Section Bank Pyschology 82

[5words]

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Here is the question:

A patient being treated for chronic pain receives weekly doses of morphine from the same doctor, with whom the patient enjoys conversing. On another occasion, the patient is treated at another location and finds that the same dose is ineffective. What may have caused this change in effectiveness?


A. The morphine interacted with another medicine the patient was taking.
B. The morphine was given in a new environment.
C. The doctor’s office used a different drug manufacturer.
D. The patient’s body became sensitized to the same dose of morphine.

Initially chose D, but the answer is B? so which concept is being tested here?? I read a few paper, and the consensus is changing envirment affect the dose but increasing its potency. So according to this paper http://serendip.brynmawr.edu/bb/neuro/neuro03/web1/crichards.html, and numerous others. The change in environment should have increased the potency of the drug so more effective...

The patient stayed in his bedroom (which was dimly lit and contained apparatus necessary for his care), and received injections in this environment. For some reason, after staying in this bedroom for about a month, the patient left his bed and went to the living room (which was brightly lit and different in many ways from the bedroom/sickroom). He was in considerable pain in the living room, and, as it was time for his next scheduled morphine administration, he was administered his usual dose of the drug. The patient quickly displayed signs of opiate overdose (constricted pupils, shallow breathing), and died a few hours later. (p. 510).

https://psysci.com/2012/11/06/classical-conditioning-of-drug-tolerance/

 

[aldol16]

B is more plausible because while the patient's body might become sensitized to the same dose of morphine, the effect of that is more likely to be gradual. It's not likely at all to occur exactly when the patient decides to get treatment at a different location. It's not just a coincidence. I think you're overthinking the question.

 

[5words]

B is more plausible because while the patient's body might become sensitized to the same dose of morphine, the effect of that is more likely to be gradual. It's not likely at all to occur exactly when the patient decides to get treatment at a different location. It's not just a coincidence. I think you're overthinking the question.

Yeah, but from the question stem how do we know that the effect is not gradual? (for example , in the Siegel Morphine study, the patient developped tolerance after a month) ... Also what, do you think about the Siegel Study on drug tolerance?

Also, i read an re-read AAMC answer, so they are basically saying the positive relationship that the patient had with her physician increased the potency of the drug, but i cant find a supporting paper online, read about 20 paper thus far. And the take-home point, is that great patient-physician relationships corrolate with positive outcomes, However nothing there seems to be no relationship with the relationship and the effect of the drug itself. Read something about placebo drugs being more potent when given my a caring Nurse practitioner but ill finish this paper tonight. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0015591

So my questions to you:
-How do we know it;s not gradual?
-also since tolerance can set in about a month so why not? why is D not better than B, coupled with the fact that the change in environment is supposed to increase the potency of the drug?


Ill add more to this after i read the aforementioned paper...

 

[aldol16]

I would advise you to go with your critical reasoning, which should tell you that D is too much of a coincidence (even if the patient developed tolerance, what are the chances it would coincide with him/her getting the treatment at a different location?) and thus B is the best answer. You can dig through the papers if you want and they may very well show that tolerance can set in within a month but again, the odds of the morphine working one week and then suddenly and completely ceasing to work the next week is probably low compared to the odds that the environmental factors contributed more to it.

-also since tolerance can set in about a month so why not? why is D not better than B, coupled with the fact that the change in environment is supposed to increase the potency of the drug?

Which references can you cite that say a change in the environment increases the potency of drugs generally or that specifically of morphine?

 

[5words]

I would advise you to go with your critical reasoning, which should tell you that D is too much of a coincidence (even if the patient developed tolerance, what are the chances it would coincide with him/her getting the treatment at a different location?) and thus B is the best answer. You can dig through the papers if you want and they may very well show that tolerance can set in within a month but again, the odds of the morphine working one week and then suddenly and completely ceasing to work the next week is probably low compared to the odds that the environmental factors contributed more to it.



Which references can you cite that say a change in the environment increases the potency of drugs generally or that specifically of morphine?

uhm, actually you maybe right , so how did you get over the plural? "A patient being treated for chronic pain receives weekly doses of morphine from the same doctor, with whom the patient enjoys conversing. On another occasion, the patient is treated at another location and finds that the same dose is ineffective. What may have caused this change in effectiveness?"

LOL, MADE SENSE.. if she was sentisized it would have happen the week prior as well.. i see what you meant now.. like one week interval is too much of coincidence..!! ok make sense, i understand WHY ITS BETTER than D now... [Critical Thinking indeed]


Now, i am going to have to reconcile the study below with the second part of the answer stem... bUT THANKS dude, i got over the biggest hurdle!!

The conclusions that are drawn from the previously mentioned observations suggest an additional tolerance caused by environmental cues. Such results can be applied to medical care and treatment. Within medical terminology, "drug overdose" may be a misnomer in many cases. An overdose may not only be the result of an alteration of the dosage. When ten drug addicts who had experienced near-death overdoses were questioned about their environment while injecting heroin, seven out of the ten claimed to have been shooting up in a new and unfamiliar setting (7).

Changing the environment where a drug is administered may be advantageous for those patients suffering from chronic illnesses [such as chronic pain i supposed] and limitations to treatments, due to developing tolerances. Typically, the development of a drug tolerance results in either an increase in the dosage, which often involves toxic side effects or a change in the prescription if the option is available. Considering the role environment plays in drug tolerance offers an alternative. That is, a patient may limit the progression of developing a tolerance by changing the environment. Astonishing medical professional, a patient suffering from cancer endured a treatment that was expected to become ineffective within two years, yet continued to be effective after almost five years (8). The lack of tolerance was attributed to the fact that the patient moved twice during the previous years of treatment and therefore changed the environmental cues

Siegel, S. Pavlovian conditioning and heroin overdose: reposts by overdose victims. Bull. Psychonomic Soc. 22, 428-430
http://serendip.brynmawr.edu/bb/neuro/neuro03/web1/crichards.html

 

[Pono_0001]

Neuroscience/psych graduate here so i'll chime in quickly.

I think the classical conditioning of addiction part confused you a bit. I don't think that's within the scope of introductory psychology, but for the Pavlovian explanation of tolerance to be applicable here, the patient would have to be desensitized to the morphine in the usual location. So D couldn't be the answer as the it is talking about sensitization. Also you can't conclude anything about the dosage of morphine really as the only thing different between the two scenario is the rapport between the patient and the doctor and the location, so the environment is the only thing that's different between them.

Also the paper you mention is on drug tolerance on drug addict. There's no mention of the patient being an addict or having developed tolerance. So it's likely that the emotional aspect of the environment, the positive relationship between the patient and the doctor, adds to the effect of morphine to have a synergistic effect.

Also sensitization is a very specific concept that's not application here as well.

 

[5words]

Neuroscience/psych graduate here so i'll chime in quickly.

I think the classical conditioning of addiction part confused you a bit. I don't think that's within the scope of introductory psychology, but for the Pavlovian explanation of tolerance to be applicable here, the patient would have to be desensitized to the morphine in the usual location. So D couldn't be the answer as the it is talking about sensitization.

Also the paper you mention is on drug tolerance on drug addict. There's no mention of the patient being an addict or having developed tolerance. So it's likely that the emotional aspect of the environment, the positive relationship between the patient and the doctor, adds to the effect of morphine to have a synergistic effect.

Also sensitization is a very specific concept that's not application here as well.

That was the part i overlooked, def make sense why D is wrong now, since according to Siegel, more of the drug (in the usual location) was needed to get the same result.

Also you can't conclude anything about the dosage of morphine really as the only thing different between the two scenario is the rapport between the patient and the doctor and the location, so the environment is the only thing that's different between them..

Hence why, i included the Dosage, if you believe that Pavolian experiment hold here, so i expected the Dosage in the New environment to be more effective, because as you stated above, the patient hasn't been de-sensitized in the new setting yet. (so, the Condition response wont kick in). So, making answer B a bit shaky, but nonetheless the best answer choice. (What are your thoughts on this?)

There's no mention of the patient being an addict or having developed tolerance. So it's likely that the emotional aspect of the environment, the positive relationship between the patient and the doctor, adds to the effect of morphine to have a synergistic effect.

Yup, exactly what i got from @aldol16 ..

But Thanks for clarifying why D was indeed wrong, i really reversed the relationship between desensitized (you need more to get same effect) and sensitized (need less to get same effect). MAKING D wrong, and B, the best Answer.

Thanks pal!

 

[neurodoc]

I think this is a badly stated question that I hope you wouldn't find on a real MCAT. Technically it is true that Rx interactions could decrease (or increase) the patient's response to morphine and it is also true, but uncommon, that morphine, especially sustained release formulations from different manufacturers, can have different efficacies even at the same mg doses. Since the question doesn't mention that the patient was taking other drugs that particular week or that any brand name morphine formulation was being used, you could assume that neither was a factor. It's nonetheless unfair for these two potentially true answers to be listed. The question asks what may have caused the change in effectiveness, not what most likely caused it.

The fourth choice, however, is clearly incorrect. Opiate tolerance could be responsible for decreased response to the same dose of morphine. Sensitivity is the opposite of tolerance, and if the patient became "sensitized" to that dose, he would have experienced a greater, not lesser, drug effect. This is a case where you need to understand the exact meanings of jargon terms like drug "sensitivity." And this would also not be a good answer even if the choice was "desensitized" (or "tolerant") because if that were the answer the patient would require higher doses when he went back to his regular doctor a week later (as was mentioned in an earlier post, tolerance develops over time and doesn't quickly come and go).

The main point of this question is that there are psychological factors that affect patient response to drugs, especially analgesics. This includes the well-studied Placebo Effect, which can sometimes be responsible for up to 30% of the treatment response rate. Less well-known is the so-called Nocebo Effect, which is essentially the opposite of the Placebo Effect. Placebo and Nocebo are Latin verbs meaning "I will please" and "I will harm," respectively. What this question describes is most likely the loss of Placebo benefit when the patient is seen by a less friendly doctor, or, a Nocebo Effect, if the new doctor is downright unfriendly and confrontational. When you get out and practice medicine you will realize just how significant this Placebo Effect can be.