PSYCH 257 - Test 3

Suicide

- more about struggling to live, than wanting to die

- 9th leading cause of death in Canada

- 2nd cause of death in youth ages 15-24 (accidents is first)

- women have higher rates of attempts but lower rates of suicide compared to men

Suicide Ideation

thoughts and intentions of killing onself

Suicide Attempts

self injury behaviours intended to cause death but that does not lead to death

Suicide Gestures

self-injury in which there is no intent to die

IS PATH WARM + Suicide

Ideation

Substance abuse

Purposelessness

Anxiety

Trapped

Hopelessness

Withdrawal

Anger

Recklessness

Mood changes

How to Help Someone - Suicide

- take all threats or attempts seriously

- be aware and learn warning signs

- be direct

- be non-judgmental and empathic

- do no minimize feelings

- do not try to take them out of their thoughts

- reach out for appropriate support

- do not leave them alone

- do not promise to keep thoughts of suicide a secret

Improving Mental Health Through Service to Others

- can stimulate reward areas of the brain

- alters your perspective of your circumstances

- increases you appreciation for the positives in your own life

What is Schizophrenia?

A psychotic disorder characterized by major disturbances in thought, emotion, and behaviour.

What happens when you have Schizophrenia

* disordered thinking

* faulty perception

* Bizzare disturbances in motor activity

Course of Schizophrenia

*Sometimes begins in childhood

* Typically have a number of acute episodes of their symptoms

* they often have less severe but still very debilitating symptoms

Positive Symptoms of Schizophrenia

* Disorganized speech

* Loose Associations

* derailment

* Delusions

* Hallucinations

Negative Symptoms of Schizophrenia

* Avolition (lack of energy)

* Alogia (poverty of speech, amount of speech)

* Anhedonia (lack of interest in recreational activities, relationships and sex)

* Flat affect (a lack of emotional expressiveness

* Asociality (Few friends, poor social skills, and little interest in being with others)

Disorganized Speech

- Can include disorganized thoughts

- disjointed though process

- speaking incoherently

- unrelated answers

- says illogical things

Delusions

- Beliefs that are contrary to reality and are firmly held even in the face of contradiction evidence

- More than half of people have delusions

- Paranoid delusions (the FBI is following you)

- Grandiose Delusions (you are the richest person in the worst or are god)

- Somatic Delusions (that something highly abnormal and improbable is happening to your body (infected with bugs)

Hallucinations

- Sensory experiences in the absence of any stimulation from the environment

- they are often auditory

- can be visual, tactile, or even olfactory

Avolition

A lack of energy and a seeming absence of interest in or an inability to persist direct activities

Alogia

Poverty of speech

- short, single word answers

Anhedonia

inability to experience pleasure

Affect (flat or inappropriate)

Virtually no stimulus can elicit an emotional response

- the client may stare vacantly, the muscles of the face flaccid, the eyes lifeless and may hvae a flat and toneless voice

Asociality

Severely impaired social relationship charachteristic referred to as a sociality

-They have few friends, poor social skills

Catatonia

- wild flailing limbs, gensture repeaditly

Impact of Schizophrenia

_ delusions and hallucinations may have cause considerable distress, compounded by the fact that hopes and dreams have been shattered

- cognitive impairments and avolition make stable employment difficult

catatonic schizophrenia

A type of schizophrenia marked by striking motor disturbances, ranging from muscular rigidity to random motor activity.

paranoid schizophrenia

A type of schizophrenia that is dominated by delusions of persecution along with delusions of grandeur.

Treating Schizophrenia

- Admission to hospital

- Biological Treatments

-Psychological treatments

- Family Therapy

Biological treatments

Lots of difficult side effects, some of which can be fatal

Some side effects require additional medication to manage

About half the people who take antipsychotics quit after one year and up to three quarters quit after two years

The most common reason given for non-compliance was drug side effects

Psychological treatments

Designed to teach people with schizophrenia behaviours that can help them succeed in a wide variety of interpersonal situations.

Focuses on three key elements: receiving skills (i.e., social cognition), processing skills, and behavioural responses in social interaction.

Found to yield significant improvements across a variety of indicators, including skill acquisition, social interaction, and appropriate personal assertiveness in social situations

Family Therapy

Educate clients and families about the biological vulnerability that predisposes people to schizophrenia, cognitive problems inherent to schizophrenia, the symptoms of the disorder, and signs of impending relapse

Provide information about and advice on monitoring the effects of antipsychotic medication

Encourage family members to blame neither themselves nor the client for the disorder and for the difficulties all are having in coping with it

DSM-5 Criteria for Anorexia Nervosa

A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

Psysical Changes of Anorexia Nervosa

- Decreased blood pressure/heart rate/bonemass

- dry skin

-brittle hair and nails

- mild anemia

- amenorrhea

Prognosis for Anorexia Nervosa

70% or patients recover

- recovery often takes 6 or 7 years

- relapse is common

- death rates are 10 times greater than the general population

Bulimia Nervosa

- Involves episodes of rapid consumption of a large amount of food (Binge) followed by a purge (vommiting, fasting)

DSM 5 Criteria for Bulimia Nervosa

-Recurrent episodes of binge eating

-Recurrent compensatory behaviors to prevent weight gain, for example, vomiting

-Body shape and weight are extremely important for self-evaluation

What is a binge?

-Eating within a 2-hour period an amount of food that is definitely larger than most people would eat in similar conditions

-A sense of loss of control over eating during the episode

Physical Changes of Bulimia Nervosa

- Potassium depletion

- Diarrhea

- Changes in electrolytes

- Irregularitiesin the heart beat

- tearing of tissue in the stomach and throat

- Loss of dental enamle

- Swollen salivary glands

Prognosis for Bulimia Nervosa

70% or people recover

- about 10% remain fully symptomatic

- mortality is much less common in bulimia nervosa than anorexia

Mortality in Eating Disorders

predictors of death include lower BMI

- people with bulimia have more suicidal ideations

- one in five deaths attributed to anorexia involved suicides

DSM-5 criteria for binge eating disorder

*A.* Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

-*1.* Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.

-*2.* A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

*B.* The binge-eating episodes are associated with three (or more) of the following:

-*1.* Eating much more rapidly than normal.

-*2.* Eating until feeling uncomfortably full.

-*3.* Eating large amounts of food when not feeling physically hungry.

-*4.* Eating alone because of feeling embarrassed by how much one is eating.

-*5.* Feeling disgusted with oneself, depressed, or very guilty afterward.

*C.* Marked distress regarding binge eating is present.

*D.* The binge eating occurs, on average, at least once a week for 3 months.

*E.* The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Risk factors for developing BED include

-Childhood Obesity

- Critical comments regarding being overweight

- Low self-concept

- Depression

- Childhood physical or sexual abuse

Biological factors of ED - Genetics

- Both anorexia and Bulimia run in families

- twin studies of eating disorders also suggest a genetic influence

- most studies of both anorexia and bulimia report higher identical than fraternal concordance rates

Biological Factors of ED - The Brain

The hypothalamus is a key brain centre in regulating hunger and eating

When our stomachs are empty, they contract, causing both hunger pangs and the secretion of chemical messages that travel to the brain to signal hunger and lead to eating

Once we have eaten the feeling of fullness, or satiety, kicks in. As blood glucose levels increase, the pancreas and liver send signals to shut off hunger and eating

The levels of some hormones regulated by the hypothalamus, such as cortisol, are abnormal in people with anorexia

Occur as a result of starvation, and levels return to normal following weight gain

Weight and Children

According to the World Health Organization's 2002 Health Behaviour in School-aged Children (HBSC) Canadian Survey, 31% of Canadian young women from grades 6 to 10 thought that they were too fat

the proportion increased with age and, by Grade 10, 44% indicated that they were too fat

Weight and Stereotypes

People in larger bodies are viewed by others as less smart and are stereotyped as being lazy

The media promotes these stereotypes

A content analysis of 18 primetime television situation comedies conducted by researchers in Calgary found that:

females with below average weights were overrepresented in these shows

the heavier the female character, the more likely she was to have negative comments directed toward her

these negative comments were especially likely to be reinforced by audience laughter

Gender and Eating Disorders

Women appear to have been more heavily influenced by the cultural ideal of thinness

Women are typically valued more for their appearance, whereas men gain esteem more for their accomplishments

Women apparently are more concerned than men about being thin, are more likely to diet, and are thus more vulnerable to eating disorders

There is a growing belief that appearance pressures are increasing on young males as well

These increasing pressures are reflected by a heightened drive for muscularity, which can take the extreme form of muscle dysmorphia (i.e., an obsession about not being as muscular as desired)

The Media and ED's

- The media's portrayal of thinness as an ideal, being overweight, and a tendency to compare oneself with especially attractive others all contribute to dissatisfaction with one's body

Personality Factors

- Six personality factors were linked consistently with eating disorders - avoidance motivation, lower extraversion and self-directedness, neuroticism, perfectionism, and sensitivity to social rewards

- People with anorexia and people with bulimia are high in neuroticism and anxiety and low in self-esteem

- Also characterized by high levels of narcissism that persist even when the eating disorder is in remission

Treating Eating Disorders

-Must address both problematic eating behaviors and the misuse of food to manage stress and emotions

-Averting a medical crisis by restoring adequate body weight

-Dealing with psychological aspects

-Stabilizing eating habits

-Changing behavior patterns and thoughts

-Possibly involving medication and/or hospitalization

CBT for eating disorders

cognitive: challenge body image/thin ideal

behavioral: reward system, identify b/p triggers, eat fear foods

Psychological Treatment of Bulimia Nervosa

Cognitive-behavioral therapy (CBT)

Treatment of choice

Basic components of CBT: Identifying maladaptive thinking patterns and behavioral habits, then gradual practice of new habits

The Maudsley Approach

a family treatment for anorexia nervosa that focuses on supporting parents as they determine how to lead their child to eat appropriately

- Parents are taught to not shame, and blame

- they are taught to be supportive

Disordered Eating

-spectrum between normal eating and an eating disorder and may include symptoms and behaviours of eating disorders, but at a lesser frequency or lower level of severity

Orthorexia

an obsession with eating foods that one considers healthy and avoiding foods that they believe are harmful

Pica

- an eating disorder in which a person eats things not usually considered food

Prader-Willi Syndrome

a rare genetic disorder that results in a number of physical, mental and behavioural problems including a constant sense of hunger

pillars of self care

- Financial

- Spiritual

- Emotional

- Physical

- Social

- Environmental

- Intellectual

- Professional

Sanguen Health Centre

- small, non-profit, community-based agency founded by Dr. Chris Steingart

- partially funded by the Ministry of Health for Hep C work, the rest is grants, partnerships and donations

- serving Waterloo Region and Guelph

The War on Drugs

- global campaign led by US or drug prohibition, military aid and military intervention

- aim of reducing illegal drug trade

- popularized by Richard Nixon

End War on Drugs

- just as prohibition, it failed

- now a drug policy crisis

- poisoned street drugs

- we treat addiction as a crime

- rooted in racism

Why do People do Drugs?

- to feel good

- to feel better

- to do better

- to explore

Social Determinants of Health for PWUD

- social, economic and political circumstances that influence individual and community health status

- experiences of discrimination and trauma related to race, gender identity, class, family history

Withdrawal

- nausea, vomiting, diarrhea

- sweating

- muscle cramping

- depression

- agitation

- anxiety, panic

- craving opioids

- can last for more than a week

Harm Reduction

- harm reduction recognizes that abstinence isn't realistic or possible for everyone

- tries to make sure that drug users get the same chances and choices around health care

The 4 Pillars - Substance Abuse

- prevention

- harm reduction

- recovery and rehabilitation

- enforcement and justice

Harm Reduction Services Include:

- syringe access

- syringe disposal

- naloxone

- safer drug use

- medication assisted treatment

- supervised consumption services

- drop-in centers

- housing first

- pharmacy access

Challenging Substance Abuse Stigma

- we are sometimes the first connection people have

- how we treat people can be their reason to reach out

- a non-judgemental attitude is key

- putting our own biases aside

- calm demeanor

- active listening

- language

Words to Avoid - Substance Abuse

- addict, junkie, user

- clean, sober, former addict

- non-compliant/unmotivated

- failed treatment

- feminine products

Policy Change - Substance Abuse

- decriminalize personal possession of all drugs - treat addiction as a health issue not a crime

- scale up harm reduction

- completely end the war on drugs

Naloxone is currently available at:

- local pharmacies

- mobile health bus

- needle syringe prgrams

- consumption treatment services

- the community health vans

What is an Opiate?

- originally derived from the opium poppy, now made in labs

- usually prescribed to treat pain

- side effects: respiratory depression, sedation (sleepiness), can induce euphoria

- opiods are synthetically made opiates

Examples of Opioid Drugs

- fentanyl

- morphine

- heroin

- dilaudid

- codeine

- oxycodone

- percocet

What is Naloxone or Narcan?

- opiate antagonist

- it completes for the same receptors in the cell that opiates do

- temporarily removes the opioids and their undersired effects

- temporarily (30-60 mins) reverses the respiratory depression that can cause opioid overdoses to be fatal

Community Treatment Orders

- stipulate that the individual will be released back into the community only if they adhere to recommended treatments (often includes medication)

- controversial because this condition of release essentially forces people to be treated

Opposing CTO

- should never force someone to take treatment

- if we had sufficent services, we would not need CTOs

- Research on CTOs is inconclusive

- CTOs will be used to sweep undesirable individuals off the streets

- Coercion drives people away from the mental health system

Supporting CTO

- predictable and acceptable consequences of deinstitutionalization

- Lack of awareness of mental illness is a persistent and pervasive symptom

- Offering services is often not enough when patients lack insight

- CTOs are less restrictive than involuntary hospitalization

- Research confirms the effectiveness of CTOs

- No evidence indicates negative effects of CTOs

What Happens Without Ethical Guidelines?

- Residential School Nutrition Experiments (1942-1952): experiment to examine malnutrition and non-intervention

- Milgram Experiments (1961)

- Stanford Prison Experiments (1971)

The Nuremberg Code

A ten point code that was drafted as a result of the trial and remains an important document upon which current ethical policy is based

- ethics is in direct relation with WWII

What is Ethical Research

1. Respect for persons recognizing the intrinsic value of each individual and their autonomy

2. Concern for welfare avoiding exposing participants to unnecessary risks

3. Justice avoiding exposing participants to unnecessary risks

Threats to Ethical Research

- increase in research by for-profit organizations: competitions pressures to maximize profits

- internationalization of research

Priviliged Communication

communication between parties in a confidential relationship that is protected by law

Naloxone

- very safe

- naloxone only reverses opiate overdoses

- no known interactions with other drugs

- allergic reactions are exceedingly rare

- safe for all people including pregnant people and children

- does not reverse overdoses related to drugs other than opioids

- wears off in about 30 mins

Signs of Opioid Overdose

- breathing is slow or stopped

- snoring or gurgling noises

- lips and fingernails are blue/purple

- eyes rolled back

- body is limp

- person can't be woken

- stiff body

- person may have vomited

Civil Commitment

- allows the state to detain a mentally ill individual without consent

- Civil commitment affects far more people than criminal commitment

Toronto's drug checking service

49% of the expected fentanyl samples contained benzodiazepine-related drug(s) and/or xylazine (horse tranqualizer)

Informal Commitment

- emergency commitment of mentally ill persons can be accomplished without initially involving the courts

- eg. if a hospital administrative board believe that a voluntary patient requesting discharge is too disturbed and dangerous to be released, it can detain the patient with a temporary, informal commitment order

Formal Commitment

- in order of a court

- can be requested by any responsible citizen

- the person has the right to object

5 Types of Support Peer Workers Provide:

1. emotional

2. motivational

3. informational

4. instrumental

5. affiliation

The Peer Support Process

- connecting with lived experience

- identifying needs and strengths

- focus on validation and safety

- explore goal setting

- determine next steps

How not to engage with peers

- tokenism

- hand holding

- undermining

- degrees do not trump experience

- language matters

(Civil Commitment) In Canada, a person can be committed to a psychiartic hospital against will if the person is:

- mentally ill

- a danger to self

- a danger to others

Group Facilitation Skills

- Assertiveness

- Boundaries

- Code of Conduct

- Confidentiality

- Conflict Resolution

- De-Escalation Skills

- Diversity and Anti-Oppression

- Group Stages & Dynamics

- Learning Styles

- Self Care

- Sexual Orientation

- Social Determinants of Health

- Stages of Change

- Time Management

- Trauma-Informed Peer Support

Fitness to Stand Trial

- the first question is whether the person is competent or fit to stand trial

Insanity

- legal term

Criminal and Civic Commitment

- Charter of Rights and Freedoms includes provisions that allow people to be removed from society if they act in a way that infringes on the rights of others

Mens Rea

- criminal intent

- the literal translation from Latin is "guilty mind"

- state of mind required in order to convict a particular defendant of a particular crime

Criminal Commitment

procedure that may confine a person in a mental institution either for determination of competency to stand trial or after a verdict of Not Criminally Responsible because of Mental Disorder (NCRMD)

Not Criminally Responsible Defence

- involves legal argument that a defendant should not be held responsible for illegal act due to mental illness

- mental disorder may operate to negate requisite mental element (mens rea) or act involuntary (actus reus)

- the phrase "not guilty of insanity" was altered to "not criminally responsible on account of mental disorder"

Civic Commitment

provided for in provincial statues, is a procedure by which a mentally ill and dangerous person who may not have broken a law can be deprived of liberty and incarcerated in a psychiatric hospital

Peer Support is not...

- telling one's story over and over again

- therapy or case management

- giving advice, or interpreting another's experience for them

- using clinical terms or other language that can disconnect

Peer Support is...

- thoughtful sharing of relevant lived experience

- walking beside someone in their recovery

- sharing coping strategies

- a relationship built on trust and mutuality

- focuses on health and recovery rather than illness or disability

Injectable vs. Nasal Naloxone

- nasal dose is 4mg and injectable is 0.4mg

- nasal dose causes more sever withdrawal