topics about psycopathology Flashcards
what is the general adaption syndrome and who came up with it?
process of stress follows: alarm–>resistence–>exhaustion - therefore severe and sustained stress can cause disease
above a model for occupational burnout
what happens when you are stressed and who realised this?
cohen et al.
stress causes: cognitive impairment, bad concentration span and disorganised thoughts –> anger –>depression, apathy and helplessness and anxiety through acute stress disorder
what are the symptoms of post traumatic stress disorders?
ptsd is a natural emotional reaction to a deeply shocking and disturbing experience
symptoms:
- repeated reliving of traumatic event
- persistent efforts at avoidance of memories and emotional blunting
- persistent symptoms of hyper arousal
- survivors guilt
what event was used to study ptsd and who studied it?
the fire on the oil rig piper alpha in 1988
hull et al
“hull of a boat, oil rigs are at sea”
who devised a social readjustment scale and what was ranked as being the top 3 most stressful things, in order?
holmes and rahe
1 - death of a spouse
2 - divorce
3 - marital seperation
who divided a hassle and uplifts scale to show how stressed people were in day to day life?
lazarus and folkeman
“shows how general FOLKE are stressed in day to day life”
what are the characteristics of type A behaviour and what does it predispose a person to?
- thinking of/doing two things at once
- scheduling more and more activities into less and less time
- hurrying the speech of others
- becoming unduly irritated when waiting in traffic/queue
- having difficulty sitting and doing nothing
- playing nearly every game to win
doubles likelihood of a heart attack
what is the lifestyle intervention used to reduce stress, what does it involve and which two researchers studied its effectiveness?
ornish programme:
- diet
- exercise
- stress management
- group support
billings (2000)
silberman (2010)
Who came up with the appraisal process (re stress)? and what are the 3 parts to it?
lazarus and folkman
- primary: perception of demands (potential for threat, harm or challenge)
- secondary: available coping options
- reappraisal: continual re-evaluation or re-labelling above
what are the 2 main types of coping mechanisms?
problem-focused:
-changing the situation, avoiding in future
emotion focused (2 subtypes):
- behavioural strategies (physical exercise, drinking, venting anger)
- cognitive strategies (denial, rumination, discussion)
describe pain as a concept
physiological - nocioception (sensory pain receptors) sensory - quality, intensity affective - unpleasantness cognitive - expectations, mental models behavioural - vocalising, posture
what is the gate control theory and who came up with it?
melzack & wall (“have GATEs in WALLs”)
gate open - pain
gate closed - pain reduces (can be closed by rubbing injury or via top-down processing)
pain is a perception of an active individual, has multiple causes and experience varies per individual
(no physical evidence of gate through neurotransmitters though)
if you are told what is going to happen do you feel more or less pain?
less pain
what are 2 mild sedatives that are used to treat chronic pain?
N20 and valium
what is the biomedical definition of disability? 2
The result of disease, trauma or some other health condition - restriction of ability within a range considered normal resulting from impairment
restriction of ability within a range considered normal RESULTING from impairment
biomedical definition of impairment
Deviations from the ‘normal’ healthy state - organic/physical loss, abnormality, disease or condition
biomedical definition of handicap
social disadvantage (social, economic and psychological handicap) - a CONSEQUENCE of disability
biomedical approach to disability interventions
aimed at the individual and their impairment , trying to facilitate normal functioning(rehabilitation)
e.g. giving someone with hearing problems hearing aids
social model of disability
rejects impairment as inevitable cause of disability
disadvantages result less from impairment than from society’s inability to accommodate difference
barriers in society disable those with impairment
suggested interventions of social model of disability
SOCIAL CHANGE, not just medical intervention or ‘prevention’ (through prenatal selection)
what is the cause of disability according to the (1) biomedical and the (2) social model of disability?
1) cause within individual
2) cause within society
definition of prejudice
affective evaluations (positive and negative attitudes) associated with stereotypes
discrimination definition
enacted behaviour influenced by attitudes
discrimination definition
to treat one group of people less favourably than others
what is indirect discrimination?
rules, regulations or procedures that have the effect of discriminating against groups of people
victimisation definition
to punish or treat a person less favourably because that person has asserted his/her rights
what is quality of life and what 6 things is it affected by?
an individual’s judgement of their overall life experience, affected by their:
1) physical health (e.g. pain, energy, sleep)
2) psycological factors (eg emotions, self esteem, memory, feelings, body image)
3) level of independence (e.g. daily activities, work, self-care, treatment, capacity to work)
4) social relationships (e.g. personal relationships, support)
5) relation to the environment (e.g. safety, home, money)
6) personal beliefs (e.g. religion)
3 key factors about quality of life
it is multidimensional (lots of different aspects contribute to it)
it is dynamic (changes over time)
it is subjective (his/her judgement within his/her culture)
what are instrumental values, what are terminal values and who came up with this approach of looking at QoL?
instrumental value = goals to allow a person to reach a TERMINAL value
Rokeach “roadkill has a pretty low QoL”
what is clinical effectiveness and what is patient reported effectiveness?
clinical: mortality, morbidity, complication rates
patient-reported: value or utility of care to patient
what is health-related QoL?
the functional effect of a medical condition and/or its therapy, as assessed by the patient
what are PROMS
patient reported outcome measures:
patient ratings of the effects of a disease, condition and/or treatment
an example of a disease specific PROM?
KDQoL - Kidney disease quality of life questionnaire
what is a recalibration of QoL? and what for what 3 reasons can it occur?
means that people with a chronic illness disability can rate their QoL as better than a ‘healthy’ person
response shift:
- when people change their internal standards, values re-evaluated, expectation-experience gap
rating scale:
- ‘health now compared to 10 years ago’ vs ‘your health compared to others your age’
items assessed:
- different stages in life, different aspects of life more important, so different scores
definition of a certain decision
know what getting (e.g. get x if chosen)
definition of an uncertain decision
chance will get/not get the outcome, probability UNKNOWN
definition of a risky decision
chance will get/not get the outcome, probability KNOWN
What is classical decision theory and who came up with it?
von Neumann and Morgenstern
“very rational, and STERN, approach to making decisions, hence the german names”
A normative theory of how people should make their decsisions
probability based
structure linking the choice made with peoples value towards the outcomes of options and the probability of these outcome occurring
4 assumptions required for rational decision making
people are motivated to follow rules or axioms
people have complete knowledge of all options
people’s representations of opinions, risk and benefits are accurate
people know what their values are and people’s values are stable
who came up with bounded rationality and what is it?
people don’t have the processing capacity to calculate EUT and so use simpler, less effortful strategies
what is the ‘satisfying’ method of decision making and who came up with it?
simon - “simple simon is easily satisfied”
choose a satisfactory criterion and the first option that matches
-eg must have 5 rooms, choose first house with 5 rooms
what is the ‘elimination by aspects’ method of decision making and who came up with it?
tversky “sounds like a russian communist leader who “eliminated” a lot of people”
choose an attribute and make trade offs between options
eg compare all houses with 5 rooms
what is the ‘heuristic’ method of decision making and who came up with it?
chaiken “your mother (her) uses a rule of thumb and writes it on a board in chalk”
use a rule of thumb, not option information
e.g. friend said X, i’ve done it before
information processing strategies: system 1
quick way- attend to part of the information or decision context
choice based on rule of thumb (heuristic)
rule of thumb enforced by experience
subconscious, quick, little effort/emotion
more likely to regret choice or make wrong choice
information processing strategies: system 2
“twice as hard, but twice as good rewards”
attend to details- evaluate pros and cons- make choice based on trade offs
conscious, time consuming and emotionally demanding,
results in more stable values
happier with choice made, less likely to regret decision
treatment decisions, risk and bias
people find risk difficult to understand and assimilate
perceptions of risk influence choice, not actual figures
people are hardwired to use context to give meaning to risk:
- representativeness
- gamblers fallacy
- availability heuristic (i.e. what we hear on the news, e.g. makes us think that tornados are more likely to kill us than asthma)
- anchoring and adjustment
- hindsight bias
- averaging
what are the three types of error in medical diagnosis and who recognised these?
graber et al “he grabs for the swiss cheese model”
1) no fault (eg silent disease, mimics, not known, poor quality data from patient etc)
2) system (e.g. culture left too long, missed appointment, unsupervised junior, delays in x-rays etc)
3) cognitive (misdiagnosis from poor data collection, interpretation, flawed reasoning, incomplete knowledge - BEING A HUMAN)
who came up with the dual process model of diagnostic reasoning?
croskerry “as he was CROSS that diagnostic mistakes kept happening”
what does it mean to be ill and who came up with this definition? 5
lau “because he loses being well”
- more than not being well:
symptoms: having bodily signs or physical sensations (pain, tired, nausea/blood pressure, rash etc)
attention: sensations are novel/non-attributable (e.g. if you have a headache because you drank a lot last night then this sensation is attributable)
perception: not feeling normal
behaviour: not being able to do what you normally do
timeline: having symptoms for some time
what percentage of symptoms result in person going to a doctor with them and who realised this?
what things affect a person’s perception of symptoms? 6
PERSISTENCE:
severity, worsening and/or more symptoms
ATTENTION:
focus/distraction/context (e.g. medical-student-itis)
SOCIETAL MORES:
- stereotypes (e.g. it is perceived that men get MIs more than women but actually same likelihood)
- cuture/socialisation (eg socially acceptable to be ill/not be ill)
INDIVIDUAL DIFFERENCES:
life stage, sex (e.g. man flu, women tend to be more stoical), personality style
MOOD:
happy, sad, anxious, relaxed (e.g. negative mood = more symptoms)
EXPERIENCE:
knowledge, lifespan, learning and illness experience
Social expectations about how people should behave when sick (‘sick role’) 5
and
who came up with it?
Parsons (like the parkinson building, where I got to medical school to try to make sick people better)
- exemption from normal social roles (must be legitimised by an authority, e.g. mum/course lead)
- exemption from responsibility for illness (must not be your fault)
- illness is undesirable (must want to get well)
- seek appropriate help (e.g. see a dr, stay in)
- time limited (e.g. acute illness)
what are illnesses behaviours
actions a person undertakes when they feel ill to:
- relieve the experience
- seek more information
names of stages in common sense model of illness
stage 1 - illness REPRESENTATION: cognitive and emotional
stage 2 - COPING
stage 3 - APPRAISAL
who came up with common sense model of illness?
leventhal
“it’s common sense that people can’t levitate”
stage 1 of common sense model of illness
illness representation:
COGNITIVE=
IDENTITY:
beliefs about the illness label and symptoms
CAUSE:
beliefs about what caused the illness
TIMELINE:
beliefs about length of illness
CONSEQUENCES:
beliefs about illness impact on physical, social and psychological well-being
CONTROL/CURE:
beliefs about how well illness can be controlled/cured
EMOTIONAL=
SYMPTOM/DIAGNOSIS:
calm, relief
shock, fear, anxiety, depression
PERIOD ADAPTATION TO ILLNESS:
initial response: defensive reaction (denial, challenge)
stage 2 of common sense model of illness
coping
IDENTIFICATION of coping behaviour/strategy:
- approach (problem-focused) to control illness (e.g. going to dr, taking remedy, talking to someone)
- avoidance (emotion focused) to control emotion (ignore, denial, avoidance, comfort)
beliefs that the actions will return them to the health status quo
stage 3 of common sense model of illness
appraisal:
- evaluate coping strategy with illness problem (worked/not worked?)
- choose another strategy and/or reappraise symptoms
what % of medicine is not taken as prescribed?
30-40%
who came up with the 4 beliefs about medicine (as potential reasons why people don’t take prescribed medication) and what are they?
Horne “people poison rhino horns to prevent them being stolen for chinese medicine where there is a belief that they help!”
1) specific: NECESSITY:
beliefs about whether this medication improves health status (efficacy)
2) specific: CONCERNS:
beliefs that this medication is harmful (e.g. dependence, side effects)
3) general: HARMS:
beliefs about harms of all medications (e.g. all some sort of poison)
4) general: OVERUSE:
beliefs professionals over-reliant on medication (e.g. over-prescription)
nb necessity-concerns trade-off key (necessary evil)
who did an experiment with asthma patients to see if sending them tailored text messages encased their adherence to using their inhalers?
petrie et al
“used petri dishes when found out about penicillin, you have to fully adhere to antibiotic treatment or it does more harm than good”
who carried out an illness perception questionnaire?
moss-morris et al
“do you feel like a piece of MOSS when you are ill or do you think you are well enough to do MORRIS dancing”
What did john snow do?
he stopped a cholera outbreak by working out that all the cholera was coming from one pump (broad street pump)
what are normative beliefs
what beliefs we think others have about a certain behaviour
what is the alameda county study and who carried it out?
long-term follow-up study to identify what sort of behaviours predicted longer lifespan
belloc and breslow
what did the alameda county study find? 7
longer life predicted by seven ‘good’ lifestyles:
1) 7-8 hours sleep a night
2) no more than 1-2 alcoholic units per day
3) not smoking
4) regular physical activity
5) not eating between meals (not snacking)
6) eating breakfast
7) moderate weight (no more than 10% overweight)
What is the social cognition theory and who came up with it?
it says that behaviour is governed by:
- EXPECTANCIES about behaviour and self-efficacy
- INCENTIVES or CONSEQUENCES behaviour
- SOCIAL COGNITIONS i.e. people’s representations of the social world
who came up with the theory of planned behaviour
Ajzen and madden
what are subjective norms?
beliefs about what significant others think (e.g. friends think me smoking is cool/gross)
what is perceived behavioural control?
beliefs that person can carry out behaviour, internal skills or ability and external restrictions or opportunities (no smoking areas, ability not to start, finance, weak-willed)
is fear tactics or factual information to change behaviour?
no
difference between absolute and relative poverty?
absolute = same across all countries
relative = defined in relation to a measure in the country where the person lives
what is the definition of relative poverty in the EU?
having a household income
what is the definition of deep poverty in the EU?
having a household income
what type of professions come under which sections of the ‘National Statistics Socio-Economic classification’ (NS-SEC)
Higher occupations (1.1, 1.2, 2) - proffessional and managerial occupations
Intermediate occupations (3, 4): - clerical, sales, service, small employers and self-employed
Lower occupations (5, 6, 7) - lower supervisory/technical occupations, semi-routine and routine occupations
never worked and long term unemployed (8)
what is a social gradient?
refers to the fact that inequalities in population health status are related to inequalities in social status.
what were the whitehall studies?
studies done in 1960s and 1980s comparing people in the civil service’s occupation level to their health
found that, better occupation = better heath (less cardio vascular disease, mental health issues and all cause mortality)
i.e. proved that there was a social gradient
what is health selection?
the theory that health status influences social position
ill health causes a downward shift in social position
who studied schizophrenia in carribean immigrants to the uk to see if it affected/was affected by their social class?
goldberg and morrison
“MORRISONs buys bananas from the carribean with GOLD coins”
what is the materialistic explanation of health and disease?
an individual’s material context is the main influence on health and illness
- housing
- pollution
- education
- employment
- working conditions
- income
what is the life-course explanation for health and disease?
health develops over a life-time and across generations
what are the 5 components of emotion?
subjective experience
internal bodily responses
thought/action tendencies
facial expression
cognitive appraisal
nb if there is a mismatch between these clues = emotional leakage
what are the 6 primary emotions and who studied these?
happiness sadness anger fear disgust SURPRISE
nb other emotions are a blend of these
ekman and friesen
“you say: HECK MAN! when you are surprised and mirriam was disgusted by the FRIESEN in NZ”
who interviewed patients with spinal injuries to find out whether the intensity that they feel emotions had changed since before the injury? and what did they find out?
hohman “studied half-men, i.e. half of their bodies were paralysed”
found that:
- spinal injury patients felt emotions with less intensity than before their injury
- the higher up the spine they were injured (i.e. the more paralysed they were), the greater the change n intensity
who found out what physical changes occur with each emotion and what changes are these?
eckman “HECK MAN = surprised”
low heart rate = happy, surprise, disgust
high heart rate (w. low skin temp.) = fear, sadness
high heart rate (w. high skin temp) = anger
what is the pattern theory of emotions and who came up with this?
encounter/event
- -> specific physiological arousal and overt behaviours
- -> experience of emotion
james-lange “james miles doesn’t really thing about the LONG term consequences of his actions and doesn’t really think through his emotions and so ends up following the same patterns”
what is the cognitive theory of emotions and who came up with it?
encounter/event
- -> general physiological arousal
- -> cognitive appraisal of arousal
- -> experience of emotion
schacter and singer “SINGER sewing machines, have time to think through emotions etc while you are sewing”
who carried out an experiment injecting people with adrenaline and either giving them information about what adrenaline did (true or false) and then, when exposed to another persons emotional behaviour, seeing who experienced the greatest change in mood?
what did they find? and how did they explain this?
schacter and singer
the people who had NOT been given any information (true or false) about the effects of adrenaline experienced emotions MORE INTENSELY than informed people
thought this was because, if you have an explanation in your head as to why you are experiencing what you are then this inhibits your natural reaction
what is the appraisal theory of emotions?
your emotional experience is linked more to your appraisal (i.e. interpretation) of the event than the actual event itself
who did studies about facial expressions across different cultural groups? and what did they find?
eck man “HECK MAN, you did a lot of studies about emotions”
that most facial expressions are pretty universal, even when compared to remote tribes
what emotion is the amygdala and limbic system of the brain associated with?
fear
“you need your LIMBs to run away from a scary lion”
who studied a woman (SM) with brain damage to see if she could interpret the motions of others by their facial expression? and what improved her ability to do so?
adolphs “adolph hitler inflicted a lot of brain damage”
if she was specifically told to focus on the person’s eyes, she was better able to interpret their emotion
normally people look at eyes mostly and a bit of mouth to detect emotions
who studied children’s future use of emotions based on whether they watched violent cartoons or ‘live’ models of violence and what did they find?
bandura “children are often banned from watching cartoons”
children are influenced more by watching live show than cartoons
- immitative aggression
explains things like if a child grows up with a parent who is domestically violent or scared of the dentist, they are also likely to show these characteristics in adulthood
define dementia
NOT a disease in its own right (a syndrome?)
deterioration in intellectual functioning and social behaviour
does not affect the brain uniformly
who came up with the enriched model of dementia and what is it?
kitwood “patients with dementia can remember playing in the WOOD as a KID, but not what happened yesterday”
dementia = NI+H+B+P+SP
NI = neurological impairment H = health and physical fitness B = biography, life history P = personality SP = social psycology
what are the types of dementia syndrome?
alzheimer's (62%) vascular dementia (17%) mixed dementia (alzheimers and vascular) (10%) dementia with lewy bodies (4%) fronto-temporal dementia (2%) parkinson's dementia (2%) other dementias (3%)
how many people suffer from dementia in the UK and what is this projected to be by 2025?
850,000 currently
1 million by 2025
what is the definition of personhood and who defined this?
a standing or status that is bestowed upon one human being, by others, in the context of relationship and social being. It implies recognition, respect and trust
their is a gradual loss of personhood in people with dementia
kitwood
what is the pharmacological treatment for all dementias?
acetylcholinesterase inhibitors:
- donepezil (aricept), rivastigmine (exelon) and galantamine (reminyl)
- temporarily improve memory
used in mild to moderate alzheimers disease
what is the pharmacological treatment for moderately severe to severe alzheimers disease?
NMDA receptor antgonist (glutamate):
- memantine (ebixa)
what is the definition of psychological abnormalities?
the 4 D’s
behaviours or thoughts that are:
DEVIANT
different, unusual, extreme, bizarre
DISTRESSING
unpleasant, upsetting to individual
DYSFUNCTIONAL
inability to conduct daily activities
DANGEROUS
to oneself or others
what are the 7 types of mental disorders (with examples)?
ORGANIC disorders (eg dementia)
PSYCHOACTIVE SUBSTANCE USE
PSYCHOTIC disorders (eg schizophrenia)
MOOD, STRESS and ANXIETY disorders (eg depression, bipolar, anxiety)
PHYSIOLOGICAL disorders (eating or sex disorders)
DEVELOPMENT disorders (e.g. learning disorders)
disorders of CHILDHOOD (e.g. hyperactivity)
what are the 3 most prevalent mental health disorders and what % of UK population has/has had them?
mixed anxiety and depressive disorders (9%)
generalised anxiety disorder (4.3%)
depressive episode (2.3%)
what are the 5 different anxiety disorders?
- panic disorder
- PTSD
- OCD
- generalised anxiety disorder
- phobias
how do anxiety disorders manifest?
- physiological/somatic (heart racing, muscle tension)
- subjective experience (terror, dread)
- behaviour (escape, unable to move)
- cognition (i’m dying)
what are the key features of PTSD? 4
- repeated re-living of traumatic event
- persistent efforts at AVOIDANCE of memories and emotional blunting
- persistent symptoms of hyperarousal
- survivors guilt
what is generalised anxiety disorder?
excessive and uncontrollable worry about future events and outcomes
intolerance of uncertainty
define phobias
- irrational fear of specific objects or situations
- realisation that fear disproportionate and irrational
- desire to AVOID object or stuation
(avoidant behaviour NEGATIVELY REINFORCED by reduction in anxiety)
what is negative reinforcement?
e.g. if you avoid a situation, you feel better and so, in the future, you avoid it again
what is agoraphobia?
- fear of crowded/enclosed spaces and open spaces
- fear of panic attack and resultant embarrassment
what is social anxiety disorder (social phobia)?
- extreme and persistent fear of humiliation and embarrassment
- avoidance of social and public activities
- onset in teens, affects more men, common
what is the theory behind CBT?
try to change the THOUGHTS and BEHAVIOURS in order to change the EMOTIONS and PHYSICAL SENSATIONS felt
what are simple phobias
phobia of a very specific thing
spiders
blood
dentist
height etc
how do you treat simple phobias?
using SYSTEMIC DESENSITSATION
- a form of behaviour therapy
- graded exposure to feared thing/experience
what are the three types of depression?
bipolar depression
- excessive elation, irritability, talkativeness
- inflated self-esteem
- followed/preceded by period of depression
unipolar depression
- no mania
dysthymia
- persistent low-grade depression
- most common
- difficult to diagnose/treat
what does anhedonia mean?
loss of interest and enjoyment
(a symptom of depression)
“someone who is HEDONISTIC has a zest for life/experiences”
drug treatments for depression
SSRIs (most common)
tricyclics
MAOIs
noradrenaline, serotonin
what is the theory that was the basis for CBT?
beck’s cognitive theory of depression
what is the cognitive triad in depression?
negative view of SELF, EXPERIENCE and FUTURE
-together produce, and maintain, depression
what is a common side effect of electro-convulsive therapy?
memory loss
what are the 3 errors in logic that occur in depression that beck described?
OVERGENERALISATION
fail at one thing so useless at another
MAGNIFICATION + MINIMISATION
making disasters, failure to take praise
PERSONALISATION
taking all the blame
what is parasuicide?
a failed suicide attempt
two main types of self-harm
self-poisoning
self-injury
what is self-harm?
intentional self-poisoning or self-injury, irrespective of motivation
8 motivations for self-harm
get relief from state of mind
escape from impossible situation
show how much you love someone
show somebody how you feel
find out if somebody loves you
seek help
frighten someone/make them sorry
influence someone
which sex is more likely to self harm
men and women are just as likely to self harm
does suicide and self harm increase or decrease with age?
self harm decreases with age
suicide increases with age
are rates of self-harm and suicide rising or falling
self harm = rising
suicide = falling
what percentage of survivors of near-lethal suicide attempts DO NOT commit suicide thereafter?
90%
