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Psychology of addictions > Lecture 3: Co-occurring Disorders > Flashcards

Lecture 3: Co-occurring Disorders Flashcards

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1
Q

Odd, Eccentric:

Paranoid

Schizoid

Schizotypal

A

Cluster A

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2
Q

Dramatic, Erratic

Antisocial

Borderline

Histrionic

Narcissistic

A

Cluster B

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3
Q

Anxious, Fearful

Avoidant

Dependant

Obsessive-Compulsive

General Big Five profile

High neuroticism

And if we remove dependent personality disorder, considering just the alternative model (DSM-5 appendix)… then the remaining 2 (avoidant, obsessive-compulsive) both have low extraversion

A

Cluster C

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4
Q

Comorbidity

A
  • Also referred to as Dual Diagnosis or Co-Occurring Disorders is when 2 disorders are present
  • Important to consider ADDICTION as primary before personality disorder.
  • Too easy to diagnose personality disorder based on addiction behaviour.
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5
Q

Concomitant Factors

A

Things that occur together

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6
Q

Schizophrenia Comorbidity

A

80% of Canadians with ________ will experience a substance abuse problem in their lifetime.

Roughly 4x the average risk.

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7
Q

Cannabis Comorbidity

A
  • gateway drug; frequent users have much greater lifetime probability than non-users to use ‘dangerous substances’; opioids or cocaine.
  • Cocaine = 12%
  • Methamphetamine = 6%
  • Heroin or other Opioids = 2%
  • 25-80% of people with SUD report use of cannabis
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8
Q

Substances with Substances

50% / 90% / 90%

A
  • if you’ve had any other substance use disorder you have a roughly _______ chance of developing an alcohol use disorder in your lifetime
  • Of those on methadone maintance treatment (recovering opiod users) _______ are smokers.
  • Of those in inpatient treatment for alcoholoism, _______ are smokers.
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9
Q

Lifetime Prevalence

21.6%

A

The proportion of a population who, at some point in life has ever had the characteristic.

  • Approximately ______ of Canadians (6 million) meet criteria for SUD during their lifetime.
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10
Q

Prevalence | Yearly Prevalence

6.4% / 2.5%

A

The proportion of a population that has the characteristic at any point during a given time period of interest, usually a year.

  • Changes of having an SUD in a given year
    • _____ for males
    • _____ for females
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11
Q

Personality Disorder

A

A persistent pattern of emotions (across situations), cognitions, and behaviour that results in enduring emotional distress for the individual or others. Assessed in terms of dysfunction (adaptive problems) and requires life long course (since at least adolescence).

  • far less researched than other disorders
  • most research is on APD
  • relegtated (DSM-IV) to Axis II. Treated as “not quite real.”
  • only some insurance providers cover them
  • Axis II defered means “this client likely has but I don’t have time or need to get to bottom of it.”
  • researchers dismissive (we’re all a little narcissistic”).
  • If you see 3 clients for SUD expect one will have a PD.
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12
Q

Personality Disorder Comorbidity

28.6% / 47.7%

A

Percentage of population with addictive disorder who also have a PD:

  • Of those with current Alcohol UD, _____ had at least one PD
  • Of those with current Drug UD, _____ had at least one PD

Those with addiction disorder and more likely in having a PD

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13
Q

CO-OC and Community Samples

(Canadian vs NA included)

A

Canadian (community samples)

  • 37 % of those with AlcoholUD have a Mental Illness
  • 53 % of those who abuse drugs have Mental Illness

North American (community samples)

  • 28.6 % of those with AlcoholUD had at least one PD
  • 47.7 % of those with DrugUD had at least one PD

Percentage of population with a PD also with addictive disorder

  • 16.4% had a current alcohol use disorder
  • 6.5% had a current SUD​

Community Samples tell us:

  1. If you meet a random person with a PD, there is a fair (but not huge) chance they’ll also have an addiction or two.
  2. If you meet a random person with Addiction, there’s a good chance they’ll also have a PD or two.
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14
Q

Co-Occuring and Clinical Samples

A

Clinical samples (have more comorbidity):

  • Of those with a current SUD:
    • 57-73% had at least one PD
    • 35-50% had at least two PDs
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15
Q

OC-OC Clinical Opiate Samples

A

Craig (1988) assessed 121 opiate addicts (in Chicago):

100% had at least one PD and 27% had more than one

  • Antisocial = 22%
  • Narcissistic = 18%
  • Borderline = 16%
  • Dependent = 16%
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16
Q

CO-OC Clinical Cocaine Samples

A

Cocaine abusers

  • 71 % had at least one PD
  • 40 % had two or more

Most common

  • Antisocial = 21 %
  • Borderline = 18 %
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17
Q

Personality Disorder Debate

A
  • Personality traits are dimensional
  • Diagnoses are categorical (either have or don’t)
  • Should PD be dimensional or categorical?
18
Q

Dead Disorders

A

DSM-1: Inadequate Personality, Learning Disturbance, Sexual Deviation, Speech Disturbance, Enuresis (bed-wetting), Somnambulism (sleep-walking)

DSM-2: Explosive, Hysterical, Asthenic (weak) neurasthenia (lassitude, fatigue, headache, and irritability, associated chiefly with emotional disturbance).

DSM-3R: Masochistic, Self-Defeating

Personality PDs has been relatively unchanged since 1980s (DSM-3)

19
Q

Paranoid Personality Disorder

A

Cluster A: Odd, Eccentric

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent

  • Not in the proposed alternative model (DSM-5 appendix)
  • Removal recommended due to little research on the disorder

​________

  • 0.5-2.5% prevalence (yearly)
  • More common in males
  • Most comorbidity with Schizotypal

  1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
  2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends and associates
  3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
  4. Reads hidden demeaning or threatening meanings into benign remarks or events
  5. Persistently bears grudges
  6. Perceives attacks on character/reputation that are not apparent to others and quick to react angrily or to counterattack
  7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
20
Q

Schizoid Personality Disorder

A

Cluster A: Odd, Eccentric

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings

  • Not in the proposed alternative model (DSM-5 appendix)
  • Removal recommended due to little research on the disorder

​______________

  • <1% prevalence
  • More common in males
  • Most comorbidity with schizotypal
21
Q

Schizotypal Personality Disorder

A

Cluster A: Odd, Eccentric

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for close relationships, as well as by cognitive and perceptual distortions and eccentricities of behaviour. / schizoid symptoms, magical thinking and odd behaviour - more letters - more symptoms

  • In the proposed alternative model (DSM-5 appendix)

​__________

  • Typical features: impairments for social/close relationships, eccentricities in cognition, perception, behaviour associated with distorted self-image, incoherent personal goals, accompanied by suspiciousness and restricted emotional expression

______________

  • 3-5% prevalence;
  • More common in males;
  • Most comorbidity with paranoid personality disorder.
22
Q

Schizo vs. Schizotypal

A

Schizotypal seen as “closer” to schizophrenia (e.g., genetically). It is listed also in the Schizophrenia Spectrum category of the DSM-5

  • Schizoid seen as having less social interest and less affect (schizotypal may have more social fear)
  • Schizotypal is better researched and supported diagnostic category of the two
23
Q

Antisocial Personality Disorder

A

Cluster B: Dramatic, Erratic

Typical features are a failure to conform to lawful, ethical behaviour and an egocentric, callous lack of concern, accompanied by deceitful ness, irresponsibility, manipulativeness, and/or risk taking.

  • Disorder is in the proposed alternative model (DSM-5 appendix)

​_________

  • pervasive pattern of disregard for / violation of rights of others
  • 3% prevalence in males
  • 1% prevalence in females
  • Most comorbidity with narcissistic personality disorder

Psychopathy (extreme APD)

Psychopathy a specifier in proposed alternative model (DSM-5 appendix):
“marked by a lack of anxiety or fear and by a bold interpersonal style that may mask maladaptive behaviours (e.g., fraudulence). […] low levels of anxiousness and withdrawal and high levels of attention seeking.”

  • 0.75 % prevalence in males
  • 0.25 % prevalence in females

Yet psychopaths count 15-25% of imprisoned Canadian offenders

Key Characteristics

  1. Glibness/superficial charm
  2. Grandiose sense of self-worth
  3. Proneness to boredom/need for stimulation
  4. Pathological lying
  5. Conning/manipulative
  6. Lack of remorse
24
Q

Borderline Personality Disorder

A

Cluster B: Dramatic, Erratic

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity

  • This disorder is in the proposed alternative model (DSM-5 appendix)

​_____

  • 1-3% prevalence
  • More common in females
  • Most comorbidity with schizotypal personality disorder

Typical features are instability of self-image, personal goals, interpersonal relationships, and affects, accompanied by impulsivity, risk-taking, and/or hostility.

Big Five Profile

  • High extraversion
  • High neuroticism
  • Low agreeableness
  • Low conscientiousness
25
Q

Histrionic Personality Disorder

A

Cluster B: Dramatic, Erratic

A pervasive pattern of excessive emotionality and attention seeking.

  • This disorder is not in the proposed alternative model (DSM-5 appendix)
  • Removal recommended. Little research on (successful treatment) of disorder

​_____

  • 2% prevalence
  • Equally common in males and females
  • Most comorbidity with narcissistic personality disorder

Big Five Profile

  • High extraversion
  • High neuroticism
  • High openness
  • Low conscientiousness
26
Q

Narcissistic Personality Disorder

A

Cluster B: Dramatic, Erratic

A pervasive pattern of grandiosity (in fantasy and behaviour), need for admiration, and lack of empathy.

  • This disorder is in the proposed alternative model (DSM-5 appendix)
  • Typical features are variable and vulnerable self-esteem, with attempts at regulation through attention and approval seeking, and either overt or covert grandiosity

​_____

  • <1% prevalence
  • More common in males
  • Most comorbidity with antisocial personality disorder
  • SIN: Single Item Narcissism Question: How Narcissistic Are you?
27
Q

Avoidant Personality Disorder

A

Cluster C: Anxious, Fearful

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

  • This disorder is in the proposed alternative model (DSM-5 appendix):
  • Typical features are avoidance of social situations and inhibition in interpersonal relationships related to feelings of ineptitude and inadequacy, anxious preoccupation with negative evaluation and rejection, and fears of ridicule or embarrassment.”

​_____

  • <1% prevalence
  • Equally common in females and males
  • Most comorbidity with schizoid personality disorder

Big Five Profile

  • Low extraversion
  • High neuroticism
28
Q

Dependent Personality Disorder

A

Cluster C: Anxious, Fearful

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency

_____

  • This disorder is not in the proposed alternative model (DSM-5 appendix)
  • Removal has been recommended due to little research on the disorder

​_____

  • 2% prevalence
  • Equally common in men and women
  • Most comorbidity with histrionic PD

Big Five Profile

  • High neuroticism
  • High agreeableness
29
Q

Obsessive-Compulsive Personality Disorder

A

Cluster C: Anxious, Fearful

“A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.”

_____

This disorder is in the proposed alternative model (DSM-5 appendix):

“Typical features are difficulties in establishing and sustaining close relationships, associated with rigid perfectionism, inflexibility, and restricted emotional expression”

​_____

  • 4% prevalence
  • More common in males
  • Most comorbidity with schizotypal personality disorder

Big Five Profile

  • High neuroticism
  • Low extraversion
  • Low openness
  • High agreeableness
30
Q

Predicting Dead PDs

A
  • Paranoid
  • Schizoid
  • Histrionic
  • Dependent

* the clients will not disappear, thier labels will change

31
Q

37% | 53%

A

________ of people with alcohol use disorder have a mental illness

________ of people who abuse drugs have a mental illness

32
Q

Affective (mood) disorders / Personality Disorders / Anxiety Disorder

A

The three most common types of addition comorbidity in order of prevalence are:

______________, ______________, and ______________

33
Q

Regressive Behaviours

A
  • Passivity (being withdrawn, isolated, feeling helpless, mentally lazy — Adapted to high reward, Social uncertainty.
  • Impulsivity (cannot delay gratification, over-reactive, low frustration tolorance) — Craving, Withdrawal
  • Self-Centredness (grandiosity, lacking empathy, no compromise, sees self as unique) — Changing priorities, Cocaine and other stimulants
  • Affect Intolerance (feeling recognition problems, fear of feeling, lesseened ability to endure/regulate emotion-states) — Stomp & Punch walls, Neurotransmitter & set-point changes, Social fallout from addition behaviour
34
Q

2.1 - 8.1 times | Risk is 22% - 32%

alcohol | drug | anxiety | depressive | bipolar | personality

A

Nicotine-dependent smokers (who experience withdrawal) are ______ - ______ times more likely to have these 6 disorders;

A_____,D _____, A_____, D_____, B_____, P_____.

Risk is _____ to _____.

35
Q

16.4% / 6.5%

A

Percentage of population with a PD also with addictive disorder

______% had a current alcohol use disorder

______% had a current SUD​

Fair chance in developing an addiction or two

36
Q

28.6 % / 47.7 %

A

North American (community samples)

______% of those with AlcoholUD had at least one PD

______% of those with DrugUD had at least one PD

This explains that people with substance disorder have a good chance in having a PD and those with a PD have a fair chance in having an addiction or two

37
Q

Adolescents using cannabis

A

Overall Internalizing Disorders 33%

Overall Externalizing Disorders 60%

38
Q

Personality Disorders

7.7% / 6.6% / 5.6% / 5.4% / 5.2% / 2-3%
roughly 6-15% of population will have PD

A

Most common Personality Disorders

(lifetime prevalence by DSM-IV):

Obsessive-Compulsive Personality ____%

Avoidant (avoiding situations) ____%

Paranoid ____%

Borderline (females more than males) ____%

Schizotypal ____%

Antisocial roughly ____%

39
Q

Psychiatric + Addictive Disorders

A
  • 37% of people with ALCOHOL USE DISORDER have a mental illness
  • 53% of people who ABUSE DRUGS have a mental illness
40
Q

Two Types of Addictive Comorbidity

A
  1. Affective Disorder - AKA Mood Disorder - euphoria to dysphoria and can happen in combination (i.e. depression, bipolar, anxiety disorder)
  2. Personality Disorder - Rigid, unhealthy pattern of thinking, feeling and behaving
41
Q

Cannabis Comorbidity to PD (Personality Disorder)

A
  1. 30% anti-social PD
  2. 24% anxiety PD
  3. 19% obsessive PD
  4. 18% paranoid PD
  5. 13% bipolar PD
  6. 11% major depressive PD

AAOPBM

42
Q

Depression Comorbidity

A
  • Smokers face a major depressive episode compared to non-smokers
  • Alcohol is bi-directional ad multigenerational in relationship with depression
  • Internet addiction is linked to depression and insomnia
  • Treatment for substance addiction is comorbid cases treat depression but every week in delay of treating addiction decreases chance of treating depression

Psychology of addictions (7 decks)

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