Health and Neuropsychology

What does Health Psychology study?

An emerging field in psychology focusing on how biopsychosocial and behavioral factors influence health and illness.

Health psychologists try to understand ___ people engage in ____________

why, unhealthy behaviours

Health psychologists design ______ using biological and psychological research.

interventions

Health psychologists create ________ and promote _________

health policies, health campaigns

what is a major role of health psychologists?

Conduct assessment on health behaviours/ problems to improve individual outcomes (improve QoL)

Assessment in health psychology gives health care teams what?

A valid and full understanding of a patient

Assessment in health psychology integrates the biopsychosocial model for what?

For a unified treatment plan

Assessment in health psychology facilitates what?

research into health-related variables

What methods are used for assessment in health psychology?

• Questionnaires

• Self-monitoring

• Behavioral observation

• Clinician-administered scales

• Psychophysiological measures

What psychophysiological measures are commonly used in health psychology?

• Heart rate → autonomic balance

• EMG → muscle tension

• Skin conductance/pulse/temp → stress arousal

• Blood pressure → hypertension

• EEG → brain activity (e.g., sleep disorders)

• Pupil size/eye movement → extra indicators

What areas does health psychology assessment focus on?

Broad range of physical & psychological conditions

• Special focus on stress and quality of life (QoL)

What is stress?

A response to demands, constraints, or opportunities involving:

• Psychological (emotions, patterns of thought)

• Physiological (bodily arousal) components

Stress is a process involving what?

stressors, strains, transactions; a dynamic relationship between the person and environment

When does stress occur?

When there is a discrepancy between the demands of a situation and a persons perceived ability to cope with these demands. Of course its important to remember that stress is subjective.

What is anxiety?

An emotional state marked by worry, tension, and tension (ANS arousal) resulting from stressful situations.

How prevalent are stress/anxiety-related illnesses?

Involved in 50–80% of illnesses.

Long-term physical effects of stress?

Mouth ulcers, headaches, colds, IBS, skin problems, psychological issues.

What is the SRRS?

The Social Readjustment Rating Scale assesses the amount of stress to which an individual is exposed.

What does the Social Readjustment Rating Scale consist of?

it consists of 43 items consisting of stressful life events (divorce, job loss) operationalised by Life Change Units (LCUs).

What does the Social readjustment Rating Scale assume?

More change results in greater stress which in turn results in greater health risk!

What is the (Life Events Rating Scale) LRE?

It is an Australian version of the SRRS, but unlike the SRRS includes minor as well as major life events.

Life Events scales are _______ and ______ to conduct and complete.

quick, easy

Life Events scales are _______ of _________ in peoples lives.

Weaknesses of Life Events Scales?

• Weak illness link

• No account for subjective interpretation {who’s to say someone might be overjoyed at getting a divorce)

• May overlap with illness measures

What are daily hassles?

Daily hassles are minor but frequent stressors that significantly affect wellbeing.

Range of daily hassles?

from minor annoyances to major difficulties

HUS

Hassles and Uplifts Scale

The Hassles scale consists of what?

117 items which have to be rated in severity over the past month (‘somewhat’ to ‘extremely’ severe)

The Uplifts Scale consists of what?

135 items representing positive daily experiences which have to be rated in relieving ability.

Both daily hassles and life events have been shown to ________ with _________.

correlate, worsened health outcomes

Uplifts appear to ______________ against negative effects of daily hassles on health.

not buffer

Increased levels of daily hassles are shown to be strongly linked to?

distress, low mood and reduced life satisfaction.

What does State Trait Anxiety Inventory (STAI) measure?

Helps distinguish between situational and dispositional anxiety

State Anxiety (A-State)

Temporary, situation-based [poor retest reliability as expected]

Trait Anxiety (A-Trait)

Stable personality characteristic [good retest reliability as expected]

What is global Quality of Life (QoL)?

An individual's evaluation of their overall life experience at a given time.

What is Health-Related QoL (HRQoL)?

An individual's evaluation of their overall life experience at a given time and how its been affected by illness, accidents or treatments.

How does WHO define QoL?

Subjective—based on how a person perceives their life in the context of culture, values, goals & expectations.

Measuring Quality of Life helps us _______ how illness impacts life to guide treatment and educate patients.

understand

Measuring Quality of Life allows us to _________ treatments based on outcomes, cost, effects; includes QALY.

compare

Measuring Quality of Life _________ patients in assessment to raise issues clinicians may overlook

involves

What are generic QoL measures?

• Allow comparison across illnesses

• Don’t capture illness-specific issues well

What is the SF-36?

Most used global HRQoL measure covering 8 domains, brief, well-validated

• No age-specific items

What is the Nottingham Health Profile (NHP)?

• 2-part measure:

  1. 38 items in 6 categories (e.g., sleep, energy) rated by importance and scaled 0–100

  2. 7 statements on life impact

  reliable & valid, esp. for elderly

What does decision theory involve?

Compare healthcare costs & benefits using QALYs (quality-adjusted life years).

What are Quality of Life Adjusted Years (QALYs)

They combine your life length & QoL to one score (0 = dead - 1 = perfect health)

Treatments can __________ QALYs by extending life or improving health quality, but side effects reduce them.

improve

Treatments can improve QALYs by extending life or improving health quality, but side effects ________ them.

reduce

Pros of disease-specific QoL measures?

Targeted detail, relevant to patient issues

Cons of disease-specific QoL measures?

Poor cross-illness comparability

What does clinical neuropsychology aim to do?

Map behavior and cognitive performance onto brain structure and function.

How does neuropsychology differ from neurology or psychiatry?

More specialized in cognitive functions.

Who were key figures in early neuropsychology?

Pierre Paul Broca & Carl Wernicke.

What did Brodmann contribute?

Mapped the brain into Brodmann Areas, linking anatomy to function.

What were Luria's 3 functional brain units?

• Unit 1: Brain stem & diencephalon → regulates tone, arousal

• Unit 2: Parietal, temporal, occipital → info reception/storage

• Unit 3: Prefrontal cortex → programming, regulation, verification

What is pluripotentiality?

Proposed by Luria it entails that any one brain area may serve multiple functions, and multiple systems may serve the same function.

What is a test implication of pluripotentiality?

Psychological test scores may be influenced by non-target factors, increasing error variance.

What do neuropsychologists assess?

Neuropsychologists assess brain-behaviour relationships in particular they explore the effects of brain-injury, illness, and even ageing on cognitive & behavioural changes.

What are 5 main purposes of neuropsychological assessments?

• Identify impairments

• Aid diagnosis

• Track functional change

• Inform treatment/care

• Provide medico-legal evidence

How does neuropsychological testing differ from intelligence testing?

Broader consideration of an individual's functioning - typically when cognitive deficits linked to brain function are suspected.

Why is neuropsychological assessment needed?

• Brain–cognition mapping is complex & variable

• Neuroimaging may not reflect symptoms

• Early signs (e.g., minor TBI, early Alzheimer’s) often missed on scans

Why must non-neuropsychologists understand neuro signs?

Symptoms may mimic psychological issues, leading to misdiagnosis and ineffective treatment.

When does most brain change occur?

During childhood, though the environment continues to shape the brain into adulthood.

How can early brain injury manifest?

Effects may emerge later when facing complex tasks.

What role does brain plasticity play in development?

Can mask deficits, but recovery is often incomplete.

What is a fixed battery approach in relation to Neuropsychological Testing?

A standardized set of tests given to all clients.

Examples of fixed batteries?

• Halstead-Reitan Battery

• Luria-Nebraska Neuropsychological Battery

Benefits of Fixed Batteries in neuropsychological testing?

Comprehensive; may detect unnoticed issues

Downsides to fixed batteries in neuropsychological testing?

Time-consuming (8–12 hrs), possible redundancy of some tests.

What is the flexible battery approach?

Test selection is tailored to referral questions and client-specific needs.

benefits of flexible battery approach?

Avoids unnecessary testing, allows qualitative data

Downsides to flexible battery in neuropsychological testing?

May omit key tests, less standardised, requires advanced training

What is the Halstead-Reitan Neuropsychological Battery used for?

To assess brain dysfunction using a wide range of psychological & neuropsychological tests (10 subtests), for example:

• WAIS (cognitive assessment)

• Often MMPI (emotional functioning)

How long does the Halstead-Reitan Battery take?

8–12 hours; versions exist for adults and children.

What is the clinical value of the Halstead-Reitan Battery?

Validated against brain region performance Useful for localizing damage (tumors, lesions)
But modern scanning preferred due to equal outcomes at faster rate.

What is the theoretical basis of the Luria-Nebraska Battery?

Based on Luria’s theory: the brain is a functional system, not fixed regions and pluripotentiality.

Who standardized the Luria-Nebraska Battery?

Golden (1981) – created a standardized version with 269 items, 11 subtests (~24 hrs).

What does the Luria-Nebraska Battery measure?

Can make fine distinctions in neuropsychological functioning

• Overall dysfunction

• Left/right hemisphere damage

• Pathognomonic scale (neuropsychological abnormality)

Downside to Nuria-Nebraska Neurpsychological Battery

Best used cautiously & often supplemented with experimental or qualitative tasks.

What are the core components of a neuropsychological assessment?

• Info from other specialists

• Clinical interview & MSE

• Informant interview

• Standardized normative tests

Why is the pattern of deficits important?

• Locate brain regions (e.g., attention vs. memory)

• Identify diseases (e.g., Parkinson’s vs. Alzheimer’s)

• Guide treatment and prognosis

How are results of neuropsych assessments used?

• Diagnosis (with other specialist input)

• Predict outcomes

• Formulate care and interventions

What does the California Verbal Learning Test (CVLT) help diagnose?

• Specific memory/learning deficits

• Strategy use, error types, memory processes

• Guides rehab planning

What is the Stroop Test used for?

• Cognitive control

• Attention & inhibition

• Prefrontal cortex function

What does the Trail Making Test Part A assess?

• Visual scanning, attention, processing speed

• Deficits = poor attention/psychomotor speed

What does Trail Making Test Part B assess?

• Set-shifting, cognitive flexibility

• Disproportionate slowing = frontal lobe impairment

What does the B–A difference score indicate?

Isolates the executive function component