Psycho review

BHAGATH M S

2013 BATCH

PSYCHOLOGY R E V I E W

RAJEEV BISWAS

Introduction of Medical Psychology REVIEW QUESTIONS 1. What is bio- psycho social model [refer slide no 8] In slide 9, understand what is bio psychological model 2. Definition of medical psychology [refer slide no 22] 1. What is bio- psycho social model [refer slide no 8] In slide 9, understand what is bio psychological model BIO-PSYCHOSOCIAL MODEL The bio-psycho-social model was developed by Dr. George Engel.

The model is a general model or approach stating that biological, psychological (which entails thoughts, emotions, and behaviors), and social (socioeconomical, socio-environmental, and cultural) factors, all play a significant role in human functioning in the context of disease or illness.

A medical professions had to pay attention to the bio-psychosocial aspects in conjunction with the biomedical principles in delivering clinical care, providing education, community service and conducting research.

2. Definition of medical psychology [refer slide no 22] - Medical psychology is the application of psychological principles to the practice of medicine for both physical and mental disorder.

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APA defines medical psychology as a branch of psychology that integrates somatic and psychotherapeutic modalities into the management of mental illness and emotional, cognitive, behavioral and substance use disorders.

Abnormal Psychology REVIEW QUESTIONS 1. What is abnormal psychology? [refer slide 2] 2. Course and prognosis of depression. [refer slide 6] 3. The treatment for depression. [refer slide 14] 4. Positive symptoms [refer slide 45] May be asked as short questions 5. Negative symptoms [refer slide 51] 1.

What is abnormal psychology?

• ABNORMAL PSYCHOLOGY is the branch of psychology that deals with the description, causes, and treatment of abnormal behavior patterns.

Course and prognosis of Depression **** doubt in ques • The course of depression, number, duration and severity of episodes varies greatly from person to person.

– Untreated the course is 6 to 9 months and it usually remits to full premorbid functioning (they go back to being like they were before they got it).

– In 20 to 30% some of the symptoms will remain for months to years.

– About 50% experience more than one episode.

– Often the first and second episode are precipitated or triggered by a major life stressor like divorce or death of a loved one.

2.

3.

The treatment for depression.

- The tricyclics (TCAs) - The SSRIs (Selective Serotonin Re-uptake Inhibitors) - MAOIs (mono-amine oxidase inhibitors)

4.

Positive symptoms • Delusions • Hallucinations • Disorganized thinking • Disorganized behavior • Catatonic behavior • Inappropriate responses

5.

Negative symptoms • Lack of emotion • Low energy • Lack of interest in life • Affective flattening • Alogia

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Inappropriate social skills Inability to make friends Social isolation

Counseling Psychology REVIEW QUESTIONS 1. Techniques of behavior treatment [refer slide no 8] 2. What is empathy? [refer slide no 15] 3. Automatic thoughts [refer slide no 19] 4. What is Rational emotive behavior therapy [refer slide no 21] 5. What is consious / preconsious / inconsious [refer slide no 28] 6. What are Id, ego and superego [refer slide no 29] 1. Techniques of behavior treatment [refer slide no 8] • BEHAVIOR MODIFICATION PROGRAMS – these approaches try to increase positive behavior and decrease negative behavior by using reinforcements and punishments in the most effective ways based on learning principles the behaviorists have discovered from research.

• PARTICIPANT MODELING - A behavior therapy in which an appropriate response is modeled in graduated steps and the client attempts each step, encouraged and supported by the therapist 2. What is empathy? [refer slide no 15] - Is a tool of humanistic therapist - Working at seeing the world from the client’s perspective.

3. Automatic thoughts [refer slide no 19] Personalized notions that are triggered by particular stimuli that lead to emotional responses 4. What is Rational emotive behavior therapy [refer slide no 21] Assumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relationship.

5. What is consious / preconsious / inconsious [refer slide no 28] • CONSCIOUS –this is the part of the mind that holds what you are aware of. You can verbalize about your conscious experience and you can think about it in a logical fashion.

• PRECONSCIOUS -- this is ordinary memory. They can be readily brought into conscious.

• UNCONSCIOUS -- this part of the mind was not directly accessible to awareness. saw it as a dump box for urges, feelings and ideas that are tied to anxiety, conflict and pain.

6. What are Id, ego and superego [refer slide no 29] • Id is driven by the pleasure principle, which strives for immediate gratification of all desires, wants, and needs.

• the ego develops from the id and ensures that the impulses of the id can be expressed in a manner acceptable in the real world. The ego functions in both the conscious, preconscious, and unconscious mind.

It is driven by the Realistic principle.

• The superego is the aspect of personality that holds all of our internalized moral standards and ideals that we acquire from both parents and society--our sense of right and wrong. It is driven by the moral principle.

Doctor patient relationship REVIEW QUESTIONS 1. What is the patient right and patient responsibility? [refer slide 11] 2. Model of Doctor patient relationship.3kinds [refer slide 14] 1. What is the patient right and patient responsibility? [refer slide 11] • Right to Medical Treatment • Right to Information • Right to Choices • Right to Privacy • Right to Complaint 2. Model of Doctor patient relationship.3kinds [refer slide 14] There are three different kinds of models :: 1. PATERNALISTIC 2. CONTRACTUAL 3. FIDUCIARY Read

Paternalistic model: The doctor is the professional. He/she gives the order, the patient obeys.

Strengths: Emphasizes the expertise and knowledge of the doctor Weaknesses: Ignores the autonomy of the patient Ignores non-health related but morally legitimate values of the patient Contractual model: The doctor and patient "contract" for each other's mutual benefit; the patient determines or agrees to the doctor’s decisions.

Strengths: Highlights the autonomy of both patient and physician Acknowledges cooperative/shared aspects of medical decision-making Weaknesses: No "contracts" developed or signed in real doctor/ patient relationships Model doesn’t allow for at trusting relationship Fiduciary model: The patient confidently entrusts his/her health care to the doctor, who takes on the obligation of working for the benefit of the patient (Fiduciary: relates to a holding of something in trust for another) Strengths: Preserves the freedom and autonomy of both patient and physician The legitimate role of physician knowledge The important role of trust in the doctor/patient relationship Questions raised by skeptics: 1. Patient trust may be manipulated for further economic gain.

2. Patient trust may undermines consumer’s awareness of need for self-protection 3. Serious illness and fear of death diminish patient autonomy and power to contract any relationship.

Health and Behaviour REVIEW QUESTIONS 1. What is theory of planned behavior ? [refer slide no 16] also add slide no 17,18 2. Trans theoretical model of health behavior changes.- include 6 stages [refer slide no 20]

1. What is theory of planned behavior ? [refer slide no 16] also add slide no 17,18 The theory of planned behavior (TPB) is a psychosocial health model of cognitive processes which seeks to predict/explain behavioral intention. According to the TPB, the more favorable the attitude and subjective norm with respect to a behavior, and the greater the perceived behavior control, the stronger should be an individual’s intention to perform the behavior under consideration. The intention and perceived behavior control then predict the behavior (Ajzen, 1991).

Attitude.

‘Attitude’ refers to the degree to which a person has a favorable or unfavorable evaluation or appraisal of the behavior in question (Ajzen, 1991).

Attitude towards the behavior

Subjective norm

Behavioral intention

behavior

Perceived

Perceived behavioral control. behavior control ‘Perceived behavior control’ refers to the perceived ease or difficulty of performing the behavior and is assumed to reflect past experience as well as anticipated impediments and obstacles (Ajzen, 1991).

Subjective norm.

‘Subjective norm’ refers to the perceived social pressure to perform or not to perform the behavior (Ajzen, 1991).

2. Trans theoretical model of health behavior changes.- include 6 stages [refer slide no 20] STAGE 1 :: PRE-CONTEMPLATION • Represents those individuals who have no desire to change behaviors in immediate future • Some in this stage are unaware of behavior • Some aware of behavior consequence but continue anyway – Create reasons why continued behavior makes sense – Recognize previous failures at behavior modification STAGE 2 :: CONTEMPLATION • Intent to change behavior within six months • Individual is aware of the desired behavior – Benefits – barriers (finances, time, support) – Change planned based on interpretation of benefits and barries STAGE 3 :: PREPARATION • Serious consideration of behavior change within 30 days • Previous attempts to change (smoking cessation for a week, eg.)

• the individual is most ready for change

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No rushing Encouragement Education Motivational techniques

STAGE 4 :: ACTION • A distinct change in behavior occurs – Change is consistent – visible – receives the most recognition • Requires the greatest commitment • Relapse common in this stage STAGE 5 :: MAINTENANCE • Should be at least six months after the behavior change, may last for years – The change behavior will dictate amount of time needed in this stage a. major changes will probably require more time b. minor changes will probably require less time • Individual’s self-efficacy is highest at this stage STAGE 6 :: TERMINATION • Behavior change has been permanently adopted • 100% self-efficacy • No temptation to relapse • A more realistic goal permanent maintenance

Suicide and crisis intervention REVIEW QUESTIONS 1. What is suicide ideation [refer slide no 8] 2. What is suicide attempt [refer slide no 10] 3. About 90% .... [refer slide 15] 1. What is suicide ideation [refer slide no 8] Suicidal ideation is thoughts of killing oneself (i.e., serving as the agent of one’s death).

2. What is suicide attempt [refer slide no 10] Suicide attempt or non-fatal suicidal behavior is self-injury with the desire to end one's life that does not result in death.

3. About 90% .... [refer slide 15] ******** doubt with the question Psychiatric Disorders Associated With Suicide • About 90% of suicides - psychiatric disorder.

• Depression, bipolar disorder, and substance abuse are most often associated with suicide.

• For patients with major depressive disorder, standardized mortality ratios show a 20-fold increase over the general population of patients.

• Studies on patients with Bipolar disorder is 26 times higher than in the international general population.

• In bipolar disorder, mixed manic-depressive states are often associated with increased suicide risk.

• Suicide rates are also surprisingly high among persons who have anxiety.

Stress and psychoanalysis REVIEW QUESTIONS 1) Category of Stress 2) General adaptation model 3) What is adjustment disorder 4) What is PTSD 5) What is ASD. What is the difference between ASD and PTSD .

6) What Id, ego and superego 7) What is the psycho sexual stages .Name of the stages and what it means 8) What is the defence mechanism? What it includes 1) Category of Stress 1. FRUSTRATIONS 2. CONFLICTS 3. PRESSURES 2) General adaptation model Phase 1 :: ALARM REACTION (mobilize resources) Phase 2 :: RESISTANCE (cope with stressor) Phase 3 :: EXHAUSTION (reserve depleted)

3) What is Adjustment disorder  Affective symptoms ( worry, depression) ，  Behavior symptoms with poor adjustment（e.g. Withdrawal，  Not paying attention to hygiene，irregular lives），  Physiological disorder（ e.g. Poor sleep，poor appetite） -

are caused by prolonged presence of stressor or difficult situation，and the patients’ personality defecit.

The disorders interfere with social function, and the duration usually is long but not exceed 6 months.

4) What is PTSD - POST TRAUMATIC STRESS DISORDER (PTSD) - In response to specific extreme stressor, characterized by intrusive memories of traumatic event, emotional withdrawal, and heightened autonomic arousal - (lasts more than 30 days).

5) What is ASD. - ACUTE STRESS DISORDER (ASD) - Exposure to a traumatic stressor resulting in dissociation, reliving the experience, and attempts to avoid reminders of the event (lasts more than 2 and less than 30 days).

6) What is the difference between ASD and PTSD. (collaboration of quest. no 4 & 5- given above ) 7) What Id, Ego and Superego ID - instinctual drives present at birth - does not distinguish between reality and fantasy - operates according to the pleasure principle EGO - develops out of the id in infancy - understands reality and logic - mediator between id and superego SUPEREGO ★ – internalization of society’s moral standards – responsible for guilt 8) What is the psycho sexual stages .Name of the stages and what it means 1. ORAL STAGE (birth – 1 year) ★Mouth is associated with sexual pleasure ★Weaning a child can lead to fixation if not handled correctly ★Fixation can lead to oral activities in adulthood 2. ANAL STAGE (1 – 3 years) ★Anus is associated with pleasure ★Toilet training can lead to fixation if not handled correctly ★Fixation can lead to anal retentive or expulsive behaviors in adulthood 3. PALLIC STAGE (3 – 5 years) ★Focus of pleasure shifts to the genitals ★Oedipus or Electra complex can occur ★Fixation can lead to excessive masculinity in males and the need for attention or domination in females 4. LATENCY STAGE (5 - puberty) - Sexuality is repressed - Children participate in hobbies, school and same-sex friendships 5. GENITAL STAGE (puberty on) ★Sexual feelings reemerge and are oriented toward others ★Healthy adults find pleasure in love and work, fixated adults have their energy tied up in earlier stages 9) What is the Defense Mechanism? What does it includes ?

Unconscious mental processes employed by the ego to reduce anxiety ★SUBLIMATION - displacement to activities that are valued by society ★DISPLACEMENT - redirection of shameful thoughts to more appropriate targets ★REGRESSION - retreating to a mode of behavior characteristic of an earlier stage of development ★RATIONALIZATION - reasoning away anxiety- producing thoughts ★PROJECTION - reducing anxiety by attributing unacceptable impulses to someone else

Medical Psychology Questions A. EXPLAIN THE GLOSSARY (6x5 = 30) 1. Systemic desensitization A behavior therapy that is used to treat phobias and that involves training clients in deep muscle relaxation and then having them confront, a graduation series of anxiety-producing situations until they can remain relaxed while confronting even the most feared situation.

2. Suicide attempt :: self-injury with the desire to end one’s life that does not result in death.

3. Empathy :: working at seeing the world from the client’s perspective.

4. Post traumatic Stress Disorder (PTSD) In response to specific extreme stressor, characterized by intrusive memories of traumatic event, emotional withdrawal, and heightened autonomic arousal (lasts more than 30 days).

5. Adjustment Disorder  Affective symptoms ( worry, depression) ，  Behavior symptoms with poor adjustment（e.g. Withdrawal，  Not paying attention to hygiene，irregular lives），  Physiological disorder（ e.g. Poor sleep，poor appetite） - are caused by prolonged presence of stressor or difficult situation，and the patients’ personality defecit.

- The disorders interfere with social function, and the duration usually is long but not exceed 6 months.

6. Projection :: A kind of Defense Mechanisms. Reducing anxiety by attributing unacceptable impulses to someone else.

B. COMPLETION (20x2 = 40) 1.The three main classes of medications for depression are The tricyclics (TCAs), The SSRIs (selective serotonin re-uptake inhibitors) , MAOs (mono-amine oxidase inhibitors) 2. The trans-theoretical models of health behavior change include six stages :: pre-contemplation, CONTEMPLATION, PREPARATION, ACTION, MAINTENANCE, termination .

3. Rational Emotive Behavior Therapy assumes that COGNITION, EMOTIONS and BEHAVIORS interact and have a reciprocal cause-and-effect relationship.

4. According to the Hong Kong Hospital authority outline the patient rights are :: RIGHT TO MEDICAL TREATMENT, RIGHT TO INFORMATION, RIGHT TO CHOICES, RIGHT TO PRIVACY, Right to Complaint.

5. GAS (General Adaptation Model) develops in 3 stages:: alarm and MOBILIZATION, RESISTANCE and EXHAUSTION. 6. Categories of Stress: FRUSTRATIONS, CONFLICTS and PRESSURES

7.Please list several Defense Mechanisms of Psychoanalysis for example: SUBLIMATION, DISPLACEMENT, REGRESSION, RATIONALIZATION and PROJECTION 8. ORAL STAGE, ANAL STAGE, PHALLIC STAGE, LATENCY STAGE and GENITAL STAGES – Freud’s five stages of personality development, each associated with a particular erogenous zone.

9. There are three different kinds of models of doctor-patient relationship: PATERNALISTIC, CONTRACTUAL, FIDUCIARY C. ESSAY QUESTIONS (5x6 = 30) 1. What are these positive symptoms for schizophrenia? > Delusions > Hallocinations > Disorganized thinking > Disorganized behavior > Catatonic behavior > Inappropriate responses 2. What is the medical psychology?

Medical psychology is the application of psychological principles to the practice of medicine for both physical and mental disorder.

APA defines medical psychology as a branch of psychology that integrates somatic and psychotherapeutic modalities into the management of mental illness and emotional, cognitive, behavioral and substance use disorders.

3. Freud divided human personality into three functional parts: ID, Ego and Superego.

Briefly describe this theory ★ Id :: - Instinctual drives present at birth - does not distinguish between reality and fantasy - operates according to the pleasure principle ★ Ego - develops out of the Id in infancy - understands reality and logic - mediator between id and superego ★ Superego - internalization of society’s moral standards - responsible for guilt - Id is driven by the pleasure principle, which strives for immediate gratification of all desires, wants and needs - the ego develops from the id and ensures that the impulses of the id can be expressed in a manner acceptable in the real world. The ego functions in both the conscious, preconscious and unconscious mind. It is driven by the realistic principle.

- superego is the aspect of personality that holds all our internalized moral standards and ideals that we acquire from parents and society- our sense of right and wrong. It is driven by the moral principle.

4. What are the main differences between Acute Stress Disorder and Post-traumatic Stress Disorder ?

Acute Stress Disorder (ASD) Post-traumatic Stress Disorder (PTSD) - Exposure to a traumatic stressor resulting in - In response to specific extreme stressor, characterized by intrusive memories of dissociation, reliving the experience, and traumatic event, emotional withdrawal, and attempts to avoid reminders of the event heightened autonomic arousal - (lasts more than 30 days).

- (lasts more than 2 and less than 30 days).

5. Please briefly explain the bio-psycho-social model ?

The bio-psycho-social model was developed by Dr. George Engel. This model is general model or approach stating that biological, psychological (which entails thoughts, emotions and behaviors) and social (socio-economical, socio-environmental and cultural) factors, all play a significant role in human functioning in the context of disease or illness.

C. ESSAY QUESTIONS (4 x 8 = 32) 1. Please describe the DSM-IV criteria for somatization disorder.

A. Somatic Symptoms :: One or more somatic symptoms that are destressing and/or result in significant disruption in daily life.

B. Excessive thoughts, feelings and behaviors related to these somatic symptoms or associated health concerns: At least one of the following must be present. > Disproportionate and persistent thoughts about the seriousness of one’s symptoms > Persistently high level of anxiety about health or symptoms > Excessive time and energy devoted to these symptoms or health concerns C. Chronicity: Although any one symptom may not be continuously present, the state of being symptomatic is persistent (typically > 6 months) 2. Please briefly describe mechanism and manifestation of General Adaptation Syndrome GAS develops in 3 stages :: 1) Alarm All of these expend 2) Resistance Metabolic energy 3) Exhaustion 3. What is abnormal psychology?

Abnormal psychology is a branch of psychology. It is a clinical medicine that studies cause, clinical syndromes, or signs, diagnosis, treatment and prognosis of mental illnesses.