PSYC241: Final Exam Flashcards
Substance use disorders
10 different classes
Recurrent use leads to negative consequences
Four general groupings of indicators of substance use disorders
1- impairment of control over use
2- social impairment
3- risky use
4- pharmacological criteria
Substance-induced disorders
Intoxication
Withdrawal
Other substance or medication induced disorder
Can be resolved when person stops using substances
Polysubstance abuse
Simultaneous misuse or dependence upon two or more substances
On the rise
More common in young people
Combining drugs is dangerous because they’re often synergistic=combined effects are more intense or different than individual effects
Change in DSM-5 related to intoxication vs substance use disorder
Eliminated the distinction between abuse and dependence
Substance intoxication
Reversible, temporary condition
Must show clinically significant maladaptive behaviour or cognitive changes
AND
Impaired thought processes or motor behaviour
Symptoms related to impaired control (substance abuse disorder)
Symptoms related to impaired control:
1- ingestion of substance in bigger amounts over a longer period of time than originally intended
2- desire to cut down or stop without success
3- lots of time spent getting, using and recovering from substance use
4- craving
Symptoms related to social impairment (substance abuse disorder)
- failure to fulfill life role obligations
- continued use despite social and interpersonal problems
- loss of activities
Symptoms related to risky use (substance abuse disorder)
- recurrent substance use in situations where it’s physically dangerous
- continued use despite knowing you have a physical or psychological problems that’s caused by substance
Pharmacological criteria (substance abuse disorder)
Tolerance and withdrawal
Common element of polysubstance abuse
Alcohol
Three main risks of polysubstance abuse
1- physically dangerous (more so than each drug by itself)
2- associated with greater commodity of other psych disorders
3- treatment challenges
DSM-5 diagnostic criteria for alcohol use disorder
Problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12 month period (1 year)
- large amounts or longer period
- desire and failed efforts to cut down control use
- lots of time spent trying to get alcohol use it recover from it
- craving
- failure to succeed in life bc of it
- continued use despite social problems
- giving up past enjoyed activities
- hazardous use
- continue despite knowledge that it’s ruining your life
- tolerance (more need and diminished effect)
- withdrawal (classic withdrawal or taking substances to relieve symptoms of withdrawal
University students statistics (alcohol)
Half report black outs
Males greater use than females
Students living on their own or in forms report more drinking
Genetic factors in alcohol use
Support significant genetic effect for males (not females)
Alcohol expectancy theory
Persons drinking is determined by other reinforcements they get from it
Alcohol and behaviour disinhibition
People with alcohol problems tend to have more difficulty controlling impulsive behaviour
Abstinence goals for alcohol
Based on the disease model where it’s assumed that alcoholics never be able to control drink in a controlled way
Traditional treatment programs and AA
Transtheoretical model of change (alcohol)
Theoretical framework for understanding the process of behavioural change Stages of change -pre contemplation -contemplation -preparation -action -maintenance
Precontemplation (transtheoretical model of change for alcohol)
Not ready to change
May not feel like they have a problem
May feel barriers or disadvantages (cons) associated with change are greater than benefits of change (pros)
Contemplation (transtheoretical model of change for alcohol)
Thinking about changing behaviours, but not committed to change
Ambivalent
Weighing pros and cons
Preparation (transtheoretical model of change)
Decided to change
Developing a plan for change
Action (transtheoretical model of change)
Actively working at changing their problem behaviour
Maintenance (transtheoretical model of change)
Working on keeping up with changes and preventing relapse
More details about transtheoretical model of change
Spiral model
Relapse is common and is normalized
Interventions made to match individuals stage of change
Integrating MI and TMC (substance abuse disorders)
Use MI at all stages of change
MI: way of interacting with clients; a stance
Use in assessments and diff types of interventions
General principles of MI (substance abuse disorders)
Belief that lasting change is unlikely to occur until individuals can resolve their ambivalence
Ambivalence=expected and understandable experience for individuals thinking about change
Miller MI: general principles (substance related disorders)
- express empathy (reflective listening, ambivalence is normal)
- develop discrepancy between present behaviours and future goals/values
- roll with resistance (don’t argue and change what you’re doing)
- support self efficacy
MI: strategies (substance related disorders)
OARS
- open ended questions
- affirmations (belief that patient’s doubts in their ability to change is bad for progress; affirm/reinforce resourcefulness, previous attempts to change, qualities of patient that facilitate change)
- reflective listening (statements not questions, simple and complex reflections)
- summarizing (type of complex reflection, selective and directive but make sure to include both sides of ambivalence, transitioning between tasks, at end of session)
What to summarize in MI? (Substance related disorders)
Pros associated with change
Cons associated with present behaviour
Intentions to change
Space between where person wants to be and their current behaviours
Harm reduction model (substance related disorders)
Focus: reducing consequences substance use (ex: needle exchange programs)
Implemented usually with counselling, edu, outreach programs
Schizophrenia
Prevalence: 1%
Most diagnosed between age 20 and 40
Men and women at equal risk but men show symptoms earlier and more severely
Positive symptoms of psychosis
More obvious symptoms of psychosis
- delusions
- hallucinations
- disorganized speech and thought disorder
- grossly disorganized or catatonic behaviours
Negative symptoms of psychosis
Absence or loss of typical behaviours
- flat effect
- avolition
- alogia
- anhedonia
Delusions
Impossible beliefs that last even if there’s evidence that contradicts them
What delusions are most common in schizophrenia ?
Persecutory delusions
Hallucinations
People see hear smell feel things that aren’t really present
Hearing voices =most common in schizophrenia
Misinterpretations of sensory perceptions
Disorganized speech and thought disorder
Loosening of associations
Least common of the positive symptoms
Flat effect
Negative symptom of schizophrenia
Limited emotional expression
Avolition
Negative symptom of schizophrenia
Lack of energy, limited ability to persist in daily routines (grooming and hygiene problems)
Alogia
Negative symptom of schizophrenia
Can take several forms;
-poverty of speech
-poverty of content of speech (vague and repetitive, doesn’t communicate much info)
Anhedonia
Negative symptom of schizophrenia
Inability to experience pleasure
Motor symptoms and catatonic behaviour (schizophrenia)
Go from agitation to immobility
Catatonic behaviour= holding body in weird positions and not letting people change how you’re positioned
Proposed changes about schizophrenia diagnosis for DSM-5
DSM-IV (4)
2+ of the following for a significant period of time during a 1 month period
-delusions
-hallucinations
-disorganized speech
-grossly disorganized or catatonic behaviour
-negative symptoms
Change to DSM-5 is it should include symptoms 1-3 (delusions, hallucinations and disorganized speech)
Note: only 1 required if:
1- delusions are bizarre
2- hallucinations=running commentary or convos between 2+ people
Subtypes of schizophrenia (5)
1- paranoid (delusions have themes, auditory hallucinations and absence of markedly impaired cog functioning; most common, least disabling, later onset than other subtypes, best prognosis) 2- disorganized 3- catatonic 4- undifferentiated 5- residual
2 proposed changes for DSM-5 about schizo
Removal of subtypes - accepted
Clinician-rated dimensions of psychosis symptom severity - accepted
5 sections of warning signs
Behavioural
Thinking and speech
Social
Emotional
Personality
Another proposed change for DSM-5: attenuated psychotic symptoms syndrome
All six of the following:
1- characteristic symptoms of delusions/hallucinations/disorganized speech (at least one and in attenuated/weakened form)
2- frequency/currency (present for a month and occur once a week)
3- progression (begun and worsened in past year)
4- distress/disability/treatment seeking (symptoms are distressing and disabling for the patient)
5- symptoms aren’t better explained by another disorder
6- clinical criteria for any DSM-5 psychotic disorder have never been met