Final Flashcards
Sociocultural theory of ED
Cultural views of body image promote eating disorder behaviours because individuals are trying to achieve what society values
Pressure from media, peers, and family cause people to internalize the thin ideal causing someone to engage in eating disorder behaviours
Affect and emotional regulation of ED
Dual-pathway model of BN: affect regulation model: pressure to be thin and thin ideal internalization leads to body dissatisfaction which leads to dieting or negative affect and causes person to engage in behaviours to cope with mood
Weight suppression
difference between highest previous weight and current weight
As this number increases risk for eating disorder increases
Weight sUppression reduces leptin (which tells us whether we’re hungry or full, appetite hormone produced by fat)
This increases reward sensitivity and decreases reward satisfaction increasing likelihood of binge eating
Treatment of ED
Inpatient or partial hospitalization: for medical stabilization for AN weight restoration
Psychotropic medications: SSRIs are effective for BN and BED in combination with psychotherapy
No approved meds for AN - preliminary efficacy for Zyprexa/Olanzapineis front line treatment for BN but
CBT is used to treat BN but only world for about 50%
2 phases of breaking disordered eating habits
Phase 1: break binge purge cycle
Monitor eating habits
Regular eating
Avoid situations leading to binging
Develop better ways of coping with stress
Phase 2:
Identify and modify irrational beliefs
Family Therapy is most effective treatment for adolescent AN
Parents are responsible for feeding the child
Criteria for Schizophrenia
At least 2 of following:
Delusions
Hallucinations
Disorganized speech
(above three are positive symptoms, must have 1)
Disorganized behaviour
Negative symptoms
Have To cause dysfunction
Have to occur for at least 6 months
Positive symptoms
Something being added to experience
Presence of unusual perceptions, thoughts, or behaviours
Negative symptoms
Deficit in something
Absence of behaviours, feelings, that are normal for person
Types of delusions
Persecutory (paranoid)
Reference: events are directed to oneself like the radio
Grandiose: i am god
Somatic: appearance or body is altered or diseased
Being controlled: aliens are controlling my thoughts
What is a delusion
Ideas that an individual believes are true, but are highly unlikely or simply impossible
Hallucinations
Unreal perceptual experiences
Hallucinations in schizophrenia are bizarre and extremely distressing and impairing
Auditory hallucinations
Most common
More common in women than men
Voices talk to each other
Can be threatening or aggressive and give orders
Disorganized thoughts and speech
Loosening of associations or derailment: words make sense but don’t fit together - go from one topic entirely to another
Word salad - words make no sense
neologisms - made up words
Disorganized or catatonic behaviour
Disorganized - unpredictable and untriggered
Can explain: disheveled appearances, inappropriate hygiene/ clothing
Shouting, swearing pacing
Catatonia refers to disorganized behaviors that refer to extreme lack of responsiveness
Negative symptoms
Affective flattening - lack of overt emotional expression or responsiveness - blunt affect to environment
Alogia - poverty of speech, few words, not initiating speech
Avolition - decreased motivation
tend to be most impairing, not targeted by medications
Cognitive deficits
Associative feature - not in criteria
Deficits in working memory, cognition and attention may cause
Phases of schizophrenia
Prodromal phase - symptoms present before full criteria is met
Acute - active psychosis
Residual phase - symptoms present after acute phase
What other health complications come with schizophrenia / what is relapse rate
Life expectancy is ten years shorter ‘
High relapse (85% have residual or active symptoms)
Higher rates of infectious and circulatory diseases
Schizoaffective disorder
mix of mood disorder and schizophrenia, mostly psychosis, but mood symptoms embedded in episode of psychosis
Schizophreniform disorder
Schizophrenia but symptoms only occur for 1-6 months
Brief psychotic disorder
1 day to one month of psychotic symptoms - more sudden onset
Delusional disorder
no symptoms other then delusions but causing distress and impairment
Genetic component of schizophrenia
50% concordance MZ twins
40% likelihood if both parents have disorder
Brain abnormalities in schizophrenia
Enlarged ventricles
Reduced gray matter in temporal and frontal lobes
Prefrontal cortex: smaller or less activation
Limbic system (amygdala) and hippocampus abnormalities
Etiological factors of schizophrenia
Prenatal virus exposure: high rates of schizophrenia associated with flu
Birth complications: perinatal hypoxia
Neurotransmitters: overactive dopamine in mesolimbic pathway, underactive dopamine in prefrontal areas
Positive symptoms from overactivity and negative symptoms from underactivity
Dopamine theory of schizophrenia
Abnormal functioning in dopamine in prefrontal - deficits in working memory - difficulty in attending relevant information - difficulty in social situations
Psychosocial factors of schizophrenia
Stress - psychotic episodes often follow periods of high stress
Interaction between life stress and genetic vulnerability
Family communication patterns - expressed emotion: critical comments, hostility, emotional over involvement, lack of warmth - increases risk of relapse
Sociogenic theory
genetic vulnerability with stress of financial insecurity leads to schizophrenia
Social drift hypothesis
people with schizophrenia drift downwards socioeconomically due to disorder
Schizophrenia psychosocial treatments
Family therapy - beneficial for families with high expressed emotion, helps facilitate healthy dialogue and help members understand disorder, teaches communication and problem solving, stops over involvement
Social skills training & Stress management training - Improves relationship building, problem solving, can be group or individual, stress training help manage stress, likely uses homework
CBT - targets negative cognitive distortions
Never done alone, always with medication
9 DSM categories of substance use disorder
Alcohol, Caffeine, cannabis, inhalant, opioid, sedative/ hypnotic anxiolytic, stimulant, tobacco, other
Diagnostic criteria for SUD
Requirements:
Impairment of control
Social impairment
Risky use
Pharmacological dependence
2+ following symptoms occuring within 12 month period:
Taken larger amount then intended
Persistent desire/ unsuccessful efforts to reduce or stop
Great time spent using, recovering, or obtaining
Craving
Failure to fulfill social, personal or professional obligations
Continued use despite social or interpersonal problems
Activities given up to use
Recurrent use in hazardous situations
Recurrent use despite psych/ phys problems
Tolerance
Withdrawal
Substance induced disorders
Intoxication
Withdrawal
substance/ medication induced
Types of substances
Depressants
Stimulants
Hallucinogens
Opioids
other
Alcohol (where does it bind, what are the effects at low and high doses
1 worldwide psychoactive substance
Binds to GABA and Glutamate receptors
Intoxication:
low doses = self confidence, relation, slight euphoria, disinhibition
High doses = fatigue, lethargy, discoordination, blackout, impaired respiration, death
Hangovers
Appear after heavy bout of drinking when BAC returns to 0
Headache, fatigue, lightheadedness, dehydration, anxiety, agitation, low mood
Caused by dehydration, sleep deprivation, and cytokines (inflammatory makers)
Withdrawal from alcohol
First few hours causes shakes, weakness, cramps, perspiration, nausea, headache
12h-3 days: convulsive seizures, delirium tremens: hallucinations, delusions, fever, perspiration, irregular heartbeat
Prevalence of AUD
80% of canadians drink - more men
AUD: 18.1% lifetime, 3.2% past year
Prevalence: 4.7% for men, 1.7% for women
Biphasic effect of alcohol
Alcohol has initially stimulating effects , but then has sedating effects as BAC decreases
Risks of alcoholism
Can cause cancer, cirrhosis of liver, FAS, and alcohol related dementia
Opioids
Opium comes from poppy plant
Morphine, heroin, fentanyl
Bind to opioid receptors
Causes euphoria, relaxation, dulled senses
Side effects of opioid use
itchiness, impaired respiration, nausea, vomiting
Prevalence of opioids
13% (2% non-medical)
13.9% women vs 12.1% men
Heroin <1% - more use among men esp injection
Cannabis
Caused by THC
Binds to cannabinoid receptors
Intoxication:
Mild changes in perception, euphoria, analgesia
Hallucination, panic, anxiety, paranoia
Cannabis withdrawal
irritability, insomnia, vivid dreams/nightmares, disrupted appetite
Risks and benefits of cannabis
deficits in working and short term memory, amotivational syndrome, psychotic episodes
Possible benefits for glaucoma, anti-nausea, epilepsy, everything else is anecdotal
Biological treatments for AUD
Benzos for withdrawal
Naltrexone (opioid antagonist)
Antabuse (blocks metabolism of acetaldehyde)
Biological treatments for opioid use
Naloxone (opioid receptor antagonist)
Methadone (opioid agonist)
Buprenorphine/ naloxone
Behavioural/ psychological treatments of SUD
12 step AA
CBT
Contingency management
Motivational interviewing
Goals of treatments
Abstinence
Moderation
Harm reduction
Personality and personality trait
complex pattern of behaviour, thought and feeling
Personality - typical ways of acting thinking believing and feeling
Considered stable across time and situations
Personality disorders
long standing pattern of maladaptive behaviours thoughts and feelings
Develops in adolescence
Tend to be highly comorbid meaning that the way we diagnose them isn’t totally accurate
Most people see their “way of seeing” as normal
These people rarely come in for their personality - often come in with depression, anxiety or other conditions where in assessment it’s determined that they may have a personality disorder
Cluster A disorders
Odd-eccentric
Paranoid
Schizotypal
Schizoid
Paranoid PD
pervasive distrust of others - runs in families
Schizoid PD
lack of desire to form personal relationships - could look like social anxiety
Schizotypal PD
odd cognitions and behaviours - looks closest to schizophrenia - could be odd beliefs or magical thinking, just short of hallucinations
Often thought of as part of schizophrenia spectrum
But not completely out of touch with reality
Cluster B Disorders
Emotional dysregulation
Borderline
Histrionic
Antisocial
Narcissistic
Antisocial PD
presence of conduct disorder before age of 15
Failure to conform
Deceitfulness
Impulsivity, failure to plan ahead
Irritability and aggressiveness
Reckless disregard for safety of self or others
Consistent irresponsibility
Lack of remorse
Everyone who has psychopathy has ASPD, but not everyone with ASPD has psychopathy
Treatment for ASPD
most don’t think they need it
Aim to recognize triggers and develop alternative coping strategies
Some aim to develop empathy
Drug treatment evidence is inconclusive
Histrionic PD
pervasive pattern of excessive emotionality and attention seeking
Four major categories of BPD
four major categories
Cognitive dysregulation Identity disturbance - struggle with forming core sense of self Chronic feelings of emptiness
Impulsivity - Binge eating, reckless sexual or driving behaviour
Emotion dysregulation - heightened emotion without skills to manage
Interpersonal problems - fears of abandonment
Biosocial model of BPD
biosocial model (Lineham - DBT queen)
Extreme emotional reactions lead to impulsivity
Emotional experiences are discounted, criticized by others (invalidating environment)
Support from others is necessary to cope
How emotionally sensitive one is to environment - more reactive
Narcissistic PD criteria
Grandiose sense of self-importance
Preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love
Believes they are special and can only be understood by other high status people
Requires excessive admiration
Sense of entitlement
Interpersonally explosive
Lacks empathy
Arrogant, haughty behaviours or attitudes
Dependent PD
pervasive and excessive need to be taken care of that leads to submissive, clingy behaviour and fear of separation
Avoidant PD
pervasive pattern of extreme social inhibition, feelings of inadequacy and sensitivity to rejection
Obsessive compulsive PD
drive for orderliness, organization, extremely high perfectionism
Some cognitive behavioural treatments shown to be effective
Problems with PD diagnosis
Categorical/ disease models
Criteria overlap
Subjective criteria/ diagnostic reliability problems
Gender and ethnic bias - black people more likely to be diagnosed with ASPD and paranoid PD, women are more diagnosed with BPD and histrionic PD
Alternative model in the DSM for PD: emerging measures and models
Hybrid dimensional/ categorical system
General criteria for PD (based on dimensional scales)
Personality functioning in self identity and interpersonal domains (empathy and intimacy) 0-4 scale
Dimensional traits in 5 domains - reflect Big 5
Antagonism v agreeableness
Detachment v extraversion
Disinhibition (impulsivity) v conscientiousness
Negative affectivity v emotional stability
Psychoticism v lucidity (grounded stability)
Six possible personality disorder types: avoidant, schizotypal, antisocial, narcissistic, obsessive-compulsive, borderline
Diathesis stress model for schizophrenia
some form of inherited biological vulnerability interacts with environmental stressors
Several genes have been implicated in schizophrenia - not one specific gene can tell whether someone will develop disorder or is vulnerable
Neurodevelopment model for schizophrenia
End state of atypical development
At all stages of development risk for schizophrenia can increased
Maternal infection is associated with increased risk
In utero exposure to famine has been linked to increased risk of disorder
People with this disorder often displayed developmental delays as children
Atypical social development as children
Many display mental health difficulties of other kinds earlier in life
Culture and schizophrenia
Culture play role in positive symptoms of disorder where asd negative, cognitive symptoms and thought disorder are seen consistently across cultures
Religion plays role in type of delusions and hallucinations
People who see things are treated with deep respect in many cultures
Some cultures incorporate traditional healers to treatment
Social risks for schizophrenia
urban upbringing, migration, childhood trauma, low intelligence, and drug abuse
Myths about eating disorders
Only affects women
Parents or medias faut
People with ed are underweight
Barbs and benzos
Depressants that inhibit activity in CNS
Sleep and antianxiety drugs
Small doses cause mild euphoria
Larger doses cause slurred speeches, poor motor coordination, impairment of judgement and concentration, eventual sleep induction
Similar to alcohol behaviour
Very large barbiturate doses lower respiration, blood pressure and heart rate, can cause suffocation, and coma due to depressing CNS
Tolerance to barbs and benzos
Tolerance to barbiturates develops fast
Tolerance to benzos develops slower
Trying to abstain with a high tolerance may lead to extreme withdrawal including delirium, convulsions, and sleep disturbances similar to alcohol withdrawal
Nicotine
CNS stimulant related to amphetamines
Stimulants create effect by influencing uptake of dopamine
When inhaled, nicotine enters the lungs and reaches the brain in seconds.
stimulates the release of dopamine in the nucleus accumbens.
thought to contribute to its rewarding and addictive properties
Dependence of nicotine seen to be greater than other addictive substances
Develops quick
Withdrawal when stopping
Amphetamines
have effects on the body similar to the naturally occurring hormone adrenalin.
Meth
Speed when injected, ice/crystal when smoked
ADHD meds, MDMA
orginally nasal decongestant
Effects of amphetamines
Increases alertness and attention
Improved cognitive tasks
Can also induce extraversion and confidence at a highr dose
Can also cause anxiety at high dose
Effects of chronic amphetamine use
Fatigue and sadness.
Social withdrawal and intense anger.
High doses can cause toxic psychosis (hallucinations, delirium, paranoia)
To counter sleeplessness, users often rely on depressants like tranquilizers, barbiturates, or alcohol
Irregular heartbeat, blood preasure fluctuations, hold/cold flashes, nausea, dilation of pupils
Weight loss after a while
High doses can cause seizures and coma
Tolerance develops quickly
Cocaine (low dose, high dose, chronic use)
Can quickly cause euphoria and confidence - alert and talkative
increases the availability of dopamine
With high dose: CNS is overstimulated
Poor muscle control, confusion, anger
Continues can cause
Weight loss, insomnia, mood swings
Toxic psychosis
Physical symptoms include blood pressure and body temp increase, and irregular heartbeat
Amotivational syndrome
Caused by chronic cannabis use
a continuing pattern of apathy, profound self-absorption, detachment from friends and family, and abandonment of career and educational goals.
Hallucinogens
change a person’s mental state by inducing perceptual and sensory distortions or hallucinations.
Hallucinogens have an excitatory effect on the CNS and mimic the effects of serotonin by acting upon serotonin receptors in the brain stem and cerebral cortex.
