Final Flashcards
(27 cards)
ECT answer structure
- ECT definition
- Against arguments (John Read)
- Against argument (reported as success)
- For arguments adressed by Read
- C.F Meechan et al For arguments
Overall belief
Against arguments John Read
-8
Evidence of persistent/ permanent memory loss occurred in 12-55% of patients
- Psychiatrists attempt to discredit these criticisms riddled with misprepresentations, omissions and inconsistencies
- Only ever been 11 placebo controlled studies with small sample sizes from 1986
- No studies found convincing evidence that ECT is better at the end of treatment
- None assess quality of life
- None are double blind
- Mean quality score attained was 12.3 out of 24
- 2 higher quality studies produces near 0 effect size
For argument adressed by read
-5
ECT used for long time (lobotomies)
- Unfair to critique 1986 RTCs with today standards (Admits lack of evidence)
- Unethical to conduct study that withhold treatment from ill (Eliminates ECT from evidence based medicine)
- non-placebo studies sufficient (2017 review found 89% of other types of studies produced no good follow up data after end of treatment)
- ECT is long term if you use antidepressants after it (shows no evidence after treatment period + ECT is reccomended for treatment resistant MDD)
C.F Meechan et al For arguments
- 4
Evald and approved by major health/ drug boards (NICE, FDA) - UK ECT review group found 6 relevant trials that support ECT as opposed to SECT effect size of 0.91
- Remission rates are higher for ECT vs rTMS with reduction of depressive symptoms in ECT group BUT neither found significant diff after disconitnuation
- RCTs provide converging evidence for the efficacy of ECT over numerous comparators like sECT, pharmacological+ non pharma interventions and alt modes of ERCT
Overall ECT
Lack of convincing evidence for ECT
What is Agoraphobia answer structure
- Definition and Symptoms
- Criteria for diagnosis
- Prevalence
- Drug treatment
- other treatment
- Potential causes
- how it is maintained
Agoraphobia definition and symptoms
Anxiety disorder/ phobia where individual experiences fear specific to leaving their home and travelling to public places. Anxiety disporportionate to actual danger posed by situation.
- Causes clinically significant distress or impairment in social, occupation or other areas of functioning
- lasts 6 or more months
Agoraphobia criteria for diagnosis
5
Individual presents with fear in at least 2 of the situations:
- Public transit
- Large open spaces
- Enclosed spaces
- Larger crowds
- Being outside the house in general
Agoraphobia prevalence
- 5
1.7% overall - Females twice as likely
Develops in late adolescence, tapers off in late adulthood
HIGH COMORBIDITY WITH PTSD
Comorbid with other anxiety, depressive and substance use disorders
Agoraphobia drug treatments
5
Ketamine
Memantine
Riluzole
Valproic acid etc
Same drugs treatments for social anxiety disorder or GAD
other treatment for agoraphobia
4
Exposure techniques most effective
Combintation of CBT and exposure therapy is effective when comorbid with panic disorder
Group therapy + individual therapy was 60-80% improvement rate when they don’t have panic disorder
BUT high relapse rate so patients should attend booster sessions
Agoraphobia potential causes
5
Generalisable to other anxiety disorders
- Learned association (Classical/operant)
Maladaptive assumptions and negsative appraisals about the environment
Fear through observation and imitation
GENETICS: MUTATION OF SEROTONIN TRANSPORTER GENE RELATED TO REDUCTION IN SEROTONIN ACITIVITY AND INCREASE IN ANXIETY RELATED TRAITS
how agoraphobia is maintained
Aographobia leads to avoidance behaviours. If the patient stays at home and lets the anxious thoughts develop, they have no way for the thoughts to be proven wrong
Usually also leads to isolation so no one is around to dispute anxious/ disporportionate thoughts, inward spiral
Millions personality theory answer structure
Definition of personality disorder
Evolutionary adaptation viewpoint
Personality as a product of 4 domains
Personality polarities (3)
r and k strategy
Balance and Maladaptive traits
taxonomy of personality disorders
Def of personality disorder
Enduring patter of inner experience and behaviour, which deviates markedly from cultural norms in two or more areas:
- Cognition
Emotional response
Interpersonal functioning
Impulse control
Millions evolutionary adaptation viewpoint
He viewed personality as an evolutionary adaptation, personality disorder is a problem in the adaptation , which gives rise to individual differences in personality style, ranging from normal to disordered
4 Domains of personality to Million
Believed personality was a product of four interacting Domains
- Interpersonal
Biological
psychodynamic
congitive
MIllion classified 3 personality polarities/ motivating aims
Personality disorder is a dysfunctional adaptation of personality polarities
Existence (Type of reinforcement)
- Pain–> pleasure
Adaptation (Coping style)
- Active –> Passive
Replication (Source of reinforcement)
- Self–> other
(R strategy at polar extreme of ‘self’, self propagating strategy, K Strategy as extreme of the ‘other’, other nurturing strategy)
Maladaptive traits due to lack of balance of personality polarities
- Adaptive inflexibility
- Vicious circles
Tenous stability
Could results in personality disorder
Millions Taxonomy
Milions approach to personality disorders involves mapping personality disorders onto his model of personality polarities to form a taxonomy of personality disorders
Approaches to describing the severity of personality disorder answer structure
Millions approach
Tyler and Johnson approach
Widiger and Sanderson
DSM categorical approach
Fallon’s approach
Other
Millions approach to describing the severity of personality disorder
internal psychological organisation can be placed on the spectrum of functionality (to dysfunctionality) depending on how well and consistently it performs within and social context
- Hints that ASPD is the leasdt severe group because it has better social adaptation than other PDs like Schizoid
Tyler and Johnson approach to severity
4 point scale
0- no disorder
1- personality difficulties
2- simple PD
3- diffuse PD
The approach lacks clinical utiity
Ordinal organisation invites bias and limitations
Widiger and Sanderson approach to severity of PD
Defined it using criteria/ ratings within each PD
- Attempts to have a categorical and dimensional approach
- rejected by DSM IV
