Exam 4 Flashcards
Substance Disorders are characterized by…
loss of control over urges to use substances
Substance Disorders in DSM-5 - Psychoactive substances are taken to…
Have an effect on mood, behavior, congition
prevent uncomfortable withdrawal symptoms
Substance Disorders DSM-5 Criteria
Within 12-month period
larger amounts than intended, use when hazardous, craving or strong desire for drugs, tolerance increases/feeling numb, withdrawal
2-3 required for mild
4-5 moderate
6-7 severe
Tolerance
repeated use - more required to get some effect
Withdrawal
symptoms that arise due to lack of use (symptoms decrease or stop)
When/how is it a problem? It develops in 3 ways…
1) unintentionally (environment)
2) psychoactive element - side effect of medical reasons unrelated to effect
3) result of intentional use of substance (person does not acknowledge the risks if known)
Common liabilities model
combination of neuro, psych, social, factors which make someone vulnerable and suggestable/impulsive
cause problem behaviors
Gateway hypothesis
there is an entry drug - individual works up to harder drug (two factors are age and quantity)
Drug types
stimulant, depressant, opioids, hallucinogen, dissociative anesthetics
Stimulant and types
stimulates CNS
nicotine, crack, cocaine, Ritalin, amphetamines, methamphetamines, bath salts
low dose can make someone alert and energetic
Cocaine + Crack
tolerance developed quickly
smoked crack acts fast
18th century Europe, associated with Freud
Amphetamines
adderall, dexedrine, benzedrite
usually pills, prescribed for ADHD/narcolepsy
longer high
help w/depression, anxiety, fatigue
Methamphetamines
highly addictive
intense rush of pleasure
larger effect
MDMA (Ecstasy) - Hallucinogen
usually in tablet form
similar to meth
stimulant and hallucinogen
produces sense of well-being, empathy, warmth to others
abuse results in poor mood, anxiety, aggression, sleep problems
withdrawal: depression, fatigue, less appetite, less concentration
Dopamine Reward System - two parts
Nucleus accumbens + Ventral tegmental area
Describe dopamine reward system
cocaine and drugs block transporters of dopamine, therefore, it takes more drugs to get the same effect (blocks reuptake)
Stimulants - Psych Factors (conditioning)
Operant Conditioning
+ using drug is positive consequence (reinforced)
- alleviate negative state, crave relief, use drugs (reinforced)
Classical: drug cues (perephenalia, environment)
Body is more likely to prepare if it knows environment, same amount in new environmen, more likely to OD
Stimulants - Social Factors
Family relations, peer relationships, norms and perceived norms, socio-cultural factors
Other abused substances
Narcotics analgesics (opioids - heroin, codeine, morphine, oxycodone, methadone)
Hallucinogen (LSD, Marijuana)
Dissociative anesthetics (PCD + Ketamine)
Origin of narcotics/characteristics of narcotics
comes from poppy plant, inject and snort in mouth, alleviate pain, highly addictive, withdrawal within 8 hours of last dose, death can happen if taken with depressant
Heroin
opioid, euphoria and tolerance, irritability, chills, vomit, sneezing, hot flashes
Neuro Factors for Heroin Use
slows down CNS activity
decrease endorphin production
Hallucinogen types
LSD, Marijuana, Mescaline
chemically similar to serotonin
LSD - symptoms of use
alter auditory sensations and perceptions
shifting emotions
unpredictable
flashbacks and psychosis
Marijuana (THD) - Characteristics
Psychoactive effects
smoked or ingested
THC activates dopamine reward system
cognitive and motor abilities impaired
CBD is not psychoactive
harmful effects vary person to person
schizophrenia is a potential risk factor of prolonged extreme Marijuana use
Neuro Factors - Marijuana
THC chemically similar to cannabinoids (which activate dopamine reward system)
Treating substance abuse disorders (two ways)
Abstinence and harm reduction
Abstinence
Alcoholics Anonymous
relapse rates 60%
meds to minimize withdrawal - block the high feeling
Harm Reduction
try to reduce harm to individual and society from abuse and dependence
People will use anyway, lets make it safer for them
safe needles rather than unsafe exchange
controlling drinking or drug use, but in a safe environment
Detoxification
Neurological treatment - medical supervision discontinuation of substance use)
Medication
Neurological treatment - interfere with pleasant effects of drugs
Treatment for Addiction - Psychological
Motivational Interviewing - boost patients motivation to decrease or stop use of drugs
goals and behavior adjusted
based on stage of change
Precontemplation
Not me
Contemplation
maybe I have an issue
Preparation
Ok, what now, I am unsure
Action
Lets do this
Maintenance
It is possible
CBT
cognitive behavioral therapy
Twelve Step Facilitation
like AA, but led by licensed counselors/professionals
Other options
residential treatment, family therapy, day programs, community treatment, AA and NA
What are personality disorders?
can date back to adolescence
psych disorders characterized by inflexible and maladaptive thought, feelings, behaviors, from situations that lead to distress or dysfunction
DIFFERENT from norm or culture
30% of those with PD commit suicide
Assessing Personality Disorders (4 ways)
1) Clinical interview
2) Collateral info from family members
3) consider culture, ethnicity, racial background
4) personality inventories: MCMI-3, MMPI-2, PAI
DSM-5 for Personality Disorder
Enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture.
Two or more of the following areas: cognition, affectivity, interpersonal functioning, impulse control
PD Cluster A - Odd/Eccentric PD - 3 ways of thinking
paranoid: pervasive, mistrust, bias toward hostile motives of others
schizoid: restricted range of emotions, few or no relationships, lack social skills, passive reactions
schizotypal: characteristics of paranoid and schizoid symptoms.
Cog/perception: magical paranoid ideation,
interpersonal symptoms such as social anxiety
disorganized symptoms: odd speech and behavior
PD Cluster B - Dramatic/Erratic PD how many are there?
4
Cluster B - Antisocial PD
persistent disregard for rights of others
violate rules or laws, lie, hurt others
act impulsively, put self and others in harms way
often conduct disorder in childhood
Cluster B - Histrionic PD
dramatic attention-seeking behavior + exaggerated emotions
seeking out novelty and excitement
patients have poor insight into their symptoms
easily and excessively frustrated by life’s challenges
delayed gratification
Cluster B - Narcissistic PD
Inflated sense of importance, lack empathy, excessive desire to be admired
overvalue themselves - undervalue people who disappoint them
insensitive to others feelings and points of view
Borderline Personality Disorder DSM-5
pervasive pattern of instability in interpersonal relationships, self-image, and affects. Marked impulsivity, beginning by early adulthood in a variety of contexts as indicated by FIVE or more of the following:
frantic efforts to avoid real or imagined abandonment
pattern of unstable and intense interpersonal relationships (alternating between extremes of idealization and devaluation)
identity disturbance
impulsivity in at least two areas that are potentially self-damaging
recurrent suicidal behavior, gestures, threats
affective instability due to a marked reactivity of mood
chronic feelings of emptiness
inappropriate, intense anger or difficulty controlling anger
transient, stress-related paranoid ideation or severe dissociative symptoms.
PD Cluster C - Fearful/Anxious PD - how many?
3
Avoidant PD
extreme social inhibition - feeling inadequate, overly sensitive to negative evaluation
shy, isolated, lonely, timid, low quality of life
hypervigilant for criticism/rejection
concerned about embarrassment
Dependent PD
submissive and clingy behaviors, fear separation
clingy: chronic pattern of helplessness - elicit reassurance
chronic self-doubt - underestimate abilities
limited social circle
other person takes initiative
Obsessive-Compulsive PD
preoccupied w/perfectionism, orderliness, self-control
decision making is long and painful
formal + serious relationships
overly conscientious
Psych factors underlying PD
operant conditioning
histrionic: attention from parents when exaggerating/performing
antisocial: AFP when child acts out
develop maladaptive or faulty beliefs self-fulfill prophecy
BPD: spouse will leave me - hypervigilance
Social factors underlying PD
attachment style
secure: view of worth and availability of others is positive
insecure: view of worth and availability of others is negative
Treating PD: General Issues
less likely to seek treatment - deeply ingrained (not dys)
if treatment sought: difficult to address
ingrained - poor motivation for change
medications: antipsychotics, antidepressants, mood stabilizers
Psych treatment: CBT, family therapy, group therapy,
Treatment for BPD
Dialectal Behavior Therapy
mindfulness, emotional regulation, distress tolerance and acceptance, accept what cannot change
Insomnia DSM-5
trouble falling and staying asleep 3 nights/week for 3 months not caused by drugs or other sleep-wake disorders
Hypersomnia DSM-5
excessive sleep despite 7+ hours. Lapsing sleep of around 9+ hours per day, not feeling rested, 3 nights/week for 3 months or longer not caused by drugs or other sleep-wake disorder
Narcolepsy DSM-5
uncontrollable need for sleep during day; 3 nights/week for 3 months or longer not drug related. Low levels of NT hypocretin-1 decreased REM, may involve cataplexy/muscle weakness
Parasomnia DSM-5 - Non-REM sleep arousal disorder
partial awakening in first third of sleep, sleepwalking or sleep terrors
Parasomnia DSM-5 - REM sleep behavior disorder
arousal w/talking or physical movement
Parasomnia DSM-5 - Nightmare disorder
repeated vivid and upsetting dreams in second half of sleep
Breathing related sleep disorders
sleep apnea types: central, obstructive hypopnea, hypoventilation
Circadian rhythm sleep-wake disorders
delayed and advanced sleep phases, irregular, non-24 hour, shift-work
Restless leg syndrome
irresistible desire to move one’s legs when resting
Sleep disturbances - historical perspective
caveman - fetal position in pits by cave walls
egypt - revered near death feel of sleep
romans - less focus on sleep
middle ages - people huddle, not comfy
renaissance - more focus on comfort
before nighttime was invented, people sleep, wake up and do stuff, then go back to sleep
Sleep Cycle
Awake - REM - non-rem (1-3)
Sleep disturbances - psych perspective and treatments
psychodynamic - meaning of dreams and their function
CBT for Insomnia
stimulus control therapy
sleep restriction therapy
sleep hygiene education
cognitive therapy
relaxation training
Sleep disturbances - sociocultural perspective
social inequality and social justice
- reduced pay, workplace inequality, wp stress > predict inadequate sleep
sleep loss: inequality based not mental disorder
Enuresis DSM-5
unintentionally or intentionally urinates in bed in clothes for 2/week for 3 months, not caused by drugs, 5 years old or equivalent developmental level
Encopresis DSM-5
bowel movements in inappropriate places once/month for 3 months
4 years old or equivalent developmental level
Intellectual Disability DSM-5
intellectual deficits
adaptive functioning deficits
onset - early development
(mild, moderate, severe, profound)
Learning Disorders DSM-5
difficulty learning/academic skill
one or more symptoms of academic difficulty
develops in school years
Motor Disorders DSM-5 - Developmental coordination disorder
poor motor skills that are lower than expected for one’s age
Motor Disorders DSM-5 - stereotypical movements disorder
repetitive and purposeless motor behavior (early development)
injury or non-injury behavior
Motor Disorders DSM-5 - tic disorders
abrupt/repetitive motor or vocal impairments
(tic, chronic, tourette’s)
Communication Disorder DSM-5 - speech/sound disorder
disorder involving difficulty producing speech and sounds
Communication Disorder DSM-5 - language
disorder involving difficulty acquiring, learning, and using language properly
Communication Disorder DSM-5 - stuttering
disorder involving repeated sounds or syllables, extending vowels or consonants
Biological Perspective - communication/stuttering
dopamine hypothesis of stuttering
stuttering - excessive dopamine in basal ganglia
antipsychotic drugs reduce dopamine prescribed
stimulants as well increase dopamine
Psych Perspective - communication
CBT for stutter
- manage stutter anxiety
- negative thought patterns examined
- not much research evidence for this
Lidcombe Program - behavior therapy
- stage 1: appointment at speech clinic, parents rate severity of stutter, positively reinforce good speech
- stage 2: teach contingency management skills more, visit speech clinic less often
Constructivist therapy + stutter relapse
meaningful understanding of self and the world
fluent in core constructions of self
narrative therapy
Delirium DSM-5
disturbed attention to and awareness of environment
develops over short period of time (hours or days) changes throughout the day
disrupted cognition
Dementia DSM-5
major and mild types
attention, language, perception, learning, memory, executive function impacted
Suicide
act of completing the ending of one’s life/self harm
common methods are drug overdoses, guns, hanging, pesticides, etc.
Suicidal ideation
thoughts of suicide, does not mean that there is a psych disorder or acute risk of suicide attempt
10-18% of general population has suicidal thoughts
30% thoughts + conceived plan
Suicide - risk factors
hopeless, no job, chronic stress and impulsivity, loss of something (support or something important)
Suicide - protective factors
married, kids under 18, support system, problem-solving skills
Suicide prevention (4 key things)
suicide prevention counseling
- trained counselor or volunteer talk individuals “off the ledge”
no suicide contracts
- ask clients to explicitly state they won’t complete suicide (is this simply coercion?
method of suicide restriction
- access to common methods made difficult
hospitalization
- involuntary commitment (it’ll be good for them)
Why do we need ethics?
therapists are human, ethics provide accountability
Ethical issues to consider
therapist competence
client welfare
confidentiality
informed consent
dual relationships
sexual relationships
Limits to confidentiality
patient permission to violate
reasonable cause to suspect child abuse
reasonable cause to suspect intent to harm self or others
records subpoenaed by court
Dangerousness of patient
severity, imminence, frequency, probability
Duty to warn
Tarasoff Rule - protect potential victims who are in imminent danger (think Gabby Gifford)
After crime: competent to stand trial?
defendant must:
understand proceedings
understand facts and legal options
consults with his/her lawyer
assists lawyer in building defense
all-or-nothing standard
APA Ethics Code (5 principles)
Beneficence and nonmaleficence
fidelity/responsibility
integrity
justice
respect for people’s rights and dignity
APA Ethics Code (10 standards)
1 Resolving Ethical Issues
2- Competence
3- Human Relations
4- Privacy and Confidentiality
5- Advertising and Other Public Statements
6- Record Keeping and Fees
7- Education and Training
8- Research and Publication
9- Assessment
10- Therapy
