LAST MINUTE - clin psyc

Question 1

______ is the accumulation of fluid (.e.g, in the brain) that can lead to there being not enough space for the braint o swell into.

Answer 1

Oedema

Question 2

Describe how the Glasgow Coma Scale is used to assess the depth of a patients coma. (describe how and what it measures)

Answer 2

The glasgow coma scale is a brief test of simple visual, verbal and motor abilities.

Visual - does the patient open their eyes? ranked from 1 (not at all) ->2 (to pain) ->3 (to speech)-> 4 (spontaneous)

Verbal - do they respond verbally? ranked from 1-5: none, incomprehensible, inappropriate, confused, orientated.

Motor - Do they respond to a motor command (e.g., can you move X) ranked from 1-6: none, extension, abnormal flexion, withdrawal, localises pain, obeys command

Question 3

What GCS rating combined with Coma durations suggest Mild, Moderate and Severe traumatic brain injuries, respectively?

What level of disability are each of these categories predictive of?

Answer 3

MILD

• GCS: greater than 13
• Duration: less than 30 minutes
• Predicts: good recovary

MODERATE

• GCS: 9-12
• Duration: less than 6 hours
• Predicts: moderate disability

SEVERE

• GCS: less than 8
• Duration: greater than 6 hours after admission
• Predicts: severe disability

Question 4

What rating on the Glasgow Coma Scale is predictive of greater mortality?

Answer 4

A GCS score of less than 7.

Question 5

At what score on the Glasgow Coma Scale is the unconsciousness considered to be a “Coma”?

Answer 5

less than or equal to 8.

however it is important to recognise that “coma” is a continuum from no coma -> shallow coma -> deep coma …and that people come out of coma gradual in stages.

Question 6

Post-traumatic amnesia severity can be categorised based on it’s duration.

at what duration would PTA be considered:

• very mild
• mild
• moderate
• severe
• very severe
• extremely severe

Answer 6

• very mild < 5 mins
• mild 5-60 mins
• moderate 1-24 hours
• severe 1-7 days
• very severe 1-4 weeks
• extremely severe > 4 weeks

Question 7

Another word for severe bleeding is_____

Answer 7

Haemorrhage

Question 8

What are the four main complications of a closed head injury?

Answer 8

1. Oedema (accumulation of fluid, not enough space for brain to swell into)
2. Haemorrhage (bleeding) and resulting hematoma (accumulation of blood)
3. Skull fractures (protrude into the brain and can result in infection)
4. Post-traumatic epilepsy (due to scar tissue)

Question 9

What are (or can be) the cognitive symptoms of traumatic head injury? (its neuropsychological profile)

Answer 9

• Orientation
• attention
• memory
• behavioural slowing
• sensory function
• verbal retrieval
• executive functioning

Question 10

What personality changes can result from traumatic brain injury?

Answer 10

• Lack of initiative & loss of spontaneity
• Temper outbursts & mood alterations
• egocentricity
• poor self-awarenss (of deficits)
• deppression (usually after 6 months post-injury)

Question 11

Describe the duration of loss of consciousness(LOC) post-traumatic amnesia (PTA) and ‘complaints’ consistent with a mild traumatic head injury (i.e., concussion)

Answer 11

• LOC: less than or equal to 30 mins
• PTA: less than or equal to 24 hours
• Complaints: less than or equal to 3 months (changes in the brain are microscopic)

Question 12

What are the common complaints of a mild traumatic head injury (i.e., a concussion)?

How long does it usually take complaints to emerge?

How long does recovary usually take?

Answer 12

PHYSICAL

• Dizziness, headaches, noise sensitivity, vision (e.g., blurred)

COGNITIVE

• Orientation (initial person/time/place), Attention (concentrating) and Memory

PERSONALITY

• Patience/temper, anxiety and deppression.

Symptoms/complaints emerge a few days after injury (When people attempt to resume regular activity)

Recovary can take 3 months and symptoms tend to disappear gradually.

Question 13

What is the timeline of recovery for traumatic brain injuries?

During what time period are the most recovery gains made?

Answer 13

Max level of recovery reached around 2 years post-THI

Most gains made during the first 6 months.

Question 14

a _______ is when a temporary obstruction occurs in an artery resulting in temporary hypoxia.

is short lasting resulting in transient deficits.

Answer 14

Transient Ischemic Attack (TIA)

Question 15

______ is when there is an permanent obstruction in a blood vessel resulting in prolonged hypoxia resulting in necrosis (i.e., an infarction)

Answer 15

Obstructive Ischemic Stroke

Question 16

What are the symtoms of a Transient Ischemic Attack (TIA)?

Answer 16

Physical - dizziness

Cognitive - orientation, sensation & perception, language, motor skills (weakness)

Question 17

_____is a Type of Obstructive Ischemic Stroke whereby plague forms elsewhere in the body and travels to the brain where it blocks a blood vessle

Answer 17

Embolic

Question 18

_____is a Type of Obstructive Ischemic Stroke whereby fatty deposits built up in vessle walls block/narrow blood vessles in the brain (accident occurs over 30minutes)

Answer 18

Thrombotic

Question 19

The space between the surgace of the brain and the skull is called the _______

Answer 19

subarachnoid space

Question 20

_____ referes to inside the brain itself

Answer 20

Intracerebral

Question 21

What are the common cognitive symptoms of a CVA?

Answer 21

• Orientation - self, place, time
• Attention -
• Motor function - slowing, paralysis, unsteady, coordination
• Executive function - trouble planning, organising, responding to novel situations
• Memory - mostly STM (LTM usually alright) misplace things, getting lost, struggle to live independently - structure is important

Question 22

What are the common cognitive symptoms of a CVA?

Answer 22

• Orientation - self, place, time
• Attention -
• Motor function - slowing, paralysis, unsteady, coordination
• Executive function - trouble planning, organising, responding to novel situations
• Memory - mostly STM (LTM usually alright) misplace things, getting lost, struggle to live independently - structure is important

Question 23

How do the symptoms of a left hemisphere stroke differ from those of a right hemisphere stroke?

(i.e., lateralisation)

Answer 23

for the 98% of people with left language lateralisation:

• damage to the left hemisphere affects receptive and expressive language.
• damage to the right hemisphere affects visual-spatial ability (perceptual, estimating distances between points)

Question 24

What personality changes can result from a CVA?

(and the hemisphere where possible)

Answer 24

• Depression (left hemisphere stroke)
• Apathy/indifference (right hemisphere)[tone expression]
• Euphoria (right hemisphere stroke)
• Impulsiveness
• Emotional lability - exagerrated or incongruent responses
• Lack of initiation - not being able to start a behaviour
• Perseveration - Not being able to stop a behaviour
• Poor judgement - leading to inappropriate or dangerous behaviour

Question 25

What are Lack of initiation and Perseveration, respectively?

Answer 25

1. Not being able to **start** a behaviour 2. Not being able to **stop** a behaviour

Question 26

What is the recovary timeline for CVAs? When does most of the recovery occur?

Answer 26

Plateau at 6 months Improve most rapidly for the first few weeks (i.e., quicker initial recovery and quicker plateau than brain injury patients.)

Question 27

what is "epilepsy"?

Answer 27

A cluster of symptoms * Recurring seizures (reversable alterations of consciousness) [ arousal alertness, awareness * Hyperventilation * Migraine

Question 28

the \_\_\_\_\_\_ posits a negative linear relationship between age of brain lesion and outcome expectancy

Answer 28

Kennard Principle

Question 29

\_\_\_\_\_\_\_ is not being able to start a behaviour

Answer 29

lack of initiation

Question 30

\_\_\_\_\_ is not being able to stop a behaviour

Answer 30

perseveration

Question 31

The first stage of a seizure where Auras occur is known as the \_\_\_\_\_

Answer 31

Prodromal phase

Question 32

The second stage of a seizure where a person experiences a temporary change in consciousness is known as the \_\_\_\_\_\_

Answer 32

Ictal phase

Question 33

The last stage of a seizure where a person regarins consciousness (minutes or hours later) is known as the \_\_\_\_\_\_

Answer 33

post-ictal phase

Question 34

strange pre-seizure symptoms that occur in the prodromol phase such as dizzy, nauseous, metallic taste, smells, mood changes, deja-vu, stomach butterflies are know as\_\_\_\_\_\_

Answer 34

AURAs

Question 35

Seizures were the whole brain is involved/affected are _______ seizures

Answer 35

Generalised

Question 36

Seizures were only part of the brain is involved/affected are _______ seizures

Answer 36

partial (focal)

Question 37

What type of genealised seizure involves a person letting out a cry, crumpling, face goes blue, stop breathing, tense/rigid ----\> follow by approx 30 secs on rythmic jerking?

Answer 37

Grand mal seizure

Question 38

in the _____ phase of a grand mal seizure a person might let out a cry, crumple, their face goes blue, they stop breating and they go tense/rigid for about 30seconds

Answer 38

Tonic

Question 39

in the _____ phase of a grand mal seizure a person has rythmic jerking of the limbs for approx 30 seconds.

Answer 39

Clonic

Question 40

partial seizures with one mode of expression are called \_\_\_\_\_\_

Answer 40

simple seizures.

Question 41

partial seizures involving an entire lobe or a number of brain areas are known as\_\_\_\_\_\_\_

Answer 41

Complex partial seizures

Question 42

partial seizures involving the motor cortex are know are\_\_\_\_\_

Answer 42

Jacksonian/marchign seizures.

Question 43

\_\_\_\_\_ involve repeatedly doing the same behaviour (i.e., 'stuck') and feature in complex partial seizures.

Answer 43

Automatisms

Question 44

Seizures of the motor cortex. That start with muscle contractions in just one area (e.g., moving one finger) then the seizure progresses across the motor cortex, are known as\_\_\_\_\_\_\_

Answer 44

Jacksonian/marching seizures

Question 45

The ________ is a test done prior to surgery for epepilepsy whereby a barbituate is injected at the base of the brain which causes 6-8 minutes of half-brain paralysis. ## Footnote This enables the neuropsychologist to ensure that the other side of the brain can compensate, thus it is highly useful for partial sezures, specifically temporal lobe seizures.

Answer 45

WADA

Question 46

What is the neuropsychological profile of epilepsy? (cognitive and personality symptoms)

Answer 46

Cogntive symptoms * attention * memory and learning Personality symptoms **Epilepsy** -\> **Reduced quality of life** -\> : limitations in driving, swimming, jobs, reduced social interaction (no late nights or alcohol. **Personality changes: **anxiety, deppression, tension, stress, psychotic. (high than in the general population)

Question 47

Personality are most common in what kind of epilepsy?

Answer 47

* Most common in temporal lobe epilepsy (mood, detail obsessed)

Question 48

What are the treatments for epilepsy?

Answer 48

* Anticonvulsant medication * Surgical procedures * Behavioural management * Seizure control

Question 49

Split-brain surgery, whereby the corpus-collosom is cut is called a \_\_\_\_\_\_\_

Answer 49

Commissurotomy

Question 50

Recognising the signs of an impending seizure and counteracting them e.g., a patient with a specific smell aura, may purposefully smell something different. A patient with a specific taste aura, may purposefully eat somehing pleasant this is an example of \_\_\_\_\_\_

Answer 50

Seizure control

Question 51

An abnormal groth of brain tissue is called a?

Answer 51

Neoplasm (i.e., brain tumour)

Question 52

What role does the Neuropsychologist have in Evaluation in the case of epilepsy?

Answer 52

* Functional asessment during WADA test (brief assessment of language and memory function) * Determine prescense and extent of cognitive & personality disturbances * Rudimentry assessment of cerebral organisation for speech.

Question 53

a tumour that is spread out, invades and destroys other areas of the brain, consumes healthy tissue has an \_\_\_\_\_\_nature

Answer 53

Infiltating

Question 54

a tumour oninvading that is an encapsulated growth, growing within itself, does NOT 'take-over' has a ______ nature

Answer 54

non-infiltrating

Question 55

a tumours rate of growth and the degree of symptoms it is casuing is reffered to as its \_\_\_\_\_

Answer 55

Malignancy

Question 56

A Secondary brain tumour" whereby tumour ceels brak of from a primary cancer elsewhere in the body (e.g., lungs) and travel through the blood to the brain is reffered to as having a ______ origin

Answer 56

Metastatic

Question 57

What is the 'malignancy' of a tumour? and how is it graded?

Answer 57

The tumours rate of growth and the degree of symptoms it is causing it is graded from 1-4 1. Slow growth, minimal symptoms 2. low-Intermediate growth, low-moderate symptoms 3. Intermediate growth, moderate symptoms 4. Fast growth, severe symptoms

Question 58

How does the damages caused by an infiltrating tumour differ from that caused by a non-infiltrating tumour?

Answer 58

* Infiltrating tumours - invade and destroy healthy brain tissue, directly damaging the brain tissues. * Non-infiltrating tumours - are encapsulated, but as they grow they cause intracranial pressure (ICP) which displacees and compresses the healthy brain tissue causing damage.

Question 59

What are the (behavioural/sickness) symptoms of a brain tumour?

Answer 59

* Headaches (pressure as tumour grows) * Nausea and vomiting * Seizures

Question 60

How is a brain tumour diagnosed?

Answer 60

Brain imaging techniques (both are similar, but MRI is more detailed) - locates tumour 1. CT - visualise structure of cells 2. MRI - differentiate between brain cells and tumour cells Brain biopsy - determines the type of tumour

Question 61

**\_\_\_\_\_\_ is a procedure by which a neuropsychologist works out what areas around a tumour 'do' and thus what will be affected by the removal of a tumour and nearby tissues. i.e., mapping out brain functions.** ## Footnote It helps the surgeon determine the "balancing act" between removing tumour cells and protecting brain cells. If the area contains important function, the surgeon may choose to be more conservative (at the risk of tumour reoccurance). Surgery is often followed by radiation. the process: Local anestetic and the skull is opened, exposing the brain Low voltage electrode directly stimulates the brain area patient responds e.g., touch motor cotex and they move their hand, or they are asked to count etc. Because, for example, a motor cortex tumour could cause motor trouble and a tumour in the basal ganglia could cause tremours.

Answer 61

Cortical stimulation

Question 63

What role does the neuropsychologist have in evaluation in the case of brain tumour (and surgery/treatment)?

Answer 63

1. Evaluate baseline (which areas are most affected by the tumour) 2. Patient has surgery or treatment 3. Follow-up (hopefully documents improvement)

Question 64

Risk factors for cerebrovascular disorders include: A. gender B. High cholesterol C. History of traumatic head injury D. Both A and B

Answer 64

D: both A and B (Gender and High cholesterol)

Question 65

The cognitive symptoms associated with temporal love epilepsy include... A. Visual-spatial deficits B. Memory impairments C. Executive dysfunction D. All of the above

Answer 65

B. Memory impairments

Question 66

The rey figure test is an assessment instrument used to measure the cogntive functioning of \_\_\_\_\_\_

Answer 66

Visual-spatial organisation

Question 67

What is the purpose of neuropsychological evaluation?

Answer 67

* Profile patient strengths and weaknesses * Differentiate between functional and organic disorder * Document impact of brain dysfunction on a patients life * Monitor progress in rehabilitation * Disability determination for froensic/legal purposes.

Question 68

What is reliability? What are the 4 types of reliability?

Answer 68

Reliability: the stability/dependability/consistency of a test on repeated measures of the same person. Includes: * Test-retest reliability - consistency between scores of an individual measured more than once. * Inter-rater reliability - reliability between different people's use of the measure to score the same individual * Split-half reliability - the correlation between two halfs of a test * Internal reliability/consistency - the degree to which items of a scale measure the same thing, also known as 'cronbach's alpha)

Question 69

What is validity? What are the 3 types of validity?

Answer 69

A test is valid when it measures what it purports to measure. The validity of a test is the meanifulness of specific inference made from the test scores. An unreliable test cannot be valid, but a non-valid test can be reliable. * Construct validity - does the test score measure the abstract psychological charactersitic or construct of interest (e.g memory or intelligence etc.) * Content validity - do the items or tasks that make up your test make conceptual sense. Various items of teh test should correspond to the behavior te test is designed to measure or predict. * Criterion validity - demonstrates that scores relate systematicaly to one or more outcome criteria. has two components: 1. Concurrent validity - relates to outcomes now (important for testing capacities now) 2. Predictive validity - relates to outcomes in the future (e.g predicting improvements or decline in recovary)

Question 70

Neuropsychological testing focuses on what functional areas? (from the most basic to the most complex)

Answer 70

1. Orientation 2. Sensation/perception 3. Attention 4. Motor skills 5. Language 6. Visuospatial 7. Memory 8. Executive functioning (abstract reasoning/conceptualisation, emotional/psychological distress, activities of daily living)

Question 71

What part of the brain is (predominately) responsible for orientation? Where is it in the brain?

Answer 71

Reticular formation. The reticular formation is a group of nerve fibers located inside the brainstem.

Question 72

The Galveston Orientation and Amnesia Test (GOAT) is used to assess\_\_\_\_?

Answer 72

Orientation and amensia (inc awareness)

Question 73

\_\_\_\_\_\_is the processing and intepretation of sensory input

Answer 73

Perception

Question 74

\_\_\_\_\_\_is the stimulation of sensory organs (touch, vision, hearing, taste, smell)

Answer 74

Sensation

Question 75

Halstead-Reiten Neuropsychological Battery (visual, auditory & tactile modalities) is used to assess?

Answer 75

Perception/intepretation

Question 76

Where are the two parts of the brain that deal with TOUCH sensation, what are they called and what do they do?

Answer 76

1. Primary somatosensory cortex - basic awareness of touch - in the parietal lobee 2. Secondary system - Intepretation - parietal lobe The primary somatosensory cortex (SI) is across the central sulcus and behind the primary motor cortex configured to generally correspond with the arrangement of nearby motor cells related to specific body parts. The area includes gray matter along the central gyrus and its extension into the postcentral gyrus. Goes across both brain hemispheres.

Question 77

Where are the two parts of the brain that deal with VISION sensation, what are they called and what do they do?

Answer 77

1. Primary visual cortex - the occipital lobe 2. Secondary area of the visual cortex - two systems: 'what' system (faces, objects), 'where' system (where in space) - the occupital lobe "The visual area known as V1, striate cortex, or (primary visual cortex, Brodmann area 17) is located on the calcarine sulcus deep within the inside folds of the occipital lobe."

Question 78

Where are the three ares of the brain that deal with HEARING sensation, what are they called and what do they do?

Answer 78

1. Primary auditory cortex - frequency volume length 2. Secondary area 1 - Wernickes area (Temporal lobe) - Understanding speech 3. Secondary area 2 - Brocha's area (Frontal lobe) - produce speech

Question 79

\_\_\_\_\_\_\_ attention is paying attention ot something over a prolonger period

Answer 79

sustained

Question 80

\_\_\_\_\_attention is paying attention to more than one thing at a time.

Answer 80

Selective

Question 81

What areas of the brain are involved in attention/concentration?

Answer 81

Frontal lobe and Parietal Lobe

Question 82

What does the Symbol Digit Modalities Test i.e., SDMT (see picture) assess?

Answer 82

Attention/concentration specifically assesses: complex scanning, visual tracking and sustained attention

Question 83

What is the D2 test used to assess?

Answer 83

test of selection attention measures processing speed, rule compliance and quality of performance; allowing estimation of individual attention and concetration performance.

Question 84

Getting a person to attend to various verbal stimuli and then repeat them, becoming progressively more complex. e.g repeating numbers (589, 9275, 71632) and then also do it backwards. is an assessment of \_\_\_\_\_\_\_\_

Answer 84

Attention span

Question 85

\_\_\_\_\_ is the inability to perform purposeful sequences of motor behaviours.

Answer 85

Apraxia

Question 86

the \_\_\_\_\_\_\_involves commands regarding shapes in a picture e.g show me a pink shape, show me a blue square, show me a small blue shape,show me the green sqaure etc.) and is a test of \_\_\_\_\_\_\_\_

Answer 86

Token test; receptive language

Question 87

What do the following subtests of the Halstead-Reitan Neuropsychological Battery assess? ## Footnote Finger-tapping test - tap index finger as fast as possible. Grip strength test - measure with a hand-dynamometer - 3 goes with each hand averaged.

Answer 87

Motor skills

Question 88

What aspects of motor function is dealt with by the frontal lobe and basal ganglia/cerebellum respectively?

Answer 88

Frontal lobe = Planning/sequencing Basal ganglia/cerebellum = coordination and balance

Question 89

What part of the brain handles understanding language? (i.e., receptive language) and where is it on the brain?

Answer 89

Wernikes area Traditionally thought to be located posterior section of the superior temporal gyrus (STG) in the dominant cerebral hemisphere (which is the left hemisphere in about 97% of people).

Question 90

Which hemisphere is broca's area and Wernickes area situatied in?

Answer 90

The left hemisphere in about 97% of people, but it is in the right hemisphere for some people.

Question 91

What part of the brain handles producing language? (i.e., expressive language) and where is it on the brain?

Answer 91

Broca's area Broca's area is a region in the frontal lobe of the left hemisphere

Question 92

the _____ involves come up with words beginning with # (a letter) letter in 1-minutes, must be more than four letters long and not names or partial repitions. and is a test of \_\_\_\_\_.

Answer 92

Controlled Oral Word Association test (COWA); Expressive language

Question 93

the __________ involves simple line drawing of common objects, if they can't name what the object is they are given a stimulus (e.g for 'seahore' might say 'it's an ocean creature'). if they still have trouble they are given a phonetic cue (e.g it starts with a 'c' sound) and is used to assess\_\_\_\_\_\_\_

Answer 93

Boston Naming Test; Language

Question 94

Why are the letters F, A and S often used in the Controlled Oral Word Association (COWA) test

Answer 94

F = lowest digital frequency A = vowel S = Highest digital frequency

Question 95

\_\_\_\_\_ language describes the patients ability to comprehend simple spoken commands (e.g., 'say hello')

Answer 95

Receptive

Question 96

\_\_\_\_ language is vocabulary knowledge and recognition of concepts and objects (e.g., please tell me wheat 'happiness' means or 'make up a sentance using the word 'vacation')

Answer 96

Expressive

Question 97

\_\_\_\_ is Deficits in the motor component of writing

Answer 97

Dysgraphia

Question 98

The clock drawing test, Rey figure test and directional skills/mazes/motor-free construction tasks; and facial recognition are used to assess \_\_\_\_\_

Answer 98

Visuo-spatial organisation

Question 99

What is 'visual-spatial organisation' and what factors does it include?

Answer 99

Involes a range of cognitive processes e.g., map reading, route finding, visual perception, constructional ability & facial expressions) * Construction * Route Finding * Spatial orientation * Facial recognition

Question 100

\_\_\_\_\_\_\_ is The intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal procecution, or obtaining drugs.

Answer 100

Malingering

Question 101

the ________ apprach to neuropsychological intepretation relis on perfroming a broad set series of standardised tests

Answer 101

standard battery approach

Question 102

the ________ is the idea that the neuropsychologist should adapt each examination to the individual patient rather than use a standard battery of tests. The neuropsychologist selects the tests and procedures for each examination, using hypotheses he or she has made from impressions of the patient and from information available about the patient.

Answer 102

Process approach

Question 103

memory for factual information is also known as \_\_\_\_\_

Answer 103

Explicit/declarative memory

Question 104

What are the **_advantages_** of the standard Battery approach to neuropsychological intepretation?

Answer 104

* Comprehensive evaluation of abilities * Objective interpretation based on normative data * Facilitates teaching because of standard rules/norms * Useful for empirical studies

Question 105

What are the **_disadvantages_** of the standard Battery approach to neuropsychological intepretation?

Answer 105

* Time demanding and labor intensive * Tests only as good as standardisation * Relatively infelxible approach to testing * Scores may not reflect a single cogitive process

Question 106

What are the **_advantages_** of the 'Process Approach' to neuropsychological intepretation?

Answer 106

* Acknowledges the individuality of the patient * Examination focuses on most important deficits * Emphasizes how a task is failed or solved * Useful for clinical case studies

Question 107

What are the **_disadvantages_** of the 'Process Approach' to neuropsychological intepretation?

Answer 107

* Test procedures may be biased by clinician * Opinion of the clinician is subjective * Difficult to teach, because it requires experience * Does not lend itself to large-scale research

Question 108

What type of memory deals with action or "doing" memory?

Answer 108

Implicit/procedural

Question 109

What 3 main areas of the brain are involved in memory? and what aspects of memory are they associated with? Where in the brain is the the basal ganglia and the cerebellum?

Answer 109

1. Hippocampus (middle of the temporal lobe) - encoding and cognitive maos 2. Basal Gaglia (mid-brain) - motor memory 3. Cerebellum - learning of procedural memory and motor learning

Question 110

The Wechsler memory scale and Rey Auditory Verbal Learning test are used to test what?

Answer 110

MEMORY WMS: verbal, visual, STM, LTM, serial recall, free recall, recognition RAVL: Immediate memory, verbal memory, suceptability to interference, recognition memory)

Question 111

What is the trail making test used to asses?

Answer 111

Executive functioning Specifically: mental flexibility

Question 112

What is the winconsin card sorting test used to assess?

Answer 112

Executive Functioning - shift between sorting categories and ignore irrelevant information

Question 113

What is the tower of london task used to assess?

Answer 113

Executive functioning - specifically plannin and problem solving.

Question 114

a _________ involves comparing an individual's test scores to test norms

Answer 114

normative comparson standard

Question 115

What is the WAIS and what is it used to test?

Answer 115

Wechsler Adult Intelligence Scale Used to assess Intelligence 6 verbal scales and 5 performance scales

Question 116

Is factual information or learning experience factors (culture incl.) fluid or crystallised intelligence?

Answer 116

Crystallised

Question 117

What is the purpose of ADLs (Adaptiving Living or Behaviour-Adaptive tests)?

Answer 117

gives an assessment of activities of daily living (e.g., bathing, grooming, feeding), that enables recommendations about care facilities or helps determine compensation litigation.

Question 118

What does the "Category" subtest of the Halstead-Reiten Neuropsychological battery assess?

Answer 118

Abstract reasoning

Question 119

What does the "seashore rhyming test" subtest of the Halstead-Reiten Neuropsychological battery assess?

Answer 119

Auditory perception

Question 120

What does the "speech-sounds perception test" subtest of the Halstead-Reiten Neuropsychological battery assess?

Answer 120

Verbal Ability

Question 121

What do the "grip-strength" and "finger tapping" subtest of the Halstead-Reiten Neuropsychological battery assess?

Answer 121

Motor Skills

Question 122

What does the "Tactile Perfromance" subtest of the Halstead-Reiten Neuropsychological battery assess?

Answer 122

Tactile Memory

Question 123

What does the "sensory-perceptual examination" subtest of the Halstead-Reiten Neuropsychological battery assess?

Answer 123

Sensory and perceptual functions

Question 124

What does the "aphasia examination" subtest of the Halstead-Reiten Neuropsychological battery assess?

Answer 124

Language ability

Question 125

\_\_\_\_\_\_\_\_\_involes testing a patient at multiple time-points (e.g every few weeks) and comparing the results. ## Footnote When assessing decline (e.g., dementia) or improvement

Answer 125

Individual compariosn (standard)

Question 126

\_\_\_\_\_ is a type of maligering were one pretends to be worse off

Answer 126

simulation

Question 127

\_\_\_\_\_ is a type of maligering were one pretends to be better off

Answer 127

dissimulation

Question 128

what is the Rey 15 item memory test used to detect?

Answer 128

Malingering

Question 129

The biological repair of neurons is called \_\_\_\_

Answer 129

Neuronal restitution

Question 130

When function is impaired but not lost and the usual 'way of doing things' is restored it is reffered to as \_\_\_\_

Answer 130

Psychological restitution.

Question 131

Compensation with other brain areas is reffered to as \_\_\_\_\_

Answer 131

Neuronal substitution.

Question 132

Use of adaptive stratergies/compensatory stratergies is reffered to as \_\_\_\_\_\_\_

Answer 132

Psychological substitution

Question 133

\_\_\_\_\_\_\_ is the processes of restitution and substitution applied to neuropsychological treatment

Answer 133

Cognitive remediation

Question 135

What does the neuropsychologist do DURING the rehabilitation process?

Answer 135

Conducts regular follow-up assessments * Monitor patient progress * Evaluate effectiveness of treatment program Counsels caregivers and family members * Effects of brain damage on behaviour * stratergies to cope with cognitive and behavioural deficits

Question 136

**Becks Depression Inventory (BDI)** What function does it test? What brain structures does it asses? What clinical population is it used for?

Answer 136

Measures deppression (both cognitive-affective and somatic symptoms) Assesses personality changes i.e., an indirect relationship to brain injury/disability any population

Question 137

**Deppression, Anxiety and Stress Scales (DASS)** What function does it test? What brain structures does it asses? What clinical population is it used for?

Answer 137

Measures deppression, Anxiety & stress (long form DASS [42 items], short for DASS-21) Assesses personality changes i.e., an indirect reaction to brain injury/diability Any population

Question 138

**Hooper Visual Organisation Test** What function does it test? What brain structures does it asses? What clinical population is it used for? What does the test involve?

Answer 138

Measures ability to mentaly manipulate and reintegrate visual imformation Parietal lobe Dementia (often used for elderly driving assessment), stroke, brain injury Patient identifies 30 objects represented in line drawings as puzzle pieces - what would the picture be if the pieces were back together

Question 139

**Judgement of Line Orientation** What function does it test? What brain structures does it asses? What clinical population is it used for? What does the test involve?

Answer 139

Measures spatial perception, orientation and visuospatial judgement Visual cortex, frontal lobe Traumatic brain injury, dementia (alzheimers, turner syndrome, parkinsons, left visual neglect) Judging the orientation of lines!

Question 140

**National Adult Reading Test (NART)** What function does it test? What brain structures does it asses? What clinical population is it used for? What does the test involve?

Answer 140

Test of premorbid intelligence functioning (level of cognitive functioning before brain injury) N/A - but damage to certain areas of the brain will mean a person is unable to pronounce words (e.g., expressive language - broca's area) Anyone for who cognitive decline is suspected (dementias or brain injuries) A list of words that have an unusual pronounciation. the person needs to be familiar with the words to be able to pronounce them)

Question 141

**Rey Auditory Verbal Learning Test (RAVL)** What function does it test? What brain structures does it asses? What clinical population is it used for? What does the test involve?

Answer 141

Test of verbal learning, immediate memory, recognition and susceptibility to inteference, recognition. Hippocampus Individuals suspected of memory dysfunction (Dementias or brain injury) Immediate memory (A-list x1) -\> verbal memory (A-list x4) -\> Immediate memory (B-list x1) -\> 20-minutes of non-related tests -\> LTM/delayed memory (A-list x1) -\> Recognition (A+B+20 similar words)

Question 142

**Rey Complex Figure** What function does it test? What brain structures does it asses? What clinical population is it used for? What does the test involve?

Answer 142

Measure of visuospatial construction and visuospatial memory (also assesses planning, organisation and fine motor skills) Parietal lobe Brain injury, dementia, and to assess some developmental learning deficits Examinees are asked to reproduce a complicated line drawing, first by copying it, and then from memory.

Question 143

**Token Test** What function does it test? What brain structures does it asses? What clinical population is it used for? What does the test involve?

Answer 143

Measures receptive language Wernickes area Brain injury, aphasia, and certain language and learning disabilities. series of commands regarding plastic shapes of different shape, size and colour - increasing complexity (e.g., touch a square, touch a yellow square, touch a yellow small square, touch a yellow small square and a small blue circle)

Question 144

**Wisconsin Card Sorting Test** What function does it test? What brain structures does it asses? What clinical population is it used for? What does the test involve?

Answer 144

Measures ability to shift categories and inhibit irrelevant responses. (executive functioning) Frontal lobe used in patients with acquired brain injury, dementias and mental illness * 4 face up cards + participant response ards with similar shapes, colours and numbers (of shapes). * Patients sort the cards either by colour, shape or number - but the examiner does NOT TELL THE P THE 'RULE' - they are told "right" or "wrong" for each sort attempt, when they do the right sort x10, the rule is changed.

Question 145

**Grip Strength Test** What function does it test? What brain structures does it asses? What clinical population is it used for? What does the test involve?

Answer 145

Assesses lataralised cortical impairment Motor cortex Brain injury Use of a hand-dynamometer

Question 146

What neurospychological tests would you use to assess depression, anxiety and stress? (personality changes)

Answer 146

Depression, Anxiety and Stress Scales (DASS) Beck Deppression Inventory (BDI)

Question 147

What test would you use to assess expressive language and Broca's area?

Answer 147

Boston Naming Test

Question 148

What test would you use to measure the ability to mentally manipulate and reintegrate visual information?

Answer 148

Hooper Visual Organisation test

Question 149

What test would you use to measure spatial perspection, orientation and visuospatial judgement?

Answer 149

Judgement of Line Orientation

Question 150

What test would you use to assess premorbid intellectual functioning?

Answer 150

National Adult Reading Test (NART)

Question 151

What test would you use to assess verbal learning, immediate memory, recognition and susceptibility o inteference?

Answer 151

Rey Auditory Verbal Learning Test (RAVL)

Question 152

What test would you use to assess visuospatial construction and visuospatial memory (also planning organisation and fine motor skills)?

Answer 152

Rey Complex Figure

Question 153

What test would you use to assess ability to shift categories and inhibit irrelevant responses?

Answer 153

Wisconsin Card Sorting Test

Question 154

What test would you use to assess receptive language?

Answer 154

Token Test

Question 155

What test would you use to assess lataralised cortical impairment?

Answer 155

Grip strength test

Question 156

What test would you use to assess excutive functioning/mental flexibility?

Answer 156

Trail-making test

Question 157

What test would you use to assess planning and problem solving (executive functioning)?

Answer 157

Tower of London Task

Question 158

According to the Diagnostic and Statistical Manual of mental disorders what is the definition of a mental disorder? (2 key components).

Answer 158

1. Clinically significant disturbances 2. Usually associated with significant distress or disability "A set of symptoms (abnormal thoughts, feelings and behaviours) that are sufficiently 'sever' to cause significant A. distress and/or B. disability (impairment/limitations)"

Question 159

A psychological disorder is NOT.....

Answer 159

* Eccentric behaviour * Violation of social codes * Temporary and expectable distress/disturbances in response to negative experience (e.g., grief)

Question 160

In terms of mental disorders, what does "qualitatively" different mean?

Answer 160

Radically different/bizzare e.g., Psychologist: " have you been nervous or tense lately?" Patient: "No, I've got a head of lettuce"

Question 161

In terms of mental disorders, what does "quantitatively different" mean?

Answer 161

Differences in quantity/degree/frequency/intensity of things that everyday people feel/experience. ## Footnote e.g., a fear of spiders VS. a **phobia** of spiders (real impact)

Question 162

What is the lifetime prevalence of Panic disorder?

Answer 162

5%

Question 163

What is the lifetime prevalence of specific phobia?

Answer 163

12%

Question 164

What is the lifetime prevalence of substance use?

Answer 164

14%

Question 165

What is the lifetime prevalence of Major deppression disorder?

Answer 165

16%

Question 166

What is the lifetime prevalence of any anxiety disorder?

Answer 166

29%

Question 167

what are the 7 major disorder groupings in the DSM?

Answer 167

1. Neurodevelopmental disorders (ADD, autism) 2. Bipolar and related disorders (mania) 3. Deppressive disorder (MDD) 4. Anxiety disorders (Panic) 5. Feeding and eating disorders (Anorexia) 6. Schizophrenia spectrum and other psychotic disorders 7. Neurocognitive disorders (Cognitive function - alzheimers/parkinsons)

Question 168

What are the three main formal assessment technique?

Answer 168

* Structured interviews * Questionaires * Daily diaries

Question 169

What are the properties of a structured interview?

Answer 169

A structured interview involving Initial & probe/follow-up questions. Follows a manual including: * Glossary of terms - definitions * Standardised scoring * Guide to intepretations Yields information about frequency, nature and (often) severity of presenting problems.

Question 170

What are questionaire inventories?

Answer 170

Self-report with close ended questions

Question 171

How does good clinical research use structured interviews and questionaires?

Answer 171

Confirms the diagnosis of participants using structured interviews. Questionaires are usefull as screening measures and often appropriate for monitoring progress in clinical practice & research. (but they do not provide specific details about the nature, occurance or impact of client's problems.

Question 172

Why are theories important?

Answer 172

They inform treatment decisions - because if we understand why a problem occurs, we're in a better position to try and solve it. Theory - \> Therapy

Question 173

What is a theory (of a disorder)?

Answer 173

Explanation for the development & maintenance of a disorder.

Question 174

A disroder reated/cause by therapy is known as a \_\_\_\_\_disorder?

Answer 174

Iatrogenic

Question 176

What is the trauma model of Dissociative Identity Disorder?

Answer 176

DID develops as a way of coping with overwhelming abuse in childhood, particularly if abuse occurs before age 5 * Dissociation (separating memories from awareness) and amnesia (repression of memories) * Differen alters 'own' different threatening emotional states (e.g., fear, rage) and different memories, so the primary personality is protected and not aware of them * high hypnotisability facilitates this.

Question 177

What are some predictors of dissociative identity disorder?

Answer 177

Sexual and physical abuse during childhood; high scores hypnotisability and dissociative capacity; PTSD, self-mutilation, suicide, aggressive behaviour; numerous other DSM-IV disorder.

Question 178

are there sex differences in the occurance of dissociative identity disorder?

Answer 178

Large number of studies suggest that it is more common in women female:male = 3:1--\>9:1 DSM-5 now says similar rates in women and men - but this is based on one small community study (bad!)

Question 179

schizophrenia, other psychotic disorders, bipolar disorder with rapid cycling, anxiety disorder, somatization disorders, personality disorders, malingering and factitious disorder are \_\_\_\_\_\_\_\_\_\_\_\_for dissociative identity disorder

Answer 179

Differential diagnosis (i.e., other disorders with which DID could be confused with/misdiagnosed)

Question 180

How did the DSM-4 and DSM-5 criteria for dissociative identity disorder differ?

Answer 180

- DSM-4 required two or more distinct identities or personality states, that take over behaviour. - DSM-5 more GENERAL, just a disruption of identity.

Question 181

What is the DSM-5 criteria for Dissociative Identity Disorder?

Answer 181

- **DSM-5 more GENERAL,** A. disruption of identity characterized by two or more distinct personality states (like possessions), alterations in affect, consciousness, memory, perception, cognition and/or sensory functioning. B. gaps in recall of everyday events/important personal info C. clinically significant distress or impairment. D. disturbance not part of culture/religion.

Question 182

Client ______ need to be considered when selecting the appropriate treatment for major depressive disorder.

Answer 182

preferences

Question 183

What is the best treatment for major depressive disorder?

Answer 183

Best? * CT = BT * BT = CBT * CBT(60=70%) \> drug (40-60%), high placebo-drug effect (30%). Medication does not require skill & might make CBT easier, but drugs have a high dropout rate.

Question 184

Cognitive therapy for major depressive disorder may include ______ which involve testing a prediction that a bad thing will happened when X happens.

Answer 184

Behavioural experiments

Question 185

outline cognitive therapy as a treatment of Major depressive disorder.

Answer 185

* AIM: teach clients to identify and challenge/refute irrational cognitions. * clients ask themself questions regarding the evidence, alternative intepretations and logical errors of their beliefs/cognitions. reinterpretation and thought diary.

Question 186

\_\_\_\_\_ is a treatment for major depressive disorder that is designed to increase activity and positive consequences and increase skills in gaining reinforcement and reducing avoidance COMPONENTs pleasant activities (Reinforcement potential) tasks that need to be done pre-agreed self-monitored (e.g., diary) Graded may also include skill training

Answer 186

Activity scheduling

Question 187

What are the properties of a structured interview?

Answer 187

A structured interview involving Initial & probe/follow-up questions. Follows a manual including: * Glossary of terms - definitions * Standardised scoring * Guide to intepretations Yields information about frequency, nature and (often) severity of presenting problems.

Question 188

What is a theory (of a disorder)?

Answer 188

Explanation for the development & maintenance of a disorder.

Question 189

\_\_\_\_\_\_\_ can be said to have occured/be occuring when anxiety diminishes with ongoing exposure to a feared stimulus.

Answer 189

Habituation

Question 190

How is systematci desensitation different to modern exposure theory?

Answer 190

Involves relaxation techniques that are not present in exposure therapy. it tries to link a CD with a state incompatible with the CR, namely, relaxation.

Question 192

What is the main premise of Operant Conditions?

Answer 192

Many behaviours depend on their consequences. Positive consequences -\> repeat behaviour Negative consequences -\> do not repeat behaviour

Question 193

According to **operant conditioning**, what types of consequences **maintain or increase** a behaviour? Give an example using the example of a phobia of birds

Answer 193

* **Positive Reinforcement** - maintenance or increase because an event/stimulus occurs as a consequence. (something plesant occurs) * **Negative Reinforcement** - maintenance or increase because an event/stimulus ceases or is prevented as a consequence (something unpleasant ceases) e.g., NEG: client with bird phobia avoided or ran way from birds - these behaviours were negatively reinfoced by prevention (because there was less anxiety)

Question 194

According to **operant conditioning**, what types of consequences cease or reduce a behaviour?

Answer 194

* **Positive punishment** - unplesant event/stimulus occurs as a consequence * **Negative punishment** - plesant even't/stimulus is removed as a consequence also. .. * **Extinction** - reduction or cessation of behaviour because reinforcement is discontinued

Question 195

What are "discriminative stimuli"?

Answer 195

Stimuli that signal the likely reinforcement or non-reinforcement (or punishing consequence) of a behaviour ## Footnote Signals to an organism that, should a particular response be made, reinforcement is available. Such a response is said to be under stimulus control because the response is usually made when only the discriminative stimulus is present. Example: Alicia knows that her business partner is in a good mood if she is smiling, is not wearing her suit jacket, and has opened the blinds. These discriminative stimuli inform Alicia that she can approach her partner with a new idea (Alicia's particular response) and expect her partner to be supportive (reinforcement). Alicia's behavior is under stimulus control because Alicia will not approach her partner unless the discriminative stimuli are present.

Question 196

\_\_\_\_\_\_\_\_\_are stimuli that signal the likely reinforcement or non-reinforcement (or punishing consequence) of a behaviour

Answer 196

Discriminative stimuli

Question 197

What are the general treatment implications of Operant Conditioning theory?

Answer 197

* **Reinforce desirable behaviours** * Reinforce behaviours incompatible with undesirable behaviours * Withdraw reinforcement for undesirable behaviour (**Extinction**) * Prevent punishment of desirable behaviour (**Teach skills**) * **Stimulus control procedures** (e.g., alco man avoids pub, then drives past, then walks past) * **Shaping**: reinforcing succssive approximations to the desire behaviour (e.g., for a client with bird phobia, for successfull steps taken in graded exposure)

Question 198

What is observational learning?

Answer 198

Learning behaviours by observing someone else (model) perform them. Whether we perform observed behaviour depends on cosequences of the behaviour for the model. * positive consequences - increased chance * negative consequences - decreased chance

Question 199

What are the treatment implications of observational learning?

Answer 199

* Model desired behaviour e. g., holding a bird to show a client with bird phobia that it is safe.

Question 200

Describe the general idea behind cognitve theories (Beck) in regard to abnormal psychology.

Answer 200

Cognitive theories emphasise people's appraisal of events/stimuli, and underlying beliefs. Thus, abnormal behaviour is thought to be caused by abnormal beliefs, intepretations and thoughts.

Question 201

What are "schema"?

Answer 201

An Underlying belief. Schemata affect attention, interpretation, memory. In psychological disorders, schemata are abnormal negative.

Question 202

\_\_\_\_\_\_\_\_ are ways of misintepreting info/event to fit schemata

Answer 202

Cognitive distortions

Question 203

\_\_\_\_\_\_\_\_ are spontaneous thoughts about a given situation

Answer 203

Automatic thoughts

Question 204

1. Recurrent and persistant thoughts, urges, or images that are... intrusive or unwanted, and in most individuals cause marked anxiety or distress 2. The person attempts to ignore, supress or 'neutralise' them. What does this describe?

Answer 204

Obsessions

Question 205

What is the relationship among the cognitive constructs (Schema, cognitive distortions and negative automatic thoughts)?

Answer 205

Schemata (Stable) -\> cognitive distortions (biases in processing of a given situation) -\> negative automatice thoughts (situation-dependant)

Question 206

Give an example (using a 'bird phobia') of the relationship between the cognitive constructs: schemata, cognitive distortions and negative automatice thoughts.

Answer 206

* **Schemata** - birds are dangerous and unpredicatable, I can't cope if I see a bird * **Cognitive distortions** - magnifiy and overgenearalise negative infor about birds; arbitary inference (inferring ngative things about birds with no evidence) * **Negative Automatic Thoughts** - "that bird will peck my eyes", "it knows I am afraid"; "my hearts pounding, I'll pass out"

Question 207

What are the treatment implications of cognitive theories?

Answer 207

AIM - identify & change negative automatic thoughts * Monitor & challenge negative automatic thoughts and dysfunctional beliefs * Substitute alternative adaptive thoughts * Often involves keeping a diary

Question 208

In OCD what are obsessions? (according to DSM-5 criteria)

Answer 208

1. **Recurrent and persistant** **thoughts**, **urges,** or **images** that are... intrusive or unwanted, and in most individuals cause marked **anxiety** or **distress** 2. The person attempts to ignore, supress or 'neutralise' them. Themes include: dirt/contamination; death/injury; violence/sex. Obsessions often occur in response to a recognised trigger.

Question 209

In OCD, what are compulsions? (According to DSM criteria)

Answer 209

1. Repetitive behaviours (e.g., washing, ordering, checking)... or metal acts (e.g., praying, counting, repeating words) that the person feels driven to perform in response to an obsession. 2. ...aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation" excessive and not relistically connected to their purpose. Compulsions are intended to achieve one of the following * Avoidance (of triggers/obsessions) * Prevention * Putting things right; verification \*compulsions reduce anxiety\*

Question 210

1. Repetitive behaviours (e.g., washing, ordering, checking)... or metal acts (e.g., praying, counting, repeating words) that the person feels driven to perform 2. ...aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation" excessive and not relistically connected to their purpose. what does this describe?

Answer 210

Compulsions

Question 211

\_\_\_\_\_ is A compulsion to check repeatedly to ensure a task has been succesfully carried out or that a particular negative event has not occured.

Answer 211

checking

Question 212

\_\_\_\_\_\_ is The compulsion to repeat a task/s in a particular way until it 'feels right'.

Answer 212

repeating

Question 213

In OCD Counting ## Footnote Repeating phrases e.g., "I hate the devil, I hate the devil" Neutralising anxiety-provoking image by imagining the opposite are all examples of what?

Answer 213

Mental acts

Question 214

In OCD, what is "hoarding" associated with?

Answer 214

Associated with a fear with losing information or objects, or a fear that objects can harm others (e.g., family or strangers)

Question 215

What is the "insight" specifier of OCD?

Answer 215

How much awareness one has of their OCD ## Footnote Good or fair insight poor insight absent insight (Delusional)

Question 216

What are common comorbid conditions of OCD?

Answer 216

Deppression, anxiety disorders; tourette's disorder (5-7%).

Question 217

(aetiology) How does learning theory explain OCD?

Answer 217

Based on Mowrer's (1960) two-stage theory - combines classical conditioning and operant learning. **Classical conditioning**: Neutral objects/situations/thoughts (e.g., locking door, passing though of car accident) become anxiety-provoking through being paired with an anxiety-provoking event (or anxious thoughts). Genaralisation to similar stimuli can occur. **Operant Learning** (consequences): Avoidance (e.g., of triggers & obsession) is negatively reinforced by decreasing or prevention of anxiety but.... Many tiggers obsessions cannot be avoided, so... Compulsions used to prevent harm or neutralise obsession, thus compulsions are negatively reinforced (Reduced anixety)

Question 218

(Aeitiology) how does cognitive theory explain OCD?

Answer 218

* Individuals with OCD **overestimate** the **probability** & **severity** of threat. * Intrusive thoughts become obsessions when they are associated with negative automatic thoughts about **responsibility**. for causing (and preventing) **harm**. * Also importance of controlling thoughts; overestimation of importance of thoughts (e.g., that they increase risk) * Obsessions lead to perceptions of danger * Person feels they must act to avert/lessen danger, leading to compulsions.

Question 219

1. (Aeitiology) how do biological models explain OCD? 2. Do biological abnormalities associated with OCD indicate that they CAUSE OCD?

Answer 219

1. * Quite a few studies using PET scans and other neuroimaging techniques suggest abnormal activity in the **nerve pathways connecting the basal ganglia and orbitofrontal cortex** - **these pathways use serotonin** * There is a relationship between OCD & other disorders associated with **abnormalities of the caudate nucleus** 2. NO The biological abnormalities may or may not be causal. Behavioural changes have been shown to cause brain changes.

Question 220

What are the three main types of treatment for OCD?

Answer 220

1. Exposure and Response Prevention (ERP) - behavioural therapy 2. Cognitive Therapy 3. Drug Therapy The behavioral and cognitive therapy are often combined (CBT!)

Question 221

Describe the treatment (therapy) for OCD based on learning theory.

Answer 221

**Exposure and Response Prevention (ERP)** Technique: 1. Exposure to avoided situations & direct contact with feared stimuli 2. Prevention of compulsions, including thoughts - graded! and individually tailored!! Self-directed ERP needed; but therapist-guided initially better outcomes * **Exposure** = In-session practice; guided practice in real life setting, therapise MODELs behaviour * **Homework** (self-guided ERP) = agreed tasks (dailyl diary), home work adherance is a strong predictor of therapeutic outcomes.

Question 222

What is the GOLDEN RULE of exposure therapy?

Answer 222

Each episode of exposure must continue until anxiety diminishes, because if client leave before anxiety diminishes - the fear/avoidance etc will be negatively reinforced i.e., it will be just another experience of anxiety regarding obsession/triggers.

Question 223

What is the rationale behind Exposure and Response Prevention (ERP) in the treatment of OCD?

Answer 223

1. Ongoing exposure to feared stimulus without performing the compulsions (though anxiety intially increase) results in **habituation** (Reduced anxiety) 2. Successively lower levels of anxiety break association between feared stimuli & anxiety (**Extinction** of conditioned response) Non-performance of the compulsion also weakens the association between obsessions (thoughts & fears) & compulsions

Question 224

Describe how OCD is treated based on cognitive theory. (what is cognitive therapy, what are the elements of the therapy, how does it help OCD?)

Answer 224

**Cogitive Therapy** * Aims to **challenge negative automatic thoughts & change underlying beliefs** (Schemata), challenge and replace dysfunctional beliefs about the **probability of harm** and **personal responsability**. * Cognitive restructuring - client taught to **(1)** Identify anxiety-provoking thoughts **(2)** Challenge them **(3)** Rehearse more constructive alternatives. **_Cognitive therapy elements:_** * Evidence for & against obsession-related beliefs * Re-assign probabilities * In session & homeword - homework= correct dysfunctional thoughts and beliefs in **daily diary**

Question 225

What kind of drug is used to treat OCDs?

Answer 225

Usually antidepressant medications.

Question 226

Is ERP or CT (and CBT) more effective in the treatment of OCD?

Answer 226

There are few direct studies. When studies are done-well, ERP can be as good as full CBT and better than CT alone (but possibly comparable) ERP tends to have larger effects than CT alone, but not always.

Question 227

is CBT or drug therapy better for treating OCD?

Answer 227

Probably CBT, but a combination can be effective (Depending on baseline severity) While the short-term effects of drugs can be as good as CBT, the long-term gain of drugs is poor and relapse is common when drugs are ceased. Drugs also have side-effects and many people do not want to take drugs or drop-out

Question 228

Why is Agoraphobia considered a seperate disorder to Panic disorder (PD)? How does this complicate current discussions?

Answer 228

Partly because agoraphobia can exist in the absence of panic attacks or PD nearly all previous research (both aeiological & treatment) on agoraphobia has been done in the context of Panic Disorder

Question 229

What are the symptoms of a panic attack according the the DMS-5?

Answer 229

4 of the following symptoms * Palpatations, pounding&/or rapid heart rate * Sweating * Trembling or shaking * Sensation of shortness of breath * Feelings of choking * Chest pain/discomfort * Nausea/abdominal distress * Dizziness, faintness or unsteadiness * Chills or heat sensations * Paraesthesia (numbness of tingling) * Derelisation (unreality) * Fear of losing control or going mad * Fear of dying

Question 230

According to the DSM-5 what are the criteria for a diagnosis of Panic Disorder (PD)?

Answer 230

1. **at least one Panic attack.** unexpected with no obvious cues/triggers. (usually more) 2. at least one of the attacks has been followed by 1 month (+) of one or both of the following * **Persistant concern about having additional panic attacks or their consequences** (e.g., of a heart attack or "going crazy", includes concern of life-threatening illness, cardiac problems, social, losing control [including bladder], insanity) * **A significant maladpative change in behaviour related to attacks** (e.g., avoids exercise or unfamiliar places - includes avoiding increasd heartrate & places where PA might be embaressing or help might not be available; repeatedly seeking medical help; work absenteeism or resign job.

Question 231

How must panic attacks differ from those of other anxiety disorders in order to be considered a diagnosis for Panic Disorder?

Answer 231

* MUST be uncued (unexpected or 'out of the blue') * Central features (and the starting point for worry and behaviour change) * Probably more frequent

Question 232

According to the DSM-5 what is the diagnostic criteria of Agoraphobia?

Answer 232

1. Marked fear/anxiety about 2(+) of the following situations * Using public transport * Open spaces (parking lots, market places) * Enclosed spaces (shops, cinemas) * Standing in a line or in a crowd * Being outside of the home alone 2. The individual **fears or avoids** these situations **because of thoughts that escape might be difficult** or help **might not be available** in the event of having **panic-like symptoms or other incapacitating or embaressing symptoms ** 3. Agoraphobia are avoided, require the prescence of a companion, orr are endured with intense fear or anxiety. 4. The fear/anxiety is excessive Avoidance Agoraphobia

Question 233

What are the 3 suggested aetiology of PD (including with comorbid agoraphobia)?

Answer 233

1. Hyperventilation 2. Cognitive theory 3. Learning - classical conditioning, operant conditioning

Question 234

How might hyperventilation explain Panic Disorder?

Answer 234

When we exhale, we excrete carbon disoxide (CO2) from our lung. When people are frightened they hyperventilate - over-breath. 1. Hyperventilation -\> decrease CO2 2. Decreased CO2 -\> increased alkalinity 3. increased alkalinity -\> physical & psychological symptoms of panic

Question 235

How might cognitive theory explain Panic Disorder?

Answer 235

* **Individuals have an enduring disposition to intepret bodily sensation in a catastophic way** (e.g., they will have a heart-attack, stroke, go mad or die) Anxiety increased, bodily sensations increase; continues in vicious cycle -\> panic attack Increasing attentiveness to boily sensations and avoidance of place where panic could occur.

Question 236

What are the problems with cognitive theory as an explaination for Panic Disorder?

Answer 236

1. Catastrophic cognitions about physical sensation can follow rather than precede the very first attack. 2. Some people (30%) do not report fearing that bodily symptoms indicate impending mental or physical disaster 3. Panic attacks can occur during non-dreaming sleep i.e., not caused by the intepretation of bodily sensations in a catastrophic way.

Question 237

How do learning theories explain Panic Disorder?

Answer 237

Combined operant and classical conditioning Classical: * Stressfull experience -\> anxiety & first panic * Other internal & external stimuli present at the time become conditioned stimuli (CSs) that can lead to further attacks (CRs) Operant: * **Avoidance** (e.g., **of physical sensations** associated with panic attacks [e.g., exercise]; **general places** that increase concern about having a PA; **specific places** where a PA occured before. * **Avoidance is maintained by negative reinforcement** (prevention/reduction of anxiety and panic attack themselves)

Question 238

How does cognitive theory and learning theory contrast in their explanations for the Panic Disorder? (think, direction of relationship between beliefs, body sensations/panic, avoidance etc)

Answer 238

Cognitive theory i.e. beliefs -\> avoidance * Dysfuntional beliefs about the meaning of bodily sensations -\> panic attacks and avoidance Learning theory i.e., body sensation/panic -\> beliefs * Conditioned associations between bodily sensations (&situations) and panic --\> beliefs/fears about bodily sensations. Avoidance neg. reinforced by reduced anxiety.

Question 239

What treatment for Panic Disorders is based on the hyperventilation theory?

Answer 239

Breathing retraining (to prevent/stop hyperventilation)

Question 240

What drug therapies are used to treat Panic DIsorder?

Answer 240

* Antidepressant medications (a range of types) * Benzodiazepines (sedatives/sleeping pills) substantial risk of tolerance & dependence - not a good idea.

Question 241

What psychological therapies are used to treat Panic DIsorder?

Answer 241

Cognitive Behavioural Therapy (CBT)

Question 242

What is the most proven treatment for Panic DIsorder? What does it involve?

Answer 242

**Cognitive Behavioural Therapy** The most empirically supported psychosocial treatment for PD/A. The central focus is repeated exposure to feared situations and sensations supported by a set of control-based coping skills. "coping skills" = cognitive therapy plus breathing retraining and relaxation. It involves: * Teaching client to identify catastropihic intepretations of boidly symptoms * Challenege; replace with rational response * Diary & daily homework exercises (often workbook)

Question 243

How is behaviour therapy used to treat Panic Disorder?

Answer 243

Exposure therapy to 1. sensations and 2. situations **Graded Interoceptive Exposure (to sensations)**

Question 244

What is **Graded Interoceptive Exposure** used to treat and what is it?

Answer 244

Used to treat Panic Disorder (and Agoraphobia) * Graded exposure to physical sensations associated with panic attacks (CSs that trigger attacks) * Initially in presence of therapist; later, by the client at home. * Daily exercises Purpose: to breain associations b/t internal (interoceptive) sensations and panic reactions - extinction of CR

Question 245

How is behavioural therapy used to treat agoraphobia?

Answer 245

**Graded exposure** to feared situations/stimuli * Usually therapist-assisted initially, because therapist-guided has a better outcome for PD with agoraphobia. * Self-direct exposure also essential - daily homework

Question 246

is Cognitive therapy or Behaviour therapy (including hyperventilation) a better treatment for Panic Disorder (and agoraphobia)?

Answer 246

Recent meta-analyses indicated exposure (interoceptive & in-vivo) combined with breathing retraining has the largest therapeutic effects for PD ("Exposure is the treatment of choice") * CT useful for panic attacks * Exposure therapy useful at managing avoidance * Introceptive exposures alone, improves beliefs about panic attacks. * Exposure for agoraphobia improves cognitions re. panic attacks & reduces frequency of panic attacks.

Question 247

IS psychological therapy or medication a better treatment for Panic Disorder?

Answer 247

* Antidepressant medications and CBT either comparable, or CBT better. * Drop-outs tend to be lower for CBT than for drug therapy * More relapse with medication than CBT They can be COMBINED, this sometimes results in better outcomes than either alone (e.g., quicker response), particularly for those with severe symptoms and comorbid deppression.

Question 248

What are the three types that symptoms of schizophrenia are commonly divided into?(As opposed to the orginal two)

Answer 248

1. Positive - presence of abnormal behaviour 2. Disorganised 3. Negative - Deficit in normal behaviour

Question 249

Give some examples of Positive symptoms of schizophrenia.

Answer 249

Delusions, hallucinations etc

Question 250

Give some examples of disorganised schizophrenia symptoms.

Answer 250

Disorganised speech, grossly disorganised or catatonic behaviour

Question 251

Give some examples of negative schizophrenia symptoms.

Answer 251

Affective flattening, alogia, avoilation

Question 252

Outline the diagnostic criteria of schizophrenia

Answer 252

essentially - A. symptoms, B. Dysfunction, C. Duration **_A_** Symptoms: two (+) of the following symptoms, each present for a significant portion of time in a 1-month period (or less if successfully treated. Must include 1, 2 or 3 . 1. Delusions 2. Hallucinations 3. Disorganised speech (e.g., frequent derailment or incoherence) 4. Grossly disorganised or catatonic behaviour 5. Negative symotms (e.g., affective flattening, alogia, avoilition, anhedonia) **_B_** Dysfunction - for a sig. portion of time since onset, lvl of functioning in one or more major areas, asuch as work, interpersonal relations or self-care, is markedly below the level achieved prior to onset. **_C_** Duration - continuous signs of disturbance for 6+ months. at least 1 month of criterion A symptoms (unless successfully treated) may include preodromal (leading up to) or residual symptoms (after the acute phase)

Question 253

What symptoms MUST be present for a disgnosis of schizoprhenia?

Answer 253

Delusions, hallucinations or disorganised speech

Question 254

(in schizophrenia) What are delusions?

Answer 254

Delusions are bizzare false beliefs.

Question 255

\_\_\_\_\_\_\_\_are the belief that someone/something is trying to harm them (e.g., spying following, posioning)

Answer 255

delusions of persection (i.e., paranoid delusions)

Question 256

The delusion of persecution whereby a person believes that someone or something is reading thoughts is known as \_\_\_\_

Answer 256

thought broadcast

Question 257

The delusion of persecution whereby a person believes that something is making them think things

Answer 257

thought insertion

Question 258

The delusion of persecution whereby a person believes that something is making them do things

Answer 258

made acts

Question 259

Belief the one has extraordinary powers (control the sun or wind) or that one is a very important person (e.g., God, bill gates, sent to prevent WW1)

Answer 259

Delusions of grandeur

Question 260

a type of delusion whereby a person sees personal significance/messages in events unrelated to them.

Answer 260

delusions of reference

Question 262

(schizophrenia) what are hallucinations?

Answer 262

Flase perceptual experiences (mostly auditory 70%, mostly hearing voices)

Question 263

Activity occurs in what part of the brain when a person is experience auditory hallucinations?

Answer 263

Primary auditory cortex.

Question 264

What is disorganised speech (schizophrenia)?

Answer 264

Frequent dereailment or incoherence

Question 265

What is grossly disorganised or catatonic behaviour? (schizophrenia)

Answer 265

Movement abnormalities, profoundly dettached, stationary, catatonic posturing. In appropriate, purposless, unable to plan and execute tasks.) examples include: * ties a ribbon around toe * points at nothing * standing in a corner * Inappropriate verbal behaviour and affect, e.g., mumbling, swearing, giggling.

Question 266

(negative symptoms - schizophrenia), what is Alogia?

Answer 266

Poverty of speech

Question 267

(negative symptoms - schizophrenia), what is avoilition?

Answer 267

Reduction in goal-directed behaviour.

Question 268

(negative symptoms - schizophrenia), what is anhedonia?

Answer 268

Reduction in the ability to experience pleasure.

Question 269

What is the prevalence, sex ratio and age of onset for schizophrenia?

Answer 269

Lifetime prevalence 1% male:female = 1:1, BUT - sex differences in the natur of the disorder trajectory. Age of onset = late to adolescent to early adulthood//// MEN - 15-24, drops of quickly WOMEN - age of onset late for women

Question 270

Describe the course of schizophrenia. (ONSET, COURSE)

Answer 270

ONSET - can be gradual or acute (Sudden) COURSE - highly variable * Frequency of relapse (Acute episodes) * Chronicity (persistance of symptoms) * Level of functioning between episodes * Symptoms * Cognitive functioning (Executive function, memory) following acute episodes - 25-30% have chroni/persistant symptoms., 50%+ of schizophrenia is episodic (i.e., relapses), 45% have periods of recovary./remission (approximations based on a number of studies)

Question 271

What are the predictors of schizophrenia course/prognosis? which is the best?

Answer 271

* Premorbid adjustment (is the BEST predictor) - people with good premorbid adjustment have a better prognosis. * Onset - gradual & earlier has a poorer prognosis. * Duration of untreated psychosis - longer -\> worse * Symptoms - prominent negative symptoms lead to more chronic disorder, poorer social and work adjustment, less symptom relief from medication& cognitive impairment. * Sex - women tend to be better adjusted.

Question 272

large diversity in course, symptoms, treatment response, functioning and disability has led some researchers to re-term/rename schizophrenia to...?

Answer 272

Scizophrenias OR schizophrenic spectrum disorder

Question 273

Are people with schizophrenia more aggressive?

Answer 273

Overall, there probably is a higher rate of aggressive behaviour in people with schizophrenia than in the general population, but “the vast majority are not aggressive” (DSM‐5, p. 101), & serious violence is rare.

Question 274

Activity occurs in what part of the brain when a person is experience auditory hallucinations?

Answer 274

Primary auditory cortex.

Question 275

What is disorganised speech (schizophrenia)?

Answer 275

Frequent dereailment or incoherence

Question 276

What is grossly disorganised or catatonic behaviour? (schizophrenia)

Answer 276

Movement abnormalities, profoundly dettached, stationary, catatonic posturing. In appropriate, purposless, unable to plan and execute tasks.) examples include: * ties a ribbon around toe * points at nothing * standing in a corner * Inappropriate verbal behaviour and affect, e.g., mumbling, swearing, giggling.

Question 277

(negative symptoms - schizophrenia), what is Alogia?

Answer 277

Poverty of speech

Question 278

(negative symptoms - schizophrenia), what is avoilition?

Answer 278

Reduction in goal-directed behaviour.

Question 279

(negative symptoms - schizophrenia), what is anhedonia?

Answer 279

Reduction in the ability to experience pleasure.

Question 280

What is the prevalence, sex ratio and age of onset for schizophrenia?

Answer 280

Lifetime prevalence 1% male:female = 1:1, BUT - sex differences in the natur of the disorder trajectory. Age of onset = late to adolescent to early adulthood//// MEN - 15-24, drops of quickly WOMEN - age of onset late for women

Question 281

Describe the course of schizophrenia. (ONSET, COURSE)

Answer 281

ONSET - can be gradual or acute (Sudden) COURSE - highly variable * Frequency of relapse (Acute episodes) * Chronicity (persistance of symptoms) * Level of functioning between episodes * Symptoms * Cognitive functioning (Executive function, memory) following acute episodes - 25-30% have chroni/persistant symptoms., 50%+ of schizophrenia is episodic (i.e., relapses), 45% have periods of recovary./remission (approximations based on a number of studies)

Question 282

What are the predictors of schizophrenia course/prognosis? which is the best?

Answer 282

* Premorbid adjustment (is the BEST predictor) - people with good premorbid adjustment have a better prognosis. * Onset - gradual & earlier has a poorer prognosis. * Duration of untreated psychosis - longer -\> worse * Symptoms - prominent negative symptoms lead to more chronic disorder, poorer social and work adjustment, less symptom relief from medication& cognitive impairment. * Sex - women tend to be better adjusted.

Question 283

large diversity in course, symptoms, treatment response, functioning and disability has led some researchers to re-term/rename schizophrenia to...?

Answer 283

Scizophrenias OR schizophrenic spectrum disorder

Question 284

Are people with schizophrenia more aggressive?

Answer 284

Overall, there probably is a higher rate of aggressive behaviour in people with schizophrenia than in the general population, but “the vast majority are not aggressive” (DSM‐5, p. 101), & serious violence is rare.

Question 285

Is schizophrenia genetic? how do we know?

Answer 285

Part-genetic, part-environmental. Twin studies have shown a cocordance rate of 50% (approx) between monzygotic twins (i.e., identical twins). Adoption studies have shown that BIOLOGY rather than rearing environment determines the risk of developing schizophrenia. BUT the genetic picture is COMPLEX - spcific gene sunknown, multiple genes over multiple chromosomes are candidates, this might explain why it is so diverse.

Question 286

What structural abnormalities (brain) are present in some people with schizophrenia?

Answer 286

* Ventricuular enlargement (atrophy), correlated with negative symptoms. * Reduced activity in frontal lobe, particularly during cognitive tasks - greatest with negative symptoms. * Neurotransmitter abnormalities - Dopamine hypotheses(more detail in another Q)

Question 287

What is the "dopamine hypothesis" for schizophrenia?

Answer 287

**That schizophrenia reflects abnormalities of dopamine (DA)** * **Underactivity in frontal cortex (might) develop first and lead to overactivity in subcorticol areas!** * underactivity in the frontal cortex -\> negative symptoms * Overactivity in subcorticol parts -\> positive symptoms.

Question 288

What three points of evidence are there for the "dopamine hypothesis" for schizophrenia?

Answer 288

1. Antipsychotic drugs WORK because they reduce subcorticol dopamine activity. 2. Antipsychotics side-effects - can produce symptoms of parkinson's due to inadequote DA activity in the nigrostriatal pathway that deals with movement. 3. Side effects of drugs that cause an increase in Dopamine e.g., ampetamines ---\> psychotic symptoms. 'amphetamine psychosis'. OR L-dopa used to treat parkinsons disease can lead to psychosis.

Question 289

Overall, in schizophrenia _____ symptoms might reflect: reduced corticol activity (D1 receptors) & atrophy in the frontal lobes.

Answer 289

NEGATIVE

Question 290

Overall, in schizophrenia _____ symptoms might reflect: excessive dopamine activity (D2 receptors) in lower (subcorticol) parts of the brain).

Question 291

In schizophrenia frontal lobe ______ (\_\_\_\_symptoms)may lead to subcorticol _______ (\_\_\_\_\_\_ symptoms)

Answer 291

Underactivity (negative), Overactivity (positive)

Question 292

What is the Diathesis-stress hypothesis for schizophrenia?

Answer 292

* Biological vulnerability + environmental stressor = schizophrenia. * Stressors include prenatal and birth complications, e.g., maternal infections and other illnesses, obstetric (e.g., oxygen deprivation, CNS trauma)

Question 293

the _________ for schizophrenia suggests that it is caused both by a combination of Biological vulnerability and environmental stressor/s

Answer 293

Diathesis-stress hypothesis

Question 294

What is the key intervention/treatment for schizophrenia?

Answer 294

Drug treatment, antipsychotics and neuroleptics.

Question 295

What % of ppl benefit little from drug treatment for schizophrenia?

Answer 295

10-30%

Question 296

How do antipsychotic medications work?

Answer 296

* They decrease DOPAMIE activity in the lower parts of the breain by blocking post-synaptic DA receptors (attach/bind them without activation them and prevent DA from attaching to them)

Question 297

What is the non-adherance rate for medication int he treatment of schizophrenia?

Answer 297

50%+ over 12 months reduce dose or stop

Question 298

Why might people non-adhere to medication treatment for schizophrenia?

Answer 298

* Remission * Perception thtat they don't work (this can be correct) * Lack of insight * other drug problems, inadequote social support, homelessness * side effects of antipsychotic drugs.

Question 299

What are the extra-pyramidal side effects of 'typical' (i.e. first gen) antipsychotics?

Answer 299

Extra-pyramidal are movement symptoms and relate to the drugs effect on the nigrostriatal pathway (dopamine pathway). e.g., * Akathisia = restelessness * Actue dystonic reactions - sudden, painful muscle spasms * Drug-induced parkinsons * Tardive dyskinesia - mouth and tongue movements.

Question 300

What is the name given to extrapyramidal side-effect of 1st gen ('typical') antipsychotic drugs involving _restlessness_

Answer 300

Akathisia

Question 301

What is the name given to extrapyramidal side-effect of 1st gen ('typical') antipsychotic drugs involving sudden, painful muscle spasms?

Answer 301

Acute Dystonic reactions

Question 302

What is the name given to extrapyramidal side-effect of 1st gen ('typical') antipsychotic drugs involving mouth and tongue movements

Answer 302

Tardive dyskinesia

Question 303

What are some of the side effects of 'typical' (first gen) antipsychotics?

Answer 303

dizziness, dry mouth, constipation, trouble urination, sedation, anxiety and depression + extra-pyramidal.

Question 304

\_\_\_\_\_\_\_\_\_\_\_\_ side-effects are movement related results of taking 'typical' nueroleptic/antipsychotic drugs.

Answer 304

Extra-Pyramidal

Question 305

What are the benefits of 2nd generation ('atypical') antipsychotic drugs over 1st generation ('typical') ?

Answer 305

* Greater potential to reduce negative symptoms (& disorganised symptoms) * Extra-pyramidal (movement) side-effects are less common and less sever (but may still occur).

Question 306

How to 2nd gen antipsychotics work different to 1st gen?

Answer 306

* They both block dopamine receptors, but 2nd gen to a lesser extent * 2nd gen also block certain serotonin receptos (5-HT, 2A) to help prevent extrapyramidal side-effects by preserving the DA function in nigrostriatal pathway.

Question 307

What are the side effects of 2nd generation antipsychotics?

Answer 307

* sedation, sleepiness, dry mouth, insomnia, dizziness, headaches, sexual problems, increase blood cholesterol, weight gain, diabetus.

Question 308

What role does psychological treatment (i.e. CBT) have in treating schizophrenia?

Answer 308

* Promote management of symptoms * Reduce relapse * Promote self-care skills and social & occupational skills where relevant * coping with symptoms such as delusions and hallucinations * treat comorbid conditions such as depression or drug dependance.

Question 309

\_\_\_\_\_\_\_ in scizophrenia includes: Movement abnormalities, profoundly dettached, stationary, catatonic posturing. In appropriate, purposless, unable to plan and execute tasks.) ## Footnote

Answer 309

Grossly disorganised or catatonic behaviour

Question 310

\_\_\_\_\_ is Poverty of speech

Answer 310

Alogia

Question 311

\_\_\_\_\_ is a reduction in goal-directed behaviour

Answer 311

Avoilition

Question 312

\_\_\_\_ is a reduction in the ability to experience pleasure.

Answer 312

Anhedonia

Question 314

What components of CBT focuses on negative symptoms, what part focuses on positive symptoms?

Answer 314

Negative - activity scheduling Positive - teaching people to .... * consider possibilitthat hallucinations come from within their own minds * evaluate the plausibility of delusions by considering evidence & alternative explanations * Using behavioural experiments.

Question 315

What is the diagnostic criteria for Major depressive disorder (DSM5)?

Answer 315

A. **MAJOR DEPRESSIVE EPISODE** five of the following symptoms must be present for at least 2 weeks. Must include 1 or 2. 1. depressed mood (sad, empty, hopeless, tearful) 2. loss of interest/pleasure in usual activities 3. Poor appetite & weight loss, or increased appetite and weight gain 4. Sleeping difficulties 5. Psychomoto agitation or retardation 6. fatigue 7. feelings of worthlessness or excessive inappropriate guilt 8. reduced concentration or ability to think 9. recurrent thoughts of death or suicide plans/attempts. B. Symptoms -\> clin sig. distress or impairment in social occupational or other important area of functioning. C. never been a manic or hypermanic episode

Question 316

What is the DSM-5 criteria for Bipolar 1 disorder?

Answer 316

**A. Manic episode** - distinct period of abnormal & persistantly elevated expansive, or irritable mood and persistently increased goal-directed activity or energy lasting at least 1 week and present most of the day, every day (or any duraction if hospitalisation is required) + B. At least 3 of the following (or 4 if only irritated not elevated mood) * inflated self-esteem or grandiosity (includes grandiose dellusions) * decreased need for sleep * more talkative than usual or pressure to keep talking * flight of ideas or subjective impression thoughts are racing * distractability; attention easily diverted * increase in goal-directed activity * excessive involvement in pleasurable activities that have high potential for painfull consequences C. the mood disturband is sufficiently severe to cause marked IMPAIRMENT (note: no distress criteria)

Question 317

what % of people suffering bipolar have delusions (i.e., psychotic features)?

Answer 317

approx 40%

Question 318

how does the psychosocial & occupational functioning of people with bipolar compare to those with schizophrenia?

Answer 318

* Bipolar better than schizophrenia * full functioning recovary between episodes more likely in bipolar * BUT substatial proportion of those with bipolar still experience sig. ongoing problems (residual symptoms, impaired functioning)

Question 319

What factors predict poor outcomes for people suffering with bipolar1 ?

Answer 319

Depressed or mixed symptoms in 1st episode( rather than pure mania) earlier onset comorbid drug dependence

Question 320

after the 1st manic episode (in bipolar1), what % have a future episode and how many relapse (to depression or mania) in a 2-year period?

Answer 320

90% 50% (1/2)

Question 321

What is the prevalence of major depressive disorder (lifetime)

Answer 321

up to 16% experience severe incapacitating depression

Question 322

Prevalence of bipolar 1 disorder? (lifetime)

Answer 322

0.6%

Question 323

is the suicide rate higher in bipolar or major depressive disorder?

Answer 323

Enourmasly elevated in bipolar 1 disorder, but still elevated in major depression.

Question 324

What is the twin concordance rate vs. fraternal rate for Major depressive disorder? what does this suggest?

Answer 324

identical twins 40%, fraternal twins 20% - (rubbery evidence though!) A probably genetic component.

Question 325

What is the twin concordance rate vs. fraternal rate for bipolar1? what does this suggest?

Answer 325

identical twins 50-60%, fraternal twins 20% A probably genetic component.

Question 326

How is it theorised that bipolar1 affects neurotransmitters?

Answer 326

Neurotransmitters – Dopamine, noradrenaline (norepinephrine) ELEVATED; serotonin deficient.

Question 327

How is it theorised that major depressive disorder affects neurotransmitters?

Answer 327

– Serotonin, noradrenaline and dopamine deficient.

Question 328

outline the behavioural/learning theory model fo major depressive disorder.

Answer 328

Behaviour/learning theory – Extinction of desirable behaviours (inadequate reinforcement for desirable behaviour – lack of skill or poor environment). non-reinforced behaviours are extinguished - person becomes withdrawn, avoidant and inactive - negative affect Reinforce depressed behaviour – sympathy/enabling.

Question 329

What is Beck's cognitive theory of major depressive disorder?

Answer 329

Cognitive theory –Beck’s negative self-schema model – depression due to negative thinking. Cognitive biases. * Person vulnerable to depression owing to cognitive schemata in whcih the self, world and future are seen as negative (from negative childhood events) (these schemata are stable). * Stressfull events can activate the schemata * Cogntive distortions/biases = life events interpreted in a way consistant with schemata (e.g., exaggerate failures, minimise successes) - strengthen schemata * Negative automatic thoughts reflect congitive distortions in a given situation.

Question 330

in Major depressive disorder (and bipolar 1) what is the relationship between biology and behaviour/mood?

Answer 330

Neurotransmitter abnormalities affect behaviour & mood Behaviour and mood affect neurotransmitter activity e.g., chronic environmental stress reduces noradrenaline physical activity affects neurotransmitters Behaviour/mood neurotransmitter activity

Question 331

Give some examples of types of cognitive distortions (seen in major depressive disorder according to Beck's negative self-schema model)

Answer 331

* Personalisation (attributing personal responsability) * selective abstraction (focusing on only neg aspects of an event) * Magnification & minimisation (magnify negative, minimise positive) * Arbitary inference (mind-reading) * Expecting the worse * over-generalisation * all or nothing thinking * catastrophising

Question 332

How to antidepressants work to treat major depressive disorder? and bipolar1?

Answer 332

MDD: depressed mood associated with reduced serotonin and noradrenalin. antidepressant medicine aims to increase these. bipolar 1: associated with increase noradrenaline and dopamine so drug treatments aim to optimise serotonin and stabalise Dopamine and noradrenaline (and other excitory neurotransmitters)

Question 333

How long does antidepressant medication usually take to take effect?

Answer 333

2-3 weeks up to 6 weeks for full therapeutic effect.

Question 334

What are the four types of antidepressant medications?

Answer 334

Monoamine oxidase inhibitors (MAOI) Tricyclic acid (e.g., amitriptyline, imipramine) Selective serotonin reuptake inhibitor (SSRIs) (e.g., fluoxetine, sertraline, paroxetine, fluvoxamine, citralopram) Serotonin & noradrenaline reuptake inhibitors (SNRIs) (e.g., bupropion, venlafaxine)

Question 335

Why are MAOI antidepressants prescribed less frequently?

Answer 335

requires heavy dietary restrictions.

Question 336

How to Selective serotonin reuptake inhibitors work?

Answer 336

They block the reuptake of serotonin the neuron synapse, such that more serotonin stays in the synapse and is more availiable for tramission along the pathway.

Question 337

What is the "first line" of treatment for bipolar?

Answer 337

DRUGS! ## Footnote Mood stabalisers e.g., lithium (effective dose is close to toxic dose) or valproate. Anti-psychotics for acute mania anti-depressants.

Question 338

adherance to medication in bipolar reduced the chance of relapse, but adherance in a problem with up to \_\_\_% non-adhering within 12 months of commencing treatment.

Answer 338

40%

Question 339

Why might people not adhere to drug treatments for bipolar1?

Answer 339

* Remission * side-effects and fear of them * perceived ineffectiveness * comorbid drug-dependance * homelessness, low social support * they ENJOY the highs of mania

Question 340

How does cognitive-behavioural therapy supplement the drug treatment for bipolar 1?

Answer 340

* promotes adherance to meds * helps recognise signs of relapse * protection during manic episodes * activity monitoring * sleep and stress maintenance (reduces relapse) * social/interpersonal problems) * others concerns (mood swings, maintaining jobs) * comorbid problems such as drug dependance.

Question 341

outline cognitive therapy as a treatment of Major depressive disorder.

Answer 341

* AIM: teach clients to identify and challenge/refute irrational cognitions. * clients ask themself questions regarding the evidence, alternative intepretations and logical errors of their beliefs/cognitions. reinterpretation and thought diary.

Question 342

As part of cognitive therapy for major depressive disorder what are "behavioural experiments"?

Answer 342

testing a prediction that a bad thing will happen when X happens. 1. make a prediction "if i disagree with her she won't like me" 2. what evidence is there for and against the predicition 3. plan specific way of testing the prediction 4. test it. If necessary, learn positve new ways of engaging in the behaviour 5. note the results and draw conclusions.

Question 343

What is the best treatment for major depressive disorder?

Answer 343

Best? * CT = BT * BT = CBT * CBT(60=70%) \> drug (40-60%), high placebo-drug effect (30%). Medication does not require skill & might make CBT easier, but drugs have a high dropout rate.

Question 344

What is the DSM-5 criteria for Dissociative Identity Disorder?

Answer 344

- **DSM-5 more GENERAL,** A. disruption of identity characterized by two or more distinct personality states (like possessions), alterations in affect, consciousness, memory, perception, cognition and/or sensory functioning. B. gaps in recall of everyday events/important personal info C. clinically significant distress or impairment. D. disturbance not part of culture/religion.

Question 345

How did the DSM-4 and DSM-5 criteria for dissociative identity disorder differ?

Answer 345

- DSM-4 required two or more distinct identities or personality states, that take over behaviour. - DSM-5 more GENERAL, just a disruption of identity.

Question 346

What is a factitious disorder?

Answer 346

deliberate production of symptoms to gain proffesional attention.

Question 347

What are some ALTERNATIVE models to the trauma model of dissociative identity disorder?

Answer 347

* Diagnostic bias (incorrect or overdiagnosis) * suggestion and shaping during therapy - including hypnotic suggestion * publicity * simulation