Module 2 - PS280

Alcohol, Mood, Eating and Psychotic Symptoms

What is Alcohol Use Disorder?

A clinical diagnosis involving problematic alcohol use causing impairment or distress; includes dependence and/or abuse.

Define tolerance in the context of alcohol use

needing an increasing amount of alcohol to achieve the same effect

what are withdrawal symptoms of alcohol

• anxiety

• tremors

• insomnia

• depression

• in severe cases

  • hallucinations

  • seizures

What is Delirium Tremens? (DTs)

severe withdrawal reaction involving hallucinations, tremors, disorientation, panic and sometimes fever

• common in chronic users

Binge Drinking

consuming 5+ drinks (men) or 4+ drinks (women) in a short time span, typically to become intoxicated

Difference between alcohol use and dependence?

• abuse = negative social/occupational effects without physical dependence

• dependence = includes tolerance, withdrawal and ability to stop

What brain changes are involved in alcohol tolerance?

• altered GABA and glutamate receptor activity

• CNS becomes less responsive, building tolerance and requiring more alcohol for same effect

Why does withdrawal lead to overexcitation of the nervous system?

alcohol is a depressant and depresses the CNS, sudden removal causes the system to become over excited

What role do psychological expectations play in alcohol tolerance?

people expecting alcohol to affect them differently may experience altered intoxication effects

• If you expect to feel nothing, you might not feel very intoxicated, even if your blood alcohol level is high.

What are signs of alcohol dependence?

daily drinking, blackouts, failed attempts to quit, binges, drinking non-bev alcohol (mouthwash)

How does female alcohol use differ from male use?

Women often begin drinking later, drink more in response to stress, and are more likely to drink alone.

What percentage of Americans have experienced alcohol abuse or dependence?

17.8% abuse, 12.5% dependence (Hasin et al., 2007).

What proportion of people with alcohol dependence never receive treatment?

75%

Which disorders commonly co-occur with AUD

• personality disorders

• mood/anxiety disorders

• other substance use disorders

• schizophrenia

why does comorbidity matter in AUD

leads to higher relapse rates and worse treatment outcomes

consequences of binge drinking in students

missed classes, unsafe sex, injury, memory loss, legal trouble

What are some cognitive impacts has binge drinking shown in university students

memory problems, especially under stress or depression and impaired attention and decision-making skills.

What prevention strategy is most effective for student drinking?

Personalized, face-to-face, feedback based interventions

Harm reduction in addiction treatment

a set of practical strategies aimed at minimizing the negative consequences associated with drug use, focusing on safer use, managed consumption, and reducing harm rather than complete abstinence.

Disease model of addiction

a framework that views addiction as a chronic disease characterized by compulsive drug seeking and use despite harmful consequences, influenced by biological, genetic, and environmental factors.

• implies lifelong illness and abstinence as the goal

Moral Model of Addiction

addiction results from personal failure or choice, blames the individual

How do educators currently conceptualize addiction?

as a maladaptive coping strategy, works short term and is a coping mechanism to cope with personal, social and psychological factors

• shifts the blame away from individual.

Jellinek’s stage model of AUD

Progression from social drinking to dependence (not always supported by research)

Pre alcoholic stage

• drinking for relief (anxiety, stress trauma)

• tolerance develops

• no signs of addiction YET

Prodromal Stage

• blackouts (periods of amnesia after drininking)

• sneaky drinking

• obsessive thoughts (about alcohol)

• guilt and shame

Crucial Stage

• loss of control (once drinking starts, can’t stop)

• binges

• failed attempts to quit

• life disruptions (personal and social life begin to suffer)

• physical dependance becomes evident

Chronic Stage

• continuous drinking (no periods of abstinence)

• tolerance drops

• withdrawal symptoms (if not drinking)

• severe health problems

• may drink non beverage alcohol (mouthwash)

Rehabilitation Stage

added later by others

• recognition of problem

• seeking help through therapy, detox, support groups

• ongoing maintenance and relapse prevention

How does the course of AUD differ by gender?

Women typically begin drinking later but deteriorate faster and are less likely to binge.

5 stages of the Jellinek’s stage model of AUD

includes pre-alcoholic, prodromal, crucial, chronic, and rehabilitation stages.

How does AUD affect healthcare usage?

people with AUD have 2x medical costs and 4x more healthcare use

What role does alcohol play in violent crimes?

involved in over 50% of homicides and 2/3 of aggressive incidents

Biphasic effects of alcohol

• initial stimulation (euphoria)

• CNS depression (drowsiness, poor coordination)

What neurotransmitters are affected by alcohol?

• GABA, serotonin and dopamine increase

  • GABA increase = relaxed calm, coordination and thinking slow down ; acts like a sedative

  • Dopamine increase = pleasure, euphoria, drinking becomes reinforced, develops addiction

  • Serotonin = reduces social anxiety, increase in happiness and confidence (SHORT TERM), disrupts serotonin balance adding to depression (LONG TERM)

• Glutamate decreases

  • glutamate decrease = slow thinking, memory loss/blackouts. poor coordination and slurred speech, reduced attention + cognitive performance

Long-term health impacts of chronic alcohol use

• liver cirrhosis

• brain damage

• malnutrition

• immune suppression

• cancer

• heart disease

Fetal Alcohol Syndrome (FAS)

Birth defects from heavy prenatal drinking

• facial abnormalities

• cognitive deficits

• developmental delays

What are mood disorders?

severe emotional disturbances that impair

• thinking

• behaviour

• physical function

they can range from depression to mania

Major Depressive Disorder (MDD)

state of intense sadness, low self esteem, guilt, with somatic, cognitive, emotional and motivation symptoms that significantly impair daily functioning and can last for weeks or longer.

DSM-5 criteria for MDD

at least 5 symptoms for more than 2 weeks

• depressed mood

• anhedonia

• sleep/appetite changes

• fatigue

• guilt

• low self worth

• suicidal thoughts

• poor concentration

common symptoms of MDD

Depressed mood, anhedonia, sleep/appetite changes, fatigue, guilt, low self-worth, suicidal thoughts, and poor concentration.

How can depression vary by age and culture?

Children show somatic complaints

• headaches, stomach aches, fatigue

• They might express emotional distress through physical symptoms as they cannot articulate emotions like sadness or hopelessness

older adults show memory issues

• forgetfulness, confusion, trouble concentrating

non-Western cultures may somaticize symptoms due to stigma.

• back pain, chest heavy

• express physical symptoms rather than emotional distress due to stigma

why is depression more common in women?

Factors such as societal pressures, gender roles, and experiences of trauma can also play significant roles.

Persistent Depressive Disorder (PDD)

chronic, less severe form of depression lasting more than 2 years, often with poor prognosis (low chance of recovery)

Signs of Mania in Bipolar Disorder

elevated

• mood

• hyperactivity

• grandiosity

• impulsivity

• distracted

• pressured speech

decreased

• need for sleep

DSM-5 criteria for Bipolar 1

At least one manic episode with elevated/irritable mood & 3+ additional manic symptoms.

How common is bipolar disorder and when does it start?

lifetime prevalence: 4.4%

onset: early 20s

What does it mean that depression may be dimensional?

It suggests that depression exists on a spectrum, varying in severity and symptoms rather than being a distinct category.

• challenges categorical diagnosis

What is heterogeneity in mood disorders?

People with the same diagnosis may show very different symptoms and trajectories.

Bipolar 2 Disorder

Involves major depressive episodes and hypomanic episodes (less severe than mania)

Mixed episode in BD

characterized by simultaneous symptoms of mania and depression.

Melancholic depression

A subtype of MDD with anhedonia, unresponsive mood, appetite loss, worse mornings, and agitation/lethargy.

Peripartum depression

depression during or after pregnancy

risk factors of peripartum depression

• past depression

• low support

• low income

• violence

• stress

Why might peer support worsen peripartum depression?

Women may engage in upward social comparison, leading to greater distress.

Seasonal Affective Disorder (SAD)

A type of depression that occurs at a specific time of year, usually in winter, due to reduced sunlight exposure.

Main treatment for SAD

light therapy

Cyclothymic Disorder

A mood disorder characterized by fluctuating periods of hypomanic symptoms and periods of depressive symptoms lasting for at least two years

• not full criteria for bipolar/depression

core idea of the diathesis - stress model in depression?

suggests that depression results from the interaction of a predisposed vulnerability (diathesis) and environmental stressors. This means individuals may inherit a genetic risk that, when combined with stress, can lead to the development of depression.

according to Freud, how does depression develop?

from unconscious conflict related to loss, where anger towards a lost person is is turned inward → self hate and depression (mourning and melancholia)

What childhood experience may lead to depressive fixation according to psychoanalysis?

over (constantly soothed) or under-gratification (neglected, inconsistently fed) in the oral stage → excessive dependancy on others

Beck’s 2 personality styles associated with depression

1. sociotropy

   1. need for approval

2. autonomy

   1. achievement focus and control

Beck’s Negative Cognitive Triad

A theory proposing that depressed individuals have negative beliefs about themselves, their world, and their future, influencing their emotional state and behavior.

What personality traits did Zuroff & Mongrain find predicted depression recurrence?

self-criticism and neediness (maladaptive dependency, unhealthy reliance on others)

3 types of perfectionism

only the first 2 are strongly linked to depression

1. self oriented

   1. high standards for yourself

2. socially prescribed

   1. believing others expect you to be perfect

3. other oriented

   1. expecting other people to be perfect

Congruency Hypothesis in depression

this hypothesis suggest that depression arises when a person’s personality vulnerability matches the type of life stressor

• match between who you are and what happens to you increases the risk of depression

  • sociotropy (dependancy) + relationship problems = more likely to be depressed

What predicts poor treatment response in CT

high self criticism, unless it improves, recovery is unlikely

SCPS and what does it predict?

Self-criticism Perfectionism Scale - best predictor of depression and social anxiety

List 3 moderators that influence depression risk.

Genetics, temperament (neuroticism), coping style (rumination)

3 components of Beck’s Negative Cognitive Triad

negative views of the self, the world, and the future

What evidence supports Beck’s theory?

Stroop tasks (slower for sad words), self-referent tasks (more negative recall), and DAS scores (predict recurrence).

core idea of learned helplessness theory

is that individuals can learn to feel helpless and incapable of changing their circumstances after experiencing repeated failures or negative outcomes, leads to depression.

What is the depressive attributional style?

A cognitive pattern where individuals attribute negative outcomes to internal, stable, and global factors, affecting their self-esteem and contributing to depression.

• an example: if someone fails a test, they might believe it's due to their own lack of intelligence (internal), that they'll always fail in similar situations (stable), and that this failure applies to all areas of their life (global).

According to the Hopelessness Theory, when does depression arise?

When a person expects nothing will improve and they have no control over the future.

What interpersonal behaviours are common in depression?

• social withdrawal

• excessive reassurance seeking

• conversational self-focus

Stress Generation Theory

The theory that suggests individuals with depression may create or exacerbate stressful situations in their lives due to their behaviors and coping styles, leading to further negative outcomes.

What factors may contribute to stress generation?

• childhood mistreatment

• reassurance seeking

• poor relationships

• serotonin gene (short-allele)

  • individuals with this gene were more likely to develop depression after stressful life events as they’re sensitive to stress

BAS dysregulation of Bipolar Disorder

A condition where the behavioral activation system is poorly regulated, leading to heightened mood swings, impulsive behavior, and an increased risk of manic episodes in individuals with bipolar disorder.

What are the main eating disorders

1. Anorexia Nervosa

2. Bullimia Nervosa

3. Binge Eating Disorder (BED)

How do biological and sociocultural factors interact in eating disorders?

they combine to increase risk - biological vulnerabilities interact with cultural pressures and personal experiences.

Is there a genetic component to eating disorders?

Yes. Twin studies show moderate heritability for anorexia and bulimia.

What brain area is involved in eating disorders?

hypothalamus, which regulates hunger and satiety.

What neurotransmitter is linked to anorexia and bulimia?

Serotonin (5-HT) — abnormalities in serotonin are linked to mood and appetite regulation issues.

• Low levels of serotonin can contribute to the development of eating disorders, affecting both mood and food intake.

How does serotonin function differ in those with eating disorders?

• anorexia: elevated serotonin activity → anxiety and appetite suppression

• bullimia : dysregulated serotonin activity → binge eating and compensatory behaviors.

What’s the role of endogenous opioids in anorexia

Starvation triggers release of endorphins (natural opioids) → reinforces starvation through pleasure and pain reduction.

What’s the reinforcing effect of starvation?

Starvation leads to the release of endorphins, which enhances feelings of pleasure and reduces pain, thereby reinforcing the behavior of starvation. Starving may also reduce anxiety or negative emotions, reinforcing restriction (especially in anorexia).

What role does media play in eating disorders?

Media promotes thin-ideal internalization, especially via social media and celebrity culture.

How do pro-anorexia websites influence behaviour?

They glorify extreme thinness, share weight-loss tips, and discourage recovery.

Who is most affected by sociocultural pressure

• girls and women

• LGBTQ+ youth

• people in western cultures

• those with perfectionist or low self esteem traits

How does culture shape eating disorder symptoms?

• Western cultures: Thin ideal → body dissatisfaction

• Non-Western cultures: Symptoms may be less focused on weight, more on control or purity

what’s the role of peer influence in eating disorders?

Peers can model disordered eating, encourage dieting, or support negative body talk.

How does gender impact ED risk?

through societal expectations, with women facing greater pressure to adhere to thin ideals, while men may experience pressures related to muscularity and strength.

heritability estimate for AN

56%

gene-environment interaction theory in ED’s

genes influence how much people internalize sociocultural ideas like thinness and can determine individual susceptibility to eating disorders based on environmental factors.

What is the role of the hypothalamus in AN

though it regulates hunger, likely isn’t the cause of AN since patients still feel hunger and fear weight gain

How do endogenous opioids affect eating disorders?

AN

• starvation raises opioid levels → euphoria and reinforcing restriction

BN

• low opioids → triggers cravings

What NT is involved in BN

serotonin (5-HT)

• low levels are linked to poor impulse control and mood disturbances

Scarlett O’Hara Effect

women eat less infant of men to appear more feminine

What scale measures internalization of cultural beauty standards?

SATAQ-3 (Sociocultural Attitudes Toward Appearance Questionnaire-3

What contradiction exists in North American culture regarding body image?

obesity rates are high (20–30%), the cultural ideal is thinness, creating dissatisfaction and disordered eating.

How do toys like Barbie affect body image?

Unrealistic proportions contribute to distorted body ideals and eating disorder risk in young girls.