Abnormal Psychology #3 Flashcards
Persistent Tic
25% of kids have transient tic, and it goes away. Only 1% experiences persistent tic.
On the OCD spectrum
Obsession and Compulsion
Obsession: intrusion, uncontrollable, unwanted
Compulsion: actions that neutralize obsession
Compulsions neutralizes the obsessions
Work temporarily, temporary escape
OCD Symptoms
A. Obsession and or compulsion (98% have both)
B. Time consuming (>1hr/day), cause significant distress, avoidance of situations and activities that prompt obsessions
C.D. Not due to substance, medical condition, or other mental disorder
OCD Symptom Domains
- Symmetry/order
- Contamination/dirt/germ
- Hoarding
- Harm
- Aggressive/sexual/religious
OCD: POC
Prevalence • 2% lifetime prevalence • Roughly equal female to male ratio Onset • Bimodal age of onset: • Age 10‐12; late adolescence to early adulthood Course • Usually chronic if untreated
OCD self-awareness
They mostly know it’s an unfounded fear, but have it nonetheless
4% has this consciousness absent
Biological Causes of OCD
Genetics: moderate heritability
Brain: increased metabolic activity in basal ganglia, orbital frontal cortex
Neurotransmitters: serotonin, and likely glutamate, GABA and dopamine
Psychological Causes of OCD
Learning
Abnormal responses to normal thoughts: appraisal of thoughts (over-reacting), thought suppression
Memory deficit (lack of confidence of memory)
Mowrer’s Two Factor Theory
Something gets labeled as bad, anxious when confronting
Ritualizes to reduce anxiety to prevent bad outcome, negatively reinforce
Abnormal response to normal bad thoughts
84% of a sample of undergraduates reported having regular, intrusive, unacceptable thoughts and impulses
Rachman & Silva, 1978; Baer, 2001
Every human being is visited from time to time by the Imp of the Perverse who makes you think the most inappropriate thought at the most inappropriate times.
Lee, Baer, Ph.D., 2001, p. 6
OCD Belief about thoughts
Bad thoughts reflect character
Thoughts SHOULD be controlled
Thought-action fusion
Thought suppression
Daniel Wegner: white bears
Suppression makes you think even more
Memory deficit
van den Hout & Kindt, 2003
OCD have no problem with their memory, but there is a problem with their confidence
Experiment: checking virtual stoves.
Results: repeated checking causes memory deficit
Environmental factors in OCD
Stress: times of heightened responsibility or loss of control, though 40% have no identifiable precipitant
Infection: PANDAS
OCD Treatment
CBT: exposure and response prevention
Medication: clomipramine, SSRI
Severe patients: DBS
Experimental: TMS Glutamatergic medication
Tourette
Born with Ticks, kicking, twitching, snapping
Doing uncontrollable things
Can’t help it, not contagious
Eating disorder spectrum
Anorexia nervosa, Bulimia nervosa, binge eating disorder
Can and often overlap and change
Anorexia Nervosa
Extreme caloric restriction
Relentless pursuit of thinness
Desperate fear, try to avoid by all means
Anorexia diagnosis
A. Restriction of energy, extreme low body weight in the context. BMI<17.5
B. Intense fear of gaining weight, behavior that interferes with weight gain
C. Disturbance in the way in which one’s body is experienced, body influence impact on self-evaluation
Anorexia subtypes
Restricting: last 3 months, had not engaged in binge eating or purging
Binge/purging: past 3 months, recurrent binge (out of control) or purging (self-induced vomiting)
Anorexia Nervosa: POC
Prevalence
• Lifetime prevalence of 0.9 % for women; 0.3% for men
• Much more common among women than men
• More common in some populations (e.g., dancers, gymnasts, models, wrestlers, gay men)
Onset
• Usually begins between 16 and 20 years old
• Often starts as a diet
Course
• Highly variable
• High rates of death from medical complications and suicide
• Recovery is also entirely possible
Anorexia: follow up
21 year follow-up study 52% fully recovered 22% partially recovered 10% not recovered 16% deceased, primarily from starvation or suicide
Bulimia Nervosa
Out of control binging and compensatory behaviors but not underweight
Binge
out of control eating, much more than one would normally eat, can eat close to 5000 calories in less than 2 hours
Bulimia Nervosa Diagnosis
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
Bulimia Nervosa: POC
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
Binge Eating Disorder
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
Binge Eating Disorder: POC
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
Etiology of eating disorders
Internalization of thin ideal
Eating disorder: biological risk factors
Genes, 28-84% heritability
Temporal cortex (body image)
Serotonin
Much of research is based on Anorexia and complicated by starvation
Eating disorder: psychological risk factors
Personality: perfectionism, impulsivity
Cognitive factors: rigidity, attentional biases, perceptual abnormalities
Emotional dysregulation: eating as a tool to regulate emotion
Comorbid depression and anxiety
Eating disorder: sociocultural risk factors
Cultural message of thinness
Demanding, overinvolved family environment
Dieting
Eating disorder treatment
Anorexia: antidepressants, antipsychotics, family therapy, CBT
Bulimia: antidepressants, CBT
Binge eating: antidepressants, IPT, CBT
Drug addiction relapse rate
Drug: 40-60%
Type I Diabetes: 30-50%
Hypertension: 50-70%
Asthma: 50-70%
Stages of Addiction
- Binge/intoxication (Nucleus accumbens)
- Withdrawal/negative affect (Amygdala)
- Preoccupation/anticipation (Cerebral cortex)
(Volkow N, NEJM 2016)
Dependence v. addiction
Dependence: tolerance/withdrawal
Addiction: compulsive
Classical Conditioning
Environmental stimuli -> Reward->̀ dopamine release -> associated learning
Mechanism of addiction
Addiction and reward system
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)
Withdrawal/negative effects
Addiction activates anti-reward system
Adaptation in amygdala:
Increase reactivity to stress, increased negative emotions, intense motivation to escape after-effects of use
Preoccupation/anticipation
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
Predisposition to addiction
Family (genetic and environmental)
Highly heritable genetically (Nature Reviews Genetics, 2005)
Early exposure to drug/high risk environment
Psychiatric disorders
Trauma/ACE
ACE
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
ACE and addiction
Stress/trauma->Increased cortisol->less developed prefrontal cortex (impaired self-control), changes in nucleus accumbens, sensitivity to DA (more rewarding, more intense craving)
Abstinence and Addiction
After prolonged abstinence, brain activation scan shows similar pattern to healthy controls
Percentage of users turning addicts
Tobacco: 32% Heroin: 29% Cocaine: 17% Alcohol: 15% Marijuana: 9%
Nicotine and Addiction
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)
Vaping
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)
Cannabis
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)
Alcohol
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)
Annual deaths in US, 2017 from substances
Tobacco: 480,000
Alcohol: 88,000
Opioids: 47,600
Opioid Crisis
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)
Overdose in Maine
418 deaths in 2017
6th highest rate in nation
Consistently higher than motor vehicle deaths
MAT
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)
Suboxone
Buprenorphine + naloxone A common treatment Control cravings Reduces heroin death Does not decrease addiction, but keeps people in treatment
Buprenorphine
- Partial activation: a ceiling effect
- High affinity: binds tightly, heroin bounces off, cannot replace buprenorephine
- Slow Dissociation: stays on receptor a long time
Naloxone (Narcan)
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
two specific instances in which we have evidence to suggest that a diathesis interacted with a stressor
- 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) - Lewinsohn 2001,
High levels of dysfunctional belief predicted later depression but only among those who also had stressful life events
Choose one symptom that is present in three or more disorders that we have studied this semester. Identify the symptom and name the disorders in which it appears. Then, speculate as to why
- 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).
Choose one specific risk factor, two disorders that this involves
• 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.
pathologize what might otherwise not be considered “disordered.
• 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.
What are your most important priorities?
○ 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.
