Block 6 W2 Flashcards
What is addiction?
The continued repetition of a behaviour despite adverse consequences. May continue to point of death.
It is ambivalence.
Affects 2mill
Outline the cycle of addiction.
Social drinking -> problem/abusive drinking -> dependence and altered brain function -> excessive and uncontrolled drinking -> abstinence -> acute/protracted withdrawal symptoms -> relapse.
Describe end-stage addiction.
Overwhelming desire to take the drug, diminished ability to control drug seeking, reduced pleasure from biological rewards -> drug becomes most salient (important) thing in their life.
What structural changes occur in the brain in addiction?
Addicts take alcohol/drugs so often it becomes an automatic habit due to changes in the prefrontal cortex -> over learning of drug-related cues and can be triggered by cues years after abstinence.
Outline dependence syndrome.
- Salience - use of substance is high priority.
- Tolerance
- Withdrawal symptoms - body’s homeostasis disrupted.
- Relief from symptoms with further use.
- Compulsion to use substance
- Narrowing of repertoire - neglect of other interests
- Reinstatement after abstinence - 1 drink ruins it all
Define pre-contemplation.
Not ready.
People are not intending to take action and can be unaware that their behaviour is problematic.
Define contemplation.
Getting ready.
People are beginning to recognise that their behaviour is problematic and start to look at the pros and cons of their continued actions.
Do some people have a vulnerability to addiction?
The alcohol gene - 25% of the sons of alcoholics develop alcohol problems themselves -> definite genetic risk of alcoholism but no single gene.
Twin studies - 4 good studies show increased concordance for monozygotic over dizygotic.
Adoption studies - 3 - 4x increase in risk in adoptees raised apart.
Describe the asian flush.
Flush reaction in 50% of asians due to variant of acetaldehyde dehydrogenase gene -> slow metabolism of alcohol.
There is a genetic contribution to heavy drinking but affected heavily by social, upbringing and personality factors.
What maintains addiction?
- Personality factors - thrill seeking, impulsive, mood dysregulation.
- Social factors - substance use amongst family and friends.
- Altered physiology in continuous presence of drug - homeostasis altered so can’t function properly without the drug.
Unpleasant effects when drug is absent - withdrawal -> strong negative reinforcement.
Discuss the environmental influences on addiction.
Vietnam war - 1/2 soldiers used heroin, when they returned to US, only 7% were addicted -> shows addiction is high dependent on circumstances.
Rat park - caged rats consume more morphine compulsively and rats in park prefer plain water.
Severely distressed animals like people will relieve their distress pharmacologically if they can.
How does addiction occur?
Drugs have highly positive reinforcing effect - high.
Negative reinforcement - feeling hungover/withdrawal - helped by more drinking.
Describe Skinner’s box.
Answers question - how is behaviour conditioned? As we go down the list, behaviour increases:
- rat presses lever to get food - positive reinforcement
- fixed interval schedule - food comes out every 5mins
- variable interval schedule - food comes every random number of presses (gambling)
- rat presses level to turn off electric shock - negative reinforcement.
What have studies on rats shown?
Rat in a cage will repeatedly self-administer heroin/cocaine even to point of death -> directly activating the dopamine reward system.
Electrodes implanted in the nucleus accumbens have the same effect.
What is the role of dopamine in addiction?
Dopamine levels spike with many pleasurable activities i.e. sex, eating.
All addictive drugs lead to increased dopamine levels in nucleus accumbens.
DA system linked to salience of an activity -> things that activate dopamine reward system become more important.
Addicts become less sensitive to natural reinforcers and substances become more salient.
What can you get addicted to?
Alcohol, drugs (legal - benzodiazepines, opiates, illegal - heroin, cocaine), gambling.
Activities associated with pleasure and activates dopamine reward system - sex, eating, porn, video games, shopping, exercise.
What makes a substance addictive?
- pleasure producing potency
- rapid onset of action
- short duration of action
- tolerance and withdrawal
What are the social and cultural attitudes to addiction?
Factors that influence societal consumption of alcohol:
- price
- availability
Alcohol has become more available and cheaper.
Education about dangers doesn’t make much difference.
Define motivational interviewing.
Counselling method that helps people resolve ambivalent feelings and insecurities to find the internal motivation they need to change their behaviour.
Interviewer evokes a conversation about change and commitment and listens and reflects back the patient’s thoughts so that the patient can hear their reasons and motivations.
How does life events cause stress?
Imbalance between the demands made on us and our personal resources to deal with these demands. Not the life events themselves that cause stress but the interpretation and the meaning to the individual.
Life events -> appraisal -> stress.
Define primary and secondary appraisal.
Primary - appraisal of the event.
Secondary - appraisal of personal coping abilities or personal resources and resources in the immediate social network.
What are the stress responses?
Emotional response - feeling on edge, irritability, tearful.
Cognitive response - difficulty concentrating, self-critical, difficulty making decisions.
Behavioural response - comfort eating, drinking/smoking, activity/underactivity.
Physiological response - increased HR, BR, perspiration.
Outline the links between a stress response and misinterpretation of physiological symptoms.
Stress -> physiological response -> physical symptoms -> misinterpretation -> anxiety -> physiological response -> cycles.
e.g. HR -> palpitations -> heart attack
Define medically unexplained symptoms.
Physical symptoms not explained by organic disease which cause distress and impair functioning and for which there is positive evidence or a strong assumption that the symptoms are linked to psychological factors e.g. stress, mental illness.
Patients have varying degrees of insight that some symptoms are due to psychological factors.
Define somatoform disorders.
Severe, chronic psychiatric disorders where patients have chronic and multiple MUS and are excessively disabled.
What are medically descriptive terms?
IBS, chronic fatigue syndrome, fibromyalgia, atypical non-cardiac chest pains.
How is stress linked to MUS?
Some MUS arise from normal bodily sensations (physiological processes) with misinterpretation.
Some MUS arise from minor pathology and are exaggerated at times of stress.
What is the biopsychosocial model of MUS?
Bodily sensations i.e. minor pathology, stress, physiological processes -> misinterpretation fed by beliefs/childhood experience and personality/mental state -> MUS and this is maintained by reaction of other iatrogenic secondary gains.
What is the impact of stress on physical illness?
Relates to relapse, control of chronic disease and morbidity.
Indirect - via behavioural changes e.g. poor compliance with medication, increased alcohol intake -> epilepsy and heart disease, reduced exercise -> heart disease.
Direct - stress activates HPA axis causing cortisol secretion and the sympathetic-adrenal-medullary system causing catecholamine secretion.
How does stress impact on heart disease?
Increased risk of death after loss of spouse - CVD accounts for 20-53% of excess deaths.
- acute bereavement associated with heightened SNS activation -> haemodynamic changes -> causing increases vascular resistance -> ischaemia.
- takotsubo cardiomyopathy - broken heart syndrome -> left ventricular dysfunction and ECG changes due to high levels of circulating catecholamines in post menopausal women.
How does stress impact mental illness?
Significant association between stressful life events and mental illness. 3-6 months preceding depressive illness, 50-80% patients will have experienced a significant life event.
6 fold excess of adverse life events in the months preceding the onset of depressive disorder.
What are the individual factors that lead to stress?
Premorbid personality - worrier, obsessive.
Prior experience of illness.
Mental state.
Childhood difficulties - early trauma, difficult interactions with health professionals.
Appraisals and coping styles.
Define illness appraisal.
Leventhal illness cognitions - a patient's own implicit common sense beliefs about their illness - provides framework around which a patient understands and copes with their illness. 5 dimensions: 1. identity - label and symptoms 2. timeline - perceived duration 3. consequences - expected outcome 4. cause - personal ideas about cause 5. control/cure - how to recover. Using this framework, patients make an interpretation of their illness, select a coping style and appraises the coping style.
Define emotion focused model of coping.
Involves managing emotions and maintaining emotional equilibrium - works well transiently so reserved of brief stress or where nothing realistically can modify stress.
Define problem focused model of coping.
Controlling the problem and reconstructing it as manageable.
