Psychopathology: Disruptive, Impulsive, Conduct Disorders, Substance related, Neurocognitive and Personality Disorders Flashcards
What are substance use disorders?
“a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems”
- can be diagnosed for all classes of substances except caffeine
- severity is determined by number of symptoms
- specifier based on early or sustained remission, maintenance therapy, controlled environment
- 2 or more characteristic symptoms within a 12 month period
What are substance-induced disorders?
- substance intoxication
- substance withdrawal
- substance/medication-induced mental disorder (e.g. substance-induced depressive disorder, anxiety disorder, major neurocognitive disorder, withdrawal delirium)
What are some of the alcohol induced disorders? (alcohol intoxication, alcohol withdrawal, alcohol-induced major neurocognitive disorder)
alcohol intoxication: problematic behavioral and psychological changes (e.g. inappropraite sexual or aggressive behavior, mood lability, impaired judgement) with at least 1 of 6 symptoms: slurred speech, incoordination, unsteady gait, nystagmus, impaired attention or memory, stupor, coma
alcohol withdrawal: at least 2 of 8 symptoms that develop within several hours to a few days following cessation or reduction of heavy and prolonged alcohol use - (1) autonomic hyperactivity, (2) hand tremor, (3) insomnia, (4) nausea or vomiting, (5) transient hallucinations or illusions, (6) anxiety, (7) psychomotor agitation, (8) generalized tonic-clonic seizures
alcohol-induced major neurocognitive disorder: significant decline in 1 or more cognitive domains that interferes with everyday activities. Specifier: nonamnestic-confabulatory type or amnestic-confabulatory type (Korsakoff syndrome – thiamine deficiency, anterograde and retrograde amnesia, confabulation)
What does opioid intoxication and opioid withdrawal look like?
- Opioid Intoxication: initial euphoria followed by apathy or dysphoria and impaired judgement + pupillary constriction and at least 1 of 3 symptoms during or after opioid use – drowsiness or coma, slurred speech, impaired attention or memory. (can include or not perceptual disturbances - i.e. hallucination with intact reality testing or illusions in the absence of delirium)
- Opioid withdrawal: 3 of 9 symptoms – dysphoric mood, nausea or vomiting, muscle aches, diarrhea, yawning, fever, insomnia
Opioids = opium, heroin, morphine, codeine (which are derived from opium poppy, synthetic and partly-synthetic drugs - methadone, oxycodone, hydrocodone, fentanyl)
What does stimulant intoxication and withdrawal look like?
stimulant intoxication: maladaptive behavioral and psychological changes (e.g. euphoria or affective blunting, hyper-vigilance, interpersonal sensitivity, anxiety or anger, impaired judgement) and 2 of 9 symptoms – tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, respiratory depression or cardiac arrhythmia, seizures or coma
stimulant withdrawal: dysphoric mood + at least 2 of 5 physiological changes develop within a few hours to several days after cessation or prolonged stimulant use – fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor agitation or retardation
Stimulants – amphetamines, methamphetamines, cocaine
What does tobacco withdrawal look like?
4 of 7 symptoms that develop within 24 hours of abrupt cessation or reduction of the use of tobacco:
1 - irritability
2 - anger or anxiety
3 - impaired concentration
4 - increased appetite
5 - restlessness
6 - depressed mood
7 - insomnia
duration and severity of withdrawal symptoms - peak 48-72 hours following cessation of nicotine use and gradually wane over several weeks
craving for nicotine last longer than withdrawal and can be cause of early and late relapse
What is hallucinogen persisting perception disorder?
re-experiencing at least one of the perceptual symptoms that were experienced while intoxicated with LSD or other hallucinogen
visual disturbances: flashes of color, halos around objects are most common
episodes/flashbacks: very brief but may recur over days, weeks, months or longer
reality testing during episodes is intact (i.e. the person is aware that current symptoms are due to previous drug use)
General components to treatment of substance-related disorders?
- usually includes individual, family and/or group interventions and medication
- cognitive behavioral therapy, motivational interviewing, contingency management, family behavior therapy, community reinforcement approach, personalized normative feedback, text messages, relapse prevention therapy, 12-step facilitation
- combined interventions most effective (e.g. tobacco use disorder - therapy (critical thinking skills training and social support) and medication - nicotine nasal spray & varenicline: both are effective alone, more effective together)
What is the community reinforcement approach (CRA) to substance use treatment?
Based on principles of operant conditioning and “helps people arrange their lifestyles so that healthy, drugfree living becomes rewarding and thereby competes with alcohol and drug use”
- Community Reinforcement and Family Training (CRAFT) - for individuals who refuse treatment. Works with Concerned Significant Other (CSO). Primary Goals:
(a) help CSO influence user to enter treatment
(b) teach CSO procedures to help reduce user’s use
(c) help CSO make positive life changes that improve CSO’s quality of life whether or not user gets treatment
What is the voucher-based reinforcement therapy (VBRT) to substance use treatment?
Contingency management: patients get vouchers to use for goods and services when they reach treatment goals (e.g. neg drug screens)
Effective as a standalone treatment (for cocaine, opiates, marijuana, tobacco)
VRBT can be better when combined - best for promoting abstinence at first, CBT less useful at the beginning better for maintaining abstinence and developing coping skills
What is the personalized normative feedback (PNF) to substance use treatment?
Based on the assumption that “if perceptions of the prevalence of a given behavior influence one’s own behavior…and one overestimates the prevalence of that behavior, then correcting the misperception should reduce the behavior”
- provide users with information that allows them to compare actual frequency and perceived frequency for a typical person in their peer group with the actual average
(originally developed as a brief stand alone intervention for heavy drinking college students who tend to overestimate the amount/frequency of their peers and the misperception was associated to higher levels of drinking. also applicable to gambling, eating disorders, IPV and other problematic behaviors. Can be combined with motivational interviewing)
What is the text-messages approach to substance use treatment?
Serve four major functions:
appointment and medication reminders, health care information, support, means of self monitoring
text message smoking cessation alone higher quit rates than minimal smoking cessation support from a doctor.
similar quit rates between text alone quit rate and other stand alone interventions
higher quit rates combining text with other interventions
What is the relapse prevention therapy (RPT) for substance use treatment?
CBT approach to relapse prevention - substance addiction as a “learned habit pattern” and lapses are typically precipitated by a high-risk situation (e.g. negative emotional state, interpersonal conflict, social pressure)
Lapses likely turn into major relapse with poor coping skills, low self-efficacy, high expectations about the positive side effects of substance and responds to lapse with “abstinence violation effect” (neg emotions, guilt, sense of personal failure)
RPT uses cognitive and behavioral strategies that enable clients to recognize and deal more effectively with high risk situations. (training in coping skills, enhancing self-efficacy, challenging myths about positive outcomes, cognitive restructuring to view lapses as mistakes rather than a personal failure, altering lifestyle factors that increase exposure or reduce resistance to high-risk situations)
What is the Project MATCH approach to substance use treatment?
Project MATCH, a multisite clinical trial, compared the effectiveness of cognitive behavioral coping skills therapy, motivational enhancement therapy, and twelve-step facilitation for clients who had received a DSM-III-R diagnosis of alcohol dependence or abuse.
It also evaluated the client-treatment matching hypothesis, which predicts that client outcomes can be improved by matching clients with certain characteristics to treatments most appropriate for those characteristics.
Clients were randomly assigned to one of the three treatments, and clients in each group were categorized in terms of several characteristics (e.g., alcohol involvement, psychiatric severity, anger, and social support for drinking versus abstinence).
Results indicated that, at one-year and three-year follow-ups, all three treatments had produced significant reductions in drinking, with twelve-step facilitation having a slight advantage over the other two treatments.
The results also provided some support for the matching hypothesis. For example, at the three-year follow-up, clients whose social networks were supportive of drinking benefited most from twelve-step facilitation, while clients who were high in anger benefited most from motivational enhancement therapy (Project MATCH Research Group, 1997, 1998).
What is the general description of disruptive, impulse-control, and conduct disorders?
problems in the self-control of emotions and behaviors
includes: oppositional defiant disorder, conduct disorder, intermittent explosive disorder
