PSYCH; Lecture 9, 10, 11 and 12 - Social psychology, Clinical decision making, Memory and Adherence to treatment

Question 1

What is an attitude?

Answer 1

Positve/negative evaluative reaction toward a stimulus, such as person, action, object or concept -> attitudes influence behaviour more strongly when situational factors that contradict our attitudes are weak

Question 2

What is the theory of planned behaviour?

Answer 2

Suggests importance of exploring social norms in changing health behaviour

Question 3

How do you resolve cognitive dissonance?

Answer 3

Change behaviour, acquire new information (such as exceptions) and reduce importance of cognition (could convince themselves to live for the moment)

Question 4

How can you change attitudes?

Answer 4

Message more effective if = reaches recipient, attention grabbing, easily understood, relevant and important, easily remembered; more persuasive messengers are = credible (doctors), trustworthy (objective) and attractive (well presented)

Question 5

How do we frame messages?

Answer 5

Either emphasising the benefits or losses of that behaviour -> take up behaviours aimed at detecting health problems then loss-framed messages; aimed at promoting prevention behaviours then gain-framed messages

Question 6

What is stereotyping?

Answer 6

Generalisations made about a group of people or members of that group, such as race, ethnicity, or gender. Or more specific such as different medical specialisations

Question 7

What is prejudice?

Answer 7

To judge, often negatively, without having relevant facts, usually about a group or its individual members

Question 8

What is discrimination?

Answer 8

Behaviours that follow from negative evaluations or attitudes towards members of particular groups

Question 9

What are schemas?

Answer 9

Mental/cognitive structures that contain general expectations and knowledge of the world -> help us process information quickly and economically and facilitate memory recall

Question 10

What is social loafing?

Answer 10

Tendency for people to expend less individual effort when working in a group than when working alone

Question 11

When is social loafing more likely to occur?

Answer 11

Person believes that individual performance isn’t being monitored; task or group has less value/meaning to person; person generally displays low motivation to strive for success; person expects other group members will display high effort -> occurs more strongly in all-male groups and in more individualistic cultures; disappears when individual performance is monitored and members highly value their group/task goal

Question 12

Which factors affect conformity?

Answer 12

Group size: conformity increases as group size increases, no increases over five group members; presence of dissenter: one person disagreeing with others, reducing group conformity; culture: greater in collectivistic cultures

Question 13

Which factors influence obedience?

Answer 13

Remoteness of victim; closeness and legitimacy of authority figure; diffusion of responsibility: obedience increases when someone else does the dirty work. NOT personal characteristics

Question 14

What is group polarisation?

Answer 14

Tendency of people to make decisions that are more extreme when they are in a group as opposed to a decision made alone or independently

Question 15

What is groupthink and when is it more likely to occur?

Answer 15

Tendency of group members to suspend critical thinking because they are striving to seek harmony/conformity. Occurs when group is: under high stress to reach a decision, insulated from outside input, has a directive leader, high cohesiveness

Question 16

What is the bystander effect?

Answer 16

Presence of multiple bystanders inhibits each person’s tendency to help

Question 17

What is the 5-step bystander decision process?

Answer 17

Notice event; decide if event is really an emergency (social comparison to see how others are reacting); assuming responsibility to intervene (diffusion of responsibility = believing someone else will help); self-efficacy in dealing with the situation; decision to help (based on cost-benefit analysis)

Question 18

How can you increase helping behaviour?

Answer 18

Reduce restraints on helping = reduce ambiguity and increase responsibility, enhance concern for self image; socialise altruism = teach moral inclusion, model helping behaviour, attributing helpful behaviours to altruistic motives, education about barriers to helping

Question 19

What are the 3 types of leadership styles and their advantages/disadvantages?

Answer 19

Question 20

What is memory?

Answer 20

Processes that are used to acquire, store, retain and later retrieve information. There are three major processes involved in memory: encoding, storage and retrieval

Question 21

What are the stages of memory?

Answer 21

x

Question 22

What is registration in memory stages?

Answer 22

Necessary for storage to take place but not everything that a person registers is stored. Something has to be stored to be retrieved but the fact that it is stored does not guarantee it will be retrieved on a particular occasion

Question 23

What is encoding in memory stages and what are the 2 types of processing?

Answer 23

Meaning to the words that you remember helps to go through processing stage much faster, so they can quickly remember it

Question 24

What are the types of storage?

Answer 24

There is more than one type of memory store Each has its own performance characteristics and function Each is the function of a different neuroanatomical system

Question 25

What is retrieval and how do we activate it?

Answer 25

x

Question 26

What is the multicomponent model of working memory?

Answer 26

* Working memory is multimodal -\> 2 different filter systems with memory, can do verbal and visual tasks at the same time. * Central executive provides filter and control to what you want to remember/process. * Episodic buffer provides a time period for events to occur. * As info comes in, info comes out of storage to make sense/piece together the new information.

Question 27

What is the function of the central executive in memory?

Answer 27

x

Question 28

What is the function of the visuospatial sketchpad?

Answer 28

Storage of visual and spatial information e.g. for constructing and manipulating visual images, for the representation of mental maps

Question 29

What is the function of the phonological loop?

Answer 29

Storage of auditory/verbal information. Preventing decay by silently articulating contents, refreshing the information in a rehearsal loop e.g. phone number/ reading

Question 30

What is the function of the episodic buffer?

Answer 30

Temporarily integrates phonological, visual, and spatial information in a unitary, episodic representation. Provides interface with episodic long-term memory

Question 31

What is the model of memory?

Answer 31

Question 32

What are the types and function of long term memory?

Answer 32

* Store of all things in memory that are not currently being used but are available for use in the future. * Allows use of past information to deal with present and the future. * Can hold unlimited amount of information. Retrieval from long term memory may be: * Explicit/Declarative (conscious, like knowing Paris is capital of France)‏ * Implicit/Non-declarative (unconscious, like buttoning up your shirt)‏. * Implicit emotional conditioning is seeing a spider and being scared. * Conditioned reflex = pulling hand away from hot surface. * Priming effect is preconceived ideas about info coming in

Question 33

What is non declarative memory?

Answer 33

Familiar with something, know how to interact with object or in situation but don’t have to think about it For actions or behaviours is called procedural memory Can carry out complex activities without having to think about them e.g. walking, eating

Question 34

What are the types of declarative memory?

Answer 34

Store of our knowledge -\>

Question 35

What is autobiographical memory?

Answer 35

x

Question 36

Summarise the 4 types of memory.

Answer 36

x

Question 37

What is the associative network in memory?

Answer 37

* Associative network -\> stored ideas are connected by links of meaning, strengthened through rehearsal and elaboration -\> * Multiple links to a given concept in memory make it easier to retrieve because of many alternative routes to locate it.

Question 38

What are schema?

Answer 38

Question 39

How do schemas affect memory recall?

Answer 39

x

Question 40

What is the serial position effect?

Answer 40

Question 41

What are the different types of committing information to memory?

Answer 41

Rote Assimilation Mnemonic devices Move your body

Question 42

What is PQRST?

Answer 42

x

Question 43

What is the Rote type of committing to memory?

Answer 43

Frequent repetition; forms separate schema, not closely linked to existing knowledge; least efficient; less deep processing.

Question 44

What is the Assimilation type of committing to memory?

Answer 44

Fitting new information into existing schema, learning by comprehension, can only be used where there is link between old and new knowledge, deep processing, wholly declarative

Question 45

How do mnemonic devices help commit info to memory?

Answer 45

Artificial structure for reorganising or encoding information to make it easier to remember Useful when info doesn’t fit existing into schemas Examples: hierarchies, chunking, visual imagery, acronyms Need to recall artificial structure to access information E.g. Naughty Elephant Squirts Water

Question 46

How does moving your body help memory recall?

Answer 46

Links learning abstract concepts to simple physical movement. Short, intense bursts of exercise helps learning- subjects asked to learn new vocabulary performed better if studied after two 3 min runs vs 40 min jog.

Question 47

Why do we forget information?

Answer 47

Question 48

How does the hippocampus become damaged?

Answer 48

In Alzheimer's disease the hippocampus is one of the first regions of the brain to suffer damage; memory problems and disorientation appear among the first symptoms. Damage to the hippocampus can also result from anoxia, encephalitis or medial temporal lobe epilepsy.

Question 49

What is the role of the medial temporal lobes?

Answer 49

Significant anterograde amnesia for autobiographical information following bilateral Medial Temporal Lobe ablation Implicit memory intact- piano playing

Question 50

What is the role of the hippocampus in memory?

Answer 50

* An important role in the formation of new episodic or autobiogrpahical memories. * Some consider the hippocampus as part of a larger medial temporal lobe memory system responsible for general declarative memory. * Older memories remain stable- this sparing of older memories leads to the idea that consolidation over time involves the transfer of memories out of the hippocampus to other parts of the brain.

Question 51

What are the can cause memory difficulties?

Answer 51

Loss of consciousness from head injury disrupts memory processing, so patient unable to make new memories/disorientated -\> significant head injuries see a period of retrograde amnesia and depending on site of injury anterograde amnesia

Question 52

What is Korsakoff's syndrome and semantic dementia?

Answer 52

Question 53

What is compliance?

Answer 53

Acting according to request/command

Question 54

What is adherence?

Answer 54

To stick fast to - the extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes– corresponds with agreed recommendations from a health care provider

Question 55

What are the methods of measuring adherence?

Answer 55

x

Question 56

What are the consequences of non-adherence?

Answer 56

x

Question 57

What are the types of non-adherence?

Answer 57

* Intentional = patients know how and what to do but are reluctant to adhere because treatment doesn't make sense, worries and concerns about treatment, beliefs about disease. * Unintentional = Poor HCP-patient conmmunication, low patient staisfaction and/or recall, cognitive difficulties (problems planning/executive functioning or prospective memory, financial or other barriers, but health beliefs still influence unintentional non-adherence

Question 58

What is intentional/nonintentional adherence?

Answer 58

Can be less helpful to have a division between intentional and non intentional adherence Need to understand causes of non adherence in order to recommend effective intervention.

Question 59

What are the predictors of non-adherence?

Answer 59

Key beliefs influencing adherence to treatment = patient's perceptions of illness and treatment

Question 60

What are the core beliefs about illness in patients?

Answer 60

Doubts about necessity and concerns about potential adverse effects leading to low adherence

Question 61

What are the illness perceptions that can affect patient treatment adherence?

Answer 61

x

Question 62

What are patient's beliefs about illness and treatment?

Answer 62

Question 63

How can you increase adherence?

Answer 63

Use consultation to anticipate and plan -\> interventions to improve understanding of illness and treatment, help patients plan and organise taking of their treatment. Check patients understanding of treatment and provide clear rationale for necessity of treatment, elicit and address concerns, agree practical plan for how, where and when to take treatment, ID any possible barriers

Question 64

What are the techniques of tailored interventions?

Answer 64

Activity – passivity e.g. coma/trauma Guidance – cooperation e.g. acute infection Mutual participation e.g. chronic illness

Question 65

How should you present information to your patients?

Answer 65

Amount of information Order Stressing importance Specificity Mode of presentation

Question 66

What are the factors affecting recall?

Answer 66

Individual factors = anxiety, medical knowledge, memory impairment

Question 67

What are the types of information and their recall?

Answer 67

Diagnostic statements = 87%, information about illness 56%, instructions 44%

Question 68

What are the methods of monitoring adherence?

Answer 68

x

Question 69

What are the regime related factors for adherence?

Answer 69

Physical aspects, complexity of instructions, frequency of schedules -\> add follow up to review monitoring and to change the plan

Question 70

What are the cognitive techniques for adherence?

Answer 70

x

Question 71

What is the social support that can affect adherence?

Answer 71

Support groups Buddy systems Social media/ web forums Making changes with other family members Support from HP

Question 72

What is a medical error?

Answer 72

An error is defined as the failure of a planned action to be completed as intended (i.e., error of execution) or the use of a wrong plan to achieve an aim (i.e., error of planning) -\> incorrect diagnosis, failure to employ indicated tests, error in the performance of an operation/procedure/test, error in dose or method of using a drug.

Question 73

What are the causes of medical errors?

Answer 73

100 cases =\> No-fault factors only (7%), system related error only (19%), cognitive error only (28%) and both system and cognitive related factors (46%)

Question 74

How do clinicians make decisions - 2 systems for decision making?

Answer 74

Heuristics -\> intuitive understanding of probabilities with cognitive processes combined, referred to as rules of thumb, usually involving pattern recognition and rely on subconscious integration of patient data with prior experience, System 1 often controls our actions automatically but system 2 is blissfully unaware, believing itself to be in charge

Question 75

What is confirmatory bias?

Answer 75

Tendency to search for or interpret information in a way that confirms one's perceptions, leading to errors (often)

Question 76

What is the sunk cost fallacy?

Answer 76

Any costs pent on a project that are irretrievable ranging inc money spent or expensive drugs to treat rare disease -\> often more we have invested in the past, the more we are prepared to invest in a problem in the future

Question 77

What is anchoring?

Answer 77

Individuals poor at adjusting estimates from a given starting point -\> adjustments crude and imprecise, anchored by starting point

Question 78

What is the Gambler's fallacy?

Answer 78

Logical fallacy involving the mistaken belief that past events will affect future events when dealing with independents -\> if patient in clinic presents with rare condition then it would be impossible that next patient would present with the same condition

Question 79

What is representativeness heuristics?

Answer 79

Subjective probability that a stimulus belongs to a particular class based on how typical of that class it appears to be

Question 80

What is framing?

Answer 80

When presented with treatment described in positive, negative or neutral terms, older adults more likely to agree to treatment when it is described positively than the same treatment negatively/neutrally

Question 81

What is the availability heuristics?

Answer 81

Probabilities estimated on the basis of how easily and/or vividly they can be called to mind -\> individuals typically overestimate frequency of occurrence of catastrophic, dramatic events -\> tend to heavily weigh their judgement toward more recent information

Question 82

\*\*How can decision making be improved?

Answer 82

* Education and training -\> cognitive/diagnostic error and heuristics and biases may affect judgement; * Feedback -\> increase autopsies, regular and systematic audits, follow up patients; * Accountability -\> establish clear accountability and follow up for decisions made; * Generating alternatives -\> establish forced consideration of alternative possibilities; * Consultations -\> use of algorithms, seek second opinions, use clinical decision making support systems

Question 83

What is an algorithm?

Answer 83

A procedure which if followed exactly will provide the most likely answer based on evidence -\> rules of probability are examples -\> most useful in situations where the problem is well defined