HP412 Exam 3

trauma-related disorders

Acute stress disorder

Adjustment disorder

Posttraumatic stress disorder (PTSD

Acute stress disorder

acute maladaptive reaction in days and weeks following traumatic event (under 1 month)
(2-4 weeks)

Adjustment disorder

A maladaptive response to some type of life stress (whether traumatic or not

Posttraumatic stress disorder (PTSD)

Prevalence: 9%

Gender differences: women more likely to get diagnosis

Risk factors for PTSD:
-women
-homeless, SUD, mental illness

schizoid and schizotypal (A)

Histrionic and Narcissistic

Definition of traumatic event

An event involving some direct threat of death, severe bodily harm, or psychological injury to the self or another person.

Diagnostic criteria for PTSD (4 clusters)

over 1 month

must have some from each cluster

Re-experiencing symptoms:

Avoidance symptoms:

negative cognitions and mood;

Heightened arousal symptoms:

Other common symptoms of PTSD

•Suicidality, self-injurious behavior

•Substance use disorders (about 35% of people with PTSD have lifetime SUD, vs. 15% in general population)

•Aggression: heightened perceptions of threat more often lead to avoidance (flight response), but can result in aggression (fight response)

•Hallucinations (e.g., hearing voices; may or may not be related to trauma)

•Mild delusions (e.g., paranoia; may or may not be related to trauma)

•Difficulties with interpersonal relationships (e.g., trust, intimacy, conflict)

Factors related to trauma V.
Factors related to person or situation

Increased risk for PTSD in serious mental illness


factors related to event:
-degree of exposure to trauma

-severity of trauma

factors related to person:
-history of abuse

-lack of social support

-genetic predisposition

-feeling of shame

-prior psychiatric history

-lack of coping

-detachment/ dissacociation

treatment for PTSD

1) Exposure therapies* (e.g., prolonged exposure therapy)



2) Cognitive restructuring* (e.g., cognitive processing therapy)


EMDR: eye movement following

SSRIs

Other treatments

Yoga and meditation

Brief therapies

Journaling

Present centered therapy

Theory underlying exposure therapies

Mower 2-factor theory (1950): classical and operant conditioning combined create PTSD

emotional processing theory: foas and kozak:
designed to reduce associations between CS (memories of event, similar situations) and CR (fear) by preventing reinforcement of avoidance of CS, resulting in habituation of fear

basic treatment for exposure therapy:

-prolonged exposure: imaginal + in vivo (most studied treatment)

-tell story, rate stress out of 100, tell again

basic treatment for cognitive restructuring

cognitive processing therapy

•Second most empirically supported treatment for PTSD (after exposure therapy)

•Individual or group therapy formats feasible

•12-16 sessions

•Most programs provide psychoeducation and strategies for coping with anxiety

•Primary focus is on teaching cognitive restructuring as skill for examining thinking related to upsetting feelings, and then using skill to address trauma-related thoughts and beliefs

•Homework collaboratively agreed upon to practice skills between sessions

•Some cognitive restructuring programs also include an exposure component

•Research indicates cognitive restructuring and exposure therapy are equally effective

•Combining cognitive restructuring and exposure therapy not more effective than either one alone

classical conditioning (learned by association)

Traumatic event (unconditioned stimulus) produces an unconditioned response (fear, pain) → previously innocuous stimuli that where present when this pairing occur of traumatic event can be conditioned through association (conditioned response- seeing certain things, triggers associated with response)

operant conditioning (learned by consequences)

avoidance of dear inducing stimuli (CS) such as driving car, leads to reduction in anxiety (negative reinforcement) and increased avoidance

Theory underlying cognitive restructuring therapies

Horowitz; Ehlers & Clarkb


-Difficulty integrating new and old beliefs leads to intrusions related to traumatic events

Traumatic events challenge previously held beliefs about self, others, or world

Giving people tools for examining thinking→ used to process and integrate trauma

Combination of 2 is not more effective than individual treatments alone

Substance use disorders (SUD)

Diagnostic criteria for SUD:
-hazerdous. use

-social/ interpersonal problems

-neglect major roles

-withdrawal

-tolerance build up

-using more amounts

-repeated attempts to regulate/ quit

-much time spent using

-physical or psychological problems

-activities given up to use

-craving


Severity of SUD:
mild: 2-3 symptoms
moderate: 4-5 symptoms
severe: 6+ symptoms

Gender differences:

psychological dependence

the feeling that a drug is needed to continue a feeling of emotional or psychological well-being

Physiological dependence

-use of increasingly greater amounts of drug to experience same effect (tolerance)

-negative physical response when the substance is no longer used (withdrawal)

General categories of SUD

Depressants
Alcohol use disorder
Alcohol withdrawal

Alcohol related brain damage: Wernicke-Korsakoff syndrome, dementia

Stimulant use disorder (cocaine, amphetamine-type)

Opioid use disorder

Cannabis use disorder

Hallucinogen use disorder

Inhalant use disorder

gambling disorder

Alcohol related brain damage: from long term use

Wernicke-Korsakoff:

dementia

Comorbidity of SUD with other psychiatric disorders

Severity of disorder= proportional to greater risk of substance disorder

Anxiety disorders and depression have rates of SUD 25-35%

PTSD has rates of 30-40%

Antisocial personality disorder= HIGHEST RISK (>50%)

Schizophrenia, schiozo effective, BPD, major depression

Risk factors for SUD

-personal: genetics, age, gender, belief, conduct disorder, antisocial personality disorder

-family/ peer use/ attitudes

-community norms, poverty, substance availability, disempowerment

protective factors for SUD

personal: social skills, sense of self, flexibility, media literacy


family/ peer support

community standards: caring, opportunities etc.

Stages of change: recognition of persons stage of change can inform immediate goals of treatments:

Precontemplation

Preparation

Action

Maintenance

*relapse*

Contemplation

Treatment for SUD

BIOLOGICAL:

Agonist substitution (same or similar effect as drug but safer or less harmful: mimicks neurotransmitter
Eg: heroin addiction→ methadone agonist


Antagonist (blocking effects of substance, such as naltrexone for alcohol use
disorder or opioid addiction)

Aversive (causes negative reactions when substance used, such as disulfiram for
alcohol use disorder)


PHYSCOSOCIAL:

Self-help (e.g., AA)
Psychosocial

(evidence-based)

Contingency management: positive reinforcement for not using substances (pay someone to stop using)


Community reinforcement approach: work with natural support, work to enforce natural reinforcers , make one realize negative consequences of using

Motivational enhancement therapy: Motivate people to change behavior based on ones personal goals in life→ helping them see the interference of substance use


CBT

Relapse prevention therapy: identify situations of when is most likley to have relapse→ prevent those

Self-control strategies for substance use

("Modifying ABCs of Substance Abuse")

Stages of change: One goes through series of stages when going through stages→ ID stage ones at to help them get to next stage

Features of personality disorders

Early onset: precursors in adolescence

Stable over time

Pervasive: evident across many aspects of individuals life: personal, social, occupational situation

Clinically significant impairment: personal distress or impairment in social/ occupational function

Gender differences of personality disorder:

Antisocial personality disorder - men

Schizoid / paranoia: men

Histrionic personality disorder: women

Borderline personality disorder: women

3 clusters of personality disorders

A: Odd or eccentric behaviors (specific personality disorders)

-paranoid personality disorder

-schizoid personality disorder

-schizotypical personality disorder

B: Dramatic, emotional, or erratic behavior (specific personality disorders)

-Antisocial

-Borderline pd

-Histionic

-narcissistic

C: Anxious or fearful behavior (specific personality disorders)

-avoidant personality disorder

-dependent personality disorder

-obsessive-compulsive personality disorder

Specific personality disorders

Personality disorders clustered into 3 clusters: A=Odd, B=Dramatic, C=Anxious

paranoid personality disorder

hypersensitive, suspicious, mistrusting

Schizoid personality disorder

•Withdrawn and reclusive
•Not interested in relationships with other

Schizotypal personality disorder

•Odd ways of thinking, perceiving, communicating, and behaving

•Considered a disorder (increased risk for schizschizophrenia-spectrum

Borderline personality disorder

•Threaten and engage in self-destructive behavior

•Impulsive

•Unstable relationships, dependency on and manipulation of others

Persuasive pattern of instability of interpersonal relationships, self image, affects, marked impulsivity, 5+ of following

Frantic efforts to avoid real or imagined abandonment

Unstable

Unusual perceptual experiences

Impulsivity in at least 2 areas that are potentially self damaging

Recurrent suicidal behavior, gestrures, threats, self injurious, self mutilating behavior

Affective instability

Chronic feeling of emptiness

Intense anger

Transient stress related paranoia or dissociation

Comorbidity with other psychiatric disorders (including PTSD & SUD)

PTSD: 50%

substance abuse: 67%

depression: 20%

eating disorder: 25%

suicide: 6%

Treatment for borderline personality disorder:

Antidepressants

Dialectical behavior therapy:
•Intensive cognitive-behavioral therapy program developed by Marsha Linehan

•Reduces "interfering" behaviors: Self-harm

•Improves coping skills and more effective interpersonal

Conduct disorder

must have conduct diagnosis before 15 to have Antisocial disorder (18+)

3+ of the following over 12-mpnth period:
Bullies, threatens, intimidates others

Initiates fights

Used harmful weapons

Physically cruel

Forced sexual activity

Stealing

Run away from home overnight at least twice

DSM-5 criteria for antisocial personality disorder:

-pervasive pattern of disregard for and violation of the rights of others since age 15 (conduct disorder diagnosis)

-at least 18

3+ over 12 mo:
Often bullies, threatens, intimidates others

Often initiates fights

Has used weapon that can cause serious harm to others

Has been physically cruel to others

Has been physically cruel to animals

Has forced someone into sexual activity

Deliberate fire setting in order to cause damage

Deliberate destruction of others' property

Broken into someone's house or building, stole car

Often lies to obtain good, favors, or to avoid obligations

Often stolen items of value
Stays out all night despite parental prohibitions

Has run away from home overnight at least twice

Often truant from school beginning age 13

antisocial comorbidity with SUD

over 50%

Distinction between antisocial personality, psychopathic personality, &
sociopathy

ASPD: diagnoses in DSM-5, defined in behavioral terms

psychopathic: diagnosed in ICD-10, emphasis on personality characteristics, manipulation of others, superficial


Sociopathy is not a term used in psychiatric diagnosis (in DSM-5 or ICD-10), but generally refers to some combination of traits typically included in ASPD and psychopathy

Narcissistic personality disorder

•Extreme sense of self-importance, yet with fragile self-esteem
•Need for constant attention, lack of empathy for others

Histrionic personality disorder

•Self-centered and manipulative
•Have stormy relationships


: 5+ symptoms (overdramatized, on stage, how people interact with ppl in world)
Overly dramatic
Impulsive
Impressionistic
Sensational
Attention seeking
Vague, superficial
Sexuall provocative
Appearance focused
Common in female

Avoidant personality disorder

•Low-self esteem

•Worry about negative evaluation by others, but desire affection and relationships

•Avoid social interaction

Dependent personality disorder

•Lack confidence in ability to function independently
•Subordinate their needs to wishes of others to maintain relationship

OCD personality disorder

•Extreme perfectionism
•Rigid approach to doing things
•Lack of ability to express warm emotions

Beliefs associated with different personality disorders