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PSY240 > EXAM > Flashcards

EXAM Flashcards

1
Q

obsession and compulsions

A

obsessions: intrusive thoughts that provoke distress or anxiety
compulsions: repetitive behaviours/mental acts to reduce anxiety/supress obsession. types: rituals (repetitive actions like checking, hand washing, reassurance seeking), neutralizations (brief actions to “undo” obsessive thought like thinking about being healthy, adding “not” to obsession)

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2
Q

OCD dsm criteria

A

A. presence of obsessions and/or compulsions
B. OC take 1+ hour per day or DnD
C, D. no better explantions

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3
Q

insight in OCD

A

can be added as a specifier (good/fair/poor)
good: knowing the compulsions are absurd but can’t stop
fair: knows it absurd but helps them feel sure
poor: feels like they truly did something wrong they cant remember, closer to psychosis, may not know the OC are connected

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4
Q

OCD brain

A

PFC dysfunction may lead to being overly focused on irrelevant details, problems with organizing relevant info, poor self-monitoring (forming concrete memory of doing something - made worse by repetition aka harder to remember if you did something if you keep checking), inability to change behaviour
Connected to serotonin

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5
Q

repeated checking leads to…

A

lowered memory confidence, increased doubt, more checking

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6
Q

OCT CBT Etiology

A

Catastrophic misinterpretations of harmless random thoughts leading to an attempt to suppress the thoughts (compulsions), validating the danger of the thoughts, thus making them worse
The loop is the disorder not the thoughts
Maintained by compulsions and the negative reinforcement of compulsions (they reduce anxiety so ill keep doing them)

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7
Q

OCD loop

A

trigger, intrusive thought, faulty appraisal (assigns scary meaning to thought and assumes responsibility to stopping it), anxiety, compulsion, relief, repeat

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8
Q

BDD dsm5

A

A. preoccupation with one or more “flaws” in appearance that appear slight to others
B. repetitive behaviours in response to appearance (mirror checking, reassurance seeking, comparing appearance)
C. DnD
D. Trait is not body weight
Specifier: muscle dysmorphia

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9
Q

Hoarding disorder DSM5

A

A. persistent difficulty parting with possessions regardless of value
B. Difficulty is bc they feel they need to save them and it is distressing to throw them out
C. accumulation of things in ACTIVE living areas that compromise intended use, if its cleared its by someone else
D. DnD
E,F. No better explanation
Subtype: animal hoarding

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10
Q

Hoarding risk factors

A

middle age, OCD, experienced major loss, poverty, indecisiveness, avoidance, difficulty planning and organizing, distractibility

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11
Q

OCD/BDD first line treatment

A

Exposure and response prevention and SSRIs are first-line.
Exposure causes anxiety by purposefully triggering obsessive thoughts, response prevention is not engaging w/a ritual (“surf the wave” of anxiety and watch as the wave lessens over time). Over time, extinguishes neg. reinforcement and reduces anxiety associated with the obsession (not necessarily the frequency of thoughts). Use the SUDS and exposure hierarchy.
Mindfulness approaches can be helpful for relapse prevention

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12
Q

hoarding treatments

A

CBT with motivational interviewing is first line (explore ambivalence to change and try to find reasons to want to change)
CBT explores dysfunctional beliefs about discarding stuff (usefulness, wasting, sentimental attachment, the need to remember). Use questions to evaluate the accuracy of these beliefs and offer alt options
Practice letting go of stuff, starting easy and increasing in difficulty up to sentimental items (exposure therapy basically, tolerate neg emotions and challenge beliefs)

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13
Q

CBT for OCD

A

challenge faulty appraisals (ignore content on obsessions) via thought records (what is a more realistic assessment of the situation)
Explores false sense of responsibility
via responsibility pie (lots of things could be the cause of something other than you)
Examine likelihoods of risk via continuum (holding baby without washing hands is not 0% danger but its much better than leaving the baby alone in a room)

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14
Q

BDD CBT

A

challenge body image equals real physical appearance
evaluate distorted thoughts about body and imagined consequences

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15
Q

Exposure therapy things therapists should do

A

Do exposure with them
ask intermittently their level of anxiety 1-10 (SUDs tracking)
point out the wave going up and down
dont try to relieve anxiety, point out the germs.
afterwards, make them feel proud and show them that the compulsion is not the only thing that can relieve anxiety - robs obsession of power and gives it to pt
Can do compulsion after but make sure anxiety came down already bc of time not compulsion.

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16
Q

SUDS

A

subjective units of distress scale

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17
Q

exposure for pedo/serial killer OCD

A

change baby, babysit kids, journal describing pedophila, reading pedo artiles
sign a contract with the devil “pls satan make me a killer”

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18
Q

PTSD DSM5

A

A. Occurs after trauma (actual or threatened death/injury/integrity of self to yourself or others, includes learning about/watching trauma done to someone else and repeated exposure that is word related)*
*unexpected
B. 1+ experiencing symptom
C. 1+ persistent avoidance symptom
D. 2+ cognitive/mood symptoms
E. 2+ hypervigiliance symptoms
F. ONE MONTH
G. DnD
F. not medication or other disorder

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19
Q

PTSD risk factors

A

women more likely to develop PTSD (more often related to rape, neglect, abuse while men are more often related to injury, natural disaster, combat)
Pre event: Low SES, low education, low IQ, previous psych history, childhood adversity
Post event: severity, lack of social support, additional stressors after event
Interpersonal trauma more likely to provoke PTSD

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20
Q

PTSD brain

A

smaller hippocampus
dysregulated endocrine system (HPA axis, cortisol)

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21
Q

PTSD reexperiencing symptoms

A

intrusive thoughts/memories
dreams
dissociative reaction (flashbacks)
intense distress when reminded
intense physiological reaction when reminded

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22
Q

PTSD avoidance symptoms

A

avoiding memories, thought, feelings associated with event
avoid external reminders of the event

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23
Q

PTSD cog and mood symptoms (7)

A

anhedonia/emotional numbing
negative beliefs/expectations about the world/oneself
persistent, distorted thoughts of blame
detachment/estrangment from others
inability to feel positive emotions
persistent negative emotional state (fear, anger, guilt)
inability to remember what happened

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24
Q

PTSD hypervigilance symptoms (6)

A

reckless/self-destructive behaviour
irritability/outbursts of anger
hypervigilance
exaggerated startle
problems with concentration
sleep problems

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25
Q

PTSD treatments

A

exposure therapy, CBT, and medication is first line
Start with imaginal (review circumstances of event, move up to details), them in-vivo if possible (walk alone at the site of trauma)
Examine maladaptive thoughts about guilt or a lack of safety everywhere
DBS or more invasive measures if treatment resistent

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26
Q

Acute stress disorder

A

Similar to PTSD but 3 days to a month

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27
Q

Adjustment disorder DSM5

A

A. Occurring before 3 months from the start of the disorder
B. DnD that’s out of proportion to the stressor, taking into account cultural factors
C. Doesnt meet criteria for another disorder
D. its not normal bereavement
E. Once stress is over, symptoms don’t persist for more than an additional 6 months
*catch all, controversial

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28
Q

Acute stress vs adjustment disorder

A

AS: occurs after sudden trauma, develops quickly, more intense
AD: after significant life change (like job change, moving, etc.), develops over a span of 3 months, less intense

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29
Q

history of dissociative disorders

A

hysteria, demonic possession, freud’s “coversion” (conversion of anxiety into physical symptoms to avoid conflict/responsibility, subconscious manifesting physically)

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30
Q

dissociation definition

A

lack of integration of features like identity, memory, consciousness, sensorimotor functioning, behaviour
“fracturing of a whole”

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31
Q

Dissociative Amnesia DSM5

A

A. Inability to recall autobiographical info, usually traumatic or stressful in nature, more than normal forgetting (can either be specific events or general identity/life history)
B. DnD
C, D. Not better explained by meds or other disorder

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32
Q

Dissociative fugue

A

Sudden memory loss and travel away from home
Acute (couple days) or chronic (months to years)
Often after traumatic event but not necessarily

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33
Q

Depersonalization/Derealization Disorder

A

A. persistent or recurrent experiences of depersonalization, derealization or both
B. During episodes, reality testing remains intact (still know who and where you are)
C. DnD
D, E. not better explained by med or other condition

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34
Q

Depersonalization

A

detachment from thoughts, feelings, action, body
Passenger in your mind/body
e.g. perceptual alterations, distorted sense or time, absent self, emotional numbing

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35
Q

Derealization

A

Dettachment from world around you, doesnt feel real
Surroundings are experienced as dreamike, foggy, lifeless, or visually distorted

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36
Q

Technique to treat dissociation

A

Grounding. ask them to notice the colour of your eyes, what is happening in the painting, throw a pillow

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37
Q

DID onset age and comorbid disorders

A

29-35
depression, anx, substance abuse, self injury, non epileptic seizure

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38
Q

DID DSM5

A

A. 2+ distinct personality states
B. Recurrent gaps in recall of everyday events (traumatic or basic personal info)
C. DnD
D. Not part of a religious or cultural practice. Not better explained by imaginary playmates in children

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39
Q

Distinct personality traits definition

A

marked discontinuity in sense of self
alterations in affect, behaviour, consciousness, memory, perception, cognition, other sensory motor functioning
observed by others or themselves
in some cultures, characterized as possession

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40
Q

recovered memory therapy

A

roots in psychoanalysis
tries to retrieve repressed memories, more often induces false memories

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41
Q

Dissociative disorders trauma model

A

Diathesis-stress
Personality traits: high hypnotisability, fantasy proneness, openness to alterned states of consciousness
Dissociation as a defence mechanism for trauma

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42
Q

Dissociative disorders attachment theory

A

Individuals with disorganized attachement as babies are more vulnerable to develop a disorder later on

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43
Q

Dissociative disorders socio-cognitive model

A

disorders are “iatrogenic” i.e manufactured or amplified by therapy
Culture/media disproportionately affects prevalence (specifically with DID)

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44
Q

Somatic symptoms disorder DSM5

A

A. One or more somatic symptoms that are causing DnD
B. Excessive preoccupation with the somatic symptoms. Manifested by at least ONE of: disproportionate thoughts about the seriousness of symptoms, persistent high anxiety about health/symptoms, excessive time and energy devoted to the symptoms.
C. Persistently symptomatic (typically 6+ months)
Specifiers: with predominant pain (symptom(s) is mostly pain related), persistent (severe, 6+ months)
Agnostic to whether the pt is exaggerating symptoms or not

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45
Q

Illness Anxiety Disorder DSM

A

aka classic hypochronasis
A. preoccupation with having/acquiring a serious illness
B. Mild/nonexistent symptoms or preoccupation is disproportionate
C. High level of anxiety about health
D. Performs health-related behaviours or avoids hospitals/doctors altogether
E. 6 MONTHS

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46
Q

Conversion disorder DSM5

A

A. 1+ symptoms of altered voluntary motor or sensory function (loss of functioning of a body part)
B. Tests show its not bc of medical condition
C. Not better explained by another condition (can be drugs tho lol)
D. DnD

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47
Q

Why is conversion disorder considered dissociative

A

High comorbidity with other dissociative disorders
High scores on measures of dissociative experiences, hypnotizability, childhood abuse, trauma

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48
Q

Factitious Disorder DSM

A

Aka Munchausen Syndrome
A. Faking symptoms (physiogical or psychiatric), injury, diseases.
B. Presents to other as ill, impaired, injured
C. Evident in the absence of obvious external reward (money, not sympathy and attention)
D. not better explained by delusion or psychotic disorder

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49
Q

Somatic disorders etiology

A

Psychoanalytic (conversion of anxiety)
HPA axis
Dysfunctional beliefs about illness
Personality traits
Early life experiences
Social Learning (adopt the sick role)

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50
Q

early understandings of eating disorders

A

anorexia was introduced in DSM1 but very rare bc intentionally losing weight was much stranger at the time, no societal expectations of thinness and malnutrition was a bigger fear
Diagnostically included slow pulse, skin changes, no period
Bulimia introduced in DSM3
Treatment: force feeding
Viewed as hysteria converted into food problems like disgust, feeling full, psychosomatic stomach pain after eating

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51
Q

ARFID

A

Most common in children
Disturbances in eating (lack of interest, avoidance based on sensory characteristics, concern about aversive consequences) manifested by significant weight loss/failure to meet weight, nutritional deficiencies, dependence on supplemental eating, interference with psychosocial functioning
Not better explained by lack of food or culture
No weight concerns

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52
Q

Pica

A

Eating non food bc of cravings, to reduce nausea, they like the taste
May be due to a nutrient deficiency

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53
Q

Rumination disorder

A

Regurgitating and rechewing food
often in children

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54
Q

Amenorrhea

A

Lack of periods
Was a criteria of AN until DSM5

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55
Q

Anorexia nervosa DSM5

A

A. Restricted eating leading to significantly low weight
B. Intense fear of gaining weight OR behaviour that interferes with gaining weight DESPITE LOW WEIGHT (necessarily irrational/delusional)
C. Disturbance in the way their weight/shape is experienced (dysmorphia or general distress/dissatisfaction with body), undue influence of weight/shape on self-evaluation, or lack of recognition of the seriousness of low body weight
Restricting type: in the last 3 months, no binging-purging behaviour, only fasting
Binging-purging type: in the last 3 months, binging and purging behaviour has been present
Mild, moderate, severe, extreme based on BMI

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56
Q

Common characteristics of AN

A

Rituals associated with eating (only 1 pea very 5 mins)
Compensatory measures after eating like excessive exercise and purging
Often conflicts between parents and children, leading to secretive behaviour
Low self esteem
Hypervigilance in assessing body
Perceive their body to be bigger than it is

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57
Q

Binge eating disorder

A

A. Objective binge eating
B. 3+ of: eating too fast, until uncomfortably full, eating large amounts when not hungry, eating alone bc of embarrassment of how much their eating, feelings of disgust, depression, or guilt with themselves after a binge (5)
C. Distress
D. At least 1x a week for 3 months
E. Not compensatory or exclusively during BN or AN

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58
Q

Objective binges/binge eating definition for BED and BN

A
  1. Eating more than most ppl would eat within usually 2 hours
  2. Feeling out of control as if they cannot stop eating or control themselves
    No firm threshold
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59
Q

Bulimia DSM 5

A

A. recurrent binge eating
B. Compensatory behaviours to prevent weight gain after binges like vomiting, laxatives, other meds, fasting, excessive exercise (“purging”)
C. Both binging and purging occur on average once a week for 3 months
D. Self evaluation is unduly influenced by weight/shape
E. Does not exclusively occur with AN (AN with binge purge subtype trumps BN)

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60
Q

AN vs BN

A

AN: Low body weight, more restrictive behaviours, purging is more associated with intentional weight loss not compensatory
BN: weight is usually maintained, binging and purging are more linked, closer in time, binges often larger (potentially more objective binges than AN)

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61
Q

Disorders that were previously called EDNOS

A

Atypical AN: all criteria met but weight in normal range
BN or BED with low frequency or limited duration
Purging disorder: purging related to weight but no binge and doesn’t meet AN criteria
Night eating syndrome

Also, other unspecified

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62
Q

Kleine levin symptom

A

hypercomnia with complusive eating
may lead to a misdiagnosis of an eating disorder

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63
Q

Why do ppl argue all EDs should be treated as one continuum of disorders?

A

Around 50% of ppl with AN will also develop BN at some point
Ppl often switch bw categories which decreases utility of diagnosis (AN usually in teens, BN in early adulthood, BED in adulthood)

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64
Q

Dimensions/alt models to consider for eating disorders

A

Age, Weight (AN<BN<BED), anxiety for AN, depression for BN/BED, different physiological symptoms for each

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65
Q

Incidence/prevalence of EDs

A

Vast majority women, huge spike at 15-19
Gay men more concerned with bein overweight than straight men

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66
Q

ED prognosis

A

Highest mortality rate, 50% ish treatment response, high relapse rate, often have another ED after, sometimes treatment can be too late

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67
Q

Refeeding syndrome

A

Lethal syndrome when nutrition is corrected too quickly

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68
Q

Physical consequences of EDs

A

osteoporosis, heart problems, fertility ssues, lethargy, hair loss, heightened sensitivity to cold, lanugo (peach fuzz to maintain warmth), amenorrhea, dental problems, Russels sign (scabs on knuckles bc of purging)

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69
Q

Brain EDs

A

Reduced serotonin density
Gender differences may be due to difference in the serotonin system - women more susceptible to dysregulated serotonin, dieting may alter serotonin in women more than men

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70
Q

Sociocultural factors for EDs

A

Internalized media ideals of thinness is believed to be a causal risk factor
Average weight is increasing in north America, discrepancy leads to increased guilt, shame, dieting, body dissatisfaction
“fitness” online
Weight concerns are culturally bound but food refusal/AN isn’t
BN IS culturally bound

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71
Q

Family factors for EDs

A

mothers who diet/have weight concerns make daughters who diet/have weight concerns
Parents who are critical and emphasize weight/appearance cause daughters with worse ED outcomes
- daughters perceive a lack of care from mothers

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72
Q

Personality/individual differences in EDs

A

Associated with AN/BN: perfectionism, obsessiveness, compliance, alexithymia (lack of emotional awareness), negative view of self
Associated with BN: impulsivity
Other EDs: low self esteem, depressive affect, poor body image, dieting, excessive exercise
More BPD/OCPD symptoms in EDs

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73
Q

Maturation factors of EDs

A

In puberty, womens bodies alter in ways incongruent with societal expectations (gain weight) while men’s alter congruently (gain muscle)
More weight leads to more body dissatisfaction
Puberty increases womens awareness of sex roles, sexuality, media, etc. causes more stress

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74
Q

Adverse events affect on EDs

A

Traumatic events especially past sexual trauma are high in eating disorders
these events have negative effects on self esteem body image sense of control
Maybe more associated with BN than AN

75
Q

Treatment for EDS

A

SSRI may exacerbate symptoms for AN. SSRIs can be good for BN but still worse than CBT alone
20 week CBT program
Phase 1: establish regular eating thru psychoeducation, self monitoring and food diaries
Phase 2: normalize eating without dieting thru behavioural plans, problem solving skills to reduce stressors, and cognitive work to identify dysfunction thoughts about body
Phase 3: strategies to maintain change and prevent relapse thru mindfulness

76
Q

Other therapies for EDs

A

Interpersonal therapy: focus on improving relationships with others, not related to food but surprisingly effective
Nutritional therapy and meal support: work with nutritionists and dieticians to restore weight, normalize eating behaviours, and decreasing rituals
Family therapy: places responsibility for recovery on whole family, ignores cause of the disorder, when improving, helps family return control of eating back to pt

77
Q

prevention interventions for EDs

A

Internet-based campaigns about body image and school programs (Healthy Schools Kids Ontario)

78
Q

BMDA

A

Brain disease model of addiction
chronic relapsing brain disease

79
Q

Other models of addiction

A

Psychological - personal deficiencies
Learning - learned behaviour
Sociological - environmental deficiencies
Biopsychosocial - combination of other models

80
Q

Alc/substance use disorder

A

A. Problematic usage causing DnD manifested by 2+ symptoms over a YEAR
11 symptoms from 4 categories: impairment of control, social impairment, risky use indicators, pharmacological dependance

81
Q

tolerance vs withdrawal

A

need increased amounts to achieve the same effect vs symptoms when recovering from substance

82
Q

Impairment of control symptoms of SU

A
  1. substance taken in large amounts over longer period than intended
  2. desire or unsuccessful attempt to reduce use
  3. great deal of time dedicated to substance (obtaining, using, recovering)
  4. Cravings
83
Q

Social impairement symptoms of SU

A
  1. continued use despite failure to fulfill obligations at home, school, work
  2. Social and interpersonal problems
  3. important activities given up or reduced (social, work, recreational)
84
Q

risky use indicators

A
  1. using when physically dangerous to do so (drinking and driving/operating heavy machinery)
  2. continued use despite knowledge of it having a persistent effect on physical or psychological problems (keep drinking even when in liver failure, usually refers to internal issues but can include blackouts)
85
Q

pharmacological dependance symptoms of SU

A
  1. tolerance
  2. withdrawl
86
Q

SUD severity

A

mild 2-3 symptoms
moderate 4-5
severe: 6+

87
Q

Other SUDs

A

(substance) intoxication - for the hours you are intoxicated
(substance) withdrawal
(substance)-induced __ disorder
Polysubstance abuse - no longer used - when 2+ substances are misused simultaneously

88
Q

frequency of drinkers

A

less than/more than weekly - light vs heavy frequency drinkers
fewer than/more than 5 per occasion - heavy/light drinkers
5+ drinks in one sitting = binge drinking

89
Q

gov of canada drinking guidelines

A

used to be no more than 2 drinks for women and 3 for men per sitting and less than 10 a week for women and 15 a week for men
its now 0 drinks - 1-2 is low risk, 3 to 6 is moderate risk, 7+ is high risk

90
Q

(wernicke)-korsakoffs syndrome

A

“wet brain”
severe brain damage due to drinking that impairs memory and contact with reality
cell loss in hypothalamus, thalamus, and hippocampus

91
Q

biological etiology of alcohol use disorder

A

enzyme levels, physiological sensitivity to the rewarding properties of alcohol, neurotransmitters (gaba, serotnonin, beta-endorphins), genes (related to gaba serotonin dopamin and opioid systems), male

92
Q

psychological factors in alcohol use disorder

A

“addictive personality” as seen by traits like rebellion, aggression, impulsivity, neuroticism, more risk taking behaviour
Tension reduction hypothesis - avoiding withdrawal by continuing to drink (negative reinforcement)
Alcohol expectancy theory - cognitive beliefs around alcohol like “ill be more social”

93
Q

sociocultural factors of alcohol use disorder

A

rite of passage
kids mimic alcohol patterns of parents

94
Q

benzos

A

downers
started as barbituraic acid, highly addictive dependency rapid, now benzos, moderately addictive dependency slower
valium, xanax, ativan
dangerous when combined with other drugs bc effects are synergistic
effects are similar to alcohol

95
Q

Chronic use of benzos could cause

A

depression, fatigue, mood swings, paranoia,
impairments to memory/judgment

96
Q

abstince syndrome

A

withdrawal from benzos
insomnia, headaches, aching, anxiety, depression, and can last
for months
* Abrupt discontinuation is not advised, can cause
serious reactions like delirium, convulsions, death

97
Q

nicotine and cigs interferes with

A

nic: thinking and problem solving, agitation and irritability, mood changes
cigs: increases alertness, improves mood, positively reinforcing

98
Q

cigs are ___ reinforcing

A

both positively (feels good) and negatively (cravings and withdrawal are deeply uncomfortable)

99
Q

nictotine in the brain

A

nicotine attaches to nicotinic receptors, releasing dopamine, dopamine drops, causing cravings
some ppl may be more sensitive to nicotine bc of alterations in their dopamine neurons

100
Q

types of amphetamines

A

mimics adrenaline
used for asthma, adhd, narcolepsy, obseity
methamphatine (MDMA, ritalin) or dextroamphatmine (dexadrine)

101
Q

effects of amphetamines

A

low: increases alertness and cog performances
higher: exhilaration, confidence
very high: anxiety, agitation
irregular heartbeat, temp flashes, nausea, seizures, weight loss, aggressive behaviour
may cause permanent cognitive defecits and depletion of serotonin

102
Q

toxic psychosis

A

chronic use of drugs that lead to delirium parania and hallucinations

103
Q

amphetamine tolerance and dependence

A

Quick, because of crashing, users have fatigue,
irritability, sadness, and cravings

104
Q

Amphetamine Withdrawal:

A

Withdrawal: apathy and prolonged sleeping

105
Q

cocaine effects

A

Low doses: euphoria, confidence, alert, talkative, reduced
appetite, increased excitement and energy
High doses: poor muscle control, confusion, anxiety,
anger, mood swings, aggression, anhedonia, weight loss,
insomnia, toxic psychosis (hallucinations, delusions)

  • Death can occur in high doses
106
Q

cocaine dependance

A

huge crash with intense cravings, depression,
paranoid, fatigue
* can take more than a month to shake this withdrawal

107
Q

cocaine brain

A

triggers dopamine release into synapse

108
Q

caffeine brain

A

affects on dopamine serotonin and noreprephrine

109
Q

opiods

A

opium (morphine, codeine)
semi synthetic opiods (heroin, oxycodon)
synethetic (fentanyl)
inhibit pain by mimicing natural opiods

110
Q

opioid brain

A

mimics endorphins

111
Q

opiods effects

A

low doses: euphoria, relaxation, appetite suppressant, restlessness,
nausea, and vomiting
* Higher doses: dangerous effects, pupils constrict, skin turns blue and cold,
breathing slows, coma, respiratory depression
Chronic use:
* Respiratory and pulmonary problems, endocarditis (infection of heart lining tissue),
abscesses, liver disease, brain damage, HIV infection due to needles

112
Q

behavioral body tolerance

A

Very easy to overdose because addicts sometimes die from a dosage that they previously tolerated in a different environment

113
Q

dependancy opioids

A

withdrawal symptoms are extremely severe and begin about 8 hours after
the last dose
* 36 hours in: muscle twitching, cramps, hot flashes, changes in HR and BP,
sleeplessness, vomiting, diarrhea
* Can last for 10 days

114
Q

amotivational syndrome

A

chronic cannabis use leading to apathy, detachment and abandonment of school/work
may be related to depression

115
Q

psychadelics brain

A

excitatory on the CNS, mimics manic episode and
increases serotonin in the brain
* Dilated pupils, increased HR/BP, increased alertness

116
Q

at risk pop for gambling

A

male, indigenous

117
Q

gambling treatment

A

interventions focusing on motivation for change
internet based CBT

118
Q

gambling disorder DSM5

A

A. persistent gambling behaviour leading to DnD in ONE YEAR as evidence by 4+ symptoms
B. not better explained by mania

119
Q

gambling symptoms

A
  1. needs to gamble more and more money to achieve same excitement (tolerance)
  2. restless or irritable when trying to cut down
  3. unsuccessful efforts to cut down
  4. often preoccupied with gambling
  5. gambles when feeling distresed
  6. keeps returning to gambling to “make up loses”
  7. lies to conceal gambling
  8. jeopardized significant relationship, education, job bc of gamblig
  9. relies on others money
120
Q

at risk pop for internet gaming disorder

A

men between 14-18

121
Q

internet gaming disorder

A

5+ symptoms:
1. preoccupation
2. withdrawl
3. tolerance
4. unsuccessful attempt to control participation
5. loss of interest in other activities
6. continued use despite knowledge of psychosocial problems
7. deception
8. uses to escape
9. lost significant relationship, job, education opportunity

122
Q

routine treatments for substance use disorders

A

month long inpatient program focused on biological dependance (often uses 12-step)
following this, focus on psychological dependance thru education, individual counselling, and GROUP therapy

123
Q

pharmacotherapy for alcohol use disorder

A

benzos, gaba and opioid antagonists used to moderate withdrawl and cravings
antabuse and CCC to make alcohol unpleasant (negative punishment)

124
Q

12 step programs

A

AA/NA: addiction is a disease, person o powerless turn to religion/higher power, complete abstinance
SMART: secular, empirical, focuses on skill building, can be abstinance or harm reduction

125
Q

BT for SUDs

A

inc awareness of cues related to drinking, rules and rewards for small steps forward, aversive conditioning, contingency contracts

126
Q

CBT for SUDs

A

restructing thoughts about drinking, being aware of patterns, SMART goals

127
Q

relapse prevention for SUDs

A

relapse due to inadequate coping skills, focus on self defeating thoughts and learning from relapse
restructure guilt and failure

128
Q

therapies for SUDs

A

bt, cbt, relpase prevention, family/martial therapy (work on potential codependance that may be fueling addiction), brief interventions

129
Q

brief interventions for SUDs

A

1-3 sessions focusing on motivating change
explore concerns about changing
motivational interviewing
focus on how to make motivation higher

130
Q

stages of motivation

A

precontemplation: denial, not seriously considering changing
contemplation: ambivalence about change, they recognize reasons to change but have hesitations
preparation: decided to make a change and start with minor changes
action: avoiding triggers, reaching out for help
maintenance: changes are maintained
relapse: often takes several bases thru stages to permanently end behavior

131
Q

nicotine treatment

A

nic replacements, wellburtin, varnicline reduces pleasurable effects of nicotine

132
Q

cocaine treatment

A

12 steps, group and ind therapy, relapse prevention, etc.
dopamine enhacing drugs to combate withdrawl

133
Q

opioid treatment

A

opioid antagonists
methadone: heroin replacement, opioid antagonist that reduces cravings
in combo with peer support etc.

134
Q

contingency management

A

reward not taking substance or punish for taking substance
if i have a craving at 50 then go for a walk, if craving at 90 go for a meeting

135
Q

SMART Goals

A

realistic, implementable and concrete goals
may not be total abstinence

136
Q

personality vs states

A

consistent persistent traits of an individual vs temporary conditional patterns

137
Q

personality disorder DSM5 (6)

A

A. Pattern of behaviour in at least two of the following areas: cognition, emotion, interpersonal functioning, impulse control
B. Behaviour across a broad range of situations
C. DnD
D. Long stable duration of symptoms starting in adolescence or earlier
E, F. not better explained

138
Q

egosyntonic

A

not viewing problematic behaviour as impairing but instead consistent with their goals
more consistent with PDs

139
Q

egodystonic

A

behaviour causes distress and is inconsistent with who they want to be
more common with classic mental health conditions

140
Q

cluster A

A

odd and eccentric disorder
paranoid, schizoid, schizotypal

141
Q

cluster B

A

dramatic emotional erratic
ASPD, BPD, NPD, histrionic

142
Q

cluster c

A

anxious and fearful
avoidant, dependant, OCPD

143
Q

why is consideration of PDs important

A

alliance between therapist and client
often misdiagnosed as axis 1
poor prognoses
make outcomes for axis 1 conditions worse

144
Q

paranoid personality disorder

A

misinterpreting
fears exploitation
humorless
hypervigilant
hostile

145
Q

Schizoid PD

A

detachment for relationships and restricted range of expressions
negative symptoms of scz
loner, lack of responsiveness, puzzles by passions of others

146
Q

schizotypal PD

A

social/interpersonal deficits (reduced capacity for close relationships) and eccentric behaviour (odd/magical beliefs and speech)
suspicious, excessive social anxiety, superstitious
some neg and pos symptoms of scz but never to the point of delusion or hallucinations just odd

147
Q

histrionic PD

A

excessive emotionality and attention seeking
rapid shifting and shallow emotions, uncomfortable when not center of attention, speech that is excessive but lacking in detail, suggestible, overestimates intimacy of relationships, cant develop deep relationships, dresses provacatively

148
Q

NPD

A

pattern of grandiosity, need for admiration and lack of empathy
believes they are “special” and can only be understood by other high class ppl, exploitative, envious, arrogant

149
Q

avoidant PD

A

pattern of inadequency, hypersensitivity to negative evalution
avoids activities bc of fear of criticism of rejection, restraint in relationships, views themselves as inferior
very close to social anx

150
Q

dependant PD

A

pervasive need to be taken care of
submissive clingly behaviour, fear of separation, difficulty making everyday decisions alone, cant express disagreement, feels helpless, unrealistically fearful of being left alone to care for themselves

151
Q

OCPD

A

preoccupation with orderliness, perfectionism, control at the expensive of openness, flexibility, and efficiency
preoccupied with rules to the point of being unable to complete tasks, maintain friendships of leisure time, inflexible morally, wont throw stuff away, wont spend money, rigid, stubborn

152
Q

problems with pd treatment

A

egodystonic and dont seek treatment, dropout rates high, poor prognosis, poor therapeutic alliance

153
Q

suggestions for improving pd treatment

A

conceptualize as both biological and psychological
assess levels of motivation for improvement
flexible treatment
goal to improve adaptability q

154
Q

treatments for pds

A

no first line drugs
object relations therapy
CBT
DBT

155
Q

object relations therapy

A

examines relationships and tries to differentiate pt from others (individuation)
confront interpersonal defenses and distortions

156
Q

CBT for pds

A

restructuring and testing of core beliefs and the rigidity of those beliefs

157
Q

ASPD DSM5

A

A. pervasive pattern of violating the rights of others starting at age 15, 3+ of the following:
1. unlawful behaviour
2. deceitfulness
3. impulsivity
4. irritability/aggressive, indicated by physical fights/assaults
5. reckless disregard for safety
6. irresponsible in work/with money
7. lack of remorse
B. at least 18 years old, no psychotic disorders

158
Q

etiology of ASPD

A

parenting influences callousness, genetic markers of aggression and impulsivity, grew up in criminogenic environments, neglect, abuse, fearlessness hypothesis

159
Q

fearlessness hypothesis

A

ppl with aspd may have a higher threshold for fear or anxiety due to a altered attentional mechanism that reduces fear

160
Q

why abuse may cause aspd

A

if punishment was not contingent with behaviour it may lead to an indifference to physical punishment or oppositional behaviour to control abuse

161
Q

burnout factor

A

symptoms of ASPD and bpd tend to decline around 40

162
Q

ASPD treatment

A

psychoeducation, beliefs about aggression, skills to manage impulsivity, substance use, problem solving
may respond to antipsychotics and sedatives

163
Q

responsivity factor

A

treatment to aspd relys on this, in which treatment works better when matched to pts interpersonal style

164
Q

dark triad of personality traits

A

Machiavellianism - callous, manipulative, amoral to achieve power - may rationalize hurting others for personal gain
psychopathy: same as above, lack remorse and emotional depth - don’t care about hurting people at all
- tend to be con artists, target ppl who are easy to manipulate, good at picking these ppl from a crowd, violent crimes
narcissism
- selectively impulsive compared to typical ASPD

165
Q

etiology of psychopathy

A

insensitive to emotional content of information, use different means to processing emotional material to compensate (lower amygdala or PFC)
abnormalities in PFC, hippocampus, basal ganglia, amygdala
lower serotonin and increased dopamine

166
Q

BPD DSM5

A

A. pattern of instability in relationships, self image, affect, and impulsivity beginning in early adulthood. 5+:
1. avoid abandonment
2. unstable/intense relationships shown by splitting
3. unstable sense of self
4. impulsivity in 2+ areas
5. suicidality
6. unstable mood
7. emptiness
8. intense inappropriate anger
9. dissociative or paranoid symptoms

167
Q

characteristic of BPD

A

inability to change emotional expressions

168
Q

dysregulated behaviours in BPD seen as a consequence of

A

inability to cope effectively

169
Q

caregivers model….

A

emotional regulation, characterized as being flexible

170
Q

biological/psychosocial factors for bpd

A

greater sensitivity to emotions, experience emotions more intensely, longer latency to return to baseline
invalidating environment (parents), diminished opportunities for learning emotional regulation

171
Q

splitting

A

alternating between ideation and devaluation
black and white thinking, holistic
may be a defense mechanism from abuse, allows ppl to split the abusive person into 2

172
Q

4 DBT approaches

A

rogerian: validate suffering nonjudgmentally, their behaviour makes sense given their suffering
learning theory: behaviour is establish thru classic learning mechanisms
zen buddism: suffering results from attachment to thing being a certain way, must accept reality as it is, suffering is because of the gap between what you want and how it is
CBT: change is required to feel better, skills based learning

173
Q

DBT format

A

ind 1 hour, group 2 hours per week for 6 months to a year

174
Q

hierarchy of DBT goals

A
  1. reduce suicidality
  2. reduce therapy interefering behaviour
  3. reduce behaviours interfering with quality of life
  4. increase emotional regulation skills
  5. decrease PTS behaviour
  6. increase self respect behaviour
175
Q

dialectic

A

the process of achieving balance between two opposing processes, acceptance and change
integrate a whole

176
Q

how can a therapist be validating

A

paraphrase, find kernal of truth, treat hem as someone who is competent

177
Q

how to get pts to commit to change dbt

A

pros and cons of current and modified behaviour, devils advocate why you should change, generate hope, highlight freedom to choose

178
Q

behavioural chain analysis

A
  1. identify behaviour
  2. identify vunerabilities
  3. identify prompting events
  4. identify links between prompting events and the behaviour
  5. identify consequences

Then, problem solving skill

179
Q

pd diagnostic issues

A

low reliability, poorly understood etiology, weak treatment effect
- are they even disorders or just constellations of maladaptive traits
cultural and gender biases (women and Hispanic ppl get diagnosed more with emotional pds, “eccentric” beliefs may be culturally founded)
May not be as chronic as first believed (bdp is usually not significant after 10 years)
Lots of comorbidity and diagnostic overlaps Vague criteria

180
Q

Attachment theory of pds

A

children learn how to relate to other thru parents - if early attachment is poor, it may lead to lack of skills and confidence in relationships

181
Q

CB perspective of pds

A

children develop schemas that the world is untrustworthy etc. that may have been useful in an abusive childhood environment but no longer are. developed strategies to avoid the schema
parents may model this themselves and reinforce it

182
Q

biological theory for pd

A

may be due to transmission of a non-disorder specific genetic risk

183
Q

therapy seekers demographics

A

women, uni degrees, young to middle aged adults

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