Exam PSYC 3604 A Flashcards
1
Q
What is addiction?
A
The tendency to persist with an appetitive or rewarding behavior that produces pleasure states and desire, despite mounting negative consequences that outweigh these more positive effects
2
Q
How does a person feel with addiction?
A
The person feels caught in this appetitive behavior, and does not want to or cannot seem to moderate or stop it
3
Q
What do negative consequences include?
A
Preoccupation and compulsive engagement with the behavior, impairment of behavioral control, persistence with or relapse to the behavior, and craving and irritability in the absence of the behavior
4
Q
Prevalence of substance use disorders?
A
Lifetime: 33.1%
12 month: 10.1
5
Q
What did Stanton Peele say?
A
“Psychoactive chemicals are perhaps the most direct means
for. But any activity that can absorb a person in such a way
affecting a person’s consciousness and state of being as to
detract from the ability to carry through other involvements is
potentially addictive. It is addictive when the experience
eradicates a person’s awareness; when it provides predictable
gratification; when it is used not to gain pleasure but to avoid
pain and unpleasantness; when it damages self-esteem; and
when it destroys other involvements. When these conditions
hold, the involvement will take over a person’s life in an
increasingly destructive cycle.”
6
Q
What causes a person to lose control?
A
It is not the substance - It is the underlying neural circuitry that fires when presented with the reward the substance provides
7
Q
In substance addiction, what does seeing a drug stimulus do? (i.e., the dealer or syringe)
A
Seeing a drug stimulus can activate the brain reward system and thus become reinforcing
8
Q
What else activates the brain reward systems and becomes reinforcing?
A
Gambling, gaming, related stimuli
9
Q
How is substance use disorder classified?
A
Each specific substance is addressed as a seperate use disorder (e.g., alcohol use disorder, stimulant use disorder, etc)
10
Q
Nearly all substances are diagnosed based on the same overarching criteria, which are:
A
Meeting at least two of the following occurring in a 12 month period:
1. Taking the substance in larger amounts or for longer than intended
2. Wanting to cut down or stop using the substance but not managing to
3. Spending a lot of time getting, using, or recovering from use of the substance
4. Cravings and urges to use the substance
5. Not meeting major work, home, or school obligations due to substance use
6. Continuing to use, even when it causes problems in relationships
7. Giving up social, work, or recreational activities due to substance use
8. Recurrent use of substance in situations that are physically hazardous
9. Continued use even when you know you have a physical or psychological problem
that could have been caused or made worse by the substance
10. Needing more of the substance to get the effect you want (tolerance)
11. Withdrawal symptoms and/or substance used to alleviate/avoid withdrawal
11
Q
What are addictive disorders?
A
Non-substance behavioral addictions (gambling disorder)
12
Q
Explain the diagnostic criteria of gambling disorder
A
A. Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress as indicated by the individual exhibiting four (or more) of the following in a 12 month period:
- Needs to gamble with increasing amounts of money in order to achieve the desired excitement
- Is restless or irritable when attempting to cut down or stop gambling
- has made repeated unsuccessful efforts to control, cut back, or stop gambling
- often preoccupied with gambling
- often gambles when distressed
- after losing money gambling, often returns another day to get even
- lies to conceal the extent of involvement with gambling
- has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
- relies on others to provide money to relieve desperate financial situations caused by gambling
B. The gambling behavior is not better explained by a manic episode
13
Q
What are the biological perspectives of SUD?
A
Familial and genetic influences
Neurobiological influences
14
Q
What are neurobiological influences of SUD?
A
Abused substance affects the internal reward system of the brain
15
Q
What is the neurobiology of reward? (rats example)
A
The reward centre in the brain. When certain areas were stimulated with small amounts of electricity, rats behaved as if they received something very pleasant.
16
Q
Where is the reward centre in the brain?
A
Exact location in human brain is still subject to debate, but believed to involve the dopaminergic system and its opioid-releasing neurons
17
Q
Mesolimbic Dopamine System includes the:
A
Prefrontal cortex, nucleus accumbens, and ventral tegmental area
18
Q
How do amphetamines move from outside the neuron into the cell?
A
Via dopamine transporters or directly by diffusing through the neural membrane
19
Q
What are amphetamines similar in structure to?
A
Dopamine
20
Q
Once inside the cell, what do amphetamines do?
A
Force dopamine out of their storage vesicles and expel them into the synapse
21
Q
Addiction is thought to be the result of repeated stimulation of the mesolimbic system, which triggers…
A
Reorganization in the brain’s neurocircuitry
21
Q
What does reorganization in the brain’s neurocircuitry do?
A
May mediate positive reinforcement, motivation, craving and relapse for the drug
21
Q
As people become more driven to use a drug, what could happen?
A
The drive can also progress to a state of negative reinforcement (i.e., to alleviate negative symptoms associated with withdrawal)
22
Q
What is neuroplasticity?
A
The brain’s ability to reorganize itself by forming new neural connections throughout life
22
What are the neural mechanisms underlying vulnerability to addiction?
Neuroplasticity and neuroadaptation
23
What does neuroplasticity allow neurons to do?
Allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment
24
Why is neuroplasticity important?
Important for learning and memory
25
What is neuroadaptation?
The process whereby the body compensates for the presence of a chemical in the body so that it can continue to function normally
26
What does neuroadaptation lead to for people who abuse substances?
Tolerance and dependence on a substance
27
When does sensitization occur?
When repeated administration of a drug elicits escalating effects at a given dose
28
What is the DA Theory of Addiction?
DA release seems to apply better to stimulants (e.g., cocaine)
29
What should've given the field pause for thought?
Mixed results from non-stimulants
30
Research has largely focused on DA in the...
Striatum
31
Decision making for the most part takes place in the...
Cortex
32
What are the other likely roles of DA?
DA receptor availability may be linked to impulsivity (in rats)
Regulate motivation to seek addictive substances
33
What is the insula?
Involved in a network of brain regions that represent bodily states associated with emotions and decision making
34
How is the insula related to craving?
Drug seeking cues activate the insula, and activity in the insula is linked with self reported craving
35
Cue induced craving can be conceptualized as..
An emotion
36
What is automatic drug seeking mode?
Divorced from the value of drug taking
No subjective craving
Unaffected by insula lesions
37
What is goal directed drug seeking mode?
Tied to value of drug taking
Subjective craving
Abolished by insula lesions
38
What are psychological perspectives of SUD?
Affect and motivation
Cognition and beliefs
Positive and negative reinforcement
Personality and other predispositions
39
Cognitions and beliefs SUD
Expectancies about taking substance or performing the behavior
40
Positive and negative reinforcement SUD
Substance increases positive affect (e.g., excitement)
Substance alleviates negative affect (e.g., anxiety)
41
Personality and other predispositions SUD
Neuroticism
Attachment styles
42
What is neuroticism?
Proneness to experience negative affect
43
What are attachment styles?
How we relate to significant others
44
Why do people consume alcohol?
Positive reinforcement (because it is exciting, to get a high)
Negative reinforcement - Depression (forget painful memories, stop me from feeling so hopeless about the future)
Negative reinforcement - Anxiety (reduce my anxiety and forget my worries)
Social (as a way to celebrate, to be sociable)
Conformity (so i won't feel left out, because my friends pressure me to use)
45
What are the three subscales of AUDIT?
1) Hazardous alcohol consumption (items 1-3)
2) Dependence symptoms (items 4-6)
3) Harmful alcohol use (items 7-10)
46
What does AUDIT stand for?
Alcohol use disorders identification test
47
What are the Big Five Personality traits?
Neuroticism, extraversion, agreeableness, conscientiousness, and openness to new experiences
48
What were the results of the "personality factors, drinking motives, and alcohol use disorder severity" study?
Greater conscientiousness was associated with less severe alcohol use via lower enhancement and lower coping-depression motives
Greater agreeableness was associated with less severe alcohol use via lower enhancement, social, and coping-depression motives
Greater extraversion was associated with more severe alcohol use via greater social and conformity motives
Greater neuroticism was associated with more severe alcohol use via coping depression motives
Openness to new experiences was not related to severity of alcohol use via drinking motives
49
What were the limitations of the "personality factors, drinking motives, and alcohol use disorder severity" study?
Cross sectional research design
Did not statistically control for shared variance between the personality traits
Did not examine interactive effects of personality on drinking motives and severity of alcohol use
Did not examine interactive effects of drinking motives on severity of alcohol
50
What are the social perspectives of SUD?
The immediate interpersonal environment of a person who develops an addictive disorder (social support, friendships, family)
Broader socio-structural properties of the environment (social disadvantage due to race, poverty, culture)
Community health and "the globalization of addiction"
51
What are some protective factors for drug use and abuse?
High GPA
Low depression
Having supportive relationships at home
Perceiving many sanctions for drug use
High religiosity
High self acceptance
High law abidance
52
What are some risk factors for drug use and abuse?
Low educational aspirations
High perceived adult drug use
High perceived peer drug use
Many deviant behaviors
High perceptions of community support for drug use
Easy availability of drugs
Low perceived opportunity
53
Predicting Concurrent Drug Use
Risk Factor Index by Protective Factor Index interaction was not predictive of all outcomes
Only for hard drug frequency (both sexes)
Cocaine and cigarette use (women only)
Buffering effect
54
What is linked to high drug use? (buffering effect)
High risk and low protection
55
What is linked to low drug use? (buffering effect)
Low risk and high protection
56
What did the risk factor index by protective factor index interaction predict about prospective drug use?
Was not predictive of all outcomes
Predicted greater cocaine and cannabis use 4 years later
Predicted greater alcohol problems 8 years later
57
T/F: Addiction increases as numbers of vulnerability conditions to which a person is exposed and with which they must cope increase
True
58
T/F: Addiction cannot be fully accounted for by any one or even a few etiological factors
True
59
T/F: SUDs and addictive disorders are multifaceted and complex
True
60
A single model cannot account for ___ when regarding addiction
The heterogeneous and complex pathways to addiction
61
A biopsychosocial perspective is helpful for ___ (addiction)
Conceptualizing the complex and varied pathways to addiction
62
What is linked to the development of addiction?
The experience of stress and trauma
63
What are biological treatment approaches for SUD?
Agonist substitution
Antagonist substitution
Aversive treatments
Drugs to help recovering person deal with withdrawal symptoms
64
What drugs work for opiate withdrawal?
Clonidine
65
What drugs work with alcohol withdrawal?
Sedatives
66
What is agonist substitution?
Replacing one drug with a similar one (methadone for heroin)
67
What is antagonist substitution?
Block one drug's effects with another drug (naltrexone for opiates and alcohol)
68
What are aversive treatments?
Make taking the drug very unpleasant
69
What is "all or nothing" rooted in?
Belief that change is motivated by the experience of negative consequences from substance use
70
What does "all or nothing" require prior to receiving treatment?
Abstinence
71
According to "all or nothing", continued substance use is a sign that
the person is unmotivated to change
72
What would providing service to persons who have not abstained result in?
Would delay their commitment to abstinence and thus change
73
What are the limitations of "all or nothing" approaches?
Deprives people who are not interested in cessation, but want to remain healthy
Deprives people who have problems controlling one addictive behavior, but not other addictive behaviors
Limits the right to self determination
Harm reduction policies, programs, and approaches deal with these limitations (e.g., safe injection sites and needle exchange programs)
74
What does relapse mean?
Failure to maintain behavioral change
75
Although changing an addictive behavior is difficult...
Maintaining change is even more challenging
76
What is the relapsing nature of addictive behaviors?
Relapse is common in the recovery process for addictive behaviors (during treatment and post-treatment)
77
What has addiction been conceptualized as?
A chronic relapsing disorder or chronic disease
78
What are the five principles of motivational interviewing?
1) Express empathy for the client
2) Develop discrepancy between the clients goals and values and their current behavior
3) Avoid argumentation and direct confrontation
4) Roll with client resistance, instead of fighting it
5) Support the clients self efficacy, or their belief that they can change
79
What are 12-Step Mutual Help Organizations?
Alcoholics Anonymous (AA)
80
What is AA?
Supports recovery through helping members cultivate spirituality and related practices as a new way of living
81
How does AA help?
Facilitates helpful social network changes
Boots people's confidence in their ability to remain sober when faced with high risk social situations or when feeling down
Reduces craving and impulsivity
82
What are the 12 AA steps?
Acceptance
Hope
Willingness
Personal inventory
Self disclosure
Reflection
Humility
Amends list
Made amends
Continued inventory
Spiritual growth
Giving back
83
What is social identity theory?
Part of people's self concept is derived from their membership in social groups
84
What is the preventure programme?
Examined how childrens temperament drives their risk for drug use, indicating different pathways to addiction
(Since most teens who try addictive substances do not become addicted, the program focuses on what's different about the minority who do)
85
What can help identify most of the highest risk children before their risk traits cause problems?
Personality testing
86
Example Questionnaire Items
Impulsivity: I often don't think things through before I speak
Sensation seeking: I would like to skydive
Hopelessness: I am very enthusiastic about my future (reversed item)
Anxiety sensitivity: I get scared when I'm too nervous
87
How does the preventure programme work?
1. An intensive two- to three-day training is given for teachers—
a crash course in therapy techniques proven to fight
psychological problems.
2. When the school year starts, middle schoolers take a
personality test to identify the outliers. Months later, two 90-
minute workshops—framed as a way to channel students’
personalities toward success—are offered to the whole
school, with only a limited number of slots.
3. The workshops teach students cognitive behavioral
techniques to address specific emotional and behavioral
problems.
88
The interventions in preventure programme workshop are conducted using manuals that incorporate components of:
-Psycho-educational
-Motivational enhancement therapy (MET)
-Cognitive-behavioral therapy (CBT)
-And include real-life 'scenarios' shared by local youth with similar personality profiles
89
What is the goal of preventure workshops?
Provide participants with the tools to moderate the cognitive and behavioral tendencies stemming from their personality that contribute to their difficulties in life
90
Is the preventure programme effective for alcohol issues?
Two RCTs show reduced alcohol consumption and initiation and problem drinking among at risk adolescents
91
Is the preventure programme effective for cannabis issues?
One RCT showed reduced cannabis consumption and initiation amongst at risk adolescents who score high on sensation seeking only
92
Why was the program for cannabis only effective with those who scored high on sensation seeking?
maybe because...
-there was more cannabis use among SS youth
-other personality factors play a role in cannabis use during later development
- other personality targeted interventions do not target motives relevant to cannabis use in youths
93
Depressive disorders and bipolar disorders in DSM-IV
Depressive disorders and bipolar and related disorders were grouped
94
Depressive disorders and bipolar disorders in DSM-V
Separate chapters
Bipolar and related disorders is placed in between chapters on Schizophrenia spectrum and other psychotic disorders and depressive disorders as a bridge between two diagnostic classes in terms of symptoms, family history, and genetics
95
General Characteristics of Mood Disorders
Much more serious than typical emotional states that everyone feels
Involve significant disturbances in emotion, including extreme sadness (depression) or elation/irritability (mania)
Are disabling (i.e., interfere with daily activities/functioning)
96
What are other serious psychological problems associated with mood disorders?
Panic attacks
Substance abuse
Sexual dysfunction
Personality disorders
97
What is the prevalence of Major Depressive Disorder?
US Lifetime = 5.2 to 17.1 %
Canada Lifetime = 11.2%
98
Which gender more common to have Major Depressive Disorder?
2x more common in women than in men (difference appears in adolescence and is maintained across the lifespan)
99
Why is there a gender difference for major depressive disorder?
Men more likely to distract
Women are more likely to ruminate (brooding) on their depressive feelings and the causes of the depressive feelings (also more likely to co-ruminate with friends)
100
What is the brooding subscale?
Think:
"What am I doing to deserve this"
"Why do i always react this way"
Wishing a situation had gone better
"Why do i have problems other people dont have"
"Why cant i handle things better"
101
Lifetime prevalence of Persistent Depressive Disorder?
4.6%
102
What is double depression?
People with persistent depressive disorder may also experience episodes of major depressive disorder
103
What was Bipolar I Disorder historically called?
Manic depressive disorder
104
What is required for a diagnosis of Bipolar I Disorder?
The presence of at least 1 manic episode
105
What is required for a diagnosis of a Bipolar II Disorder?
At least 1 hypomanic episode, and at least 1 manic depressive episode is required
106
What is mania?
An emotional state or mood of intense but unfounded elation accompanied by irritability, hyperactivity, talkativeness, flight of ideas, distractibility, and impractical grandiose plans
107
How is mani noticed by others?
Due to loud and incessant remarks, sometimes full of puns, jokes, rhyming, etc., difficult to interrupt, shifting from topic to topic, need for activity that can be annoying to others and with poor planning
108
What is a mixed episode?
Individual experiences rapidly alternating moods (sadness, irritability, euphoria) accompanied by symptoms of mania and depression
Criteria are met for both a Manic/Hypomanic Episode and a Major Depressive Episode nearly everyday
109
When can a mixed episode occur?
During a depressive, manic, or hypomanic episode
110
When do symptoms occur during mixed episode?
Symptoms during the majority of the days of the episode
111
What is the lifetime prevalence for Bipolar Disorders?
4.4%
112
What is lifetime prevalence of cyclothymic disorder?
2.5%
113
Does bipolar or MDD occur more often?
MDD
114
When is the average age of onset of Bipolar disorders?
20s
115
What are the differences in symptoms of Bipolar Disorders between genders?
In women, depression episodes more common
In men, episodes of mania are more common
116
Does Bipolar Disorders occur more in men or women?
Bipolar disorders occur equally often in men and women, however kinds of episodes vary
117
How do Bipolar Disorders recur?
More than 50% have a recurrence within 12 months
More than 50% of cases have 4+ episodes
118
What is the Psychoanalytic Theory of Depression ?
Analogy to bereavement, according to Freud
Depression is seen to be like a mourner who over-identifies with (introjects) the lost love one
Anger turned inward (resents feeling abandoned)
Research: some individuals who show high dependency traits are more prone to depression following less experiences
119
What is sociotrophy?
Over concern with pleasing others, avoiding disapproval, and avoiding separation
120
What is autonomy?
-Self critical
-Preference for solitude
-Freedom from control (independence)
121
What are personality factors that increase vulnerability to depression?
Sociotropy
Autonomy
Perfectionism
122
What is cognitive research?
Recall of cognitive products (the stimuli that is recalled)
Cognitive processes or operations involving attention
Cognitive structure/organization of the schema
123
What are the three helplessness theories of depression?
1. Learned Helplessness
2. Attributional Reformulation
3. Learned Helplessness
124
What is Interpersonal Theory of Depression?
Sparse social networks that provide little support (decreased an individuals ability to handle negative life events, increase vulnerability to depression)
Depressed people also elicit negative reactions from others and are low in social skills
They also constantly seek the reassurance of others
125
Which theory of Bipolar Disorder are largely neglected by scholars and clinicians?
Psychological Theories
126
What genes may be linked to Bipolar Disorder?
A dominant gene on the 11th chromosome
Brain derived neurotrophic factor (BBDNF) gene
127
What is the twin concordance rate of Bipolar Disorder?
as high as 85%
128
What is the heritability estimate of MDD?
35%
129
Relatives of MDD probands are at what risk for MDD?
Increased risk
130
What is considered to be a genetic factor in MDD?
Serotonin transporter gene-linked promoter region (5-HTTLPR)
131
Early biological theories postulated what about Bipolar disorders?
Decreased levels of norepinephrine and dopamine lead to depression
Elevated levels of norepinephrine and dopamine lead to mania
132
What is serotonin theory?
Serotonin (which regulates norepinephrine) produces both depression and mania
133
What do tricyclic drugs do?
Prevent some of the reuptake of norepinephrine, serotonin, and/or dopamine by the presynaptic neuron after it has fired
134
What do monoamine oxidase (MAO) inhibitors do?
Keep the enzyme monoamine oxidase from deactivating neurotransmitters therefore increasing the levels of serotonin, norepinephrine, and/or dopamine in the synapse
135
What do selective serotonin reuptake inhibitors (SSRI) do?
Inhibit the reuptake of serotonin
136
What did neuroimaging studies find in BPD?
Decreased hippocampal volume and neurocognitive impairment
137
What has functional imaging of cingulated area 25?
Induction of dysphoria in healthy people cause increased glucose metabolism in cingulated area 25
Treatment with paroxetine showed decreased hypermetabolism in cingulated area 25
138
T/F: MAO-A levels in the brain are elevated during untreated depression
True
139
How does HPA axis play a role in depression?
Limbic area of brain (closely linked to emotion) affects the hypothalamus which in turn controls endocrine glands (release of hormones)
Increased levels of cortisol in depressed patients
140
How are disorders of thyroid function are often seen in bipolar patients?
Thyroid hormones can induce mania
141
What is suicidal ideation?
Thoughts and intentions of killing oneself
142
What are suicide attempts?
Self-injury behaviors intended to cause death but that do not lead to death
143
What are suicide gestures?
Self injury in which there is no intent to die
144
What is suicide?
Behaviors intended to cause death and death occurs
145
Explain suicide in Canada
Suicide was the 9th leading cause of death in Canada
Suicide is the 2nd cause of death (after accidents) in youth ages 15 to 24
146
What is gender paradox of suicidal behavior?
Women have higher rates of suicide attempts but lower rates of suicide as compared to men
147
Do all people with MDD have suicidal ideation?
Suicidal ideation was moderately stable, but not more stable than other non-core symptoms of MDD (fatigue, appetite/weight change, sleep disturbance, psychomotor disturbance, etc)
148
What was most stable factor of MDD?
Insomnia
149
What was least stable factor of MDD?
Weight decrease
150
Are core symptoms more stable than non-core symptoms?
Interestingly, the two core symptoms (anhedonia and depressed mood) were not more stable than the non-core symptoms
151
What are the four categories of relevant factors in risk factor model?
1. Predisposing
2. Precipitating
3. Contributing
4. Protective
152
Examples of predisposing factors
Psychological disorder, abuse, early loss
153
Examples of precipitating factors
End of relationship, job loss, rejection
154
Examples of contributing factors
Physical illness, isolation
155
Examples of protective factors
Personal resilience, active coping skills, positive future expectations, social support
156
What are common risk factors for suicide attempts?
Previous mental or SUD and exposure to interpersonal violence
157
What are women specific risk factors for suicide attempts?
Eating disorders, PTSD, bipolar disorder, being a victim of dating violence, depressive symptoms, interpersonal problems and previous abortion
158
What are men specific risk factors for suicide attempts?
Disruptive behavior/conduct problems, hopelessness, parental separation/divorce, friend's suicidal behavior, access to means (e.g., firearms, pesticides, toxic gas)
159
What are men specific risk factors for suicide death?
Drug abuse, externalizing disorders, and access to means
160
What is Shneidman's Approach?
Perturbation of mind is a key feature
Suicidal individuals are experiencing psychache which is intense anguish
161
What is Baumeister's Escape Theory and Perfectionism?
Painfully aware of person shortcomings
Become suicidal to escape aversive self awareness
Perfectionists have such impossibly high self standards
162
What is perfection and social disconnection?
Perfectionism is linked to low perceived social support, having no sense of belonging, not being accepted, and failing to meet others expectations
163
What is constricted thinking?
Makes it hard to see options - need to help them see a wider range of alternatives to solve the problem that provoked the suicidal distress
164
What are physical factors in suicide?
Repeated concussion injuries (such as hockey 'enforcers') develop chronic traumatic encephalopathy (CTE)
Decreased levels of 5-HIAA related suicide
165
