PSYCH 223 Exam 3

Biological Views of Biochemical Abnormalities of Schizophrenia

One promising theory is the dopamine hypothesis

Substance use disorder (SUD)

is a treatable mental disorder that affects a person's brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications. Symptoms can be moderate to severe, with addiction being the most severe form of a substance use disorder

There are a broad range of factors that clinical theorists believe explain why substance use disorders emerge

No single root cause!

Final answer: Substance use disorders occur due to a combination of factors

Cognitive Behavioral affects of SUD

People with this disorder become conditioned by the rewarding effects of the drug

This leads to repeated use in higher frequencies

There's an expectancy that the substance will be rewarding, so people continue to use

Treatment for substance use disorders

Cognitive Behavioral Therapies

Biological Therapies

Sociocultural therapies

Person centered care

Cognitive Behavioral Therapies for SUD

Behavioral self-control training (BSCT)

Relapse-Prevention Training

Behavioral self-control training (BSCT)

Clients keep track of their own use and triggers

Learn coping strategies for such events

Learn to set limits on drinking

Relapse-Prevention Training

Planning ahead for triggering situations

Gaining control of cravings or urges to use

Detox

Patients reduce their intake of the substance over time

This should be ideally medically managed in either outpatient or inpatient care

Antagonistic Drugs

aid in the detox process by reducing symptoms and reducing cravings after you've completely detoxed

Drug Maintenance therapy

is when people are given a medication substitute for the drug they're using (e.g. methadone for heroine) to reduce cravings and some of the dangers of using a street drug

Antagonists drugs

Drugs that occupy receptors but do not activate them. Antagonists block receptor activation by agonists.

People receive the least treatment for SUD in

prison or jail

People receive the most treatment for SUD in

outpatient rehab

Classes & Categories of SUD (Greatest to least)

Depressants

Stimulants

Hallucinogens

Cannabis

Polydrug use

Depressants can

Slow the activity of the central nervous system

Reduce tension, interferes with judgement, motor control, concentration

Depressants

Alcohol

Sedative-hypnotic (anxiolytic)

Opiods

Alcohol

ethyl alcohol is absorbed through the blood via the stomach. Alcohol helps GABA - an inhibitory messenger - block messages from transmitting from neuron to neuron which relaxes the user

Sedative-hypnotic (anxiolytic)

produce feelings of relaxation and drowsiness

At low doses, they have a calming or sedative effect

At high doses, they function as sleep inducers or hypnotics

Include benzodiazepines and barbiturates, which are normally used to treat anxiety but can be misused

opiods

include oxycodone, heroine, morphine, methadone, fentanyl and more

Can be taken orally (oxycodone) or by injection (heroine)

People quickly become dependent on opioids , and build up a tolerance so they begin using more and more

Withdraw symptoms can be quite severe: anxiety, restlessness, twitching, aches, vomiting, diarrhea, and fever

risk of opiods

injection use places people at risk for HIV, hepatitis; overdoses are common, especially as fentanyl has become more common. Naloxone can be used to prevent overdoses.

Opioid Addiction is often treated with methadone, buprenorphine, or naltrexone

stimulants can

increase activity of the central nervous system (CNS) - increase blood pressure, heart rate, and alertness

hallucinogens can

aka psychedelics can cause changes to your sensory perception causing illusions or hallucinations

Include psilocybin, Lysergic acid diethylamide (LSD), MDMA (Ecstasy)

stimulants

cocaine, Amphetamines, caffeine

hallucionigens

Hallucinogens induce hallucinogen intoxication (hallucinosis) which causes altered sensory perception, synesthesia, strong emotions

Binds to serotonin receptions, which typically control visual info and emotions

cannabis

produced from varieties of the hemp plant

Major active ingredient is THC

Can cause the user to feel joyful and relaxed, can induce paranoia or irritation. If used excessively can cause odd visual experiences, changes in body image, hallucinogens

cannabis can

cause substance dependence!

Cannabinoid hyperemesis syndrome (CHS) or cyclic vomiting syndrome (CVS)

Polysubstance Use

People often take more than one drug at a time

Drugs can have synergistic effects (complementary) or antagonistic effects (opposite)

Synergistic drugs might heighten the effects of the drug

Two depressants might make you feel more relaxed than just using one

This increases the risks of substance use considerably

Harm reduction for people with SUD

Overdose prevention

Clean needle exchanges

Fentanyl testing strips (often used for cocaine)

2 categories of Sexual Disorders

sexual dysfunctions and paraphilic disorders

sexual dysfunctions

problems with sexual responses

paraphilias

repeated and intense sexual urges and fantasies in response to socially inappropriate objects or situations

DSM-IV-TR included a diagnosis of gender identity disorder, a sex-related pattern in which people feel that they have been assigned to the ___ sex.

wrong

GID (gender identity disorder) removed from DSM-V; now "Gender Dysphoria"

Sexual dysfunctions are disorders in which people cannot respond normally in key areas of ___ functioning

sexual

Sexual dysfunctions are typically very ___, and often lead to sexual frustration, guilt, loss of self-esteem, and interpersonal problems

distressing

Often patients with one dysfunction experience another as well

The human sexual response can be described as a cycle with 4 phases

Desire

Excitement

Orgasm

Resolution

- Sexual dysfunctions affect one or more of the first three phases

Some people struggle with sexual dysfunction their whole lives ("lifelong type")

For others, normal sexual functioning preceded the disorder ("acquired type")

In some cases the dysfunction is present during all sexual situations ("generalized type")

In others it is tied to particular situations ("situational type")

Desire phase of the sexual response cycle

Consists of an urge to have sex, sexual fantasies, and sexual attraction to others

2 dysfunctions affects of desire phase

Hypoactive sexual desire disorder and Sexual aversion disorder

Hypoactive sexual desire disorder

Characterized by a lack of interest in sex and little sexual activity

Physical responses may be normal

Prevalent in about 16% of men and 33% of women

DSM refers to "deficient" sexual interest/activity but provides ___ definition of "deficient"

no]

In reality, this criterion is difficult to define

Sexual aversion disorder

Characterized by a total aversion to (disgust of) sex

Sexual advances may sicken, repulse, or frighten

This disorder seems to be rare in men and more common in women

A person's sex drive is determined by a combination of biological, psychological, and sociocultural factors, and any of these may ___ sexual desire

reduce

Most cases caused primarily by sociocultural and psychological factors, but biological conditions can also lower sex drive significantly

The excitement phase of the sexual response cycle

Marked by changes in the pelvic region, general physical arousal, and increases in heart rate, muscle tension, blood pressure, and rate of breathing

Disorders of Excitement

female sexual arousal disorder (formerly "frigidity"), male erectile disorder (formerly "impotence")

Disorders of Desire Biological causes

hormone abnormalities, chronic illness, drugs (OC's, some psychotropics, other narcotics)

Disorders of Desire Psychological causes

anxiety, depression, OCD, anger, fears, attitudes, memories

Disorders of Desire Sociocultural causes

attitudes, fears, and psychological disorders that contribute to sexual desire disorders occur within a social context, i.e. situational pressures such as divorce, death, relationship problems, past sexual trauma

Female sexual arousal disorder

Characterized by repeated inability to maintain proper lubrication or genital swelling during sexual activity

Many with this disorder also have desire or orgasmic disorders

It is estimated that more than 10% of women experience this disorder

Because this disorder is so often tied to an orgasmic disorder, researchers usually study the two together

Male erectile disorder (ED)

Characterized by repeated inability to attain or maintain an adequate erection during sexual activity

An estimated 10% of men experience this disorder

According to surveys, HALF of all adult men have erectile difficulty during intercourse at least some of the time

Disorders of Excitement Sociocultural causes

same as Hypoactive Sexual Desire, particularly job and marital stress

Disorders of Excitement Biological causes

same as HSD, also vascular problems or damage to nervous system via disease, disorders, or injuries

Medical devices have been developed for diagnosing biological causes of ED

Nocturnal penile tumescence (NPT)

Even minor physical impairment of the erection response may make a man vulnerable to the effects of psychosocial factors

Disorders of Excitement Psychological causes

Same as HSD

For example, as many as 90% of men with severe depression experience some degree of ED

One cognitive explanation for ED emphasizes performance anxiety and the spectator role

Once a man begins to have erectile difficulties, he becomes fearful and worried during sexual encounters; instead of being a participant, he becomes a spectator and judge

This can create a vicious cycle of sexual dysfunction where the original cause of the erectile failure becomes less important than the fear of failure

Disorders of Orgasm phase of he sexual response cycle

Sexual pleasure peaks and sexual tension is released as the muscles in the pelvic region contract rhythmically

3 disorders of orgasm

Rapid or Premature ejaculation

Male orgasmic disorder

Female orgasmic disorder

Rapid or Premature ejaculation

Characterized by persistent reaching of orgasm and ejaculation with little sexual stimulation

Behavioral explanations for Rapid or Premature ejaculation have received strongest support

The dysfunction seems to be typical of young, sexually inexperienced men

May be related to anxiety, hurried masturbation experiences, or poor recognition of arousal

Biological factors of Rapid or Premature ejaculation

May be born with a genetic predisposition

Brains of men with rapid ejaculation may contain certain serotonin receptors that are overactive and others that are underactive

Men with this dysfunction may experience greater sensitivity or nerve conduction in their penises

Male orgasmic disorder

Characterized by a repeated inability to reach orgasm or by a very delayed orgasm after normal sexual excitement

Psychological causes include performance anxiety and the spectator role

Biological causes include low testosterone, neurological disease, and head or spinal cord injury

Medications, including certain antidepressants (especially SSRIs) and drugs that slow down the central nervous system (CNS), can also affect ejaculation

Female orgasmic disorder

Characterized by persistent delay in or absence of orgasm following normal sexual excitement

Almost 25% of women appear to have this problem

10% or more have never reached orgasm

An additional 10% reach orgasm only rarely

Women who are more sexually assertive and more comfortable with masturbation tend to have orgasms more regularly

Most clinicians believe that Female orgasmic disorder

Orgasms during intercourse is not mandatory for normal sexual functioning

Early psychoanalytic theory used to consider lack of orgasm during intercourse to be pathological

Typically linked to female sexual arousal disorder - disorders studied/treated together

Again, a confluence of factors may combine to produce these disorders

Biological causes of Female orgasmic disorder

illnesses (i.e. diabetes, MS), medications, postmenopausal changes

Psychological causes of Female orgasmic disorder

depression, traumatic memories

Sociocultural causes of Female orgasmic disorder

stressful events, traumas, lack of intimacy in relationships

For years, sociocultural theory of female sexual dysfunction was that it resulted from sexually restrictive cultural messages; now challenged

Sexually restrictive histories are equally common in women with and without disorders

Cultural messages about female sexuality have been changing while the rate of female sexual dysfunction stays constant

2 types of sexual pain disorders

Vaginismus and Dyspareunia

These sexual dysfunctions do not fit neatly into a specific phase of the sexual response cycle

Vaginismus

Characterized by involuntary contractions of the muscles of the outer third of the vagina

Severe cases can prevent a woman from having intercourse

Perhaps 20% of women occasionally have pain during intercourse, but less than 1% of all women have vaginismus

Most agree with the cognitive-behavioral theory that vaginismus is a ___ ___ ___.

learned fear response

Anxiety and ignorance about intercourse, trauma caused by an unskilled partner, childhood sexual abuse

Some women experience painful intercourse because of infection or disease, leading to "rational" vaginismus

Most women with vaginismus also have other sexual disorders

Dyspareunia

Characterized by severe pain in the genitals during sexual activity

As almost 14% of women and about 3% of men

Dyspareunia in women usually has a physical cause, most commonly from injury sustained in childbirth

Although relationship problems or psychological trauma from abuse may contribute to dyspareunia, psychosocial factors alone are rarely responsible

Treatments for Sexual Dysfunctions: Early 20th century

psychodynamic therapy

Believed that sexual dysfunction was caused by a failure to negotiate the stages of psychosexual development

Therapy focused on gaining insight and making broad personality changes; was generally unhelpful

Treatments for Sexual Dysfunctions: 1950s and 1960s

behavioral therapy

Behavioral therapists - relaxation training and systematic desensitization

Moderately successful, but failed to work when key problems were misinformation, negative attitudes, and lack of effective sexual techniques

Treatments for Sexual Dysfunctions: 1970s

Human Sexual Inadequacy

This book, written by William Masters and Virginia Johnson, revolutionized the treatment of sexual dysfunctions

This original "sex therapy" program has evolved into a complex, multidimensional approach

Includes techniques from cognitive, behavioral, couples, and family systems therapies, along with a number of sex-specific techniques

More recently, biological interventions have also been incorporated

General Features of Sex Therapy

is short-term and instructive

Therapy typically lasts 15 to 20 sessions

It is centered on specific sexual problems rather than on broad personality issues

General Features of Sex Therapy includes:

Assessing and conceptualizing the problem

Assigning "mutual responsibility" for the problem

Education about sexuality

Attitude change

Elimination of performance anxiety and the spectator role

Increasing sexual and general communication skills

Changing destructive lifestyles and marital interactions

Addressing physical and medical factors

Hypoactive sexual desire and sexual aversion Techniques for treatment

hese disorders are among the most difficult to treat because of the many issues that feed into them

Therapists typically apply a combination of techniques, which may include:

Affectual awareness, self-instruction training, behavioral techniques, insight-oriented exercises, and biological interventions such as hormone treatments

Erectile disorder Techniques for treatment

Treatments focus on reducing a man's performance anxiety and/or increasing his stimulation

May include sensate-focus exercises such as the "tease technique"

-> Biological - Sildenafil (Viagra) and other erectile dysfunction drugs, gels, suppositories, penile injections, vacuum erection device (VED), penile implant surgery

Rapid or Premature ejaculation Techniques for treatment

Behavioral procedures such as the "stop-start" or "pause" procedure and the "squeeze" technique

Some clinicians favor the use of fluoxetine (Prozac) and other serotonin-enhancing antidepressant drugs

Because these drugs often reduce sexual arousal or orgasm, they may be helpful in delaying premature ejaculation

Female arousal and orgasmic disorders Techniques for treatment

Specific treatments for these disorders include cognitive-behavioral techniques, self-exploration, enhancement of body awareness, and directed masturbation training; also psychoeducation for women whose only concern is lack of orgasm during intercourse

-> Biological treatments, including hormone therapy or the use of sildenafil (Viagra), have also been tried, (not consistently helpful in many cases)

Vaginismus Techniques for treatment

Specific treatment for vaginismus takes two approaches:

Practice tightening and releasing the muscles of the vagina to gain more voluntary control

Overcome fear of intercourse through gradual behavioral exposure treatment

Most women treated for vaginismus using these methods eventually report pain-free intercourse

Dyspareunia Techniques for treatment

Determining the specific cause of dyspareunia is the first stage of treatment

Given that most cases are caused by physical problems, medical intervention may be necessary

Paraphilias

These disorders are characterized by unusual fantasies and sexual urges or behaviors that are recurrent and sexually arousing

Paraphilias involve

Nonhumans

Children

Nonconsenting adults

Humiliation of self or partner

According to the DSM, paraphilias should be diagnosed only when the urges, fantasies, or behaviors last at least ___ ___.

6 months

For certain paraphilias, however, performance of the behavior itself is indicative of a disorder, even if the individual experiences no distress or impairment

EX: sexual contact with children

Some experts argue that, with the exception of nonconsensual paraphilias, paraphilic activities should be considered a disorder only when they are the exclusive or preferred means of achieving sexual excitement and orgasm

Although theorists have proposed various explanations for paraphilias, there is little formal evidence to support the theories

None of the treatments applied to paraphilias have received much research or been proved clearly effective

Psychological and sociocultural treatments have been available the longest, but today's professionals are also using biological interventions

Fetishism

Are recurrent intense sexual urges, sexually arousing fantasies, or behaviors that involve the use of a nonliving object, often to the exclusion of all other stimuli

The disorder usually begins in adolescence

Almost anything can be a fetish

Women's underwear, shoes, and boots are especially common

Researchers have been unable to pinpoint the causes of fetishism

Psychodynamic theorists view fetishes as defense mechanisms, but therapy using this model has been unsuccessful

Behaviorists propose that fetishes are learned through ___ ___.

classical conditioning

Fetishes are sometimes treated with aversion therapy, covert sensitization, or imaginal exposure with either Masturbatory satiation and/or Orgasmic reorientation

Masturbatory satiation

clients masturbate to boredom while imagining the fetish object

Orgasmic reorientation

process which teaches individuals to respond to more appropriate sources of sexual stimulation

Transvestic Fetishism

Aka transvestism or cross-dressing

Characterized by fantasies, urges, or behaviors involving dressing in the clothes of the opposite sex in order to achieve sexual arousal

The typical person with transvestism is a heterosexual male who began cross-dressing in childhood or adolescence

Transvestism is often confused with gender dysphoria (transsexualism), but the two are separate patterns

Seems to follow behavioral principles of operant conditioning

Exhibitionism

Aka Also known as "flashing"

Sexual contact is neither initiated nor desired

Characterized by arousal from the exposure of genitals in a public setting

Usually begins before age 18 and is most common in males

Treatment for Exhibitionism

Aversion therapy and masturbatory satiation

May be combined with orgasmic reorientation, social skills training, or cognitive-behavioral therapy

Voyeurism

Characterized by repeated and intense sexual desires to observe people as they undress or to spy on couples having intercourse; may involve acting upon these desires

The person may masturbate during the act of observing or while remembering it later

The risk of discovery often adds to the excitement

Many psychodynamic theorists propose that voyeurs are seeking power

Behaviorists explain voyeurism as a ___ behavior that can be traced to a chance and secret observation of a sexually arousing scene

learned

Frotteurism

Recurrent and intense fantasies, urges, or behaviors involving touching and rubbing against a nonconsenting person

Almost always male, the person fantasizes during the act that he is having a caring relationship with the victim

Usually begins in the teen years or earlier

Acts generally decrease and disappear after age 25

Pedophilia

Characterized by fantasies, urges, or behaviors involving sexual activity with a prepubescent child, usually 13 years of age or younger

Some people are satisfied with child pornography

Others are driven to watching, fondling, or engaging in sexual intercourse with children

Evidence suggests that two-thirds of victims are female

People with pedophilia develop the disorder in ___.

Adolescence

Some were sexually abused as children

Many were neglected, excessively punished, or deprived of close relationships in childhood

Most are immature, display distorted thinking, and have an additional psychological disorder

Some theorists have proposed a related biochemical or brain structure abnormality but clear ___ factors have yet to emerge in research

biological