Cognition, learning and creativity

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Cognition, learning and creativity

  1. 1. By Abdul-Muqueeth, Syed Kazmi 3rd year Windsor Medical Student
  2. 2.  Cognition usually refers to an information processing view of an individual„s psychological functions.(5)  It measures group of mental processes that includes attention, memory, understanding language, learning, reasoning, problem solving, and decision making skills. (5)
  3. 3.  Early studies in the field of cognitive sciences were recorded about 2300 years ago. For Example, Aristotle, a Greek philosopher focused on memory, perception and mental imagery.(5)  Thomas Aquinas an Italian philosopher in 1225- 1274: studied behavioral sciences and divided the human behavior into two broad categories: a.) cognitive: how we know the world b.) Affective: how we understand the world via feelings and emotions. He studied the concepts of memory, associations, concept formation, pattern recognition, language, attention, perception, action, problem solving and mental imagery. (5)
  4. 4.  Centuries later these concepts were again revisited by early European and American scientists in early 1800 years. (5)  Wilhelm Wundt 1832-1920: focused on examining the inner feeling of the individuals  Herman Ebbinghaus 1850-1909: conducted studies to examine the capacity of human memory  Mary Whiton Calkins 1863-1930: developed a theory of “recent effect” measures the ability of the individual to accurately re-collect the final items presented in a sequence of stimuli.(5).
  5. 5. Stage 1 (oral stage) Birth to 18 months Mouth is the main site of gratification chewing, biting and sucking Stage 2: anal stage 1 to 3 years Anus and surrounding areas are the main site of gratification. Primarily involved in bowel function and bladder control. If toilet training is harsh person can develop OCD
  6. 6. Stage 3 phallic stage 3 to 5 years Genital area is the main site of gratification. Penis envy and fear of castration are evident during this stage. “Oedipal complex” love with opposite parents Stage 4 Latency period 5-13 years Formation of the superego, sexual interest. Sublimation of sexual energy into energetic learning and play activities Stage 5 Genital stage 13 years to adulthood Capacity of true intimacy
  7. 7. Sensorimotor stage Infancy 0-2 years Infant begin to learn through sensory observation and gain control of their motor functions through activity, exploration and manipulation of the environment Pre-operational stage Toddlers and early childhood 2-7 years Child uses symbols and language more extensively. Children are egocentric use animistic thinking and have a sense of immanent justice Concrete operational stage Elementary and Early adolescence 7-12 years They started seeing things from other perspective. They have operational thoughts Formal operational stage Adolescence and adulthood 12 years to adult Ability to think abstractly, reason deduce concepts have deductive reasoning
  8. 8.  Pediatrics: Attention deficit disorder, Conduct disorder, Oppositional defiant disorder, Separation anxiety disorder, Autistic disorder, Asperger‟s disorder, Retts disorder, Childhood disintegrative disorder, Bulimia, Anorexia nervosa & Substance Abuse  In Adults: Amnesias, Delirium, Hallucinations, Schizophrenias, Dissociative disorders, Delusions, Mania, Depression, Personality disorders, Substance Abuse problems, Dementia and Alzheimer. (4)
  9. 9.  Any treatment of psychiatric illness or different Cognitive problems should involves a combination of pharmacotherapy and Psychotherapy.(1)  Randomized trial have found that primary care clinicians and nurses who receive training in evidence based psychotherapy can achieve higher rate of improved outcomes compared to control intervention, particularly working with patients with major depression.
  10. 10.  In a large randomized trial that involved 932 depressed patient at 46 primary care clinics who received 12 -16 sessions of psychotherapy with pharmacotherapy for 6- 12 months found that patient that used both psychotherapy with pharmacotherapy were 8- 10 percentage points less likely to have a depressive disorder compared to patients in usual care of only pharmacotherapy. (1).
  11. 11.  Although they are many therapies, Clinical trials have found that four type of psychotherapies are the most effective for different cognitive disorders  Cognitive and behavioral psychotherapy  Psychodynamic psychotherapy  Interpersonal psychotherapy  Motivational interviewing  Two other widely use therapies for which efficacy has not been systematically studied.  Supportive psychotherapy  Eclectic or integrative psychotherapy. (1)
  12. 12.  CBT (Cognitive Behavioral therapy) is an evidence base treatment that attacks the dysfunctional thoughts, beliefs and attitudes that causes cognitive disorders  The standard treatment is one to one interaction or individual therapy.  Group therapy can also occurs in CBT but the most effective outcome is from personalize individual interactions (1)
  13. 13.  Cognitive Behavior Therapy can be used for:  Depression  Generalized anxiety disorder  Post-Traumatic stress disorder  Panic disorder  Eating disorders such as i.) anorexia & ii.) Bulimia  Obsessive Compulsive disorders  Other medical conditions that includes: i.) smoking ii.) insomnia iii.) low back pain. (1)
  14. 14.  Psychodynamic psychotherapy is based upon the idea that childhood experiences, past unresolved conflicts, and previous relationships significantly influence an individual‟s current situation in life. (1)  Adult relationships are understood to be the byproduct of unconscious pattern that begins in childhood. (1)  The therapy uncovers the unconscious patterns of interpersonal relationships, conflicts, and desires with the goal of improved functioning of the person.(1)
  15. 15.  Depression  Anorexia nervosa  Personality disorder
  16. 16.  Interpersonal therapy (IPT) address the difficulties that lead to psychological problems  Interpersonal psychotherapy focuses on the individuals interpersonal life in four problems: A.) Grief over loss; B.) Interpersonal disputes C.) role transitions; D.) Interpersonal skill Deficits (1)
  17. 17.  Depression  Bipolar disorder  Eating disorder
  18. 18.  Uses primary care and mental health care to encourage patients to change maladaptive behaviors  Motivational Interviewing is derived from CBT models  Its uses the concepts of Empathy  It helps the patient identify discrepancies between his or her problematic behaviors and broader, personal values  Expecting the patient to resist change and accept it  It enhance the patient‟s self-efficacy (confidence in his or her capability to surmount obstacles and successful change. (1)
  19. 19.  Motivational interview can varies, but effective models are approximately 60 min in length delivered over one to five sessions.(1)
  20. 20.  Substance abuse  Lifestyle changes such as weight reduction, smoking cessations.  Complex medical treatment for Cancer and Heart failures  Childhood obesity and weight reduction programs  Behavior changes in teenagers (1)
  21. 21.  Supportive psychotherapy uses models that emphasize communication of interest, empathy and maintain optimism or hope Application of supportive psychotherapy includes  Guidance  Advise  Respect  Praise or encouragement  Coping with illness  Deal with crisis (1)
  22. 22.  Eclectic or integrative psychotherapy draws concepts from variety of different form of therapies including  Psychodynamic therapy  Cognitive therapy &  Behavioral approaches (1)
  23. 23.  Medical instability: needs to stabilize before commencing the theory  Suicidal ideation or behavior  Substance abuse  Severe Major Depression where psychosocial functioning is impaired  Major life events or crises  Competing commitments: inability to attend sessions disrupts therapeutic momentum (1)
  24. 24.  A one year randomized maintenance trial compared CBT with nutritional counseling in 33 outpatients with anorexia nervosa. The study found that the treatment failure occurred in significantly fewer patients who received CBT than nutritional counseling. The ratio was 23% treatment failure with CBT to 73 % who were given nutritional therapy. (2)
  25. 25.  A meta analysis of five randomized trials that had 204 patients with bulimia nervosa found a remission of 100 % abstinence was significantly greater in patients who received the CBT than control 37% vs. 3 %. (3)  A meta analysis of seven randomized trials that had 484 patients with bulimia nervosa found that remission was significantly higher in patients who received CBT than other type of psychotherapies such as interpersonal psychotherapy, behavior therapy, hypnosis or supportive therapy. The ration of CBT to other therapy to no therapy was 33 % to 22 % to 3%. (3)
  26. 26.  The most effective treatment for Cognitive disturbance patients are the integrative therapy that uses the combination of Pharmacotherapy and Psychotherapy  Only four psychotherapy have been shown to be affective in combating different cognitive problems  Cognitive and behavioral psychotherapy  Psychodynamic psychotherapy  Interpersonal psychotherapy  Motivational interviewing  The other psychotherapies are either in the experimental stages where we as a physician has no data to analyze its success/failure or just aren‟t as effective as these four therapies
  27. 27.  Herman.R,Lebow.J, Skodol.A, (2013). “Overview of psychotherapies”. Up-to-date. Retrieved on September 9,2013  Mitchell. J, Solomon.D, Yager.J, (2013). “ Bulimia nervosa in Adults: Cognitive behavioral therapy (CBT). Retrieved on August 25,2013.  Pike.K, Solomon.D,Yager.J, (2013). “ Anorexia nervosa in Adults: Cognitive-behavioral therapy (CBT). Retrieved on September 3, 2013.  Tao.L, Vikas.B (2011), First Aid for USMLE Step 1, Mc- Graw Hill.  Wikepedia, Cognition, http://en.wikipedia.org/wiki/Cognitive. retrieved on September 10, 2013.

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