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HYMS Y1 > Block 6 W4 > Flashcards

Block 6 W4 Flashcards

1
Q

What are the 4 aspects of learning disabilities?

A
  1. significant impairment in intelligence - IQ.
  2. significant impairment in adaptive behaviour - reading, writing, numeracy.
  3. Significant impairment in social functioning - varies with diagnosis.
  4. onset during developmental period (<18 years).
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2
Q

Describe the Stanford-Binet scale for measuring intelligence.

A

Guages intelligence through 5 factors of cognitive ability:

  • fluid reasoning
  • knowledge
  • quantitative reasoning
  • visual-spatial processing
  • working memory
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3
Q

How is IQ measured?

A

IQ = (mental age/chronological age) x 100

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4
Q

What is the Wechsler adult intelligence scale (WAIS)?

A

Stanford Binet wasn’t appropriate for adults as it relied too heavily on language ability.
Includes verbal and performance sub scales.

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5
Q

Describe the normal distribution of IQ.

A

LD - if IQ less than 70 (2SD below the mean of 100)
50-70 -> mild LD
35-49 -> moderate
20-34 -> increased sensory and motor deficits, 50% have epilepsy.
<20 -> profound, developmental level 12 months.

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6
Q

How does trauma cause LD?

A

Related to forceps delivery or ventouse delivery -> could damage the brain.

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7
Q

How does toxin cause LD?

A

Foetal alcohol syndrome:

  • underdeveloped jaw
  • smooth philtrum
  • low nasal bridge
  • small head
  • flat midface
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8
Q

Describe the genetics of tuberous sclerosis.

A

Autosomal dominant disorder
Affects genes that contribute to production of hamartin and tuberin (TSC 1 - Ch9, TSC 2 - Ch16) -> responsible for halting growth of tumours.
Causes growth of hamartomas across the body - brain, skin, kidneys, heart.

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9
Q

Describe the signs of tuberous sclerosis.

A

Adenoma sebaceoum are tumours that are vascular and fibrous in origin and found on cheeks or within folds at the side of mouth and nose.
Areas of macular hypo-pigmentation occurs in ovoid or leaf-shapes.
Sections of cerebral cortex show tuber life growths on brain, which calcify and become sclerotic.
Thus, 50% have LD.

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10
Q

How does genetics contribute to LD?

A

Down’s syndrome - 95% caused by trisomy Ch21
People with DS living longer now.
45% over 45 develop Alzheimer’s -> cerebral atrophy.

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11
Q

Describe the metabolic causes of LD.

A 
Autosomal recessive gene
Phenylketonuria - 1/10,000 births -> absence of phenylalanine hydroxylase -> build up of phenylalanine:
- microcephaly
- epilepsy
- over activity
- autism 
- albinism
- musty odor
People with PKU can't produce tyrosine, AA, involved in melanin production -> fair skinned and blue eyes.
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12
Q

Describe the Guthrie test.

A

Primary diagnostic test for PKU - measurement of phenylalanine levels in drop of blood taken from heel of a newborns foot.
Screening procedure
PKU confirmed by appearance of bacteria growing around high conc. of phenylalanine in blood spot.
Normal development occurs with low phenylalanine diet and drugs.

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13
Q

What are the major infections that causes LD?

A 
T - 
O - toxoplasmosis
R - rubella
C - cytomegalovirus and congenital syphilis
H - herpes
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14
Q

How does the foetus contract toxoplasmosis?

A

Through placental connection with infected mother.

Mother infected by improper handling of cat litter or contaminated meat.

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15
Q

Describe the Toxoplasmosis gondii.

A

Protozoa
Found in undercooked meat, raw meat and cat faeces.
25-50% of worlds population is infected and around 1% in UK catch toxoplasmosis/year.
Causes flu-like symptoms - affects babies/foetuses, immune deficient people.

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16
Q

Describe cerebral infections.

A

Meningitis and encephalitis -> rare complication of common infections. Rate decreased due to MMR vaccine.
Herpes simplex virus - most common cause.

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17
Q

Describe the morbidity and mortality of LD patients.

A
  • Significant physical health needs - 74% needed specialist care.
  • Life expectancy markedly reduced - directly proportional to level of disability.
  • Death by indifference -> neglected within healthcare, delayed diagnosis and treatment, institutional discrimination.
  • Significant increased mental disorder compared to general population.
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18
Q

What services are available to LD patients?

A

GP, hospital, liaison nurse, community LD team, inpatient services.
Independent sector organisations e.g. Wilf Ward family trust and Mencap.

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19
Q

Define psychosis.

A

Fundamental and characteristic distortions of thinking and perception. Clear consciousness and intellectual capacity is usually maintained.

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20
Q

Describe the ICD-10 diagnostic requirement for schizophrenia.

A

1 syndrome or 2 symptoms for most of the time for at least 1 month.
Not manic or depressive episode or at least present before these.
Not attributable to organic brain disease.
Not attributable to alcohol or drug-related intoxication, dependence or withdrawal.

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21
Q

List the symptoms of schizophrenia.

A
  • thought echo, insertion, withdrawal or thought broadcasting
  • delusions of control, influence or passivity of thought, action or sensation
  • delusional perceptions
  • persistent delusions that are bizarre or impossible
  • catatonic behaviour i.e. mutism, stupor, posturing
  • disordered thought (derailment, incoherence, neologisms, irrelevance)
  • hallucinatory voice in 3rd person, discussing, running commentary or coming from part of body
  • negative symptoms
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22
Q

What are the 7As of negative symptoms?

A 
Apathy (lack of interest)
Avolition (lack of motivation)
Anergia (lack of energy)
Alogia (poverty of speech)
Anhedonia
Asociality (lack of social interaction)
Affective flattenening (restricted range of emotions)
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23
Q

Describe the cognitive symptoms in schizophrenia.

A

Average IQ = 95 -> declines after 1st episode
Discrepancy in verbal/non-verbal IQ
Impaired attention
Over-inclusiveness, verbal redundancy

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24
Q

Describe Liddle’s 3 syndrome model.

A
  1. reality distortion - hallucinations, delusions
  2. disorganisation - thought disorder, inappropriate affect
  3. psychomotor poverty - poverty of speech, blunted affect
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25
Q

What are the structural findings of the brain in psychosis?

A
  • increased ventricle volume
  • decreased volume of cortex
  • more neurones with less connections
  • functional imaging shows patterning of activity that reflects symptoms:
    • auditory hallucinations -> Broca’s area
    • negative symptoms -> prefrontal cortex
    • passivity -> cingulate gyrus
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26
Q

Explain the epidemiology of schizophrenia.

A 
M=F
Earlier peak onset in males (22 vs. 26)
Incidence - 1-2/10,000 per year
Lifetime prevalence - 1%
Urban > rural (2-3x risk)
Most common in SEC IV &amp; V.
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27
Q

What are the prenatal risk factors of schizophrenia?

A
  • premature birth
  • unwanted pregnancy
  • maternal influenza
  • rubella
  • malnutrition
  • associated medical problems e.g. diabetes
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28
Q

What are the obstetrics and neonatal risk factors of schizophrenia?

A
  • obstetrics complications
  • low birth weight
  • hypoxia
  • association with structural brain abnormalities
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29
Q

What are the early childhood risk factors of schizophrenia?

A
  • mixed handedness (crow)
  • mixed hand and eye dominance (cannon)
  • late milestones
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30
Q

What are the adult risk factors of schizophrenia?

A
  • age
  • gender effects
  • urban vs. rural
  • migrants risk is 4-6x greater in 2nd generation, declining in subsequent generations.
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31
Q

What are the late risk factors of schizophrenia?

A 
Precipitants:
- life events 
- substance abuse
Cannabis - dose response effect, gene x environment. Low CBD:THC ratio worse.
Amphetamines/cocaine/crack
Hallucinogens
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32
Q

What is the dopamine hypothesis of psychosis?

A

Increased dopamine activity in striatal dopaminergic neurones -> psychosis.
Increased synaptic release and D2 receptor occupancy.
- acutely psychotic individuals -> have excessive striatal release of dopamine
- excessive dopamine release leads to aberrant assignment of salience to unimportant stimuli
- delusions may arise from attempts to explain this abnormal salience.

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33
Q

Define acute and transient psychotic episodes.

A

Acute onset of delusions, hallucinations, incomprehensible or incoherent speech.
Interval from 1st appearance to presentation is <2 weeks
Not due to drugs or organic cause
Not fulfilling criteria for mania or depression

34
Q

What are the treatments available for schizophrenia?

A

Antipsychotics - dopamine (D2) antagonists
main side effects: sedation, weight gain, hyperprolactinaemia, involuntary movements.

Psychological - family therapy, CBT, trauma focus, help with voice hearing.
Social - housing, employment/education support, social connections, community engagement.
Treatment for substance abuse and other co-morbid problems.

35
Q

What are the prevention methods for psychosis?

A

Early detection, early intervention in psychosis services, open referral and 2 week standard for assessment and start of treatment for any suspicion of psychosis.
3 years of intensive support
Treatment of the ‘at risk mental state’

36
Q

Define at risk mental state.

A

Subthreshold positive symptoms that are not severe or persistent enough for a diagnosis of psychotic disorder other than brief psychotic disorder.
OR
A family history of psychotic disorder or schizotypal disorder in a 1st degree relative + significant, persistent but non-specific decline in psychosocial functioning within last year.

37
Q

Define personality.

A

The relatively stable characteristics that differentiate one person from another, demonstrated in the consistent and predictable way in which people behave in different situations over extended periods of time.
An enduring set of habitual patterns of behaviour, cognition and emotion across time and situation.

38
Q

Describe the psychodynamic theory of personality development.

A

Cause of behaviour patterns, thoughts and feelings arise from:
- unconscious internal conflicts associated with childhood experience
- unconscious conflicts between pleasure-seeking impulses and social restraints/demands
Main focus - unconscious motives and importance of childhood.

39
Q

Describe Freud’s 3 levels of awareness.

A
  1. conscious mind - contacts with outside world
  2. preconscious mind - just below surface of awareness
  3. unconscious mind - difficult to retrieve things, well below surface of awareness.
40
Q

Define id.

A 
Instincts
- primitive thinking
- driven by basic biological urges e.g. hungry infant will cry to be fed
- seeks pleasure and avoids pain
- operates unconsciously 
2 major instincts:
Eros - life instinct
Thanatos - death instinct
41
Q

Define ego.

A

Reality

  • conscious processing
  • intelligent consideration of reality
  • rational decision making/problem solving
  • considers consequences of behaviour
  • controls higher mental processes
42
Q

Define superego.

A

Morality

  • partly conscious and partly unconscious
  • internalised rules of society/family
  • stops us from gratifying every whim because they are immoral
    1. conscience - notions of right and wrong
    2. ego ideal - how we ideally like to be
43
Q

How do the id, ego and superego interact?

A

Id - pleasure principle, immediately satisfies basic needs.
Ego - reality principle, restrains instinctive energy
Superego - voice of conscience

44
Q

What are the defence mechanisms?

A

Repression - removal of threatening thoughts from awareness
Projection - attribution of unacceptable impulses to others
Denial - refusal to recognise a threatening situation or thought
Reaction formation - expression of the opposite of disturbing ideas
Displacement - substituting a less threatening object for impulses
Sublimation - channeling of impulses to socially acceptable outlets
Regression - return to a less mature, anxiety reducing behaviour.

45
Q

Describe Freud’s, Carl Jung’s and Alfred Adler’s personality development theories.

A

Freud - personality develops during the first few years of life, rooted in unresolved conflicts of early childhood.
Carl Jung - personal vs. collective unconscious. Balance between introversion and extroversion.
Alfred Adler - striving for superiority and inferiority complex.

46
Q

Describe the humanistic theories of personality development.

A

Focuses on subjective human experience and perspective.
People have free will and are basically good.
Optimistic view focusing on positive human capacity to overcome hardship and pain.
Fulfilment and personal growth are a basic human motive (self-actualisation).

47
Q

What are Carl Roger’s key concepts?

A

Self-concept - our own image or perception of ourselves and comprises self-image, self-esteem and ideal self.
We need positive regard/approval from others and we change our behaviour to obtain it.
Anxiety indicates conflict in not being true to our ideal self.
Fully functioning person is: open to experience, able to live for the moment, able to trust their own feelings, creative and fulfilled.

48
Q

Describe Maslow’s hierarchy of needs.

A 
At the top - self-actualisation -> realisation of personal potential, becoming everything one is capable of becoming.
Esteem
Love/belonging
Safety
Physiology
49
Q

What are Maslow’s characteristics of the self-actualised person?

A

Creative and open to new experiences
Committed to higher cause
Trusting and caring of others
Have courage to act on own convictions.

50
Q

Describe the trait theories of personality development.

A

Tries to identify the most basic enduring dimensions in which people differ from one another - these dimensions known as traits.

51
Q

Describe Eysenck’s three factor theory.

A

There are 3 factors that determine personality (determined by hereditary).

  • introversion vs. extroversion
  • emotional stability vs. neuroticism
  • impulse control vs. psychosis
52
Q

Describe Cattell’s 16 personality factors.

A

Collected data:

  • L-data -> life record data e.g. school grades, absence from work
  • Q-data -> questionnaire to rate individuals personality
  • T-data -> objective tests designed to tap into personality construct.
53
Q

What are the big 5 personality factors?

A

5 dimensions - all people will score along the dimension from high to low in each trait.
O - openess (imagination, insight)
C - conscientiousness (thoughtfulness, responsibility)
E - extroversion (excitability, sociability)
A - agreeableness (trust, altruism)
N - neuroticism (instability, anxiety)

54
Q

What are the application for the big 5 personality factors?

A 
Measuring traits:
- mental health setting
- occupational health setting
- matching applicants to particular jobs
- research
Criticism:
- doesn't comment on personality development
- poor predictor of future behaviour
- offers nothing about changing personality
55
Q

Describe the social cognitive theories of personality development.

A

Based on interrelationship of individual and others and the environment. Influenced by social learning theory and emphasises the role of learning in development of personality.
Classical conditioning and operant conditioning.
Modelling.
How environment shapes personality.

56
Q

Describe the internal and external worlds of the social cognitive theory.

A

Rotter’s theory of locus of control:
Internal world + external world = individual.
Internal locus - you control your own destiny
External locus - luck/fate/chance control your destiny
Learned helplessness - sense of hopelessness in which an individual thinks they are unable to prevent bad things from happening.

57
Q

What are personality assessments?

A

Used to help diagnose psychological disorders, counsel people about normal day-to-day problems, select personnel for organisations and conduct research

58
Q

Define objective and projective personality tests.

A

Objective personality tests - self-report inventories i.e. MMPI-2, 16PF and NEO personality inventory,
Projective personality tests - subjects respond to ambiguous stimuli e.g. Rorschach test and Thematic apperception test.

59
Q

What is the impact of personality?

A

Affects:

  • physical health
  • mental health
  • personality disorders
  • behaviour (criminality, relationships and work)
60
Q

Describe how personality affects physical health.

A
  • type A behaviour associated with higher rate of heart disease
  • optimism, conscientiousness and openess associated with better health including lower incidence of CHD, reduced incidence of strokes, greater longevity.
  • neuroticism and negative affect associated with reduced lifespan and increased incidence of objectively diagnosed somatic illness including heart disease, lung disease and arthritis.
61
Q

Describe how personality affects mental health.

A

Development of bipolar associated with low ratings for emotional stability aged 18.
High levels of emotional stability, social maturity, mental energy were protective against schizoaffective disorder.
People with personality disorders have higher rates of mental illness in general.

62
Q

Define personality disorder.

A

Diverse category of psychiatric disorders characterised by long-term behaviour that deviates markedly from the expectations of the individual’s culture and:
- this pattern of deviation is pervasive and inflexible and is stable over time
- this behavioural pattern negatively interferes with relationships and work
Problematic, persistent and pervasive.
Cause - unknown but genes and childhood experiences play a role.

63
Q

Describe the effects of personality disorder.

A

People with personality disorder have difficulty dealing with everyday stresses and problems.
Symptoms vary widely depending on type
Often have stormy relationships.

64
Q

What are the types of personality disorders?

A

Cluster A - odd or eccentric - suspicious, paranoid, schizoid, antisocial.
Cluster B - dramatic, emotional, erratic - borderline, histrionic and narcissistic.
Cluster C - anxious and fearful - avoidant, dependent, obsessive compulsive.

65
Q

Define attachment.

A

Deep and enduring emotional bond that connects two people across time and space.

66
Q

Define attachment disorder.

A

Umbrella term used to describe disorders of mood, behaviour and social relationships arising from failure to form normal attachments to primary caregivers in early childhood.

67
Q

What are the classifications of attachment?

A

Secure, insecure-avoidant, insecure-resistant, disorganised.

68
Q

Describe secure attachment.

A

Type B - 55-65% of population

  • Children show some distress when caregiver leads but compose themselves knowing their caregiver will return.
  • Feel protected by their caregivers.
  • Use caregiver as secure base in which to explore environment.
  • Seeks caregiver when distressed.
  • Caregiver is sensitive to child cues and signals and responds appropriately to their needs.
69
Q

Describe insecure-avoidant attachment.

A

Type A - 20-25% population

  • do not orient to the caregiver whilst investigating the environment
  • independent of caregiver both physically and emotionally
  • do not feel caregiver when distressed
  • caregiver is insensitive and rejecting of their needs and unavailable during times of stress.
70
Q

Describe insecure-resistant attachment.

A

Type C - 10-15% population

  • Clingy and dependent towards caregiver
  • rejecting caregiver during interaction
  • fails to develop any feelings of security from caregiver
  • difficulty in moving away from caregiver to explore novel environments
  • difficult to sooth and not comforted by caregiver when distressed
  • inconsistent level of response to their needs from caregiver
71
Q

Describe disorganised attachment.

A

Type D - 15-20% population
- associated with trauma - abuse, neglect, loss
- defined by fear and fright
- lack of attachment behaviour
- odd or ambivalent behaviour - no organisation of behaviour
- may seek out comfort but fear close proximity with caregiver
depressed, freeze, withdrawn

72
Q

What are the outcomes of secure attachment?

A

Confidence and social-emotional wellbeing
Good social relationships
Positive long-term outcomes.

73
Q

What are the outcomes of insecure attachment?

A

Anxiety/depression
Behaviour problems/conflict
Poor social skills
Negative long-term outcomes

74
Q

How do you measure attachment according to NICE guidelines?

A

1-2yrs - strange situation procedure
1-4yrs - attachment Q-Sort
2-4yrs - Cassidy Marvin Preschool Attachment Coding System and Preschool assessment of attachment.
4-7yrs - Manchester child attachment story task, McArthur story stem battery and Story stem attachment profile.
7-15yrs - child attachment interview
15+yrs - adult attachment interview

75
Q

Define strange situation procedure.

A

Observational
Parent and infant introduced to experimental room alone. Infant explores whilst parent doesn’t participate. Stranger enters, converses with parent then approaches infant. Parent leaves.
1st separation episode - strangers behaviour geared to infants.
1st reunion - parent greets and comforts infant then leaves.
2nd separation - infant alone
Continuation of 2nd separation - stranger enters and gears behaviour to infants.
2nd reunion - parent enters, greets and picks up infant, stranger leaves conspicuously.

76
Q

Define story stem attachment profile.

A

Interview:
Children asked to respond to set of narrative story stems where they are given beginning of story highlighting everyday scenarios with inherent dilemma.
Children asked to show and tell me what happens next.
Allows assessment of child’s expectations and perceptions of family roles, attachments and relationships without directly asking them.
Relies on non-verbal and verbal comms.

77
Q

Define child attachment interview.

A

Focuses on current memories and assesses children’s perceptions of their attachment figure’s current availability and sensitive responsiveness through eliciting internal representations of attachment figures.
19 Qs require children to recall and describe their attachment experiences at times of emotional state.
e.g. what happens when your mom gets cross with you or tells you off?

78
Q

How does adult attachment interview differ from child?

A

Similar but asks the adult to focus specifically on past events in childhood.

79
Q

Describe video guidance as an intervention.

A
  • purpose is to enhance relationships, communication and social-emotional wellbeing
  • 3 sessions/3 filmed interactions
  • focus on positive interaction between parents and children
  • parent only discussions with trained facilitators.
80
Q

Describe parental sensitivity and behaviour training as an intervention.

A
  • purpose is to encourage parents to understand and manage child behaviour
  • between 5-15 sessions weekly
  • focus on improving parental sensitivity and quality of parenting
  • parent only or parent-child
81
Q

Describe home-visiting programmes as an intervention.

A
  • purpose is to improve parental comms and relationship with child
  • 12 weekly or month sessions lasting 30-90 minutes over 18 months
  • focus on supporting positive parent-child interaction using role modelling and reinforcing positive interactions
  • parent-child
82
Q

Describe parent-child psychosocial therapy as an intervention.

A
  • purpose is to improve parent-child relationship by improving the way they interact with their social environment
  • e.g. CBT and counselling
  • varying number of sessions depending on specific therapy used
  • parent or child & parent-child

HYMS Y1 (25 decks)

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