Comprehensive Guide to Substance-Related, Gender, Schizophrenia, and Sleep Disorders

Substance Use Disorder (SUD)

A maladaptive pattern of substance use leading to significant impairment or distress.

Substance-Induced Disorder

Conditions caused directly by substance use—such as intoxication, withdrawal, or substance-induced mental disorders (e.g., depression, psychosis).

Impaired Control

Using larger amounts or over longer periods than intended; persistent desire or unsuccessful efforts to cut down; excessive time spent obtaining, using, or recovering from use; craving or strong desire to use.

Social Impairment

Failure to fulfill major role obligations; continued use despite interpersonal problems; giving up important activities.

Risky Use

Recurrent use in physically hazardous situations; continued use despite physical or psychological problems.

Pharmacological Criteria

Tolerance: Needing more for same effect; Withdrawal: Physiological symptoms when use stops.

Severity of Substance Use Disorder

Mild: 2-3 symptoms; Moderate: 4-5 symptoms; Severe: 6+ symptoms.

Withdrawal

Physiological and psychological symptoms after reduction or cessation of substance use.

Withdrawal Symptoms

Sweating, shaking, nausea, irritability, anxiety, insomnia, seizures (severe alcohol withdrawal).

Delirium Tremens (DTs)

Severe alcohol withdrawal involving confusion, agitation, hallucinations, tremors, and autonomic instability—potentially fatal.

Tolerance

The need for increased amounts of a substance to achieve the same effect.

Metabolic Tolerance

Faster metabolism of the drug.

Pharmacodynamic Tolerance

Neurons adapt and reduce response.

Behavioral Tolerance

Learning to compensate for effects.

Cross-Tolerance

Tolerance to one drug produces tolerance to another acting on the same system.

Depressants / Sedative-Hypnotics

Drugs that increase GABA inhibition, leading to slowed brain activity.

Examples of Depressants

Alcohol, Barbiturates, Benzodiazepines.

Initial Alcohol Effects

Disinhibition, euphoria, sociability.

Later Alcohol Effects

Motor impairment, sedation, depression, respiratory failure.

Binge Definition

4+ drinks (women), 5+ drinks (men) in about 2 hours.

FASD

Fetal Alcohol Spectrum Disorder—cognitive, facial, and physical abnormalities due to prenatal alcohol exposure.

Cirrhosis

Liver scarring and loss of function from chronic alcohol use.

CBT

Helps clients recognize triggers, develop coping strategies, and prevent relapse.

GABA Receptor

Inhibitory receptor; depressants bind to it, increasing chloride ion flow → hyperpolarization → sedation.

Synergistic Effects

Combined use of depressants increases risk of overdose.

Stimulants

Drugs that affect neurotransmitter systems like dopamine, norepinephrine, and serotonin.

Cocaine

Blocks reuptake of dopamine → euphoria, energy.

Amphetamines

Increase dopamine and norepinephrine release.

Medical Uses of Amphetamines

ADHD, narcolepsy, obesity (short-term).

Opiates / Narcotics

Drugs used for pain relief, cough suppression, and diarrhea control.

Examples of Opiates

Heroin, morphine, codeine, oxycodone.

Narcan (Naloxone)

Opioid antagonist—reverses overdose rapidly.

Marijuana (Cannabis sativa)

A plant whose active ingredient is THC (tetrahydrocannabinol).

THC (tetrahydrocannabinol)

The active ingredient in marijuana.

CB1 and CB2

Cannabinoid receptors that THC interacts with.

Medical Effects of Marijuana

Includes appetite stimulation, pain reduction, and nausea control (e.g., chemotherapy).

Effects on Sleep

Marijuana reduces REM sleep.

Hormonal Effects

Marijuana alters reproductive hormones.

Hashish

Concentrated resin of the marijuana plant.

Marinol

Synthetic THC (dronabinol) used medically.

Smoking Risks/Benefits

Smoking marijuana has a rapid onset but potential lung irritation.

Entourage Compounds

Non-THC cannabinoids that modulate THC's effects.

CBD (Cannabidiol)

A non-psychoactive compound with anti-anxiety and anti-inflammatory properties.

Retrograde Transmission

Signals sent backward from postsynaptic to presynaptic neuron to inhibit neurotransmitter release.

PCP (Phencyclidine)

An NMDA receptor antagonist that causes hallucinations, dissociation, aggression, and numbness.

LSD

A hallucinogen that acts on serotonin (5-HT2A) receptors, leading to hallucinations and altered perception.

Substance-Induced Disorders

Conditions directly caused by substance use, including intoxication, withdrawal, and substance-induced mental disorders.

Detoxification

Medically supervised withdrawal from substances.

Disulfiram (Antabuse)

A medication that causes nausea/vomiting when alcohol is consumed.

Naltrexone

A medication that blocks opioid and alcohol reward pathways.

Methadone

Maintenance therapy for opioid dependence.

Blum's Reward Deficiency Syndrome

A hypothesis related to the brain's reward pathways and addiction.

Nucleus Accumbens

The brain's reward center.

Medial Forebrain Bundle (MFB)

Connects the brainstem to reward regions.

Ventral Tegmental Area (VTA)

The origin of dopamine projecting to the nucleus accumbens.

Gender Dysphoria

Clinically significant distress from incongruence between experienced gender and assigned sex.

Natal Sex

Biological/anatomical sex at birth, including chromosomes, hormones, and genitalia.

Gender Identity

One's internal sense of being male, female, both, neither, etc.

Gender Non-Binary

A person who does not identify strictly as male or female.

Pedophile

sexual interest in pre-pubescent children

Incest

sexual acts between family members

Signs of Sexual Abuse

Sexual knowledge inappropriate for age, regression, withdrawal, nightmares, physical injuries, STIs, sudden fear of certain people, pregnant

Megan's Law

Law requiring public notification of sex offenders.

Methods of notification under Megan's Law

Online searchable databases, community notification (mailers, police notice)

Biological Sex Determination

Father determines genetic sex (sperm = X or Y); Y chromosome → SRY gene → testes; testes release androgens + MIS → male genital development

At Puberty

Testosterone ↑ → secondary male traits (voice deepens, muscle, facial hair)

Androgen Insensitivity Syndrome

XY but body can't use androgens → female external appearance

5-Alpha-Reductase Deficiency

XY; cannot convert testosterone → DHT; appear female until puberty, then masculinize

Turner Syndrome

XO (female) → short, infertility, webbed neck

Klinefelter Syndrome

XXY (male) → tall, small testes, possible breast development

Psychosis

Loss of contact with reality (hallucinations, delusions)

Schizophrenia

Chronic psychotic disorder with positive + negative symptoms

Kraepelin

First described schizophrenia ("dementia praecox")

Bleuler

Coined term schizophrenia ("split mind" meaning split from reality)

Age of Onset for Schizophrenia

Men: late teens-early 20s; Women: mid-20s-early 30s

DSM-5 Criteria for Schizophrenia

2+ symptoms for ≥1 month (one must be starred): delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms

Positive Symptoms

Added symptoms: delusions, hallucinations, disorganized speech, catatonia

Negative Symptoms

Loss of functions: flat affect, alogia, avolition, anhedonia, social withdrawal

Delusions

False, fixed belief (e.g., persecution, grandeur, reference, control)

Hallucinations

False sensory perceptions; most common: auditory

Catatonia

Motor disturbance; waxy flexibility (maintains imposed posture)

Phases of Schizophrenia

Prodromal: gradual decline; Active: full symptoms; Residual: symptoms lessen

Stress & EE

Stress can trigger episodes; High Expressed Emotion (EE) → ↑ relapse rates

Elyn Saks

Law professor with schizophrenia who advocates for humane treatment

Dopamine Hypothesis

2/3 cases involve dopamine dysfunction; functional excess = too much dopamine release, too many receptors

Hypersensitive receptors

Evidence: Antipsychotics block dopamine & improve symptoms; Amphetamines increase dopamine → can trigger psychosis.

Antipsychotics

Medications used to treat psychosis.

First-Gen (Typical) Antipsychotics

Examples: Thorazine, Haldol, Compazine; Dopamine antagonists; more motor side effects.

Second-Gen (Atypical) Antipsychotics

Examples: Clozapine, Seroquel, Risperdal, Zyprexa; Dopamine + serotonin effect; fewer motor side effects but not side-effect free (e.g., weight gain, diabetes).

Cogentin

Used to treat extrapyramidal symptoms.

Diphenhydramine (Benadryl)

Can treat acute dystonic reaction.

Movement Side Effects

Includes extrapyramidal symptoms (parkinsonism), acute dystonia, tardive dyskinesia (late-onset, often irreversible).

Genetics & Environment

Twin concordance: ~50% identical twins; Single-gene paternal mutation risk increases with older fathers; Maternal infections: influenza, rubella, toxoplasmosis during pregnancy ↑ risk.

Hypothalamus

Monitors: Hunger, satiety, body weight, energy balance.

Lateral hypothalamus (LH)

Stimulates hunger ('Large Hunger').

Ventromedial hypothalamus (VMH)

Stimulates satiety ('Very Much Had enough').

Leptin

Satiety hormone (fat cells → brain) ↓ hunger.

Ghrelin

Hunger hormone (stomach → brain) ↑ hunger.

Orexin

Regulates hunger + wakefulness.

Anorexia Nervosa

Characterized by restriction of energy intake → significantly low weight, intense fear of gaining weight, body image disturbance or denial of seriousness.