Abnormal Psychology #3 Flashcards

Question

Bulimia Nervosa Diagnosis

Answer 1

A. Episodes of binge, with eating and sense of lack of control B. Recurrent inappropriate compensatory behaviors to prevent weight gain: vomiting, medication, fasting, misuse of laxatives, etc. C. Once a week for at least 3 months D. Self-evaluation influenced by body shape

Answer 2

``` Prevalence • 1.5% lifetime prevalence for women • 0.5% lifetime prevalence for men Onset • Most likely to begin in early 20s (21‐24) • Often starts as a diet Course • 11‐12 year follow‐up: • 70 % recovered ```

Answer 3

A. episodes of binge eating B. 3 or more: more rapid than normal, feeling uncomfortably full, eating when not hungry, embarrassed for how much one eats, disgusted with self C. Distress regarding binge eating D. Once a week for at least 3 months

Answer 4

``` Prevalence • Most common eating disorder • 3.5% lifetime prevalence for women • 2% lifetime prevalence for men Onset • Typically later: 30s to 50s • Often starts as a diet Course • 6 year follow‐up: 60 % recovered ```

Answer 5

Internalization of thin ideal

Answer 6

Genes, 28-84% heritability Temporal cortex (body image) Serotonin Much of research is based on Anorexia and complicated by starvation

Answer 7

Personality: perfectionism, impulsivity Cognitive factors: rigidity, attentional biases, perceptual abnormalities Emotional dysregulation: eating as a tool to regulate emotion Comorbid depression and anxiety

Answer 8

Cultural message of thinness Demanding, overinvolved family environment Dieting

Answer 9

Anorexia: antidepressants, antipsychotics, family therapy, CBT Bulimia: antidepressants, CBT Binge eating: antidepressants, IPT, CBT

Answer 10

Drug: 40-60% Type I Diabetes: 30-50% Hypertension: 50-70% Asthma: 50-70%

Answer 11

1. Binge/intoxication (Nucleus accumbens) 2. Withdrawal/negative affect (Amygdala) 3. Preoccupation/anticipation (Cerebral cortex) (Volkow N, NEJM 2016)

Answer 12

Dependence: tolerance/withdrawal Addiction: compulsive

Answer 13

Environmental stimuli -> Reward->̀ dopamine release -> associated learning Mechanism of addiction

Answer 14

More drug consumption triggers smaller and smaller release of dopamine in nucleus accumbens Reward system less sensitive to stimulation Drug and non-drug related rewards Less motivated by everyday stimuli (relationships, hobbies)

Answer 15

Addiction activates anti-reward system Adaptation in amygdala: Increase reactivity to stress, increased negative emotions, intense motivation to escape after-effects of use

Answer 16

Addiction disrupts decision making Down regulation of dopamine in prefrontal cortex impact executive functioning Decision making, self-regulation, prioritization Weakens ability to resist strong urges

Answer 17

Family (genetic and environmental) Highly heritable genetically (Nature Reviews Genetics, 2005) Early exposure to drug/high risk environment Psychiatric disorders Trauma/ACE

Answer 18

``` Adverse Childhood Experiences (ACEs) Early Adversities has lasting impacts on injury, mental health, maternal health, infectious disease, chronic disease, risky behavior, opportunities Emotional Abuse Physical Abuse Sexual Abuse Witnessed Abuse Neglect Divorce Parent Addiction Mental illness Incarceration Death ```

Answer 19

Stress/trauma->Increased cortisol->less developed prefrontal cortex (impaired self-control), changes in nucleus accumbens, sensitivity to DA (more rewarding, more intense craving)

Answer 20

After prolonged abstinence, brain activation scan shows similar pattern to healthy controls

Answer 21

``` Tobacco: 32% Heroin: 29% Cocaine: 17% Alcohol: 15% Marijuana: 9% ```

Answer 22

Nicotine primes the brain for addiction Causes epigenetic changes in cholinergic and dopaminergic systems, sensitizing brain to other drugs Nicotine reinforces addictive brain circuits, making it easier for drugs to “teach” the brain to keep using (Yuan, J Phisiology, 2015; Kandel, NEJM, 2014; Science Translational Research, 2011)

Answer 23

Vaping in 12th graders increased 90% between 2017 and 2018 21% of 12th graders report vaping in past 30 days Vaping associated lung injuries More likely to transition into using tobacco products THC vaping product thickening it, causes inflammatory responses (2018 Monitoring the Future Survey)

Answer 24

Abstaining from cannabis improves memory and learning in 18-25 year old regular users Strong association between regular cannabis use and development of psychosis (Schuster, J Clin Psych, 2018) Cannabis impairs driving 12% increase in the relative risk of a fatal traffic crash after 4:20 PM on April 20 (Staples, JAMA IM, 2018)

Answer 25

Optimal amount of alcohol per week that maximizes benefits and limits harm is ZERO Leading risk factor of disability/death in adults 15-49 (Burton, Lancet, 2018) Alcohol increases cancer risk: Bottle of wine/week = = 1-1.5% lifetime increase in cancer = 5-10 cigarettes/week (Hydes, BMC Pub Health, 2018)

Answer 26

Tobacco: 480,000 Alcohol: 88,000 Opioids: 47,600

Answer 27

Patients are overmedicated Doctors feel pressured to prescribe opioid to treat pain Cited 1980 New England Journal of Medicine, but the study is very tenuous Rx Opioids Heroin Fentanyl, much more potent than Heroin Society's perception changed from criminal issue to public health issue Life expectancy for American white males age 45-54 is declining for first time in modern history Suicide Drug overdoses Alcohol (Case and Deaton, Brookings Inst, 2017)

Answer 28

418 deaths in 2017 6th highest rate in nation Consistently higher than motor vehicle deaths

Answer 29

Medication-Assisted Treatment (MAT) Important part of the solution MAT reduces heroin deaths (Schwartz, Am J Public Health, 2013) Maintenance is key, all control dropped out after 60 days, 20% died (Kakko, Lancet, 2003)

Answer 30

``` Buprenorphine + naloxone A common treatment Control cravings Reduces heroin death Does not decrease addiction, but keeps people in treatment ```

Answer 31

1. Partial activation: a ceiling effect 2. High affinity: binds tightly, heroin bounces off, cannot replace buprenorephine 3. Slow Dissociation: stays on receptor a long time

Answer 32

Naloxone blocks or reverses the effects of opioid medication, including extreme drowsiness, slowed breathing, or loss of consciousness. Deterrent to IV use, only active IV

Answer 33

1. Caspi et al., 2003 Study about diathesis-stress • Longitudinal study of 1037 children in New Zealand • Relationship between stress and depression • But not everyone who is stressed gets depressed • Genotyping: 5HTT gene (s/s; s/l, l/l) 2. Lewinsohn 2001, High levels of dysfunctional belief predicted later depression but only among those who also had stressful life events

Answer 34

* Diminished interest in activities: PTSD, schizophrenia, major depression * Reason: rather than distinct and separate categories, these disorders may be the same system of an individual respond to different kinds of stress (negative valence system).

Answer 35

• Lack of social support: major depression, PTSD • Depression: Individuals without meaningful social support are at greater risk of developing depression when they encounter stress (Brown & Harris, 1978) • PTSD: Negative or unsupportive environment can predispose someone at greater risk of developing PTSD as a result of a traumatic event. In both of these disorders, social support is an important factor that helps individual deal with stress. A lack of social support can result in an inadequate and unhealthy response to stressful events and subsequent development of disorders.

Answer 36

• Psychotic disorder and its hallucinatory symptoms, in a country where religion plays a bigger role in people's lives, might be considered a divine message or the likes of it.

Answer 37

○ Research into CBT and mindfulness. More and more research are affirming the efficacy of CBT and mindfulness in the treating of many mental disorders. ○ More and more research are affirming the efficacy of CBT and mindfulness in the treating of many mental disorders. While a therapist is often integral to the treatment and recovery of the patient, in many cases people may not feel like they meet the threshold of a mental disorder even though they experience distress, or people may not have access to quality treatment of their mental disorder, and this is where greater education about CBT and mindfulness comes in. It may not be a perfect solution, since it requires an individual to actively put in the work, but it can be a remedy that improves the situation. ○ De-privatize healthcare. The private healthcare system, operating through Health Maintenance Organizations, often fail to provide adequate care, albeit provided at a discounted price. In many cases, such care is insufficient. Public healthcare, given sufficient funds, is the solution needed for providing adequate care to more people.