I. MCQs Choose only one correct combination 1. Information contagion can be, directly or indirectly, dependent on: 1. 2. 3. 4. suggestibility; anxiety; patient’s personality type; negative transference. The correct answer is : A.1,2,3 ; B.1,2 ; C.1,3 ; D.2,4 ; E.1,2,3,4 ; F.2,3,4 ; G.1,3,4. I. MCQs Choose only one correct combination 2. What is the definition of “personality disorders”? 1. exogenous behavioral changes, curable by psychotherapy ; 2. endogenous psychic diseases, that occur in adults ; 3. durable behavioral changes, developed in childhood or adolescence, and characterized mainly by a trouble of adaptation to the social environment; 4. behavioral changes due mainly to the exposure to psychic stressors. The correct answer is : A.only 1 ; B.only 2 ; C.only 3 ; D.only 4 ; E.1,2 ; F.3,4 ; G.1,2,3 ; H.2,3,4 ; I.2,4 ; J.1,2,3,4. I. MCQs Choose only one correct combination 3. Therapeutic adherence: 1. 2. 3. 4. 5. is high in depressive patients; is higher, as the informal prestige of the doctor is higher; is low, in chronic diseases; tends to be higher in acute diseases; is high, in people with very high anxiety (panic). The correct answer is: A.1,2,4; B.2,4; C.2,5; D.2,3,4; E.1,3,4; F.2,3,4,5; G.1,2,3. I. MCQs Choose only one correct combination 4. What are the correct correspondences to the characteristics of type A and C personalities: 1. type A = involvement in multiple professional activities; 2. type A = repressed hostility, high vulnerability to cancer; 3. type C = frequently hostile to others; 4. type A = high frequency of psychosomatic (especially cardiovascular) diseases; 5. type A = high frequency of alexithymia. The correct answer is: A.1,2,3 ; B.1,3,4 ; C.1,4 ; D.2,3,5 ; E.3,5 ; F.1,4,5. I. MCQs Choose only one correct combination 5. Which of the following behaviors CAN result from acute anxiety? 1. 2. 3. 4. 5. consulting alternative medicine practitioners; information contagion; high therapeutic adherence; the onset of a personality disorder; low therapeutic adherence. The correct answer is: A.1,3,4; B.1,3,5; C.1,2,3,5; D.2,4,5; E.4,5; F.1,2,4; G.1,2,3. I. MCQs Choose only one correct combination 6. The non-directive style of anamnesis is recommended mostly for: 1. patients with acute and small gravity diseases, without an important psychological component; 2. patients with acute diseases (still, not emergencies), with emotional disturbances produced by their condition ; 3. chronic patients, with multiple relapses of their disease; 4. emergency cases; 5. chronic patients, with a significant change in their quality of life. The correct answer is: A.1,2,3 ; B.2,3,5 ; C.1,2,4 ; D.3,4 ; E.2,3 ; F.2,4; G.1,4,5. II. Cause-effect questions Choose only one correct answer For the following two questions, please answer, according to the legend below: A. the both sentences are true, and there is a causal link between them; B. the both sentences are true, without a causal link between them; C. the first sentence is true, and the second is false; D. the first sentence is false and the second is true; E. the both sentences are false. 7. Hysterical people are incapable of empathy or have a very low empathy BECAUSE hysterical people, being very suspicious, have real difficulties in getting close to other persons. C II. Cause-effect questions Choose only one correct answer For the following two questions, please answer, according to the legend below: A. the both sentences are true, and there is a causal link between them; B. the both sentences are true, without a causal link between them; C. the first sentence is true, and the second is false; D. the first sentence is false and the second is true; E. the both sentences are false. 8. The experiments of Seligman on hopelesshelplessness prove the importance of threat predictibility BECAUSE the passive behavior of the rat is the result of its increased possibilities of anticipating the danger. C III. Open-ended questions 9. What is functional specificity? The right of the doctor to access the physical and / or psychological intimacy of the patient. This right can be used only for the benefit of the patient. III. Open-ended questions 10. What is transference? The emotions developed by the patient for the doctor during the therapeutic process. III. Open-ended questions 11. What is counter-transference? Describe briefly 3 categories of patients that could induce negative counter-transference at untrained doctors. The emotions developed by the doctor for the patient during the therapeutic process. 1.schizoid: “ungrateful” patient, cannot be reached after being released from the hospital; 2.paranoid: always distrusting the doctor, predisposed to self-diagnosis and self-treatment, sometimes openly hostile; 3.depressive: “doesn’t want to get healed”, non-compliant. III. Open-ended questions 12. What is the nocebo effect? Describe briefly 3 categories of factors that could influence its onset. The patient is given a drug without active substance, feels worse afterwards. Can be motivated by negative experiences patient has had in the past with some drugs. Can be influenced by: 1. suggestibility (can precipitate the onset of N.E.); 2. quality of the Dr-Pt relationship (e.g. active listening, emotional support can prevent N.E.); 3. alarming information from mass-media (can focus attention on some particular drug and all those ressembling it). III. CLINICAL CASE A 56 years old patient is admitted at the hospital for recurrent pain in the cardiac area, which is aggravated by heavy meals (they appear approximately 15 minutes after lunch), and are not influenced by effort. Although the patient is convinced that he has a cardiovascular disease, the objective exam and lab tests plead in favor of an esophageal spasm with gastro-esophageal reflux. Three months before the onset of these symptoms, the patient was fired and suffered from the death of his wife. 1. In this particular context, in which broader category of conditions would you put the somatic diagnosis of this patient? 2. One of the instruments that can be used for diagnosing this kind of situations is the so-called Holmes-Rahe Scale. Which are its main characteristics and how would you interpret its results? 3. Which kind of psychotherapeutic technique is the most efficient to obtain a good outcome on a long run, if the patient associates to his symptoms: (a) a long history of separation traumas, beginning in his childhood; (b) type A personality. Glossary of terms Transference = emotions / feelings felt for the patient. Can be negative (e.g.paranoid), positive (hysterical) or absent (schizoid). Counter-transference = emotions / feelings felt by the doctor for the patient (in the case of psychopaths (e.g.paranoid, schizoid, hysterical) can be negative. Type A personality = hostile, competitive, always lacking time, easy to get frustrated High secretion of cathecolamines (adrenaline, noradrenaline) Predisposed to cardiovascular diseases. Type C personality = always repressing emotions, not talking about them. High secretion of cortisole. Predisposed to cancer. Mistakes in doctor-patient relationship (examples) Use of technical language Not letting the patient express himself Giving complicated prescriptions Personality disorders Commonalities = lack of empathy, difficult relationships with others (including the Dr), rigidity of behavior. Can be non-compliant Differences = at the level of transference (high = hysterical, low = schizoid), relations with other patients (aggressive – paranoid, absent – schizoid), adherence (low – paranoid, high – obsessional) Glossary of terms Depression = sadness, lack of energy, feeling guilty without reason Various causes = endogenous / exogenous Leads often to non-compliance (the patient does not take the drugs as prescribed) Anxiety Fear without reason Can develop into panic attacks Often surrounded by somatic symptoms Psychosomatic disorders: physiological changes that occur as a result of a psychological factor (e.g. stress) and are entirely reversible (e.g. gastric hypersecretion, coronary spasm) Psychosomatic diseases: diseases that occur as a result of a long-term effect of a psychological factor (e.g. stress) and are chronic. Examples: ulcer arterial hypertension, asthma Paranoid personality type: suspicious, hypersensitivity to criticism, self-centeredness, revengeful, aggressive, rigidity Often non-compliant, has a difficult relationship to the Dr Psycho-asthenic (obssesive-compulsive) personality type: Excessive care about details, tendency to pay equal attention to essential and non-essential aspects of therapy, unsure about the outcome. Can be both compliant and non-compliant. Distress: stress associated with negative events (high levels of cathecolamines and cortisole). Eustress: stress associated with positive events (high levels of cathecolamines and endorphins). Main effects of endorphins: decreasing the pain, euphoria, stimulation of immunity.