surgical interruption of dopaminergic pathway impairs drug seeking behaviour in experimental situations

If you sever the dopaminergic neurones, the drugs are no longer seeked as it is no longer rewarding.

Question 562

What is a summary of drug dependence?

Answer 562

Experimentation&raquo_space; positive reinforcement&raquo_space; repeated use&raquo_space; tolerance&raquo_space; withdrawal&raquo_space; dug seeking (negative reinforcement)&raquo_space; drug dependence

There are some other worrying features about experimentation. Some predisposing factors cause some to seek drugs more than others. If bot parents smoke, you are very likely to smoke, same with alcohol.

Question 563

What is classical conditioning?

Answer 563

Stimulus&raquo_space; Response
• Unconditioned stimulus (UCS) elicits an Unconditioned Response (UCR)
• Neutral stimulus (NS) found that doesn’t elicit UCR
• Neutral stimulus repeatedly paired with UCS
• Neutral stimulus becomes a Conditioned Stimulus (CS) that can elicit the Conditioned Response (CR)

Best known example in humans is if diagnosed with cancer and get put on chemotherapy, causes nausea, if keep eating same diet as normal on chemotherapy, you are pairing the regular diet with feeling nauseous then when stop the chemo still have the nausea after. This is why when put on chemo sent to a dietician to change what you eat so that when the treatment stops can go back onto normal foods and not feel sick.

Alcohol is the odd one out though - every time drink to excess causes vomiting but doesn’t lead to aversion. This is partly due to a memory thing, having deactivated the thinking centres of the brain you don’t link the things so much.

Question 564

What is the little albert experiment?

Answer 564

JB Watson (1920)

• Infant Albert initially demonstrated no fear of a tame white rabbit
  
  • Watson paired the white rat with a loud BANG!
  • White rat began to elicit a fear response
  • Other similar objects elicited anxious responses
• The Little Albert experiment demonstrated classical conditioning in humans
  
  • The strongest applications of classical conditioning involve emotions
  • Classical Conditioning underlies some phobias

Child has learnt that fear comes with the rat.

Also child conditioning eg spiders, falling over, colours, toys

Question 565

What are potential conditioned stimuli for classical conditioning?

Answer 565

• Injecting equipment
• Location/Environment
• Cook-up ritual
• Psychological state
• Physical State

Merely setting up the injection equipment is a reinforcer. Same with alcohol.

We develop a cognitive bias towards that stimulus - if you injest a lot of alcohol for a long time you reduce the brain mass by 3% BUT develop very fast processing systems for recognising alcohol.

Primary enforcer - relationship or sex.

Similarly, all naturally conditioned to look at attractive people.

Question 566

What are the categories of conditioned drug responses?

Answer 566

CRs can be drug-like or drug-opposite depending on the circumstances and the drug
Drug-Opposite Conditioned Responses
• Conditioned Withdrawal
• Conditioned Tolerance
Drug-Like Conditioned Responses
• Conditioned euphoria (‘needle freak’ phenomenon)
• Placebo effects (under certain circumstances)

Conditioned tolerance - eg in a certain environment
Conditioned withdrawal - similar but felt more in certain environments

This conditioned withdrawal can help you to stop taking the drug as if always drink in one place then all the cues are in that environment. Therefore one of the easiest ways to stop is to get away from that environment as you remove the cues. This is why rehab doesn’t continue to work when you get home.

Conditioned euphoria - just on seeing the paraphernalia associated with drug use can get a high

Question 567

What are drug opposite conditioned responses?

Answer 567

• Withdrawal symptoms are compensatory reactions that oppose the primary effects of the drug
• Drug opposite CR can mimic withdrawal symptoms
• If occur before drug they will attenuate the drug effect (form of tolerance)
• These reactions can produce relapse in abstinent people, and contribute to tolerance in drug users

Question 568

What is conditioned withdrawal (drug opposite conditioned responses)?

Answer 568

• Abraham Wickler
  
  • 1940s
  • Examined relapse among heroin users
  • Observed opioid withdrawal signs and symptoms when heroin free individuals talked about drug use during group therapy
• Heroin users may experience withdrawal several times per day
  
  • Thus, ample opportunities for pairing withdrawal symptoms with environmental stimuli

Talking about it is giving them a return of withdrawal symptoms which is weird. Cravings not always biologically driven and can be driven by other factors eg seeing cues or talking about it.

Question 569

What is conditioned tolerance (drug opposite conditioned responses)?

Answer 569

• Drug opposite CRs may also contribute to the development of tolerance
• Tolerance:
  
  • Effects of a drug diminish with repeated use
  • A compensatory mechanism to maintain homeostasis
• Siegel (1979)
  
  • It is the body’s homeostatic response in advance of drug administration that becomes conditioned
  • Environmental cues signal the body to prepare for administration
• Risk of OD may be greater in novel environments
  
  • drug tolerance conditioned to cues in normal environment
  • in novel environments won’t have the same degree of tolerance
• Some evidence to support this hypothesis
  
  • Interviews with OD survivors (Wikler, 1948)
  • Rats: OD occurs when injected morphine in novel environments (Siegel, Hinson, Krank & McCully, 1982)
  • Humans: Unsignalled morphine produces greater response than when expected (Ehrman, Ternes, O’Brien & McLellan, 1992)

Environment cues signal to the body to prepare for the drug coming.

Question 570

What are the major categories of addiction treatment types?

Answer 570

• Overview of major categories
• First contact
○ By far the biggest barrier to treatment is making the initial contact with patients
○ Primary healthcare workers, GPs and outreach teams are well placed to do this
○ Strategies are required to help individuals view treatment as something ‘for them’
• Detoxification (Detox)
○ The earliest stages of abstinence can be very tough, and so detox programmes are designed to support individuals through this phase of the treatment process
• Drug substitution treatment
○ Though at first it may seem paradoxical, providing drugs to drug users can be a useful strategy to help them quit
○ For example, methadone is prescribed as a long-acting opioid therapy to heroin dependent patients, and it acts to alleviate the aversive symptoms associated with heroin withdrawal
○ This both allows for a controlled ‘weening’ off of the substance, and also minimises some of the problems associated with illegal drugs (e.g. unknown/unhealthy contents, unsafe administration practices)
○ Not currently available for all forms of drug dependence (esp. alcohol) nor for most behavioural dependences
• Blocking and Aversive Pharmacotherapy
○ Involves the administration of drugs which minimise or totally counteract the effects of a drug of abuse (blocking- naltrexone for heroin) or interacts with the drug of abuse to create extremely aversive effects (aversive- disulfiram or ‘Antabuse’ for alcohol)
• Psychosocial interventions
○ Addressing the problems of physical dependence is less difficult than dealing with the psychological dependence that individuals develop towards their drug or behaviour
○ These interventions are designed to support an individual in the longer term, and to deal with underlying issues which lead to, or have resulted from, their addiction

The biggest barrier is making initial contact with patients.

70% of people with depression don’t seek help.

Alcohol withdrawal can kill you, so is probably the worst biologically.

Other eg nicotine can make you feel awful and like you’re going crazy but wont die.

Methadone replacement treatment - given a biologically equivalent substance to heroin which is given under medical supervision, and although may then be addicted to this for the rest of their lives it stops associated behaviours with the heroin eg diseases, stealing, etc while alleviating withdrawal symptoms as it acts in the same way. All you are doing essentially is switching one addiction for another.

Alternatives for alcohol eg antabuse are really nasty as if you drink whilst on them get really ill and can die. If really addicted then will just stop taking them. To avoid this they can be put in you in an implant which slow releases the drug to stop you drinking and you cant take it out.

Question 571

What are some psychosocial interventions for addiction treatment?

Answer 571

• Motivational Interviewing
• Aimed at increasing motivation to change
• Creates ‘psychological squirm’ (Saunders et al., 1991) whereby an individual feels conflicted between their view of themselves ‘as an addict’
• This can be an effective and powerful motivator for change
• Behavioural Therapy
• Basic idea is that addiction is learned, and therefore can be unlearned
• Use of aversive pharmacotherapies is an example of the use of punishments to decrease the likelihood of future use
• Careful consideration of the factors which precipitate drug use can help the individual to avoid ‘triggers’, and make plans for what to do if they are encountered
• Contingency management involves providing rewards for non-use, and is an effective but controversial intervention
• Cognitive Behavioural Therapy
• A more broad-based approach than traditional behavioural therapies
• Involves identifying triggers to drug use, and provides patients with training in various key skills
○ Relaxation training
○ Drug refusal skills
○ Problem solving skills
○ Cognitive restructuring
○ Relapse prevention training
• Peer Support/Mutual Help
• Residential treatment centres
○ Priory, PROMIS, etc.
• Alcoholics Anonymous/12-Step organisation
• Aim to provide wider social support, often from individuals who are at further stages of the recovery process

Try to show them that there are other routes to pleasure than the drugs, which are healthier.

The what the hell effect: when you trip up on something, eg a diet, instead of going back to it and carrying on the diet, people go and buy loads of the food and just eat everything and think as they’ve broken the diet they may as well go all out. This can be easily prevented just by changing the way of thinking

Drug refusal skills - contingency planning - you plan for scenarios and develop a strategy of dealing with these things. Its critical that the person develops these strategies ahead of time.

Peer support/mutual health seems to work but not for everyone.

Question 572

What is project MATCH?

Answer 572

• Matching Alcoholics to Treatment based on Client Heterogeneity
• Largest ever clinical trial of psychotherapies
• Recruited 1726 alcohol dependent patients into either an aftercare or outpatient treatment arm, receiving one of:
○ 12 step facilitation therapy
○ Cognitive behavioural therapy
○ Motivational enhancement therapy
• Predicted that patient characteristics would predict treatment success (recovery?)
• Operationalised as the number of days abstinence, number of drinks per drinking day, post-treatment completion, psychosocial functioning, quality of life measures, utilisation of treatment services
• Assessed at 1 year follow-up in 3 monthly intervals
• Primary Findings from MATCH (Project MATCH Research Group, 1997a)
• MATCH participants demonstrated improvements in abstinence and reduced drinks per drinking day across all conditions
• That is, all treatments were (equally) effective
• Furthermore, there was no evidence that matching patients to different treatments would be more or less effective
• ‘Everybody wins’
• Secondary Outcomes from MATCH (Project MATCH Research Group, 1997b)
• Those treated in outpatient settings who were (a) high in anger and (b) received MET had better drinking outcomes than those given CBT
• Patients receiving aftercare who had high severity of dependence scores had better outcomes if given TSF; low dependence patients did better in CBT
• However, these results were inconsistent over time (i.e. at 3, 6, 9, & 12 month follow-ups), and at 12 months were statistically non-significant
• 3-year Outcomes from MATCH (Project MATCH Research Group, 1998)
• Included 952 clients across the 5 outpatient sites
• Client anger was the most consistent predictor of treatment outcome, in terms of matching effects
○ High-anger clients responded better to MET in contrast to CBT and TSF
○ Amongst the top third of clients (in terms of high-anger), MET was associated with 76.4% abstinent days over three years compared to 66% abstinent days in CBT and TSF
• 3 year outcomes correlated well with initial 1 year outcomes
• Still no major differences between matched and unmatched clients, or between different interventions
• TSF demonstrated slight (but non-significant) advantage
○ Possibly simply due to the availability of many TSF (i.e. AA) groups which provide more consistent support
• Follow up analysis of MATCH data
• Cutler and Fishbain (2005, BMC Public Health) reanalysed the MATCH data and suggested that treatments only accounted for around 3% of drinking outcomes
• Led some to suggest that the biggest predictor of success may in fact be the simple motivation to overcome an addiction (Ryan, 2006) – the treatment context provides a ‘stage’ for the addict to recover upon

Good that it had a big follow up - 1 year at 3 monthly intervals.

Found that all treatments are equally effective.

Similarly, in the 1990s they thought that if you were British but with Indian heritage, you’d do better with Indian therapists. They tried matching people on this basis but found there was no difference.

MET: motivational enhancement therapy

Client anger most consistent predictor.

MATCH data follow up analysis: only accounted for 3% of drinking outcomes which suggests that it is more to do with the individual and relapse being the most likely outcome even when treatment works so not responsible for a huge amount of recovery.

Question 573

What is UKATT?

Answer 573

• United Kingdom Alcohol Treatment Trial
  
  • Was developed, and therefore informed by, the findings from MATCH
  • Aimed to investigate whether less intensive (and therefore more cost effective) treatments (MET) should replace the more favoured CBT in the UK, given that MATCH data suggested that treatment intensity did not predict more positive outcomes
  • Randomised participants to MET and Social Behaviour Network Therapy (SBNT – a novel treatment designed for the study) using hi- and lo-intensity variants (3 vs. 8 sessions) to assess health economic benefits
  • N = 742
• UKATT Findings
  
  • Again, no significant difference in outcomes for either MET or SBNT were found, with both demonstrating positive effects on drinking reduction and abstinence
  • Again, no measured patient characteristics predicted better outcomes in either of the two treatments

CBT is expensive and time intensive, so this study is looking at if shorter quicker and cheaper treatments are better then these would be used more.

Question 574

What is project COMBINE?

Answer 574

• Combined Pharmacotherapies and Behavioural Interventions for Alcohol Dependence
• Aimed to evaluate pharmacotherapies, behavioural interventions and their combinations in the treatment of alcohol dependence
• 1,383 harmful drinkers
○ Drinking >21/14 units per week (m/f) and also meeting diagnostic criteria for alcohol dependence
• Randomised 1383 recently abstinent alcohol dependents across 8 treatment conditions
• Naltrexone (100 mg/d) or Acamprosate (3 g/d), both, and/or both placebos, with or without a combined behavioural intervention (CBI), or CBI alone
○ CBI involved components of cognitive behavioral therapy, 12-step facilitation, motivational interviewing, and external support systems
• Findings from COMBINE
• During active treatment
○ Participants given Naltrexone, CBI or both had more days abstinent than placebo groups
○ Acamprosate did not appear efficacious in reducing the risk of heavy drinking days or increasing days of abstinence, either alone or in combination with Naltrexone and/or CBI
○ Placebo pill patients experienced more positive outcomes than CBI only patients
• At 1-year follow-up
○ Similar trends were observed as above, but were not statistically significant
• Recommendations of COMBINE? Prescribe Naltrexone…

Benzodiazepine is basically just a sedative

Drugs seemed to work in terms of abstinence

Question 575

Findings of MARCH, UKATT and COMBINE…

Answer 575

• MATCH à ‘Careful’ matching of patients to different treatments does not improve outcome
• UKATT à MET was not found to differ significantly from a novel intervention (SBNT)
à Patient characteristics failed to predict outcomes based on intervention type
• COMBINE à Combinations of pharmaco- and behavioural therapies seemed to produce some positive treatment effects, but placebos were also efficacious in some cases, and overall effects were small and short-lived

Overall this means its not looking great for treatment

Question 576

What were the criticisms of MATCH, UKATT and COMBINE?

Answer 576

“Two sizeable controlled trials of psychological treatment for alcohol [MATCH and UKATT] were each unable to reject the idea that the treatments they compared were equivalent in their effects despite contrasting theories underlying the treatments employed and unparalleled statistical power.”
Jim Orford, 2007

“The major absence in the discussions of the results from the COMBINE study… is any discussion of the treatment mechanisms that are supposed to have generated the improvement in the participants’ drinking practices.”
Anders Bergmark, 2007

“To overcome our impression that ‘everything works’, and to improve treatment outcomes generally and treatment allocation procedures specifically, we have to open the black box to understand the processes of change and the factors which stimulate or impede them.”
	Gerhard Bühringer & Tim Pfeiffer-Gerschel, 2007 [writing about the results of COMBINE]

Question 577

Does addiction treatment work?

Answer 577

• In idealistic terms? Arguably not:
• Gossop et al. (2003) demonstrated 5-year recovery among opiate users ranging from 25-38%
• Other estimates on recovery rates vary above and below this range. Why?
○ Dependent on time to follow-up (6mths, 1yr, 3yrs, 5…)
○ ‘Outcome’ can be measured in various ways (reduced drinking, total abstinence, improvements in social functioning), and failure to ‘recover; in one area is not necessarily failure to recover at all
• In Health Economic Terms? Yes:
• Estimates on the ‘cost-effectiveness’ of treatments in this field suggest an overall saving to society of £2.50 for every £1 put in by the taxpayer (Davies et al., 2009)
• Complete recovery may not always be the outcome, but lower engagement with the CJS, health services and so on leads to benefit for the individual and society
• Putting this in context:
○ Gossop et al. (2001) showed that the costs to society from a group of 1075 drug users, just in terms of criminal activity, totalled £5,000,000 in ONE YEAR

If it doesn’t work very well than why do we invest so much into it? Works on a small number of people but also it is cost effective for society as even if you don’t stop them drinking entirely but reduce it or to a point where need less contact with hospitals and other services etc which makes it cheaper for society, the same for needle replacement services.

Question 578

Evaluating addiction treatment efficacy…

Answer 578

• Not a clear-cut task
• Requires consideration of the many facets of ‘addiction’ itself
• Arguably, addiction is about more than the problematic behaviour, but also about the consequences of the behaviour which can become self-perpetuating
• Research in to ‘what works’ has to then focus on a broad definition of ‘improvement’
○ If an injecting drug user continues to inject heroin after treatment, but begins to do so safely (i.e. using clean equipment), this is a real benefit, even though they have not ‘recovered’
□ E.g. 95%of Hep C infections in the UK are amongst populations of injecting drug users; Hep C can be fatal, and is very expensive to treat

Question 579

The theory behind ‘think positive’

Answer 579

When you have certain psychological emotions eg anxiety or fear we release cortisol and other hormones that have an effect on the body.

People say things like ‘think positive’ and this was founded in neuroscience. Constant negative thoughts and emotions cause the neural pathways in your brain to become stronger. This positive thinking psychological therapy tries to combat this, making the negative pathways weaker and positive stronger. Can have effect son physical health recovery.

Has an effect on the immune system and with the repeated negative emotions we have it buckles the immune system. Research has shown that pessimists get ill earlier and die younger than people who have positive emotions.

Question 580

Cortisol in anxiety and fear

Answer 580

Cortisol released in response to anxiety/fear and too much of this is a risk factor for vascular diseases. Interferes with T-lymphocytes and cytokines which are needed to fight infection.

Question 581

About the sympathetic andrenomedullary (SAM) system

Answer 581

Releases adrenaline (gets muscles ready for action) and noradrenaline (attention and concentration). The release of these chemicals are more from physical demands than emotional demands.

Research has found that over-activation of this system can cause narrowing of blood vessels and thickening of arteries which can lead to vascular diseases.

Question 582

About proinflammatory cytokines

Answer 582

2 main types of cytokines - proinflammatory and antinflammatory.

Antinflammatory facilitate healing.

Proinflammatory cytokines increase inflammation in infection and reduce immune responses. Has been shown to be associated with heart failure.

Question 583

About social support

Answer 583

Social support is quite an abstract concept.

Perceived is often found to be better than actual.

Social support can also be negative - for example encouraging drinking/drugs etc. Also could be through negative relationships with parents.

The most protective thing.

Question 584

What is a mediator of social support?

Answer 584

Mediates stress illness link - between stress and illness and having causal affect.

Recover from illness better with high social support.

Direct effect.

Question 585

What is a moderator of social support?

Answer 585

Between stress and illness, social support will have an indirect effect on illness recovery, progression and whether it occurs in the first place.

Question 586

What is negative social support?

Answer 586

Could be as simple as not being valued in a friendship group or being ignored. Undermining, insensitivity.

Question 587

The biology of social support

Answer 587

People with positive social support have bene reported to have a decrease in the HPA system. They secrete less cortisol. This is because there seems to be some sort of protective factor that social support has which suppresses its release. Some researchers have tried to explain this by saying the release of oxytocin suppresses the cortisol release which we get from physical contact and genuine boding with other people. People on the surface can feel fine but not actually be.

Decreased social support has also been associated with higher activation of the SAM system, and so they have more signs of physical stress. This agrees with the psychological theories.

Couple in conflict produce less cytokines and positive social support has been related to an increase in cytokine production.

Our social networks have a physiological effect on us.

Question 588

About social support and diseases

Answer 588

Social support has been related to all kinds of unhealthy behaviours and illnesses such as smoking, diet, exercise etc… these ones are quite obvious, feeling lonely might mean engaging in unhealthy behaviours such as drinking or smoking or not eating well, but these will then have effects on their long term health - hypertension, cancer, HIV, risky sexual behaviours, cardiovascular disease and stroke.

Question 589

About coping

Answer 589

Problem focused coping - the individual comes up with practical ways to combat stressful situations.

This is the best way of coping with things - use common sense first.

Emotion focussed coping is when someone tries to change their emotional reaction to the stressful situation and that is how they cope with the event.

There are other ways of coping such as avoidance styles.

Question 590

About repressive coping

Answer 590

A disposition to repress or avoid negative affect. They actively avoid negative emotions like fear and anxiety. Typically repressive copers are defined as having high defensiveness and low trait anxiety.

High defensiveness means that they say they’re fine when they’re not. Low trait anxiety means that (state: something that changes, trait: something that doesn’t really change, it’s something that you have) they are generally not anxious. The person doesn’t always know that they are repressing, so can be very difficult to know when someone exhibits repressing coping.

They also show lower signs of distress, but physiologically do show signs of stress eg increased HR etc.

Has been research that repressive coping might be psychologically healthy to a point, as the ability to separate feelings so that you’re not hit by a wave of emotion has been hypothesised to be psychologically healthy. However they do become physically unhealthy.

Myers is the leading expert on repressive coping.

Increased levels of cortisol and adrenaline.

Question 591

About repressive coping and disease

Answer 591

Non-repressors able to absorb information better than repressors - better outcomes.

Non-adherence - because repressive coping style think that everything is ok (indirect effect of disease)

Repressors with cardiovascular disease - fid it difficult to absorb the information and if they do absorb it they report more complications afterwards. Patients that seem good but actually end up recovering slower than other patients who are honest.

The Montreal heart attack readjustment trail

Interventions for repressive coping. As repressors don’t have conscious awareness of anxiety there are no standard interventions that the health system/psychology has been able to develop so far, they don’t realise they have a problem so hard to get them to go for help.

Question 592

How does tolerance develop?

Answer 592

Happens because of up/down regulation of receptors depending on the drug.

Question 593

About heroin addiction

Answer 593

Heroin is injected as you get more of it into the system than smoking. It is more pure. Has a short half life, have to inject 4 times a day, up to 2 bags each time so up to £80 a day. This is why addicts turn to crime.

Potent full agonist on the mu receptors in the brain - opioid system.

Risks of infection from injection - Hep B, C and HIV. There is also risk of crime and violence to others and self.

The main cause of death in addiction is overdose causing respiratory depression. To reduce these risks, harm reduction, we can clean needles, methadone substitution. The lesser evil. An individual on methadone is still an addict but the addiction has shifted from heroin and its associated effects to methadone. Has a longer half life and lasts 24 hours, can be done in front of a nurse.

Half life is important as it determines how addictive a substance is.

Question 594

About opiate OD deaths - prevention

Answer 594

Prevention:

- Give advice, psycho-education, eg only inject when someone is there so they can make sure ok, only inject a small amount first, when released from prison and tolerance has gone down need to be careful about how much using
- Naloxone - an opiate antagonists which blocks the mu receptors and can save a patients life similar to an epipen. Can be prescribed to patients to take home, although cant be injected themselves once they have started to overdose, but a friend could do it and then call 999. this reverses the effect also immediately. However if you give a heroin addict naloxone they experience dreadful withdrawal symptoms.

Question 595

What can be done in terms of harm minimisation in drug addiction?

Answer 595

Can treat HIV but not cure
Vaccinate for hepatitis
Clean needles and education
Condoms 
NRT eg e-cigarettes
Methadone - syrupy and sugary, given this way because if injected it is really painful so less likely to inject it.

Question 596

What is the value of brief interventions in addiction?

Answer 596

Often helps people move from the pre-contemplation to contemplation phase

Question 597

About global life expectancy

Answer 597

Why is there a difference in male and female life expectancy? UK has a year difference, which is standard for western countries. Russia male life expectancy is 59, whilst female is 79 years old. There is such a huge disparity because in Russia smoking, drinking and violence (including war and conflict) are high. The demographics of Russia are strange. In Japan they have historically had the highest life expectancy, male life expectancy is 86 while female is 88. This is now going down, Japan losing it’s life expectancy because of Americanisation, with the largest shift being the shift from fish to meat. They also have some of the lowest rates of cancer in the world because of lifestyle factors such as diet (bowel cancer).

At the end of the second world war, 1 million UK men were killed, over 6 million Jews had died, whilst 19 million Russians had been killed, with 26 million injured. This has affected the population as all the Russian deaths were men, so there were no men left at the end of the war and that is partly why there is such a lower life expectancy fro men now as this happened.

Population pyramid - triangle with base at bottom. Many people when young and as you age people die so gets thinner.

Question 598

What is the mortality blip?

Answer 598

in the 6 months following retirement you have a higher chance of dying. If you don’t retire you don’t get this, for example cultures like Japan, so its not to do with the age.

You can only delay your own death by about a week - you can delay your time of death.
Christmas/boxing day there is a very low death rate, however around a week later there is a huge increase compared to what we would expect.

We can also suffer more deaths as result of a psychological concept, such as retirement. This is because of the loss of social contact/support. The average male over 40 in the UK has 1 friend, whilst females have 7. This is because although males are good at social support through work, they are not so good in daily life so this is lost following retirement. Retirement also has a negative effect on your perceived usefulness.

To get rid of the mortality blip individuals can take up something else which is seen as contributing to others, eg starting up own business, buying a holiday house and renting it out, etc.

Question 599

About life landmarks…

Answer 599

If we had to describe the average life we would start with birth, then childhood (biological terms of social terms, its about dependency ~14 years), school (male and female disparity in many countries of the world is important to remember), job/work (~40-42 years in the UK), marriage (29-30), children (~31), retirement, failing health and death.

National divorce rate is ~40%, in London its around 50%. Average age of divorce is around 50, when the children leave home. The ages for getting marriage and having children are going up dramatically, particularly in London. During working life likely to also be caring for elderly relatives. Average age for suicide in the UK is in the part of your life where you have kids, work, caring for relatives, paying mortgage etc. This shows us that this part of life is hard. This is only in males, women’s suicide rates are stable across lifetime. The three high points for make suicide are 15-21, 46 and over 80s.

We have put the life landmarks at average ages, but we know that these things can occur at completely different ages, for example can get married really old or really young. If things occur at the normative time, it requires no psychological adjustment (Neugarten). Particularly in females, if haven’t met the right person by the average age of marriage etc, socially people start to be intrusive and questioning, potentially setting people up. They are doing this to try and tie you into the socially normative timeline of ages. If you’re someone who doesn’t want to get married etc, society will start asking questions like ‘are you gay?’, ‘don’t you want a family?’. This timeline of events is also there to make us reproduce, keeping things occurring at the right ages. Neugarten’s theory also suggests that if one of these things happens at a non-normative time, it is much more psychologically damaging, requiring much more adjustment.

Question 600

What is the importance of ageing?

Answer 600

• People over 50 years of age are the fastest growing age group in the UK
• By 2031 nearly half of the UK population will be over 50 years of age (Shaw, 2001, ONS 2003)
• In the European Union 30% of the population will be over 65 by 2050 (Eurostat, 2005)
• Health issues

Supporting this ageing population is the main problem. Government have increased tax for this reason.

Question 601

What are some age related issues?

Answer 601

• Health
• Income
• Social status
• Contact
• Working
• International outlook

Social status - a composite of earnings, education and cultured background. Not a simple measure. Can have phenomenally wealthy people who may not have a very high social status if not well educated or cultured background etc. This is important as the mortality blip is mainly due to a drop in social status, so can have an effect on physical health. This is possible as it can affect your self-worth, as we link our own perception of out worth to a social construct of worth. Historically, would have heard things like ‘you have ideas above your station’ meaning that you think you’re better than you are, but these things still exist.

Contact - basically social contact with others which has a massive effect on life expectancy, is one of the most protective for health.

Working - in people who don’t work we see reduced LE, massively elevated rates of mental and physical health problems. There is an argument fro research over the direction of causality. Both affect each other.

International Outlook - Problems are similar internationally. Either we can elevate the birth rate, which would be a massive strain on resources. Don’t currently have the resources to cope with the population we currently have worldwide. This tells us that one way it can be solved is through immigration.

Question 602

What is the socioemotional selectivity theory?

Answer 602

Socioemotional selectivity theory - Between birth and death - there are shifts in motivation at different points in your life span. When you are young it makes sense to chance things that pay off in the future, the reward comes later - working, dates. Older you get, doesn’t make sense to do things that pay off in the future as that future may not ever come. Because of this, they are doing things that make them happy currently, in the moment, which means that older people are much happier than younger people in general.

Question 603

What are the main themes of ageing?

Answer 603

• Bio-psychology: focus = ageing of the CNS and associated decline of mental functions. Second law of thermodynamics – given enough time all physical systems break down.
• With advancing age all body systems decline
• Concept of biological maturity – after which decline is constant until death – loss of biological fidelity.
• Bio-psycho-social approach: focus upon multiple sources of decline/vulnerability (physical health to social networks) and how individuals ‘adjust’
• Psychosocial approach: focus is upon ‘lifespan development’ and human character and personality across the whole lifespan

Question 604

About age and CNS decline

Answer 604

We know that as we age the brain and CNS declines. The CNS loses neurones, neural regeneration does occur but it’s not massive. Over the course of your lifespan you lose more neurones than you gain. Across the lifespan IQ decreases, but only puzzle solving and speed IQ, not stored memory. Doesn’t decline sufficiently to impact on ongoing function. Normal decline with age you notice that you’re more forgetful and lower to do things, but should still be able to work and go on with life.

The second law of thermodynamics - everything breaks - means that materialism doesn’t make sense. The brain is no different to this. Eyes are the first system to go - by 80 years old, 90% of people will have cataracts. The body is like a machine, some parts last longer than others. Other parts certain to fail if live long enough include joints, hearing, prostate cancer, sarcopaenia (loss of muscle - between 20 and 65 lose 38% of body’s muscle)

Question 605

About gender specific ageing

Answer 605

Women reach biological maturity at around 23, men at around 21. This is the point at which you will never be fitter, better, stronger - you are at your peak. Therefore it makes sense for people to have children at this age, the children would be much healthier. Society has shifted it because of women’s liberation (having careers etc), and because women no longer require a male in order to do this and have children, as there is now maternity pay, ability to freeze eggs, IVF, sperm donation, surrogacy etc.

Average number of children people have, in the UK it is currently 1.3 without immigration, with immigration it is over 2. Historically, people have been outliers in terms of global reproduction - most years of extra life have not been solved by people living longer, but by solving death in childhood. Have enabled people to survive to 5 years of age. Previously, to make sure continued family people would have lots of children, they would need good fertility and to keep having children to do this. Genghis Khan verified to have had over 600 children that survived, but it is possible that he had up to 1000 children, and estimated that 1% of Asian people are related to him. He reproduced everywhere that he went, distributing his offspring across a massive area.

Women are much more successful at reproducing than men - women 99.9% of women able to reproduce do, males only 50%. Historically no choice but to marry someone who could and would support women so made most sense for women to look for higher social status men because the child was then guaranteed the best possible chance of survival. This meant that the men who didn’t reproduce in history were less desirable and so didn’t pass on their genetic material.

There is evidence that the social construct operates at the biological sperm level, 30% of sperm stay behind to prevent other sperm from getting close to the egg. Males have evolved to fight even after they have already fought, in order to make sure they reproduce. This makes sense so that they have the child. Currently found that between 20-30% of children can not possibly be from their ‘father’.

People who don’t have children can be a bit uncomfortable with death as haven’t left anything behind, so historically people find different ways of leaving a mark. Eg - leaving something like a book or building, inventing something, or having a belief in the afterlife is another way of feeling more accepting of dying.

If you don’t have a faith the problem with aging is that you may believe nothing happens and this can make you very afraid of dying.

We don’t only see declines in CNS, also see social decline and an increase in vulnerability to diseases.

Females live longer - oestrogen etc protective for life, wars women don’t have to fight

Question 606

What is the biopsychosocial approach to ageing?

Answer 606

• Suggests that the ageing brain is the principle determinant of psychological changes associated with age
• Cross sectional evidence of loss of brain weight/cell numbers indicate loss-deterioration of brain power - ie decline in cognitive skill.

Cross sectional not a great approach because there are so many other factors involved that aren’t considered, longitudinal across long period of time is much better.

Question 607

What research has been done on intellectual decline in later life?

Answer 607

• David Wechsler - score on IQ tests were highest in early 20s and declines constantly afterwards
• When the first longitudinal studies followed up people’s performance on tests at various times after initial testing, results indicated less decline (Owens, Schaie)
• Laboratory vs real world - the evidence from prospective memory.

In the real world we don’t always find decline. Some time older adults out perform younger ones, this is because they develop strategies to overcome the deficits. Eg lists.

Question 608

What is the cross sectional versus longitudinal approach to ageing?

Answer 608

• Cross sectional accentuates loss, due to cohort inequalities (eg progressively more education received from 1890s to 1980s, so each cohort of twenty year olds/seventy year olds, will be better educated than previous cohorts) - Flynn effect - https://www.youtube.com/watch?v=9vpqilhW9uI
• Longitudinal data collection minimises the evidence of decline, because those who are able and willing to be re-tested tend to be healthier, wealthier and wiser than those who ‘drop out or die’.

The flynn effect says that people are getting more intelligent. For every 30 years there is about a 9 point IQ gain. This is why we cant really do cross sectional studies.

IQ shifting hasn’t necessarily done much socially.

Question 609

Is intellectual decline normal with age?

Answer 609

• There is evidence supported by both cross sectional and longitudinal studies of a drop in performance associated with greater age.
• This is more noticeable for tasks requiring speed of processing than for tasks dependent upon acquired knowledge and established problem solving strategies. BUT remember assessment issues.
• Not everyone follows such a path. The proportion of people exhibiting intellectual decline is small in a fifty to sixty year old population, but becomes common in people aged over eighty, often referred to as the “old-old”.
• Even then substantial numbers of people aged 80 and over do not show evidence of intellectual decline

Question 610

About normal and abnormal ageing

Answer 610

• Statistically intellectual decline is more abnormal when it occurs earlier in old age.
• Loss of wisdom (crystallised intelligence) is less common than loss of wit (fluid intelligence). Lay perceptions suggest wisdom may even increase in older adults – however the research does not support this.
• The distinction between normal and abnormal is not fixed: however the transition from a maintained functioning to decline is usually one way.
• Recovery from progressive (vs. acute) mental decline remains an elusive goal and many prefer to bank on primary prevention. Importantly use of intellect and enriched environment across the lifespan appears protective (Leal-Galicia et al 2008).

Once you hit period of lifestyle where you start to decline it is one way, very rare to regain functioning.

Protective factors include having a higher intelligence to begin with, the more active you are throughout life the more protected you are (research has looked at occupations and rates of dementia - more use of brain, less dementia), caffeine, a more enriched environment is very protective.

Question 611

What is Bernice Neugarten’s work on ageing?

Answer 611

• The life course is bio-socially structured through events such as birth, education, work, marriage, childbirth, children leaving home, retirement and widowhood
• The more predictable the event, i.e. the more socially expected it is, the less likely it is to demand individual adjustment (e.g. widowhood for women over sixty)
• The less predictable the event (e.g. death of an adult child) the more effortful the adjustment and the greater the risk of being destabilised
• Positive illusions work (Taylor & Brown)

To really mess up someone’s life, give them something unexpected at an unexpected time.

Positive illusions - an interesting phenomenon where Taylor and Brown sought out normal individuals with no medical knowledge, and asked them questions like what’s your likelihood of getting cancer? And they answer things like 1 in 10,000 which is obviously massively inaccurate. Taylor and Brown also looked at likelihood of other things such as accidents occurring. The estimates were again massively inaccurate. They then looked at every negative experience, and the estimation of likelihood in normal people was always massively underestimated the likelihood of it happening. Humans underestimate the likelihood of bad things happening which makes evolutionary sense because this allows us to be happier as not worrying about these things happening to us etc. This is bad though as people don’t screen for things or pick up on signs and symptoms and take precautions to things. They also found that people overestimate the likelihood of good things happening to them, including people normally overestimate how intelligent/attractive/personality they are. HOWEVER, when you ask them to estimate it happening to someone else they are much more accurate.

Depressed individuals are very accurate, this is called depressive realism. This happens even without them having any extra knowledge. Once the depression remits, you get a return of the inaccurate estimates.

This is a problem for the life course as when something bad happens, which it will, it is much harder to adjust. Therefore it is good to study this and learn that it may happen and to somewhat expect it, and to know that you’ll be ok when it does and that you are strong enough to cope with it.

Question 612

About character and adjustment in ageing?

Answer 612

• The experience of permanent physical impairment is a stressor for many people.
• Some research suggests that those who express a sense of personal responsibility for what has happened are more likely to adjust to such trauma than those who see such events as their bad luck
• Positivity effects in old age (Carstensen).

Study found that in nursing hoes on average would fie within 6 months. She gave half of individuals a pot plant and half didn’t, and having a pot plant was so effective that they were living up to 4 months longer.

This is why we have moved from telling patients what to do, to giving them options, as this sense of responsibility has a massive effect.

Question 613

About lifespan developmental psychology

Answer 613

• The work of Jung first introduced the idea that continuing psychosocial development is normal during adult life. Thus, development continues across the lifespan.
• For Jung he argued that there needed to be a shift in character and temperament from early to late adulthood
• One central feature was the expression of aspects of one’s character in later life that had been hidden or held back in early adulthood [e.g. exhibiting one’s feminine/masculine side]

Argued that at each age group there is a particular crisis that you have to go through. Seen in Eriksonian stages of psychosocial development slide.

Question 614

What is the socioemotional selectivity theory?

Answer 614

• Carstensen et al 2003.
• Perception of time remaining in life prompts shifts in motivation away from gaining knowledge towards emotional satisfaction.
• May confer defensive advantages in later life.

Without this emotional shift, ageing would be terrible.

Question 615

What is the theory of the third age?

Answer 615

• Peter Laslett (1989)
• Looks at late life as a period of self-fulfilment when
individuals can follow their own projects and plan their
lives.
• But this has been criticised as this is only possible if
physical and material well being in ok.
• Responsible for growing emphasis on older adults
taking an active role in their care and treatment.

This is bad theory and has been dropped as it is a narrow minded theory from a very Western perspective. Assumes that you have good enough income and health which we know isn’t true - the average old age pension is £7,200 per year, if married then it is £12,000 TOGETHER, which is not enough to live on at all.

Question 616

What are erikson’s stages of development?

Answer 616

• Erikson’s model is probably the best known though least well researched example of lifespan development
• He argued that at each stage of life we face a particular type of psychosocial crisis, whose resolution helps establish an emergent trait or ‘virtue’ that then serves us well in addressing challenges later in life

Infancy: basic trust vs mistrust
Early childhood: autonomy vs doubt
Play age: initiative vs guilt
School age: industry vs inferiority
Adolescence: identity vs role diffusion
Young adulthood: intimacy vs isolation
Middle adulthood: generatively vs stagnation
Late adulthood: integrity vs despair

Question 617

What are the applications of Eriksonian theory to assessment?

Answer 617

• Key adult ‘qualities’ are
  
  • Sense of identity [being a somebody]
  • Capacity for intimacy [having a somebody]
  • Experience of generativity [helping a somebody]
  • Acquisition of integrity [taking responsibility]
• How can care maximise the chances that these qualities continue to be expressed?
• How can care support these qualities to develop?
• How can care protect those with limited or no experience of developing or exercising these qualities?
• Older adult assessment is difficult in view of their tendency to underreport psychological complaints.
• “Masked depression” – Older adults are high risk for suicide – especially older adult males (Szanto et al., 2001) Yet difficult to detect as older adults tend to minimise psychological symptoms and great overlap between physical symptoms and psychological.
• 50% of suicide victims older than 60 had seen GP in the month of death with 26% in the week of death yet more than half only reported physical complaints (Harwood et al 2000).

World wide, the most likely group to kill themselves is males over 80.

Question 618

What are the psychological constructs of ageing?

Answer 618

• Research and practice reflect and reinforce implicit models of ageing
• Some reinforce a notion of decline, and a categorisation of normal/natural versus abnormal/unnatural types of decline
• Others focus upon what living longer adds to human personality development
• Finally some steer a middle position looking at how ageing challenges personal adjustment and the factors that help or hinder such adjustment.
• The different approaches vary in the distinction they make between individuals and the ageing process

Question 619

Personality change with age

Answer 619

• Introversion – extroversion
• Neuroticism
• Agreeableness
• Conscientiousness
• Openness
• What happens to these personality dimensions across the life span?
• Roberts, Walton & Viechtbauer (2006)
• With age conscientiousness and emotional stability increase especially between 20 and 40
• Openness decreases across the lifespan
• Agreeableness rises
• Neuroticism declines

This happens to everyone, but because it happens to everyone, your relative position compared to everyone else stays the same.

Really strong effect in mental health - even in the absence of treatment they all decline with age.

Question 620

What are longevity studies in ageing?

Answer 620

• longevity studies - positive emotionality (extraversion) and conscientiousness predict longer lives (Danner et al. 2001, Friedman et al. 1995).
• hostility (low agreeableness) predicts poorer physical health (e.g., cardiovascular illness)

Question 621

What is repressive coping with age?

Answer 621

• Repressive coping = automatic tendency to avoid negative and personally threatening information (Myers, 2000).
• Repression may increase across the lifespan (Erskine et al 2007).
• Longitudinal Study of Repressive Coping and Age

Question 622

What was found by Erskine et al 2007 on ageing?

Answer 622

• Older adults demonstrated significantly less
  
  • Trait anxiety
  • Depression
  • Neuroticism
  • Unhappiness
  • Rumination
  • Thought suppression

Compare older and younger adults and track them over time. Interested in physically unhealthy older adults and their happiness - found that consistently happiness increases in spite of ill health in older adults.

• However the older adults demonstrated more repressive coping.
• 11% of the young sample were classified as repressive copers
• 41% of the older adults were repressive copers.
• Older adults show significantly lower scores on virtually all indices of psychopathology when compared to young participants.
• But they are more likely to be repressive copers
• Problems – does repressive coping rise with advancing age or is this a cohort effect?
• Erskine et al (under review) conducted a follow up study tracking the sample of older adults reported in 2007 over a 7 year period.
  
  • Critically, the rate of repressive coping had risen from (41%) at Time 1 to (56%) at Time 2. Statistical tests indicated that this approached significance p=.07
  • Power was an issue because of sample loss due to death or ill health

Idea is that repressive coping increases with age - become more delusional with age but in a helpful way. Know this from looking at diaries and social media (can be a bit artificial on social media as people don’t tend to post negative stuff).

When you look back on life as an older adult, you will remember life as better than it actually was.

May rewrite negative experiences as positive to make it easier to look back on.

Question 623

What are the implications of repressive coping with ageing?

Answer 623

While physical health declines with age mental health often improves. This seems due to a rise in repressive coping which increases with age. However among participants that do not become repressive copers mental health declines with physical health.

Question 624

What is CAMHS?

Answer 624

Child and Adolescent Mental Health Service

- Tier 2 - usually in school, staff commissioned from NHS
- Tier 3 - outpatient CAMHS
- Tier 4 - inpatient/day patient services, specialist services

Question 625

What was Bowlby’s 1982 work on attachment?

Answer 625

Child’s disposition to
“seek proximity to and contact with a specific
figure and to do so in certain situations,
notably when… frightened, tired or ill. The
disposition to behave in this way is an attribute
of the child, and an attribute which changes
only slowly over time and which is unaffected
by the situation of the moment”

Question 626

What is attachment?

Answer 626

• Observational behaviours of a child with respect to its caregiver
	• Maintain proximity
	• Safe base for exploration
	• Separation results in distress 
		○ Stages: 
			§ Protest
			§ Despair 
			§ Detachment 
• Innate
	• Pre-programmed propensity to form a special relationship with the caregiver
• Conditions necessary:
	• Significant time spent with caregiver
	• Cognitive age: 7-9 months        

Caregiver could be anyone.

Question 627

What is the internal working model of attachment?

Answer 627

• Observational behaviours of a child with respect to its caregiver
	• Maintain proximity
	• Safe base for exploration
	• Separation results in distress 
		○ Stages: 
			§ Protest
			§ Despair 
			§ Detachment 
• Innate
	• Pre-programmed propensity to form a special relationship with the caregiver
• Conditions necessary:
	• Significant time spent with caregiver
	• Cognitive age: 7-9 months        

Caregiver could be anyone.

Question 628

What was Harlow’s monkey’s 1959?

Answer 628

Experiment:
• Wire surrogate mother and/ or a softer one
• Feeding varied
• Monkeys would cling to the cloth mother and occasionally feed from the wire mother
• When stressed the monkeys would run to the cloth mother
• Concluded - warmth and comfort most important

To determine if food or comfort was more important in developing attachments
Experiment: Sixteen young isolated monkeys kept in cages with:
A wire surrogate mother and/ or a softer one covered in cloth
Sometimes the monkeys would be fed by the wire mother and other times by the softer mother
Monkeys would spend most time clinging to the cloth mother and occasionally feed from the wire mother
When stressed the monkeys would run to the cloth mother for safety
Concluded - warmth and comfort rather than food were more important in nurturing an attachment
Attachment behaviour is different from feeding relationship – attachment not driven by the need for food

Warmth and comfort proved particularly important when the monkeys were stressed.

Question 629

What are the stages of attachment?

Answer 629

• Newborn to 2 months: Limited discrimination
• 2-8 months: Discrimination with limited preference
• 8-12 months: Focused attachment
• 12-20 months: Secure base
• 20 months +: Goal corrected partnership

Limited discrimination (ability to discriminate between caregivers limited)

Discrimination with limited preference (discriminates between different caregivers, evidenced by different patterns of interacting. But engages readily with strangers)

Focused attachment (separation protest, stranger wariness. Typically attaches to more than 1 caregiver, demonstrates a hierarchy of preference evidenced when stressed, fatigued or frightened)

Secure base (independent exploration away from attachment figure, alternating with returns in which proximity is sought)

Goal corrected partnership – attachment relationship shifts from nearly complete dependency to one in which child is aware that caregiver has intentions and wishes different from own)

Age, cognitive growth, and continued social experience advance the development and complexity of the internal working model. Attachment-related behaviours lose some characteristics typical of the infant-toddler period and take on age-related tendencies. The preschool period involves the use of negotiation and bargaining. For example, four-year-olds are not distressed by separation if they and their caregiver have already negotiated a shared plan for the separation and reunion.
Ideally, these social skills become incorporated into the internal working model to be used with other children and later with adult peers. As children move into the school years at about six years old, most develop a goal-corrected partnership with parents, in which each partner is willing to compromise in order to maintain a gratifying relationship. By middle childhood, the goal of the attachment behavioural system has changed from proximity to the attachment figure to availability. Generally, a child is content with longer separations, provided contact—or the possibility of physically reuniting, if needed—is available. Attachment behaviours such as clinging and following decline and self-reliance increases.

By middle childhood (ages 7–11), there may be a shift toward mutual coregulation of secure-base contact in which caregiver and child negotiate methods of maintaining communication and supervision as the child moves toward a greater degree of independence

Question 630

What is the strange situation procedure?

Answer 630

• By age of 1 year can assess the quality of a child’s attachment to their caregiver
• SSP: Studied attachment in laboratory setting
• Measure 4 behaviours:
1. Willingness to explore
2. Separation anxiety
3. Stranger anxiety
4. Reunion Behaviour
• Quality of parenting is crucial in shaping attachment

Mary Ainsworth
SSP: only reliable under 2 years

1. Caregiver enters room with child, child explores
2. A Stranger enters and joins the caregiver and infant, talks to caregiver
3. Caregiver leaves the infant with the stranger
4. Caregiver returns and the stranger leaves. Caregiver settles the infant.
5. Caregiver leaves again. Infant left alone
6. Stranger returns. Tries to comfort infant
7. Caregiver returns and stranger leaves

The experiment:
Small room with one way glass
Children aged between 12 and 18 months
Each phase lasts 3 minutes

Experiment only works from ages 1-2 years.

Question 631

What are the three types of attachment?

Answer 631

Secure attachment
Insecure-resistant
Insecure-avoidant

Question 632

What was main and solomon’s work on attachment?

Answer 632

• Disorganised:
• Fearful, freezing, contradictory attachment behaviour
• Prevalence varies. 14% low risk. 75-80% high risk
• Associated with disturbances in caregiving behaviour – frightening behaviour, antagonism, role confusion, withdrawal, contradictory cues
• Strongest link to psychopathology of attachment classifications
• Not a clinical disorder:
○ Child’s attachment may be disordered to one caregiver, but not another
○ May be transient

However, after reviewing a further 200 tapes of children in the strange situation Main and Solomon added a fourth type of attachment that they referred to as ‘disorganised.’ The infant’s behaviour is not consistent and shows signs of indecisiveness and confusion. Sometimes the child will freeze or rock back and forth
Insecure attachments - ? Association with increased likelihood of psychopathology
Disorganised attachment - Strongest link to psychopathology of attachment classifications– social difficulties, role inappropriate parent – child interactions, peer rejection, aggression, disruptive behaviour, emotional problems, dissociative disorders

Fourth type of attachment.

Question 633

What characteristics hinder attachment?

Answer 633

A: Caregivers
• Abuse
• Baby not wanted
• Caregiver insensitive to infant cues and may under-or over-stimulate
• Poor marital relationship
• Severe emotional trauma experienced during pregnancy
• Drug addiction or serious psychiatric disorder
• High stress
• Lack of support
• Poverty

B: Child 
	• Separation from the caregiver
	• Abuse and neglect
	• Genetic predisposition / illness
	• Frequent moves and placements
	• Birth trauma

Question 634

What was Rene Spitz’s work on attachment?

Answer 634

Observational Study, 1940’s: compared a group of infants raised in isolated hospital cribs with those raised in a prison by their own incarcerated mothers

* Psychoanalyst and psychiatrist
* Coined “hospitalism” – wasting away of infants in hospital
* Anaclitic depression - seriously impaired physical, social, and intellectual development in some infants following sudden separation from mother
* The physical conditions in the hospital were better then those in the prison, but the illness and death rates were higher.
* Although developmentally the foundling home infants were superior, after a year of
* institutionalization they were inferior to
* those in the prison setting.
* Within two years, 37 percent of the hospital children were dead (only 2 from disease) this rate rose the next year as well; all the prison children were alive five years later. Cause of death was unknown
* Spitz suggested that this lack of stimulation explained the rapid deterioration in children's intellectual development. He found a drastic drop in infants' developmental quotients (DQ) over the first few months of life in institutions, and by the end of the second year Spitz reported that infants' DQs had dropped to a low of 45, where an average DQ is 100. 
* Concluded that the damage inflicted on children during their first year of life was irreparable

Question 635

What was Hodges and Tizard’s study in 1989 on attachment?

Answer 635

• 65 children, in institutional care until 4 yrs, observed over 16 yrs
  
  • 25 returned to biological parents; 33 adopted; 7 remained in the institution with fostering
• At 16 years:
  
  • Majority of adoptive mothers felt their child was deeply attached
  • Only half of the restored children were deeply attached
• Children can make attachments later
• Described development of children who experienced varying lengths of time in care in GB
• Caregiver to child ratios were better than those in older studies (3:1), Stimulating environment – books, toys and instruction. High turnover of staff. High turn over of staff - average 24 different carers. Caregivers were discouraged from forming attachments to the children in
• their care.
• Hodges and Tizard offer an explanation for why the adopted children were more likely to overcome some of the problems of early institutional upbringing better than the restored children. The financial situation of the adoptive families was often better, they had on average fewer children to provide for, and the adoptive parents were particularly highly motivated to have a child and to develop a relationship with that child. The biological parents in Hodges and Tizard’s sample seemed to have been ‘more ambivalent about their child living with them’.

Question 636

About attachment disorders

Answer 636

• Onset before 5 years
• Presents with unusual: social interactions, emotions, attachment behaviours
• 2 Types:
  
  • Emotionally withdrawn/inhibited (RAD)
  • Indiscriminately social/disinhibited (DAD / DSED)
• Result from limited opportunities to form selected attachments

RAD:

• Lack of emotional responsiveness
• Withdrawal reactions
• Aggressive responses to the child’s own or others’ distress
• Fearful hypervigilance
• DAD / disinhibited social engagement disorder

Relative failure to show selective social attachments manifest by:

• A normal tendency to seek comfort from others when distressed;
• An abnormal lack of selectivity in the people from whom comfort is sought
• Social interactions with unfamiliar people are poorly modulated

At least one of:

• Generally clinging behaviour in infancy
• Attention-seeking and indiscriminately friendly behaviour in early or middle childhood
• Reactive attachment disorder
• If caregivers are not reliably or consistently present or if they respond in an unpredictable and uncertain way, infants cannot establish a pattern of confident expectation
• Disinhibited social engagement disorder
• Young children exposed to multiple caregivers simultaneously or sequentially do not easily experience the sense of security associated with unique and exclusive longstanding relationships.

Very specific and quite rare to see.

Question 637

About assessment of attachment

Answer 637

• Caregiver interviews:
• Focus on child attachment behaviours
• Signs of disordered attachment
• History of constancy of caregivers
• Observed interactions of parent and child together
• Include observation of some degree of distress to activate child’s need for attachment figure (separations, scary toy).
○ Look for: safe haven, secure base, affectionate bond, selectivity

Safe haven (turns to caregiver in times of distress).

Question 638

Management of attachment disorders

Answer 638

• Enhance caregiving environment, improve institutions, fostering / adoptions
• Psycho-educational approaches – training parents to respond sensitively to their child’s needs
• Offer advice to social services and courts

Question 639

Prognosis of attachment disorders

Answer 639

• Poor without support
• Interfere with friendships / relationships, behavioural problems, affect cognitive development
• Poor medical care and injuries

Shown in other studies that signs of RAD can be eliminated by improvements in care giving, but indiscriminate behaviour can persist
Bucharest Early Intervention Project - RCT to evaluate intervention for AD after early institutional rearing:

Can lead to impairing how the child parents their future children.

Question 640

Contributing factors to child mental health

Answer 640

Individual attributes and behaviours
Environmental factors
Social and economic circumstances

Question 641

What is the definition of ADHD?

Answer 641

• Definition: chronic condition marked by persistent inattention, hyperactivity, and sometimes impulsivity
• The child must display either inattention or hyperactivity-impulsivity (or both) and symptoms must have been present for at least 6 months.

Question 642

What is inattention?

Answer 642

• Fails to pay close attention to details or makes careless errors in schoolwork, work or other activities
• Has trouble keeping attention on tasks or play
• Doesn’t appear to listen when being told something
• Neither follows through on instructions nor completes chores, schoolwork, or jobs (not due to failure to understand or a deliberate attempt to disobey)
• Has trouble organising activities and tasks
• Dislikes or avoids tasks that involve sustained mental effort (homework, schoolwork)
• Loses materials needed for activities (assignments, books, pencils, tools, toys)
• Easily distracted by irrelevant information
• Forgetful

By far the most common symptom of ADHD

Question 643

What is hyperactivity-impulsivity?

Answer 643

Hyperactivity
• Squirms in seat or fidgets
• Inappropriately leaves seat
• Inappropriately runs or climbs (in adolescents or adults, there may be only a subjective feeling of restlessness)
• Has trouble quietly playing or engaging in leisure activity
• Appears driven or “on the go”
• Talks excessively

Impulsivity
• Answers questions before they have been completely asked
• Has trouble waiting his/her turn
• Interrupts others

Question 644

What is the diagnostic criteria for ADHD?

Answer 644

• Symptoms begin before age 7 (12 DSM-5)
• Symptoms must be present in at least 2 places, such as school and home
• The disorder negatively affects school, social or occupational functioning
• The symptoms do not occur solely due to a psychotic disorder (such as schizophrenia)
• The symptoms are not better explained by an alternative disorder (such as a mood, anxiety or personality disorder)

Question 645

What is the management of ADHD?

Answer 645

Stimulant medication:
Methylphenidate increases the activity of dopamine and noradrenaline in areas of the brain that play a part in controlling attention and behaviour.

(Ritalin)
Side effects of insomnia and reduced appetite so have to be careful about giving second doses after school.

Only 20% adults have it into adulthood, burns out for 80% of child sufferers.

Question 646

What are the characteristics of ADHD?

Answer 646

• Spoken language
  
  • Limited use, monotonous tone
  • Repetitive, stererotyped speech
  • Responses that are rude/inappropriate
  • Talking ‘at’ someone – usually about own interest
• Responding to others
  
  • Reduced/absent response to facial expression
  • Difficulties understanding sarcasm or metaphor
  • Delayed response to name being called (normal hearing)
• Interacting with others
  
  • Reduced awareness of personal space
  • Reduced/absent greetings or farewell behaviour
  • Reduced social interest in others’ interests
  • Reduced/absent social awareness
• Eye contact, pointing and gestures
  
  • Reduced/absent use of social eye contact
  • Reduced/poorly integrated use of gestures
  • Reduced/absent joint attention e.g lack of following a point
• Ideas and imagination
  
  • Reduced/absent imaginative play but may re-enact scenes from visual media
• Unusual/restricted interests or rigid/repetitive behaviours
  
  • Stereotypical movements
  • Overfocused or unusual interests
  • Repetitive play oriented towards objects
  • Extremes of emotional reactivity excessive for the circumstances
  • Dislike of change
  • Excessive reaction to taste, smell, texture e.g. of food

Question 647

How do we assess ASD?

Answer 647

• 3DI (parent interview)
• ADOS (Autism diagnostic observational schedule)
• Psychology Questionnaires
• School report
• Educational psychology assessment
• Graded
• Our assessment is a tool – not indicative of the individual’s experience

Question 648

About OCD

Answer 648

• Symptoms:
	• Obsessive thoughts
	• Compulsive actions
• Affects on life:
	• Slowness – getting to school, school work
	• Socialising
• Management:
	□ Antidepressants
	□ CBT for OCD

Obtrusive thoughts not controlled by the individual. The compulsive actions not necessarily linked to the thoughts but they’re what people do to try and manage the thoughts from happening - eg light switch to stop someone dying etc.

Question 649

What is CBT?

Answer 649

• pragmatic (specific)
• highly structured (goals)
• focused on current problems
• collaborative

Question 650

What is Oppositional Defiant Disorder (ODD)?

Answer 650

• “recurrent pattern of negativistic, defiant, disobedient and hostile behavior towards authority figures…”
• (1) often loses temper
(2) often argues with adults
(3) often actively defies or refuses to comply with adults’ requests or rules
(4) often deliberately annoys people
(5) often blames others for his or her mistakes or misbehavior
(6) is often touchy or easily annoyed by others
(7) is often angry and resentful
(8) is often spiteful and vindictive.

Have to have had the symptoms before the age of 8 and must have 4/8 symptoms.

Question 651

What is conduct disorder?

Answer 651

“repetitive and persistent pattern” of rule breaking or activity which violates other people’s basic rights

Aggression to people and animals:

(1) often bullies, threatens, or intimidates others
(2) often initiates physical fights
(3) has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle,)
(4) has been physically cruel to people
(5) has been physically cruel to animals
(6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
(7) has forced someone into sexual activity

Destruction of property

(8) has deliberately engaged in fire setting with the intention of causing serious damage
(9) has deliberately destroyed others’ property (other than by fire setting)

Deceitfulness or theft
(10) has broken into someone else’s house, building, or car
(11) often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)
(12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting; forgery)
Serious violations of rules
(13) often stays out at night despite parental prohibitions, beginning before age 13 years
(14) has run away from home at least twice while living in parental or parental surrogate home
(15) is often truant from school, beginning before age 13 years

One step further than ODD

Need to have 3/15 characteristics.

Question 652

What is the history of schizophrenia?

Answer 652

• In 1887, Emil Kraepelin the German Psychiatrist, isolated Dementia Preacox from other forms of psychosis
• The term schizophrenia was coined in 1910 by the Swiss psychiatrist Paul Eugen Bleuler
• First antipsychotic Chlorpromazine synthesized in 1950

Before this was thought that all psychosis was like one unit, no type was distinct.

Question 653

What are the symptoms of schizophrenia?

Answer 653

Acute schizophrenia - positive symptoms

- Hallucination
- Delusion
- Interference with thinking
- Some recover, some progress to…

Chronic symptoms - negative symptoms

- Apathy
- Lack of drive
- Slowness
- Social withdrawal

Positive symptoms respond well to anti-psychotic treatments, when progress into chronic makes it harder to treat.

Question 654

What is hallucination

Answer 654

False perception without an external stimulus, such as hearing voices, seeing things etc.

* Auditory: running commentary; voices discussing the person in third person; hearing one's own thoughts aloud (thought echo)
* Visual: may suggest an organic brain disease
* Olfactory: smelling gas
* Gustatory: can taste 'poison' in food
* Tactile: insects crawling upon skin, sexual sensations

Illusion - there is a stimuli but you’re not receiving it as it is, its just been changed for you. Hallucination is different as there is no stimuli there in the first place.

Different forms of auditory hallucinations. Running commentary common.

Tactile - very common in delirium treatments in alcohol intoxication. Sexual sensations can be common if the patient has delusional love affairs etc.

Question 655

What is delusion?

Answer 655

False perception without an external stimulus, such as hearing voices, seeing things etc.

* Auditory: running commentary; voices discussing the person in third person; hearing one's own thoughts aloud (thought echo)
* Visual: may suggest an organic brain disease
* Olfactory: smelling gas
* Gustatory: can taste 'poison' in food
* Tactile: insects crawling upon skin, sexual sensations

Illusion - there is a stimuli but you’re not receiving it as it is, its just been changed for you. Hallucination is different as there is no stimuli there in the first place.

Different forms of auditory hallucinations. Running commentary common.

Tactile - very common in delirium treatments in alcohol intoxication. Sexual sensations can be common if the patient has delusional love affairs etc.

Question 656

What is Schneider’s first rank symptoms of schizophrenia?

Answer 656

Proposed this group of symptoms but said they were in no way essential to diagnose schizophrenia.

Perception is real but perceived in a delusional way.

Question 657

About the ICD 10 criteria for diagnosing schizophrenia

Answer 657

Proposed this group of symptoms but said they were in no way essential to diagnose schizophrenia.

Perception is real but perceived in a delusional way.

Question 658

About F20.0 paranoid schizophrenia

Answer 658

The most common type.

Negative symptoms can be present but must not dominate the positive symptoms.

Question 659

About F20.1 hebephrenic schizophrenia

Answer 659

This presentation is getting much more rate in industrialised countries

Question 660

What is the epidemiology of schizophrenia?

Answer 660

Prevalence around 1% of population, and this is the same anywhere in the world.

Question 661

Does schizophrenia have a genetic component

Answer 661

There is a very strong relationship with genetics

Question 662

What is the biochemistry of schizophrenia?

Answer 662

Prevalence around 1% of population, and this is the same anywhere in the world.

Question 663

Neuroimaging of schizophrenia

Answer 663

Haas been proved that there are some structural changes in the brains of patients with schizophrenia. Interestingly, none of them are specific for schizophrenia however, so they can’t be used as diagnostic criteria.

Neuroimaging can help to exclude other causes - organic causes.

Question 664

What are the psychological factors of schizophrenia

Answer 664

Stereotyping

Double bind - in period of development, if parents are communicating with the child in a confusing way - calling to a child but sounding like rejection.

Expressed emotion - study on dorms.

Question 665

What is the social learning theory

Answer 665

Learning behaviour form others e.g. parents, and it is reinforced by the parents continuing to behave in this way

Question 666

About antipsychotic medication for schizophrenia

Answer 666

Good evidence to treat acute schizophrenia - mainly for positive symptoms

Question 667

What are the 2 main types of antipsychotic medication for schizophrenia?

Answer 667

Typical came earlier than atypical (aka second generation)

Extra pyramidal side effects - shakes, movement problems, rigidity, involuntary facial movements, eye rolling etc. Can get so bad that people may have to stop treatment.

Question 668

Course and outcome of schizophrenia

Answer 668

Typical came earlier than atypical (aka second generation)

Extra pyramidal side effects - shakes, movement problems, rigidity, involuntary facial movements, eye rolling etc. Can get so bad that people may have to stop treatment.

Roughly half patients have multiple episodes…Static impairment means that it isn’t getting worse.

Question 669

What is the difference between neurosis and psychosis?

Answer 669

Neurosis is anything where you feel negative. Psychosis is where you lose touch with reality and you lose insight, which is the critical distinction. You don’t know that you are ill if you are psychotic. This makes it more dangerous as you don’t seek help and you also believe your own delusions.

Question 670

About drug induced psychosis

Answer 670

If drug induced need to stop the drug. Change the environment to lose the cues.

Family history - has a genetic factor so can make someone predisposed, meaning that any drugs etc can have an ever greater risk than those without this predisposition.

Question 671

About alcohol withdrawal and psychosis

Answer 671

Of all the drugs, we chose to legalise potentially the worst one because this is the only one which you can die from the withdrawal symptoms (10% mortality in normal individuals, up to 30% if have another comorbidity eg diabetes or a chest infection etc).

Alcohol works on GABA which is to do with inhibition. Higher level functioning parts of the brain (planning, scheduling, attention etc) are inhibited. The remaining active parts of the brain is the brain stem - eg breathing, and also the limbic system which is to do with the emotional response. Therefore you start to display behaviours like fighting, doing inappropriate emotionally driven things as you are still able to react in this way but not reason.

If you drink habitually you constantly suppress the neocortex. You get tolerance (needing higher amounts to get the same effect) and withdrawal. If drinking a lot daily then you are permanently inhibiting brain function. If you suddenly stop drinking then the brain turns back on what you’ve turned on - get massive activation, brain switching on all at once, and this is why you get terrible withdrawal - hallucinations (usually visual), delusions, tremors. If this is untreated there is a high mortality rate. Treated using a drug that inhibits a measure of the same thing, using benzodiazepine (also a GABA inhibitor). If you’re not used to it then it will totally inhibit you and put you to sleep.

When taking these drugs while withdrawing from alcohol your body biologically has what the alcohol was doing so you don’t get the withdrawal symptoms. These drugs are however very addictive so to come off of these we lower the dose daily over around 8-10 days. Any longer than this then it is addiction territory. Must NOT drink whilst on these drugs or will get respiratory depression. However, less likely to drink on this medication as they are not biologically n withdrawal any more anyway.

Takes about 48 hours for withdrawal effects from alcohol to take place.

Question 672

About psychosis and comorbidity

Answer 672

You can get psychosis with other conditions; psychotic depression for example. There is some overlap with depression which is interesting as there is a neurosis and a psychosis.

Question 673

Top 3 most common delusions

Answer 673

1. Persecution/paranoia
2. Grandiosity
3. Delusions where you believe you are some key figure eg Christ

Question 674

Talking to patients about hallucinations

Answer 674

Patients will talk to you about their hallucinations openly. This shows that they truly believe that they are real. They will also frequently ask you to stop the person they can hear talking etc. By them approaching you this show that they clearly lack insight. They can’t realise in the moment how this seems to you who can see/hear the things they can. Their behaviour is also very consistent with the delusions and hallucinations. They are out of touch with our reality but within their own the are very consistent. They behave as though what they believe they are/see/hear is actual reality.

Question 675

Psychosis and depression

Answer 675

Patients will talk to you about their hallucinations openly. This shows that they truly believe that they are real. They will also frequently ask you to stop the person they can hear talking etc. By them approaching you this show that they clearly lack insight. They can’t realise in the moment how this seems to you who can see/hear the things they can. Their behaviour is also very consistent with the delusions and hallucinations. They are out of touch with our reality but within their own the are very consistent. They behave as though what they believe they are/see/hear is actual reality.

Question 676

What is the definition of social psychology?

Answer 676

Social psychology is the scientific study of the way in which people’s thoughts, feelings and behaviours are influences by the real or imagined presence of other people.
- Allport (1968, p3)

Question 677

What is social psychology?

Answer 677

Social psychology is quite broad. Thoughts are not easy to get at, might ask people to verbalise them but people don’t always express accurately what they think. Self report not always the most reliable method. Could do other things such as measuring heart rate, skin conductance rate, etc.

One really crucial part is about how people are influenced by others. The most extreme part of interest is obedience, and Stanley Milgram’s work.

Question 678

What was Milgram’s experiment on obedience?

Answer 678

Classic experiment on obedience.

Cover story: experiment to investigate the effects fo punishment on learning.
Not the true intention - wanted to see if you put people into a situation where they have to apply deadly electric shocks to others, would they do it?

One teacher (real participant), one learner (a confederate of the experimenter), both male, paired association learning task.

Learner strapped to an ‘electric chair’ that was allegedly attached to a shock generator in an adjacent room.

Shock generator: 30 switches, marker with voltage that ranged from 15 to 450 volts, 15-volt increments from one switch to the next.

Participants instructed to give a shock to the learner each time he gave a wrong response and to increase the shock level by one each time. The switches had indications of the severity of the shock levels (mild-danger).

[PIC]

Series of prods delivered in order when p’s refused to continue

- 'please continue' or 'please go on'
- 'the experiment requires that you continue'
- 'it is absolutely essential that you continue'
- 'you have no other choice, you must go on'

Dependent measure: maximum shock administered before the participant refused to continue.

Results: when teacher could neither see nor hear the learner, no participant stopped before 300 volts (when the learner seemed to band on the wall and no longer answered). 65% of the participants showed maximum obedience (ie. Administered 450 volts three times), mean maximum shock, 405 volts.

Conducted a series of experiments on obedience from early 60s to mid 70s when he published ‘Obedience to Authority’.

Began experiments following second world war to try and find some explanation of why people behaved in that way and killed so many people. Was it to do with German society, child rearing, something specific to that particular society. However, Milgram was more hesitant and said there were certain social principles at work that applied to any human individual so wanted to find out more.

Looked specifically for a wide variety of people (professions, etc). When people who volunteered arrived, they met another person who knew about the underlying aims of the experiment and was an actor. They then drew lots on which was going to be the teacher or the learner, but this was fixed so that the real participant was always the teacher. They then did a word association task.

The real aim of the shock task was to see how far people would go in this procedure before they refused to go further.

Found that around 2/3 of people went all the way to the highest shock levels.

Question 679

What are some variations on Milgrams experiment?

Answer 679

1. Closeness of the victim - not just in terms of physical closeness but also an element of psychological closeness. Can they see and/or hear the victim, is the victim in the same room? The last variation was called ‘touch proximity’ where the person had to take the victims hand and press it down to apply the shock. 30% still went all the way at touch proximity, 40% in the same room but not touching.
2. Authority of the experimenter (eg absent experimenter, office building location) - the experimenter being called away by a phone call and telling the participant to continue in his absence, % of people who go all the way drops but still 20%, however sometimes people started to stop following the rules and not increase the shock, or would lie to the experimenter when asked if they did as requested. When taken into a more everyday setting (office) there is more doubt about its legitimacy than in the scientific university environment so falls slightly.
3. Group conditions (eg confederate administers shock, confederates rebel) - not actually the participants task to administer the shocks, they just read the questions. When it’s not the person themselves who administers the shock they were almost all happy to continue the procedure. They did not intervene. Tendency to look the other way and not take responsibility for the situation. However, if they has already seen others refusing to administer the shocks, this made them more likely to do the same.

Another variation was when the experimenter was more friendly, but the confederate (actor) wasn’t as likeable. As the experimenter was less forceful, less likely to do it. The important relationship here is between the experimenter and the participant, not so much the victim.

Question 680

What causes obedience?

Answer 680

Milgram’s explanation
People move from a self-directed, autonomous state to an agentic state: They come to see themselves as an agent who acts on behalf of someone else.

Evolutionarily, people would be more likely to survive and pass on their genes if they were obedient so some innate tendency. Obedience is also typically associated with reward.

Ideology of what you’re doing - eg here it was about helping science and how important this is in their opinion. The reason that youre doing it.

Milgram suggested things happen when people move into the agentic state - they become tuned (pay more attention to the experimenter, not so much the victim), redefining the meaning of the situation (see it as supporting science not hurting people, change the meaning of their actions), loss of personal responsibility (because someone else has told them to do it they distance themselves from their actions), self evaluation is inhibited (because they are taking less responsibility for their actions so don’t feel the same guilt/shame/etc)

Milgram said people can come in and out of the agentic state, so to break out of the chain then they have to have come out of it. May happen when the victims protests become too strong.

Evidence for the agentic state and for loss of responsibility is not always clear cut. People have tried to do experiments later on and results not always the same. Tried to replicate in states (Berger) tried to get it through but with amended procedure. People were screened beforehand for psychological and vulnerability factors. The experiment was then administered by a clinical psychologist and could intervene if necessary. More important change however was that the shocks only went up to 150 volts and the only thing they were interested in was if people would go beyond 150 volts. 150 volts was the point at which people started to protest in Milgram’s experiment. Obedience rate didn’t change significantly from the 60s - this still happens today. They also tried to screen people out who may have had knowledge of the previous experiments.

Question 681

What are the properties of an agentic state?

Answer 681

Properties of the agentic state:
• Tuning ie maximal receptivity to the authority while the learner’s protests are shut out
• Redefining the meaning of the situation as one of supporting science
• Loss of personal responsibility
Inhibition of self-evaluation

Question 682

What might be some criticisms on the Milgram experiment?

Answer 682

Ethical concerns - not informed consent as didn’t know what was actually being tested.

Data interpretation - sample may not be representative, self selected sample in response to an advert. May not be representative of all people.

Evidence that these kind of things happen in other situations. Heufling asked 22 psychiatric nurses and observed them in a situation where they had placed a placebo on the ward of a drug where the maximum dose is stated and someone instructs the nurse to administer over this dose and he will come and sign the papers after, and 21/22 nurses did this.

Other criticisms include, maybe people didn’t think the situation was real. They assumed that the psychologists weren’t doing what they said they were doing. However video evidence of the experiments show that the participants experience visual stress symptoms which would have been difficult to fake if they didn’t believe the situation.

Some others question whether it is actually obedience that these experiments test. If it was then the participants would have reacted in a particular way to the prods. The opposite was often the case after the 4th prod, which is the one which actually sounded the most like an order.
Ethical concerns - not informed consent as didn’t know what was actually being tested.

Data interpretation - sample may not be representative, self selected sample in response to an advert. May not be representative of all people.

Evidence that these kind of things happen in other situations. Heufling asked 22 psychiatric nurses and observed them in a situation where they had placed a placebo on the ward of a drug where the maximum dose is stated and someone instructs the nurse to administer over this dose and he will come and sign the papers after, and 21/22 nurses did this.

Other criticisms include, maybe people didn’t think the situation was real. They assumed that the psychologists weren’t doing what they said they were doing. However video evidence of the experiments show that the participants experience visual stress symptoms which would have been difficult to fake if they didn’t believe the situation.

Some others question whether it is actually obedience that these experiments test. If it was then the participants would have reacted in a particular way to the prods. The opposite was often the case after the 4th prod, which is the one which actually sounded the most like an order.

Question 683

Social identity explained

Answer 683

How people behave depend son how much they perceive a shared identity with the experimenter or the victim. At the beginning there is a shared identity with the experimenter (invited them to come, scientific authority, etc). However, as soon as participants are not as strongly encouraged to put themselves into the same category as the experimenter the obedience levels fall (could be due to spatial arrangements etc, experimenter not being in the room, or fi they are less prototypical of the science category eg in the office building instead of university, or simply because participant becomes more ware of the victim).

This is the more recent idea about obedience. Even though these experiments are very important for our understanding of some of these issues, we also need to see the explanations slightly differently now.

Lower educational level, higher in authoritarian values more likely to go ahead. No/very few gender differences were found

Question 684

What is the definition of conformity?

Answer 684

A change of an individual’s behaviours and opinions when the learn that the majority of the people in a group they belong to behave differently or hold different opinions.

Question 685

What is majority influence and how did Sherif investigate it (1935, 1936)?

Answer 685

This is part of a group and the relationships in that groups are of same hierarchy, no authority power difference, adopt these different behaviours because they want to.

Sherif used autokinetic effect (completely dark room, single point of light which you focus on and over time this seems to move. It is actually stationary but what moves is your eyes, and as you have no reference point as its completely dark, it seems to be the light that this moving.

Question 686

What did Sherif find from his 1935 experiment on majority influence?

Answer 686

At first where people di it on their own, then median judgement. Sessions 2, 3 and 4 carried out as part of a group. We see that the very different judgements when alone start to converge when part of a group. Sherif called this the funnelling effect.

Other version where did it first in a group and then on their own. In this case it isn’t an exact reverse of the first version, the answers only slightly split off when do it on their own, so seems that to an extent they have internalised the norm they found in the group situation.

Question 687

What was the Asch experiment on majority influence in 1951, 1952)?

Answer 687

Was also interested and wanted to see if this also happens when people are exposed to a situation where others are confederates and are instructed to give judgements which were clearly wrong. Had to match standard lines with comparison lines. There was only one true participant, but 6 confederates instructed to give the same unanimous answer in 12/18 times.

Participants had to match a standard line to one of three comparison lines.

In 36.8% of the trials, conformity to the wrong judgements of the majority was observed, however there were strong individual differences. Only about 5% shows conformity on al trials, 24% remained independent all the time, but the majority gave a different anwser at least once.

Question 688

What was the Mari and Arai (2010) experiment on majority influence?

Answer 688

Asch experiment has been repeated many times but has been changes slightly to make it more efficient as original method requires a lot of confederates.

Mori and Arai have all people are participants, but give them polarised glasses, with one person seeing the line as longer than others which gives the advantage that don’t have to do the acting of the confederates. On the whole the results are relatively similar to what Asch found much earlier.

Question 689

What was the Teunissen et al (2010) experiment on majority influence?

Answer 689

People have looked to take this into more directly relevant domains. Looking here at adolescent self reported readiness to drink alcohol in certain situations. Carried out on Dutch boys who interacted on what they saw as a chat room but actually was set up so that the participant was interacting with e-confederates which has pre-programmed responses. They were given 10 situations in which they were meant to indicate if they would drink alcohol or not in the situation and the e-confederates would either give a response which was more in favour of alcohol than the typical response for boys of that age, or they would give a more anti-alcohol response. Also manipulated whether these peers were supposedly popular or not. They then looked at the extent that the real participant would respond after being exposed to these alleged peers.

Unsurprisingly, there was more conformity when the peers were seen as more popular, and interestingly also when the response was more anti-alcohol. Maybe feel permission to voice the opinion when a popular person has said it.

Another area that has been investigated is star rating on products. People are influenced by these ratings. This can be manipulated by companies.

Question 690

Why do people conform?

Answer 690

Suggested that people have 2 goals - want to be correct about what they think and want to make a good impression on other people. Sometimes these two are in conflict.

The distinction between the 2 forms of social influence is important.
Informational - when they think the other people have the right answer and they follow them to be correct.
Normative - when they want to make a good impression on other people.

In Asch’s experiment its clear that they wanted to make a good impression, as the answer was clear, whilst Sherif was more informational.

Question 691

What is informational vs normative influence?

Answer 691

In normative - you comply. However, compliance means publicly you go along with it, but privately you actually disagree. If you ask the person on their own they wouldn’t stick to the wrong answers of the group.

Informational is different though - people look to others for the answer and they internalise it, meaning they don’t only go along with it publicly but also privately so they maintained the norm when away from the situation.

Question 692

What was the Moscovici, Lage and Naffrechoux (1969) experiment on minority influence?

Answer 692

Argued that the key influential person was typically not of authority. Instead of having a majority instructed to give answers to an individual (such as in Asch experiment) it was a minority who did this in order to instruct the group.

6 person group with 2 confederates instructed to say a wrong answer about slide colour.

Interesting because they found that the minority could have an influence and even though the influence was not massive, in the consistent condition 32% of the participants gave at least 1 green response when all slides were blue, and 8% of responses were all green when all the slides were blue.

Second variation, he measured people colour perception for green, and had shifted and even the case in individuals who hasn’t publicly said green but influenced on a more latent level.

This suggests that the influence happens both directly and indirectly.

Question 693

What was the Moscovici and Personnaz (1980) experiment on minority influence?

Answer 693

Did this in pairs with one being a confederate.

Was particularly interested in how judgement of after image changes depending on if been exposed to majority or minority influence.

If people are low on the graph this suggests they have seen the slide as blue. If higher then suggests they have seen green. Majority influence start seeing blue and continue to do so.

If people are exposed to the green response and think it is a minority then they also start off with blue and then start to see green as their after image moves towards the purple point.

On an indirect level something seems to be going on, even though not publicly. Suggested that people pay a lot of attention to what the minority says as they try to work out why they say these things. In doing so, cognitively something changes, they really start to consider the issue and think maybe there’s something behind it and might be converted to that opinion, even though often not publicly.

Question 694

What is the definition of attitude?

Answer 694

A mental and neural state of readiness organised through experience, exerting a directive or dynamic influence upon the individual’s response to all objects and situations with which it is related”
Allport, 1935, p810

Question 695

What is the three component model to attitudes?

Answer 695

Early and Chaiken (1993, 1998)

• Input
• How you feel
• What you do in response (behavioural)

Question 696

What are the functions of attitudes?

Answer 696

Katz (1960): attitudes have 4 main functions
• Knowledge: provides orientation, allows object appraisal without having to start from scratch each time
• Instrumentality: means to an end/goal eg obtain social approval from important others, maximise rewards, minimise punishments
• Ego defence: protecting one’s self-esteem
• Value expressiveness: allowing the expression of values that identify and define individuals, self-expression

Instrumental function means that its an end to a goal in order to obtain the approval of others we maximise rewards and minimise punishments - goes towards conformity route. Might have these as beneficial.

Ego defence - important - if have beliefs that people from a particular university are worse than yours, then this serves as protecting your self-esteem. This could be in all sorts of other domains as well.

Value expressiveness - identify us so our attitudes partly make us who we are and allow us to express ourselves.

Question 697

What are summated ratings of attitudes (Likert 1932)

Answer 697

Many methods but this is most likely to be come across.

This is where people response to certain statements on a scale from strongly agree to strongly disagree. When these scales are developed they first have to collect a really large number of statements that might express the attitude in some way. These are then asked to be responded to on the scale on how far the individual agrees with them.

Important that acquiescent bias is avoided. Need to word the statements so that people aren’t just agreeing to a particular statement. Agreeing should mean you have a positive attitude to some statements and negative attitude to others. Then on the scoring system some items have their scoring reversed so that get an indication of what extend people feel positively or negatively to a statement.

The problem with summing up and taking a mean of scores is that you assume that the distance between the scale point sis the same. This is not always the case (eg different between 4 and 5 is not always the same as between 3 and 4). If you cant be sure that the difference between the points is the same and significant then you shouldn’t be using these methods.

Question 698

What is the DOPRAQ-16?

Answer 698

Koutsosimou et al 2013

16 items to assess relationship between doctors and patients as is important issue. Measure both from patient and doctors point of view and this might indicate particular problems that you need to take account of and work on.

Question 699

What are the problems with LaPiere’s study?

Answer 699

• His accompaniment will have probably played a big role
• Issue of accountability
• May not have been the same people who were on the door as responded
• Also was a time lag between the events so things could have changed and changes attitudes between these times

Question 700

What is the theory of reasoned action?

Answer 700

Fishbein and Ajzen 1974

Also takes into account whether you believe you can do this thing which has an effect on intention and behaviour directly.

This is shown in dieting, studies have shown the perceived behavioural control is very important.

Question 701

About Madden, Ellen and Ajzen work on attitudes 1992….

Answer 701

Things that are relatively easy to control (eg taking vitamins) these models are pretty similar in how good they are. However, things that are harder to control (eg hours of sleep per night) then less so as take into account how much control people think they have over that behaviour.

Other models important in seeing whether people would be able to or be willing to change their behaviours for a positive change.

Question 702

About changing attitudes through persuasion

Answer 702

Early models of persuasion looked at factors like the communicator (is this being communicated by someone thought to be an expert or not for example), the nature of the message (is it one sided? Or two sided?), nature of audients (more intelligent audiences like a 2 sided argument, audience things yeh but what if?), and partly the situation in which the communication is made.

Question 703

Wha t is the sleeper effect?

Answer 703

The sleeper effect: if you try to persuade people and not particularly persuaded at the beginning as source isn’t what they are keen on but over time they forget the source but the message stays. The message become strong but only after a while.

Question 704

What is the elaboration-likelihood model?

Answer 704

Petter and Cacioppo 1986

If high as highly motivated to process the message, have the intelligence to do so and are interested and it relates to them then they will take a central route in which they carefully process the information in the message and the changing of their attitude depends o the message of the argument.

If these things are ow they will take a peripheral route involving heuristic processing (is the message from an expert, are they physically attractive, etc). An example of this is car adverts with attractive women in them (but not so much if the audience was a car expert).

Question 705

What are the seven important factors in group definitions?

Answer 705

Johnson and Johnson 1987

1. Interaction
2. Self-perception of belonging to a group
3. Interdependent (‘being in the same boat’)
4. Purpose of goal achievement
5. Purpose of need satisfaction
6. Structure through roles and norms
7. Mutual influence

Question 706

What is social facilitation?

Answer 706

Improvement of the performance of other sin the presence of others

Question 707

What is social loafing?

Answer 707

Investing less effort whoen part of a group

Question 708

What are the possible changes of the effects of the present of others on performance?

Answer 708

Social Facilitation

Social Loafing

Question 709

What is the drive theory of social facilitation experiment?

Answer 709

Zajonc, (1965)

Did experiment with cockroaches - easy maze and harder maze. If shine light on them they run to find the dark again.

He let cockroaches run through these mazes and either did or didn’t place other cockroaches in glass containers around them. When they were watched by other cockroaches they ran through the simple maze more quickly, but took longer on the complicated maze. This is because the complicated maze is not a dominant response so the presence of an audience damages their response.

Question 710

What was found about social loafing by Latané, Williams and Harkins (1979)?

Answer 710

Got people to shout in groups of difference sizes. In larger groups they found that the performance of individuals goes down as don’t have to try so hard. Some of that loss from what happens in real groups is due to coordination loss. Also loss from reduced effort.

Question 711

What was the Stasser and Titus (1985) study on group mentality?

Answer 711

Based on a real study.
Have a group of 4 people and they are meant to decide which of 2 candidates is better for a job there are 2 conditions:

shared information condition where all members of the group have exactly the same information on the candidates.

In the group, the information is distributed amongst different people.as a group they have the same information as the other type, but the problem is that not everyone has the same information - they need to share it. What happens is people don’t share well enough and as a result they make different decisions.

End up making a sub-optimal decision in the seconds condition compared to the first.

This illustrates the importance of effective information sharing.

Question 712

What was the Larson, Jr., Christensen, Franz and Abbott (1998) study on group mentality?

Answer 712

Similar to the job interview one but in a medical context. 22 nurses instructed to give dosage above maximum.

Tend to focus on the shared information - like to have approval, people like to agree with others, also if something is not shared might assume that it’s not important. As humans we fight against the wish for conformity and for things to go smoothly and to not rock the boat. Can be difficult to disagree with people.

Important to be aware that these human difficulties can stand in the way of making optimal decisions.

Question 713

What is anxiety?

Answer 713

Normal anxiety is an expected, normal, transient response to stress; it may be a necessary cue for adaptation and coping.

Pathological anxiety results from an unknown internal stimulus, or is inappropriate or excessive when compared with existing external stimulus.

Anxiety is not one disorder. Majority of neurotic disorders fall under anxiety (eg OCD, PTSD, panic attacks, panic disorder, generalised anxiety disorder).

Main focus of lecture on GAD as most common (7% of world’s population at any one time). Almost rivals depression in prevalence. There is a massive overlap between depression and anxiety though, occurs together in about 78% of people.

In some respects anxiety is a normal human disorder.

Needs to be present for 6 months before can be diagnosed.

Anxiety is a natural response and is needed for survival so don’t want to eradicate it entirely. Body’s preparatory mechanism to cope with stress. Need a certain level of anxiety in order to do anything and take action.

Separate out the pathology by duration, intensity and impact on daily life.

Debate in literature come from CBT - suggest appraisal of stimulus that results in anxiety - and not the stimulus itself but what you think of it.

GAD - don’t know the stimulus but constantly anxious.

• Is a negative emotion that occurs in response to perceived threats and an inability to predict or control the threatening situation
• Anxiety and depression tend to co-occur
• Anxiety is common in cardiac patients
• Findings on the role of anxiety as a prognostic factors are mixed
• Many studies have found a relationship between anxiety and adverse clinical events
• Associated with poor health status and quality of life
• Shen et al (2008) in a study of 735 older men (60+) without a history of CHD found that anxiety characteristics independently ad prospectively predicted MI incidence after controlling for confounders (age, education, marital status, fasting glucose, BMI, HDL, systolic BP)
• These relationships remained significant after controlling for health behaviours.

If you can control the stressor to a degree, it creates less anxiety.

Anxiety in cardiac patients greatly reduces life expectancy and increases risk of another MI. if you treat the psychological complaint, the risk of dying from another MI goes down to the level of someone who never had it in the first place. Clear that psychological treatment can have physical benefits.

- Maladaptive thoughts
- Catastrophizing/Magnification
- Minimisation (downplaying things)

Social support most protective think you can get psychologically - even if you don’t use it.

We find things less bothersome if it is controllable by us.

Question 714

What is the criteria in distinguishing pathological anxiety?

Answer 714

• Autonomy
  
  • Intensity
  • Duration
  • Behaviour

Issues/problems with this view? We all do the weird things at some times in our lives. What is occurring pathologically is not a really abnormal thing but is a much more intense situation. Not like psychosis where you lose insight and touch with reality. Insight is not lost in anxiety disorders. However, this insight makes the anxiety worse. You know you’re doing something that you cant control - an element of magical thinking and also an element of compulsion.

Question 715

What is the existential view of anxiety?

Answer 715

This would say that anxiety is absolutely necessary and useful, and if we are all deeply engaged in living then we should all be anxious. Has been found that normal individuals are positively biased (more good things will happen to them than reality, and less bad things - depressed individuals are actually more accurate).

Question 716

Why is the medical/biological model of anxiety?

Answer 716

SSRIs most current treatment, suggests that the mann biological candidate is serotonin so there is a biological element.

Question 717

What are the manifestations of anxiety?

Answer 717

• Affective symptoms (feelings of edginess, ‘losing control’, ‘going to die’)
• Physical symptoms (tachycardia, diarrhoea, dizziness, lightheadedness)
• Behaviour (avoidance, compulsions)
• Cognitions (apprehension, worry, obsessions)

Question 718

What is generalised anxiety disorder (GAD)?

Answer 718

• Uncontrollable, persistent anxiety and worry
• Constant level of anxiety unrelated to specific stimulus
• People with GAD worry about their health and daily concerns
• Personality style of catastrophising
• Usually do not seek treatment
• Difficult to treat
• More common among women than men
• 6 months continuous duration

These things have to be present constantly for 6 months in order to be diagnosed.

Less than 30% of patients with anxiety disorders seek treatment.

Women to men 2:1

Question 719

What is the prevalence of GAD?

Answer 719

Lifetime prevalence between 4.3 and 5.9% in European epidemiological studies.

Major issue - comorbidity with depression

Question 720

About substance-induced anxiety disorder

Answer 720

Drug related
Intoxication
- Caffeine
- Cocaine

Withdrawal

- Alcohol
- Opioid and opiates
- Sedative-hypnotics

Question 721

What is the treatment of substance induced anxiety disorder?

Answer 721

Pharmacotherapy = SSRIs, antidepressants, anxiolytics

Psychological therapy = cognitive, emotional, behavioural, systematic desensitisation, exposure

Question 722

What are techniques used in intervention studies in anxiety/substance induced anxiety?

Answer 722

• Relaxation training
• Cognitive behavioural stress management
• Meditation
• Group emotional support
• Cognitive therapy

Question 723

What is the prognosis of anxiety?

Answer 723

Only 40% of people seek help - afraid to leave house, afraid to drive, afraid to see GP, what if its serious, aware of not being in a normal frame of mind, etc.

Question 724

Aah are the various anxiety disorders?

Answer 724

• Panic disorder with or without agoraphobia
• Generalised anxiety disorder
• Obsessive-compulsive disorder
• Acute stress disorder
• Social phobia
• Simple phobia
• Anxiety disorder fur to medical condition
• Substance-induced anxiety disorder
• Anxiety disorder NOS

Question 725

What is anxiety prevalence?

Answer 725

Lifetime prevalence between 4.3 and 5.9% in European epidemiological studies.

Major issue - comorbidity especially with major depression where roughly 6/10 individuals with GAD will simultaneously have a major depression diagnosis.

Question 726

What si the ethology of generalised anxiety disorder (GAD)?

Answer 726

Lifetime prevalence between 4.3 and 5.9% in European epidemiological studies.

Major issue - comorbidity especially with major depression where roughly 6/10 individuals with GAD will simultaneously have a major depression diagnosis.

Question 727

Anxiety disorder due to medical condition

Answer 727

Medical illnesses:

- Endocrinologic (hyperthyroidism, hyperparathyroidism, hypoglycaemia, PMS)
- Cardiovascular (angina, arrhythmias, etc)
- Neoplastic (pheocromocytoma, insulinoma, carcinoid)
- Neurologic (vestibular dysfunction, seizures, TIA ('mini stroke'))
- Pulmonary (COPD, PE, asthma)

Question 728

The future of anxiety treatment and techniques

Answer 728

Poulin, Brown, Dillard and Smith (2013)
Helping others significantly eliminates association between stress and mortality in 5 year prospective study.

Keller, Litzelman, Wisk, Maddox, Cheng, Creswell and Witt (2013)
Perception of stress being harmful and amount associated with mortality but not if don’t’ perceive stress as harmful.

Jamieson, Nock and Mendes (2012)
Appraising stress in a positive way resulted in adaptive cardiovascular stress responses.

Big literature on social helping to get better. Volunteer to help people that are less fortunate than yourself. In terms of cognitive bias - tend to have habitual thought that is only you. When in a depressed or anxious state then you may know it is only focussed on yourself.

Perception of the stress being harmful and of mortality.

Keller at al. - Found that if you believe stress is negative then it is, if you believe it isn’t bad then it stops being bad.

Question 729

Prognosis of anxiety

Answer 729

• Only 40% of sufferers seek treatment
• 5 years after initiation of treatment only 40% show partial or full remission
• Those with comorbid conditions are harder to treat

Only 40% of people seek help - afraid to leave house, afraid to drive, afraid to see GP, what if its serious, aware of not being in a normal frame of mind, etc.

Question 730

What are the signs and symptoms of psychosis?

Answer 730

• Delusions
• Hallucinations
• Bizarre behaviour or posture
• Disorganised speech

Question 731

What is the standard model of delusions?

Answer 731

• Jaspers (1959) – The standard model
  
  • False judgements
  • Extraordinary conviction
  • Impervious to counterargument
  • Impossible content

Question 732

What are themes of delusions?

Answer 732

• Persecutory
• Morbid jealousy
• Love
• Misidentification - Capgras, Fregoli
• Grandiose
• Religious
• Guilt/worthlessness
• Poverty
• Hypochondriacal
• Infestation
• Communicated - la folie a deux

Question 733

What are primary and secondary delusions?

Answer 733

Primary - ununderstandable

Secondary - understandable given what we know about the patient’s mood, life history etc

Question 734

What are over-valued ideas?

Answer 734

An acceptable, comprehensible idea which is pursued beyond the bounds of reason

Question 735

What are hallucinations?

Answer 735

False perception without an external stimulus, such as hearing voices, seeing things, etc

- Auditory: running commentary, voice discussing the person in third person, hearing one's own thoughts aloud (thought echo)
- Visual: may suggest an organic brain disease
- Olfactory: smelling gas
- Gustatory: can taste 'poison' in food
- Tactile: insects crawling upon skin, sexual sensations

Question 736

What are pseudohallucinations?

Answer 736

• Lacking in some quality of hallucinations
• Take place in ‘inner space’
• Patient is aware that they are not real

Question 737

About bizarre behaviour and posture in psychosis?

Answer 737

• Catatonia
• Grimacing
• Waxy flexibility
• Psychological pillow

Question 738

What are the problems with process in formal though disorder?

Answer 738

• Acceleration
• Retardation
• Circumstantial
• Derailment
• Fusion
• Perseveration

Question 739

About passivity in formal though disorder

Answer 739

Control over thoughts

- Withdrawal
- Broadcast
- Insertion

Question 740

What is psychosis?

Answer 740

• Categorical vs dimensional approach
• How do we decide when someone is psychotic?
• 5-8% of population hear voices
• 10-15% of population delusions

Question 741

What is the differential diagnosis of psychosis?

Answer 741

○ Schizophrenia
○ Schizoaffective disorder
○ Brief psychotic episode
○ Substance misuse
○ Mood disorder with psychosis
○ Personality disorder
○ Epilepsy
○ Delirium
○ Dementia
○ Brain tumour
○ Stroke
○ Ganser syndrome
○ Delusional disorder
○ Malingering
○ Delirium tremens

Question 742

Epidemiology of schizophrenia

Answer 742

• 20 per 100,000 per year
• 0.5-1% population
• Occur sin all cultures
• Males age onset 28
• Females age onset 32

Question 743

Aetiology of psychosis

Answer 743

• Winter births
• Left handed
• Obstetric complications
• Urban birth
• 2nd generation immigration (Africa and Caribbean)
• South Asian
• Cannabis

Question 744

What is the genetic link between twins in schizophrenia?

Answer 744

48%

Question 745

What is the biochemistry of schizophrenia?

Answer 745

Dopamine hypothesis

- Amphetamine psychosis
- Antipsychotic action

Serotonin
- LSD psychosis

Excitatory amino acids
- PCP

Question 746

About neuroimaging in schizophrenia

Answer 746

• Enlarged lateral ventricles
• Left temporal lobe abnormalities
• Broca’s area in hallucinations
• Exclude organic causes
• Brain volume reduction 3%
• Significant loss of grey matter, up to 25%
• Parietal, temporal, frontal loss

Question 747

What are the psychological factors in schizophrenia?

Answer 747

• “Schizophrenogenic mother” and double blind
• Expressed emotion - predicts relapse
• Life events - 3 weeks prior to relapse

Question 748

Psychodynamic explanations of schizophrenia

Answer 748

Psychological conflicts usually arise in childhood, result of problems and conflicts between the developing personality (the ID, ego and superego).

Manifest as ‘ego defence mechanism’ eg repression, projection, denial, regression, sublimation, displacement, humour, rationality and intellectualisation.

Question 749

Family systems theory of schizophrenia

Answer 749

• The psychoanalytical tradition (the influence of the family on abnormal behaviour)
• Systems thinking (idea that things are best understood by looking at the relationships between a set of entities)
• Family set of interacting entities

Question 750

Neuropsychology of schizophrenia

Answer 750

• Intellectual impairment in negative syndrome
• Some premorbid IQ deficit
• Attention - poorer information processing
• Perception - impairment in picture and face recognition
• Executive function - frontal lobe

Question 751

Cognitive psychology of schizpphrenia

Answer 751

• Filter theories/internal monitoring - unable to ‘filter out’ irrelevant info, misinterpret as external rather than internal source
• Overinclusive thinking
• Theory of mind

Question 752

Social learning theory of schizophrenia

Answer 752

• Consequence of faulty learning
• Children who do not receive reinforcement early in their lives will put larger attention into irrelevant environmental cues
• Bizarre behaviour by parents is copied by children
• Parents then reinforce this behaviour and the behaviour

Question 753

Cognitive behavioural model of schizophrenia

Answer 753

• Breakdown of relationship between information that has already been stored in memory and new, incoming information eg schemas
• Sensory overload and do not know which aspects of a situation to
• Internal thoughts are attributed to external sources

Question 754

Frith 1992 - schizophrenia

Answer 754

• Unable to distinguish between actions generated externally and those generated internally
• Inability to generate willed actions, to monitor willed action, to monitor beliefs and intentions of others
• Specifically a disconnection between frontal and posterior areas of the brain
• In people with schizophrenia, this differentiation between schemas and new situations does not occur
• There is a confusion between internal events and external stimuli and can result in the experience of hallucinations

Question 755

What is a neurodevelopmental disorder?

Answer 755

Neurodevelopmental: means that the primary brain insult or pathology occurs during brain development, long before the illness is clinically manifest.

Question 756

What sit eh neurodevelopmental hypothesis of schizophrenia?

Answer 756

• Brain abnormalities: increased ventircular size and decreased frontal and temporal volume are present at the onset of the disorder
• Evidence of pregnancy and birth complications, season’s of birth effect and inconclusive evidence for viral influences
• Childhood antecedents of schizophrenia
• Neuropathological evidence for neuronal disorganisation

Question 757

What is evidence for schizophrenia being a neurodevelopment disorder?

Answer 757

Evidence:

- Minor physical abnormalities
- Soft neurological signs
- Childhood antecedents
- Reduced cortical/cerebral volume predating the onset of illness
- Abnormalities of cerebral lateralisation

Possible causes:

- Pregnancy and birth complications
- Prenatal viral exposure

Question 758

What investigations are done into schizophrenia?

Answer 758

Rule out organic causes

- CT head
- Bloods (infection, metabolic abnormalities)
- ?Auto-immune screen
- EEG

Baseline before starting treatment

- Glucose
- Cholesterol
- ECG
- Prolactin

Question 759

What is the course and outcome in schizophrenia?

Answer 759

• Duration of untreated psychosis (DUP) is a predictor of outcome
• 2 fold increase I standardised mortality ratio, conservatively
• Higher suicide rate (?up to 7%, usually near onset)
• Physical health - higher rate of MI, stroke, diabetes
• 80-90% smoke versus 20% general population

Question 760

What are good prognostic factors in schizophrenia?

Answer 760

• Abrupt onset
• Marked mood component
• Family history mood disorder
• Later onset

Question 761

What are poor prognostic factors in schizophrenia?

Answer 761

• Male
• Insidious onset
• Negative syndrome
• Cognitive impairment
• Poor premorbid adjustment
• Early onset

Question 762

Outcomes of schizophrenia treatment

Answer 762

• One episode no impairment 22%
• Several episodes, minimal impairment 35%
• Multiple episodes, static impairment 8%
• Multiple episodes, worsening impairment 35%

Question 763

Do the milligram experiments actually show obedience?

Answer 763

Symptoms of acute stress are common in the first month after trauma and, when substantial, need basic non-pharmacological support from PHC providers.
The management of PTSD in PHC involves addressing psychosocial stressors, psycho-education, stress management, and if available referral for CBT/EMDR.
Anti-depressants are second-line line treatment for PTSD.
People who are grieving need basic non-pharmacological support from PHC providers.
If grief is both disabling and prolonged, consult with a specialist.
Consider a range of mhGAP conditions beyond PTSD in people who have been exposed to extreme stressors.

Question 764

What did Sherif (1935, 1936) do on majority influence?

Answer 764

Used autokinetic effect (in dark room, a stationary point f light seems to be moving) participants estimated how far a point of light had moved. First alone, then in groups of 2 or 3 vs first in groups, then alone

This is part of a group and the relationships in that groups are of same hierarchy, no authority power difference, adopt these different behaviours because they want to.

Sherif used autokinetic effect (completely dark room, single point of light which you focus on and over time this seems to move. It is actually stationary but what moves is your eyes, and as you have no reference point as its completely dark, it seems to be the light that this moving.

When participants responded first individually, then in groups, the personal norms developed during the individual judgement converged towards a group norm when judging as part of a group (funnelling effect)

Participants who had first responded in groups kept the group norm when responding individually

At first where people di it on their own, then median judgement. Sessions 2, 3 and 4 carried out as part of a group. We see that the very different judgements when alone start to converge when part of a group. Sherif called this the funnelling effect.

Other version where did it first in a group and then on their own. In this case it isn’t an exact reverse of the first version, the answers only slightly split off when do it on their own, so seems that to an extent they have internalised the norm they found in the group situation.

Question 765

What was the Asch experiment (1951, 1952)?

Answer 765

Participants had to match a standard line to one of three comparison lines.

1 participant, 6 confederates who had been instructed to unanimously give a wrong answer on 12/18 trials.

In 36.8% of the trials, conformity to the wrong judgements of the majority was observed, however there were strong individual differences. Only about 5% shows conformity on al trials, 24% remained independent all the time, but the majority gave a different answer at least once.

Strong individual differences:

- 5% showed conformity on all trials
- 76.4% gave a wrong answer at least once
- 23.6% remained completely independent

Was also interested and wanted to see if this also happens when people are exposed to a situation where others are confederates and are instructed to give judgements which were clearly wrong. Had to match standard lines with comparison lines. There was only one true participant, but 6 confederates instructed to give the same unanimous answer in 12/18 times.

Question 766

What is Mari and Arai (2010) experiment?

Answer 766

Asch without confederates, using polarising glasses.

Asch experiment has been repeated many times but has been changes slightly to make it more efficient as original method requires a lot of confederates.

Mori and Arai have all people are participants, but give them polarised glasses, with one person seeing the line as longer than others which gives the advantage that don’t have to do the acting of the confederates. On the whole the results are relatively similar to what Asch found much earlier.

Question 767

What was the Teunissen et al 2012 experiment?

Answer 767

Social influence on self-reported willingness to drink alcohol
74 14-15-year-old Dutch boys
interacted in a simulated Internet chat room
with 3 pre-programmed e-confederates, whom they believed to be real peers in their year
• pro-alcohol vs. anti-alcohol norm
• popular vs. unpopular peers
conformity to pro- as well as anti-alcohol norm peers was observed
more conformity to popular peers, particularly if they supported an anti-alcohol norm

Participants were provided with 10 scenarios and had to indicate how willing they were to drink alcohol in this situation. For 6 scenarios the e-confederates seemed to suggest an answer either above (pro-alcohol norm) or below (anti-alcohol norm) the average willingness to drink alcohol of boys of this age in this situation established in a pre-test, for the remaining 4 scenarios they gave the average answer. Participants then responded to the scenarios again privately. There was some indication of internalisation of the norm the “peers” had suggested.

People have looked to take this into more directly relevant domains. Looking here at adolescent self reported readiness to drink alcohol in certain situations. Carried out on Dutch boys who interacted on what they saw as a chat room but actually was set up so that the participant was interacting with e-confederates which has pre-programmed responses. They were given 10 situations in which they were meant to indicate if they would drink alcohol or not in the situation and the e-confederates would either give a response which was more in favour of alcohol than the typical response for boys of that age, or they would give a more anti-alcohol response. Also manipulated whether these peers were supposedly popular or not. They then looked at the extent that the real participant would respond after being exposed to these alleged peers.

Unsurprisingly, there was more conformity when the peers were seen as more popular, and interestingly also when the response was more anti-alcohol. Maybe feel permission to voice the opinion when a popular person has said it.

Another area that has been investigated is star rating on products. People are influenced by these ratings. This can be manipulated by companies.

Question 768

Why do people conform?

Answer 768

2 goals:
• being correct
• making a good impression on other people
these result in 2 fundamentally different forms of social influence:
• informational influence
• normative influence

Dual process dependency model (Turner et al., 1997)

Suggested that people have 2 goals - want to be correct about what they think and want to make a good impression on other people. Sometimes these two are in conflict.

The distinction between the 2 forms of social influence is important.
Informational - when they think the other people have the right answer and they follow them to be correct.
Normative - when they want to make a good impression on other people.

In Asch’s experiment its clear that they wanted to make a good impression, as the answer was clear, whilst Sherif was more informational.

Question 769

Different between informational and normative influence

Answer 769

Informational influence results in private acceptance, normative influence results in public compliance.

Question 770

What did Moscovici, Lage and Naffrechoux say about minority influence?

Answer 770

Moscovici, Lage and Naffrechoux (1969): Social influence is not limited to a one-directional influence of the majority on the minority, but a minority can also influence the majority.
Similar to Asch experiment, but with minority of confederates
Task and experimental conditions:
To name aloud the colour of slides
4 participants, 2 confederates who were instructed to state that the slides were green
- on every of the 36 trials (consistent condition)
- on only 24 of the 36 trials (inconsistent
condition)
- control condition: 6 participants

Results:
Consistent condition: 32% of the p’s gave at least one ‘green’ response, 8.42% of all responses given were ‘green’
Inconsistent condition: no significant influence, 1.25% ‘green’ responses
Control condition: 0.25% ‘green’ responses
Shift in the threshold for perception of ‘green’ particularly for p’s who hadn’t publically conformed to the minority

Argued that the key influential person was typically not of authority. Instead of having a majority instructed to give answers to an individual (such as in Asch experiment) it was a minority who did this in order to instruct the group.

6 person group with 2 confederates instructed to say a wrong answer about slide colour.

Interesting because they found that the minority could have an influence and even though the influence was not massive, in the consistent condition 32% of the participants gave at least 1 green response when all slides were blue, and 8% of responses were all green when all the slides were blue.

Second variation, he measured people colour perception for green, and had shifted and even the case in individuals who hasn’t publicly said green but influenced on a more latent level.

This suggests that the influence happens both directly and indirectly.

Question 771

What did Fazio (1995) say about attitudes?

Answer 771

Fazio (1995): attitudes as object-evaluation associations, strong object-evaluation associations result in automatic activation of an attitude.

Question 772

What are the two ways of measuring attitudes?

Answer 772

2 main assumptions when measuring attitudes:
• Attitudes can be quantitatively measured (people’s attitudes can be assigned numerical values)
• A particular questionnaire item has the same meaning for all participants – the given response is scored the same for everyone

Question 773

Summated ratings (Likert, 1932)

Answer 773

• Most common
• Initially pool of about 100 attitude statements that clearly express a positive or a negative attitude
• Respondents indicate the degree of agreement with each statement, typically on a 5- or 7-point scale, ranging from ‘strongly agree’ to ‘strongly disagree’
• The attitude score is the sum of scores (or the average)
• In order to avoid acquiescence bias, for about half of the statements agreement should indicate a positive attitude and for the remaining statements agreement should indicate a negative attitude (scoring for the latter items is reversed)
• Statements that don’t correlate highly with the overall score are dropped

Many methods but this is most likely to be come across.

This is where people response to certain statements on a scale from strongly agree to strongly disagree. When these scales are developed they first have to collect a really large number of statements that might express the attitude in some way. These are then asked to be responded to on the scale on how far the individual agrees with them.

Important that acquiescent bias is avoided. Need to word the statements so that people aren’t just agreeing to a particular statement. Agreeing should mean you have a positive attitude to some statements and negative attitude to others. Then on the scoring system some items have their scoring reversed so that get an indication of what extend people feel positively or negatively to a statement.

The problem with summing up and taking a mean of scores is that you assume that the distance between the scale point sis the same. This is not always the case (eg different between 4 and 5 is not always the same as between 3 and 4). If you cant be sure that the difference between the points is the same and significant then you shouldn’t be using these methods.

Question 774

Attitude-behaviour relationship

Answer 774

The correlation between attitude and behaviour is often low or non-significant

LaPiere (1934):
travelled through the US with a young Chinese couple at a time when there was a strong prejudice against Chinese people, had no problems getting rooms in hotels or tables in restaurants
however, when LaPiere wrote to the hotels and restaurants afterwards, asking whether they would accept Chinese people as guests, he received 92% rejections (1% approval, 7% undecided)

Had accepted the people without problem, but when asked about it they said that they wouldn’t.

Wicker (1969):
review of research on the attitude-behaviour relationship
average correlation between attitudes and behaviour only .15, rarely larger than .30
however: there are conditions that result in a high attitude-behaviour consistency, e.g., when the attitude is strong, stable, salient and relevant

Problem: the observed behaviour is specific, but the attitude that is measured is often general
One solution:
multiple behaviour observations which generalise across one or more of the four elements: action, target, context, time (repeated behaviour criterion, multiple act criterion)
Fishbein & Ajzen (1974): correlation of .70 between attitude towards religion and religious behaviours using this method

There are cases where the effect is bigger - where belief is stronger salient at that time and when it is relevant.

Question 775

What are the problems with LaPiere’s study?

Answer 775

• Respondents were not always the same as those who had admitted them when travelling
• Attitudes were assessed 6 months later – could have changed, e.g., due to political changes
• Would the same results have been obtained if the Chinese couple had not been well-dressed and travelled without the high-status white professor?
• His accompaniment will have probably played a big role
• Issue of accountability
• May not have been the same people who were on the door as responded
• Also was a time lag between the events so things could have changed and changes attitudes between these times

Question 776

Theory f reasoned action (fishbein and ajzen 1974)

Answer 776

Attitude towards a behaviour and subjective norms (each weighted for their relative importance) jointly determine the intention to perform a behaviour

Have to take into account attitude and also the subjective social norms. Need to know what people believe, do they think if what they believe happens is good or bad, what do other people think and do they want to comply with what other people think. From these things we get a prediction of what people will do.

Question 777

Manstead, Profitt and Smart 1983 (attitudes)

Answer 777

prediction of whether mothers would
breastfeed their newborn baby, correlation
intention-behaviour .77
Intention predicted measuring the TRA
factors:
• behavioural belief
e.g., “Breastfeeding establishes a closer mother-baby bond.”
• outcome evaluation
e.g., “Establishing a closer mother-baby bond is very important.”
• subjective norm
e.g., “My midwife is in favour of my breastfeeding my baby.”
• motivation to comply
e.g., “I want to do what my midwife says.”

Question 778

Theory of planned behaviour (ajzen 1985)

Answer 778

Extension of the TRA, added construct of perceived behaviou-ral control (extent to which ability to perform behaviour is seen to be dependent on certain opportunities or resources)

Also takes into account whether you believe you can do this thing which has an effect on intention and behaviour directly.

This is shown in dieting, studies have shown the perceived behavioural control is very important.

Question 779

What did Madden, Ellen and Ajzen show in 1992?

Answer 779

Demonstrates better ability of the TPB to explain behaviour when behaviour in question is more difficult to control, e.g., getting a good night’s sleep as opposed to taking vitamins

Things that are relatively easy to control (eg taking vitamins) these models are pretty similar in how good they are. However, things that are harder to control (eg hours of sleep per night) then less so as take into account how much control people think they have over that behaviour.

Other models important in seeing whether people would be able to or be willing to change their behaviours for a positive change.

Question 780

About changing attitudes through persuasion?

Answer 780

Early models focused on
• the communicator (source factors)
• the nature of the communication or
message (message factors)
• the nature of the audience or target (receiver/audience factors)
• the situation in which the communication
is made

Early models of persuasion looked at factors like the communicator (is this being communicated by someone thought to be an expert or not for example), the nature of the message (is it one sided? Or two sided?), nature of audients (more intelligent audiences like a 2 sided argument, audience things yeh but what if?), and partly the situation in which the communication is made.

Question 781

Overview of the persuasion process

Answer 781

Things that people looked at, to what extent does credibility, likability, the strengths of the arguments, forewarning or distractions etc - what extent do these things make a difference?

The sleeper effect: if you try to persuade people and not particularly persuaded at the beginning as source isn’t what they are keen on but over time they forget the source but the message stays. The message become strong but only after a while.

Question 782

Bother and Insko (1966) the effects of source credibility and position discrepancy

Answer 782

Low credibility:
YMCA instructor 
High credibility: 
Nobel Prize 
winner

Participants were exposed to a message arguing that the average adult sleeps too much and should get 8, 7, 6, 5, 4, 3, 2, 1, or 0 hours sleep per night. The source was said to be a Nobel Prize winning physiologist or a YMCA director. In both cases the observed attitude change increased up to certain point and then decreased again. Where this point was depended on credibility, e.g., if credibility was high, attitude change was observed even when the message was highly rather than moderately discrepant from the participants’ initial attitude

Question 783

Duel process models of persuasion

Answer 783

• Stemming from the more recent focus on cognitive responses to the content of a message, i.e., focus on what cognitive processes determine whether someone is persuaded
• Elaboration-likelihood model (Petty & Cacioppo, 1986)
• Heuristic-systematic model (Eagly & Chaiken, 1993)

More about looking at what happens cognitively when people are presented with something that tries to persuade them.

Question 784

Elaboration-likelihood model (Petty and Cacioppo, 1986)

Answer 784

If high as highly motivated to process the message, have the intelligence to do so and are interested and it relates to them then they will take a central route in which they carefully process the information in the message and the changing of their attitude depends o the message of the argument.

If these things are ow they will take a peripheral route involving heuristic processing (is the message from an expert, are they physically attractive, etc). An example of this is car adverts with attractive women in them (but not so much if the audience was a car expert).

Question 785

Petty, Cacioppo and Goldman

Answer 785

One factor that affects whether people take the central or the peripheral route is personal involvement. If it is high, people are more influenced by the quality of the arguments than by the expertise of the speaker, if it is low, however, they are more influenced by the expertise of the speaker than by the quality of the arguments. Therefore, if people are personally involved, whether or not they are persuaded by a message should only depend on the quality of the arguments, but not on the expertise of the source, whereas if people are not personally involved, attitude change should depend more on the expertise on the speaker than on the quality of the arguments.
This was confirmed in the experiment by Petty et al. (1981) on US college students who listened to a speech arguing that all students should be required to pass a comprehensive exam in their major subject before they graduate. In the high personal involvement condition participants were told that the university was considering this at the moment, in the low personal involvement condition subjects were told that the university was considering to introduce this not before in 10 years time. The high expertise source was said to be professor at Princeton University, whereas the low expertise source was said to be a high school student. As expected, highly involved participants showed a similar level of attitude change, regardless of whether the speech was said to come from a Princeton professor or high school student (this change overall was low, because students who would be affected by the suggestion obviously didn’t want to do another exam). They were affected by the quality of the arguments, however, with significantly more attitude change towards the position supported by the speech when the speech contained strong arguments. Participants with a low involvement, on the other hand, were strongly affected by the expertise of the speaker (they changed their attitude more towards his position when he was said to have high rather than low expertise).

Question 786

Heuristic-systematic model

Answer 786

• Heuristic: rule of thumb, mental shortcut
• People are motivated to hold valid attitudes
• Reliance on heuristics (e.g., expertise, attractiveness, message length) as long as they satisfy need for confidence in attitude we adopt; switch to systematic, effortful processing if heuristic processing doesn’t create sufficient confidence
• Sufficiency principle: process as much as necessary to reach sufficient degree of confidence, sufficiency threshold
• Heuristic and systematic processing can co-occur

• Motivation can also influence likelihood of systematic processing
• Processing motives (Chaiken, Liberman & Eagly, 1989)
• accuracy motivation (unbiased processing aimed at arriving at a valid position)
• defense motivation (biased processing aimed at
confirming the validity of a preferred position)
• impression motivation (strategic processing aimed at expressing attitudes that will please potential evaluators)

Question 787

What are the seven important factors in group definitions (Johnson and Johnson 1987)?

Answer 787

1. Interaction
2. Self-perception of belonging to a group
3. Interdependent (‘being in the same boat’)
4. Purpose of goal achievement
5. Purpose of need satisfaction
6. Structure through roles and norms
7. Mutual influence

Question 788

What is the effect of the presence of others on performance?

Answer 788

Both positive and negative effects of the presence of others on performance have been observed

Social facilitation:
Improvement in performance as a result of the mere presence of others

Social loafing:
Tendency to invest less effort when being part of a group

Social facilitation - improvement of the performance of others in the presence of others

Social loafing - investing less effort when part of a group

Question 789

What is the drive theory of social facilitation (Zajonc, 1965)?

Answer 789

Zajonc, Heingartner, and Herman (1969):
social facilitation in cockroaches, 32 female cockroaches were exposed to a bright light (a noxious stimulus for cockroaches) which was placed at the end of a maze. The maze was either a simple maze (a straight runway) or a complex maze where cockroaches had to turn right to reach the goal, a dark box into which they could escape. The time it took the cockroaches to run to the other end was recorded. In some of the conditions other cockroaches were forced to play the passive audience by putting them into see-through plastic boxes located around the maze. The results showed that, as predicted, the cockroaches ran faster through the simple maze and more slowly through the complex maze in the presence of other cockroaches compared to when they were alone.

Did experiment with cockroaches - easy maze and harder maze. If shine light on them they run to find the dark again.

He let cockroaches run through these mazes and either did or didn’t place other cockroaches in glass containers around them. When they were watched by other cockroaches they ran through the simple maze more quickly, but took longer on the complicated maze. This is because the complicated maze is not a dominant response so the presence of an audience damages their response.

Question 790

The effects of evaluation apprehension - Markus 1978

Answer 790

An attentive audience
improved performance at a simple task (taking
off and putting on normal clothes) and
impaired performance at a difficult task (putting on and taking off lab clothes)

Incidental audience: back turned, mere presence
Attentive audience: watching audience, evaluation apprehension

Question 791

Social loafing - Lantana, Williams and Harkins 1979

Answer 791

An attentive audience
improved performance
at a simple task (taking 
off and putting on normal clothes) and
impaired performance
at a difficult task (putting on and taking off lab clothes)

Incidental audience: back turned, mere presence
Attentive audience: watching audience, evaluation apprehension

Question 792

Information sampling model of group discussion (Stasser and Titus 1985, 1987)

Answer 792

Probability that an item of information will be discussed increases as the number of members who can recall and mention the item increases
• Individual more likely to mention info related to their preferred decision
• Info related to preferred decision is more salient, so better recalled
• The more group members have a piece of info the more likely it is that it will be mentioned during discussions
If information distribution is biased amongst group members (hidden profile), then discussion will improve decision making, if information distribution is not biased, then discussion will have no effect

A model that looks at what happens when people make decisions as part of a group.

Groups consisting of 4 members discussed the suitability of 2 candidates for student body president. The information they were given about candidate B was the same for all groups and consisted of 4 positive and 4 negative items. Information about candidate A consisted of 8 positive and 4 negative qualities, hence this candidate was the superior candidate. In the shared information condition, all group members received complete information about candidate A. In the unshared information condition, group members were told the same negative qualities of candidate A, but each person only received information about two positive qualities, which no-one else in the group was told about. Stasser and Titus found that, when asked to make a decision about who was the more suitable candidate, the groups focused on the information they shared, with the result that in the unshared condition only 24% of groups preferred candidate A, whereas in the shared condition 83% of groups preferred candidate A. It has been found that if group members are told that others don’t know what they know and that different members are responsible for different kinds of information, people will share more.

Based on a real study.
Have a group of 4 people and they are meant to decide which of 2 candidates is better for a job there are 2 conditions:

shared information condition where all members of the group have exactly the same information on the candidates.

In the group, the information is distributed amongst different people.as a group they have the same information as the other type, but the problem is that not everyone has the same information - they need to share it. What happens is people don’t share well enough and as a result they make different decisions.

End up making a sub-optimal decision in the seconds condition compared to the first.

This illustrates the importance of effective information sharing.

Question 793

What did Larson, Jr., Christensen, Franz and Abbott (1998) study in group behaviour?

Answer 793

• Application of Titus & Stasser’s paradigm in a medical context
• Groups consisting of 2 assistant doctors and 1 medical student viewed different tapes of 2 doctor-patient interviews and discussed diagnosis
• Vigilance vs. no vigilance instruction
• Shared information mentioned and repeated more often and mentioned earlier in the discussion than unshared information
• Diseases implicated by shared information were rated as more likely than diseases implicated by unshared information, no effect of vigilance

Example of this in a medical context.

Tend to focus on the shared information - like to have approval, people like to agree with others, also if something is not shared might assume that it’s not important. As humans we fight against the wish for conformity and for things to go smoothly and to not rock the boat. Can be difficult to disagree with people.

Important to be aware that these human difficulties can stand in the way of making optimal decisions.

Question 794

What are various stress conditions?

Answer 794

• Application of Titus & Stasser’s paradigm in a medical context
• Groups consisting of 2 assistant doctors and 1 medical student viewed different tapes of 2 doctor-patient interviews and discussed diagnosis
• Vigilance vs. no vigilance instruction
• Shared information mentioned and repeated more often and mentioned earlier in the discussion than unshared information
• Diseases implicated by shared information were rated as more likely than diseases implicated by unshared information, no effect of vigilance

Example of this in a medical context.

Tend to focus on the shared information - like to have approval, people like to agree with others, also if something is not shared might assume that it’s not important. As humans we fight against the wish for conformity and for things to go smoothly and to not rock the boat. Can be difficult to disagree with people.

Important to be aware that these human difficulties can stand in the way of making optimal decisions.

Question 795

What happens following exposure to extreme stressors?

Answer 795

1. Problems and disorders that are more likely to occur after exposure to extreme stressors but that also occur in the absence of such exposure:
   • depressive disorder (DEP)
   • psychosis (PSY)
   • behavioural disorders (BEH)
   • alcohol use and drug disorder (ALC, DRU)
   • self-harm/suicide (SUI)
   • Other significant emotional or medically unexplained complaints (OTH).
2. Problems and disorders that require exposure to extreme stressors:
   • significant symptoms of acute stress
   • post-traumatic stress disorder (PTSD)
   • grief and prolonged grief disorder
   • Remember that these often occur in combination with other conditions.

Question 796

Establishing communication and building trust following extreme stressors

Answer 796

• People who have traumatic stress may avoid communicating about traumatic events because talking about it may trigger re-experiencing symptoms.
• Important to ensure confidentiality when discussing traumatic and private issues.
  
  • E.g. people often have great difficulty talking about sexual violence and torture.
• Never pressure the person to talk about the issue.
• It is very important to listen if the person wants to talk about the issue.
• It is crucial to discuss the experience at the pace with which the patient is comfortable.

Question 797

Symptoms of acute stress (within one month of the event)

Answer 797

• After recent exposure to potentially traumatic events, people’s reactions tend to be diverse.
• symptoms of acute stress (within one month of the traumatic event) cover a wide range of symptoms occurring in both adults and children, such as:
  
  • feeling tearful, frightened, angry or guilty
  • jumpiness or difficulty sleeping, nightmares or continually replaying the event in one’s mind
  • physical reactions (eg hyperventilation)
• These symptoms can indicate mental disorder, but often are transient and not part of a disorder. If they impair day-to-day functioning or if people seek help for them, then they are significant symptoms of acute stress.

Question 798

what are the three key symptoms clusters of PTSD?

Answer 798

• Three clusters of traumatic stress symptoms require attention
1. Re-experiencing symptoms
2. Avoidance symptoms
3. Symptoms related to a sense of heightened current threat
• In people with PTSD, the event occurred more than approximately one month ago, at least one symptom from all 3 clusters is present, and the symptoms cause difficulties in day-to-day functioning.

Explain that there are three major clusters of symptoms that should be assessed.

The criteria for PTSD are not met unless all of the points in the second bullet are present.
Emphasize that difficulties in day-to-day functioning is an essential criterion

Question 799

Re-experiencing symptoms in PTSD?

Answer 799

• These are repeated and unwanted recollections of the traumatic event.
• 3 types of re-experiencing symptoms:
  
  • An intrusive memory is unwanted, usually vivid, and causes intense fear or horror.
  • A flashbacks is an episode where the person believes and acts for a moment as though they are back at the time of the event, living through it again. People with flashbacks lose touch with reality, usually for a few seconds or minutes.
  • Frightening dreams
• In adults, the frightening dreams must be of the event or of aspects related to the event.
• In children, re-experiencing may involve frightening dreams without clear content, night terrors or trauma specific re-enactments in repetitive play or drawings.

Question 800

What are PTSD avoidance symptoms?

Answer 800

• These include purposely avoiding situations, activities, thoughts or memories that remind the person of the traumatic event.
  
  • a person may not want to get in a car after a road accident
  • a rape survivor may all the time try to avoid thinking of the rape.
  • the person may wish not to talk about the event with the health-care provider
• Paradox: trying very hard not to think of something, makes one think more it.

Question 801

What PTSD symptoms are related to a sense of heightened current threat?

Answer 801

• Affected persons may feel constantly in danger,
• 2 types of symptoms related to a sense of heightened current threat
• Hypervigilance: exaggerated concern and alertness to danger
○ Eg the person is much more watchful in public than others, unnecessarily selecting “safer” places to sit.
• Exaggerated startle response: being easily startled or jumpy - reacting with excessive fear to unexpected sudden movements or loud noises.
○ Eg person reacts much more strongly than others and takes considerable time to calm down.

Question 802

What features are associated with PTSD?

Answer 802

• All ages
  
  • Anxiety, depression, anger
  • Numbing, insomnia
  • Medically unexplained complaints
• In adolescents and adults
  
  • Alcohol and drug use problems
• In adolescents
  
  • Risk-taking behaviour.
• In children
  
  • Regressive behaviours, such as bedwetting, clinging and temper tantrums.

Question 803

INT referral for CBT or EMDR (stress)

Answer 803

• Cognitive-behavioural therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are 2 psychotherapeutic techniques that have good evidence for PTSD.
• Other therapies (whether psychotherapeutic or pharmacological) do not have such evidence basis for PTSD.
• Refer for CBT or EMDR, if competent (trained and supervised) CBT or EMDR therapists are available. Are they available here?

Question 804

CBT-T

Answer 804

• Cognitive behavioural therapy with a trauma focus (CBT-T)
• Individual or group cognitive behavioural therapy with a trauma focus (CBT-T) is based on the idea that people with PTSD have unhelpful thoughts and beliefs related to a traumatic event and its consequences. These thoughts and beliefs result in unhelpful avoidance of reminders of the event(s) and maintain a sense of current threat. Cognitive behavioural interventions with a trauma focus usually include (imaginal and/or in vivo) exposure treatment and/or direct challenging of unhelpful trauma-related thoughts and beliefs.

Question 805

EMDR

Answer 805

• Eye movement desensitization and reprocessing (EMDR) therapy is based on the idea that negative thoughts, feelings and behaviours are the result of unprocessed memories. The treatment involves standardized procedures that include focusing simultaneously on (a) spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and (b) bilateral stimulation that is most commonly in the form of repeated eye movements. Like CBT-T, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event. Does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure or (d) homework.

Question 806

Treatment of PTSD

Answer 806

Offer psychosocial support
• Address current psychosocial stressors
• Refer to protection or human rights if appropriate
• Strengthen social supports
• teach stress management   

Educate on PTSD
• May recover without treatment 
• Re-experience emotions of event 
• Jumpiness
• Avoid reminders è Impair life
• Other physical and mental problems

Advise to: 
• Continue normal daily routine
• Talk to trusted people about what happened when ready
• Relaxation and activities
• Avoid alcohol or drugs 

If trained and supervised therapists are available, consider referring for
• Cognitive behavioural therapy with a trauma focus
• Eye movement desensitisation and reprocessing

In adults, consider antidepressants when psychological interventions do not work or not available.

Question 807

Anti-depressants in PTSD

Answer 807

• Research shows that antidepressants in most people with PTSD only have a small effect (they tend to work on average a bit better than placebo).
• In adults, only consider antidepressants when CBT, EMDR, or stress management prove ineffective or are unavailable.
• In children and adolescents, NEVER offer antidepressants to manage PTSD.

Question 808

Psychological first aid

Answer 808

• Psychological first aid is a humane, supportive response to a fellow human being who is suffering and who may need support
• All health workers should be able to provide very basic psychological first aid.
• Key actions:
  
  • listen to the person without pressuring them to talk.
  • provide practical care and support without asking intrusive questions.
  • assess needs and concerns.
  • help the person to address immediate, basic physical needs (e.g. shelter for the night).
  • help connect to services, family, social supports and accurate information.
  • As far as possible, protect people from further harm.

Question 809

Addressing current psychosocial stressors

Answer 809

• Sometimes the trauma is ongoing (eg domestic abuse) or can lead to a whole new range of stressors (eg refugee camp life).
• Ask about current psychosocial stressors and as far as possible, use problem-solving techniques to help the person reduce major psychosocial stressors or relationship difficulties,
• Assess and manage any situation of abuse (e.g. domestic violence) and neglect (e.g. of children or older people).
• As appropriate, Identify supportive family members and involve them as much as possible.

Question 810

What are the six steps of problem solving?

Answer 810

Identify and  define the problem
Analyse the problem
identify possible solutions
select and plan the solution
implement the solution
evaluate the solution
(goes round in a  circuit)

Question 811

Stress management

Answer 811

• The health care provider may have time to train people in breathing exercises, progressive muscle relaxation, and cultural equivalents.
• Breathing exercises
• Progressive muscle relaxation

Question 812

Strengthening of positive coping methods and social supports

Answer 812

• Encourage the person to seek the support of trusted family members, friends or people in the community.
• Build on the person’s strengths and abilities.
  
  • Ask what is going well.?
  • What are some methods to cope with hardship that have worked in the past?
• Encourage resumption of social activities and normal routines as far as possible
  
  • school attendance, family gatherings, outings with friends, visiting neighbours, social activities at work sites, sports, community activities.
• Alert that use of alcohol and drugs does not help recovery and can lead to new problems.

Question 813

About insomnia

Answer 813

• Apply general management strategies for symptoms of acute stress. In addition:
  
  • Rule out or manage external causes (e.g., noise) and physical causes (e.g. physical pain).
  • Ask for the person’s explanation of why insomnia may be present.
  • In adolescents and adults, consider relaxation techniques (see STR 3.3) and advice about sleep hygiene (regular bed times, avoiding coffee and alcohol).
  • Explain insomnia is a common problem after experiencing extreme stressors.
• If the problem persists after one month, re-assess for and treat any concurrent mental or physical disorder.

Question 814

Pharmacological management of insomnia

Answer 814

In exceptional cases only

• In exceptional cases in adults when psychologically oriented interventions are not feasible, short-term treatment (3-7 days) with benzodiazepines (e.g., diazepam 2-5 mg/day, lorazepam 0.5-2mg/day) may be considered for insomnia that severely interferes with daily functioning.
• Precautions:
  
  • Risk of dependence. Only prescribe benzodiazepines for insomnia for a very short time and in exceptional cases.
  • In the elderly, use lower doses (e.g., half of adult doses).
  • Do not prescribe benzodiazepines for insomnia during pregnancy and breastfeeding or in children and adolescents

Question 815

Bed-wetting as a symptom of acute stress in children

Answer 815

• Apply general management strategies for symptoms of acute stress. In addition:
  
  • Obtain history of bedwetting (to confirm whether the problem started only after the event). Rule out and manage possible physical causes.
  • Manage carers’ mental disorders and psychosocial stressors.
  • Educate carers. Explain that they should not punish the child for bedwetting. It may make the symptoms worse.
  • Consider training parents in the use of simple behavioral interventions (e.g., rewarding avoidance of excessive fluid intake before sleep, rewarding toileting before sleep). The rewards can be extra play time, stars on a chart, etc.
• If the problem persists after one month, re-assess for and treat any concurrent mental or physical disorder.

Question 816

Frequency of follow up (stress)

Answer 816

• For symptoms of acute stress (i.e within 1 month of event)
  
  • Follow up is needed after 1 month in case person is not improving.
  • At follow up, assess for a range of conditions, incl. PTSD.
• For PTSD
  
  • Follow is also needed after 2-4 weeks to see whether management is working.
  • Long-term follow up at regular intervals may be necessary.
• For grief
  
  • Follow-up is needed 6 month after loss to assess for prolonged grief disorder.
• Follow up may be done in different ways (e.g. in person at the clinic, by phone, or through community health worker).

Question 817

What to do at follow up (stress)

Answer 817

• Monitor improvement by asking the person and family.
• Ask about and possibly address ongoing psychosocial stressors.
• Monitor adherence, response and side-effects of medications, if prescribed.
• Provide more psychoeducation (STR 3.6).

Question 818

Key messages about stress

Answer 818

• Symptoms of acute stress are common in the first month after trauma and, when substantial, need basic non-pharmacological support from PHC providers.
• The management of PTSD in PHC involves addressing psychosocial stressors, psycho-education, stress management, and if available referral for CBT/EMDR.
• Anti-depressants are second-line line treatment for PTSD.
• People who are grieving need basic non-pharmacological support from PHC providers.
• If grief is both disabling and prolonged, consult with a specialist.
• Consider a range of mhGAP conditions beyond PTSD in people who have been exposed to extreme stressors.