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. 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. 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. 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. 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. 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
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. 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. 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. 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. 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. 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)
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)
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. Motivational interview can varies, but
effective models are approximately 60 min in
length delivered over one to five sessions.(1)
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. 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. Eclectic or integrative psychotherapy draws
concepts from variety of different form of
therapies including
Psychodynamic therapy
Cognitive therapy &
Behavioral approaches (1)
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. 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. 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. 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. 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.
