Exam 3

Clinical Description of Female Sexual interest/arousal disorder

• Lack of or significantly reduced sexual interest/arousal (factors could be losing interest in your partner or relationship stress)

  • Typically manifesting in:

    • Reduced sexual interest

    • Reduced sexual activity

    • Fewer sexual thoughts

    • Reduced arousal to sexual cues

    • Reduced pleasure or sensations during almost all sexual encounters

  • And causes significant distress

  • Research suggests 7-46% of women experience low sexual desire

Clinical Description of Male hypoactive sexual desire disorder

• Little or no interest in any type of sexual activity

• Masturbation, sexual fantasies, and intercourse are rare

• Affects approximately 5% of men

• As with other disorders: not better explained by something else

Clinical description of Genito-pelvic pain/penetration disorder

• In females, difficulty with vaginal penetration during intercourse, associated with one or more of the following:

  • Pain during intercourse or penetration attempts

  • fear/anxiety about pain during sexual activity

  • Tensing of pelvic floor muscles in anticipation of sexual activity

Clinical description of erectile disorder

• Difficulty achieving or maintaining an erection

• Sexual desire is usually intact

• Most common problem for which men seek treatment

• Prevalence increases with age

  • 50% of men over 60 experience erectile dysfunction (correlation between age and experiencing erectile dysfunction)

Social/cultural influences on sexual functioning?

• Learned negative attitudes toward sex and sexuality (Erotophobia)

• Negative sexual experiences

• Relationship challenges; dissatisfaction within romantic relationships

How physical disorders/disability can impact sexual functioning?

• Physical disability often increases the likelihood of sexual functioning problems

• People with more severe physical disability report on average lower-sexual satisfaction

Treatment options for sexual dysfunction

• Educate clients and patients, not assume that they know anything, 

• Masters and Johnson’s psychosocial intervention (no actual sexual intercourse)

  • Sensate focus and nondemand pleasuring

    • Sexual activity with the goal of focusing on sensations without trying to achieve orgasm

• Use of dilators to help women with painful intercourse

• Exposure to erotic material for problems with low sexual desire

• Medications (oral, injectable), vacuum-pump devices for ED

• Referral to appropriate medical professionals (PCP, PT)

Psychological disorders that may make someone more vulnerable to sexual dysfunction

• Anxiety disorders

• Mood disorders

• Trauma

• Somatic disorders

• Substance use disorders

Recognize circumstances where a diagnosis may be inappropriate despite symptoms being present

• Outside factors such as severe relationship stress that could be accounting for symptoms

Reasons as to why healthcare professionals may be less inclined to bring up sexual health in an appointment with a patient/client

• It’s often minimally covered in professional and medical education

• assuming patient doesn’t want to talk about sex or would feel too embarrassed if you brought it up 

Distinguish between substance use and abuse?

Substance use: taking moderate amounts of a substance in a way that doesn’t interfere with functioning

Substance abuse: use in a way that is dangerous or causes substantial impairment (e.g. affecting job or relationships)

Distinguish between tolerance and withdrawal?

Tolerance: needing more of a substance to get the same effect/reduced effects from the same amount

Withdrawal: physical symptom reaction when substance is discontinued after regular use

Clinical Features of substance use disorders

• Pattern of substance use leading to significant impairment and/or distress

• Symptoms (need 2+ within a year mild) (4 or 5 moderate) (6 or more severe)

  • Taking more of the substance than intended

  • Desire to cut down use

  • Excessive time spent using/acquiring/recovering

  • Craving for the substance

  • Role disruption (e.g. can’t perform at work

  • Interpersonal problems

  • Reduction of important activities

  • Use in physically hazardous situations (e.g. driving)

  • Keep using despite causing physical or psychological problems

  • Tolerance

  • Withdrawal

Recognize 5 main categories of substances, common features of each, and example of drugs that belong to each category?

• Depressants

  • Behavioral sedation (e.g. alcohol, sedative, anxiolytic drugs)

• Stimulants

  • Increase alertness and elevate mood (e.g. cocaine, nicotine)

• Opiates

  • Produce analgesia and euphoria (e.g. heroin, morphine, codeine)

• Hallucinogens

  • Alter sensory perceptions (e.g. marijuana, LSD)

• Other drugs of abuse

  • Include inhalants, anabolic steroids, medications

What are the long-term effects of heavy drinking?

• Tremors

• Nausea/vomiting

• Hallucinations

• Agitation

• Insomnia

• Seizures

• Delirium tremens

• Liver disease (½ of cases are because of alcohol abuse, includes cirrhosis-scarring of the liver) 

• Pancreatitis

• Cardiovascular disorders

• Depression

• Certain cancers (breast cancer link to alcohol, 

• Brain damage

  • Dementia

  • Wernicke-korsakoff syndrome

What are delirium tremens (DT)?

• in severe cases (3-5% will experience)

• when people appear disoriented and affects their voluntary muscle movement and have tremors

• can be serious because it involves body's ability to regulate basic functions, can affect heart rate and respiration (breathing)

Long term-effects of heavy drinking: Fetal Alcohol Syndrome

• Condition that affects children exposed to alcohol before birth. Commonly affects behavior, learning, and physical features (low iq, hyperactive behavior, speech and language delays, learning disabilities)

  • Physically looks like: large forehead, thin upper lip, minor skin folds on ears

Common comorbid diagnoses with substance use disorders?

• Approximately 75% of people in addiction treatment meet criteria for at least one other psychiatric disorder

  • Mood disorders (40% or more)

  • Anxiety disorders and PTSD (25% or more)

• When other psychiatric symptoms occur in the context of active substance use, clinicians must proceed carefully with diagnosis

What counts as a standard drink for beer, wine, and liquor?

• 12 oz of regular beer (5% alc)

• 5 oz of table wine (12% alc)

• 1.5 fl oz of distilled spirits (40% alc)

What is meant by moderate, heavy drinking, and binge drinking for men and women?

• According to the 2020-2025 Dietary Guidelines for Americans

  • Recommend for adults of legal drinking age to drink no more than 2 drinks/day (men) or 1 drink/day (women)

  • Some people (e.g. pregnant women) should not drink

• Heavy drinking according to NIAAA

  • For men, consuming >4 drinks on any day or more than 14/week

  • For women, consuming >3 drinks on any day or more than 7/week

• Binge-drinking

  • 4+ drinks for women; 5+ drinks for men within 2-hour period

What is meant by prescription drug misuse/abuse?

• Prescription drug misuse and abuse is when someone takes a medication inappropriately (NIDA)

• Adolescents are particularly vulnerable

• Most of the prescription drugs that are misused are pain-relieving drugs

How do opioids have their effect?

• Opioid drugs bind to opioid receptors in the CNS

• Inhibit production of GABA (dopamine police, increase in euphoria)

• Allows more dopamine to be available in the brain

Why would someone be at high risk of overdose from a relapse after a period of abstinence?

They do not realize that they do not need as much to get the same effect, so they take a higher amount

Relevant biological treatments (like Naltrexone and Methadone) for opioid use disorder and alcohol use disorder?

• Naltrexone 

  • FDA-approved for opioid and alcohol use disorders

  • Blocks pleasant effects of drugs; reduce cravings

  • Patients must complete detox (medically managed withdrawal) prior to initiating

• Suboxone (is an opioid)

  • FDA-approved for opioid use disorders

  • Blocks pleasant effects of drugs; reduce cravings

  • Potentially addictive

• Methadone (is an opioid)

  • FDA-approved for opioid use disorders

  • Blocks pleasant effects of drugs; reduce cravings

  • Potentially addictive

Describe some of the positive outcomes of medication-assisted treatment for opioid use disorder?

• Lower the risk of fatal overdoses by approx. 50%

• Lower the risk of non-fatal overdoses

• Reduce drug-injecting

• Reduce HIV transmission

• Reduces criminal activity by opioid users

Questions asked on the CAGE alcohol use disorder screening tool?

1. Have you felt the need to Cut down on your drinking?
2. Do you feel Annoyed by people complaining about your drinking?
3. Do you ever feel Guilty about your drinking?
4. Do you ever drink an Eye-opener in the morning to relive the shakes?

General Nature of Personality Disorders (PD)

• Enduring, inflexible predispositions

• Maladaptive, causing distress and/or impairment

• High comorbidity

• Poorer prognosis

What are the 3 personality clusters and what PDs belong to each cluster?

• A (follows B)

  • Odd or eccentric cluster

  • Includes paranoid, schizoid, schizotypal

• B (most prevalent in US)

  • Dramatic, emotional, erratic cluster

  • Includes antisocial, borderline, histrionic, narcissistic

• C (follows A)

  • Fearful or anxious cluster

  • Includes avoidant, dependent, obsessive-compulsive

Common focus of treatment for Cluster A PDs?

• Focus on interpersonal skills

• Building trust where paranoia is a factor

• Address comorbid conditions

Clinical features of antisocial PD?

• Failure to comply with social norms

• Violation of the rights of others

• Irresponsible, impulsive, and deceitful

• Lack of a conscience, empathy, and remorse

• May be charming, interpersonally manipulative

• Most often diagnosed in males

Antisocial PD: Common features of early/family history?

• Relation with early behavior problems and conduct disorder

  • Early histories of behavioral problems including conduct d/o

    • “Callous-unemotional” type of conduct disorder most likely to evolve into antisocial PD

  • Families with inconsistent parental discipline and support (modeling and demonstrating)

  • Families often have histories of criminal and violent behavior

Clinical features of Borderline PD?

• Unstable moods and relationships

• Impulsivity, fear of abandonment, poor self-image

• Self-mutilation and suicidal gestures

Treatment options for Borderline PD?

• Antidepressant medications provide some short-term relief

• Dialectical behavior therapy is most promising treatment; 4 components:

  • Mindfulness: the practice of being fully aware and present

  • Distress Tolerance: how to tolerate pain in difficult situations

  • Interpersonal effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others

  • Emotion regulation: how to decrease vulnerability to painful emotions and change emotions that you want to change

Clinical features of Obsessive-Compulsive PD and how it differs from OCD?

• Excessive and rigid fixation on doing things the right way

• Highly perfectionistic and orderly (to an extreme)

• Obsessions and compulsions are rare

DSM-5 criteria for schizophrenia?

• A. Two (or more) of the following each present for a significant portion of time during a one-month period:

  • Delusions

  • Hallucinations

  • Disorganized speech

  • Grossly disorganized or catatonic behavior

  • Negative symptoms

• B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset

• C. Continuous signs of the disturbance persist for at least six months

• In children, not making milestones

• Parkinsons and dementia

What are hallucinations?

• Experience of sensory events without environmental input

• Can involve all senses (e.g. tasting something when not eating, having skin sensations when not being touched)

• Most common: auditory

What are some types of hallucinations?

• Auditory (hearing things that aren’t there)

  • Subtype: command hallucinations (are when a voice tells you to do something)

• Visual (seeing things that aren’t there) (tree trunks falling in front of you)

• Olfactory (smelling things that aren’t there) (rotten eggs)

• Tactile (feeling things that aren’t there) (bugs crawling on skin)

What are delusions?

Gross misrepresentations of reality

What are some examples of delusions?

• Delusions of grandeur (beliefs that I have special skills or famous person, unique abilities)

• Delusions of persecution (believe other people are out to harm or get them, being followed, CIA is tracking them)

Clinical Description for schizophreniform

• Psychotic symptoms lasting between one and six months

• Need 2+ symptoms (delusions, hallucination, disorganized speech, disorganized or catatonic behavior, negative symptoms)

Clinical description for brief psychotic disorder

• Psychotic symptoms lasting less than one month

• Need 1+ symptom(s) (delusions, hallucinations, disorganized speech, disorganized or catatonic behavior)

Clinical description for schizoaffective disorder

• Symptoms of schizophrenia + additional experience of a major mood episode (depressive or manic)

• Psychotic symptoms must also occur outside the mood disturbance

• Prognosis is similar for people with schizophrenia

• Such persons do not tend to get better on their own

Clinical description for catatonia

• Unusual motor responses, particularly immobility or agitation, and odd mannerisms

• Tends to be severe and quite rare

• May be present in psychotic disorders or diagnosed alone

• May include

  • Stupor, mutism, or maintaining the same pose for hours

  • Opposition or lack of response to instructions

  • Repetitive, meaningless motor behaviors

  • Mimicking others’ speech or movement

Positive Symptom Cluster in Schizophrenia (things happening on top of normal experiences)

• Hallucinations

  • Experience of sensory events without environmental input

  • Can involve all senses (e.g. tasting something when not eating, having skin sensations when not being touched)

  • Most common: auditory

• Delusions

  • Gross misrepresentations of reality

  • Most common:

    • Delusions of grandeur (beliefs that I have special skills or famous person, unique abilities)

    • Delusions of persecution (believe other people are out to harm or get them, being followed, CIA is tracking them)

Negative symptom cluster in schizophrenia (absence of normal experiences)

• The negative symptoms

  • Absence of insufficiency of normal behavior

• Spectrum of negative symptoms

  • Avolition (or apathy) - lack of initiation and persistence (even if offered enticement, will still be incapable of doing it)

  • Alogia - relative absence of speech (when asked a question, will answer in only one or two words)

  • Anhedonia - lack of pleasure, or indifference (normal things that brings one joy is not getting joy anymore)

  • Affective flattening - little expressed emotion (expression is flat, not showing anything)

Disorganized symptom cluster in schizophrenia

• Disorganized speech

  • Tangentiality - “going off on a tangent” (start at point a, end at point d, never make point back to a)

  • Loose associations - conversation in unrelated directions (ideas loosely held together and don’t make a lot of sense, person has lumped them together)

• Disorganized affect (what they are saying doesn’t match outward expression of emotion)

  • Inappropriate emotional behavior

• Disorganized behavior

  • Includes a variety of unusual behaviors

  • Catatonia

    • Considered a psychotic spectrum disorder in its own right or, when occurring in the presence of schizophrenia, a symptom of schizophrenia

Describe differential diagnoses for schizophrenia (i.e. disorders we would need to rule out because they share similar clinical features)

• Multiple personality/dissociative identity disorder

• Sleep paralysis

• Substances

• Bipolar (Type 1)

• Major depression

• Parkinsons

• Lewy Body

Prevalence Rate of Schizophrenia

• Onset and prevalence of schizophrenia worldwide

  • about 1% of the population

  • Often develops in early adulthood

  • Can emerge at any time; childhood cases are very rare

• Tends to follow chronic course

  • Most with mod-severe impairment

  • Lower life expectancy (due to increased risk of suicide, accidents, and poorer self-care)

Demographic patterns in age of onset

• Affect males and females about equally

  • Onset slightly earlier for males

• females tend to have one big peak from ages 20-24

• males have two peaks from 25-29 and 45-49

Relationship between schizophrenia and life expectancy

Lower life expectancy (due to increased risk of suicide, accidents, and poorer self-care)

Describe what is meant by the “prodromal” phase of schizophrenia

unusual psychotic-like behaviors

What are the causal factors and correlates of schizophrenia?

• Degree of genetic relatedness matters

• Adoption studies

  • Adopted children whose bio parents have schizophrenia are still at risk for developing schizophrenia

  • BUT a healthy environment is a protective factor

• The dopamine hypothesis: Schizophrenia is partially caused by overactive dopamine

  • Drugs that increase dopamine (agonists) result in schizophrenic-like behavior

  • Drugs that decrease dopamine (antagonists) reduce schizophrenic-like behavior

• Structural and functional abnormalities in the brain

  • Enlarged ventricles and reduced tissue volume

  • Hypofrontality - less active frontal lobes

• Viral infections during early prenatal development

  • Findings are inconclusive

• The role of stress

  • May activate underlying vulnerability (think: diathesis-stress)

  • May also increase risk of relapse

• Cold parenting - unsupported theory

• High expressed emotion within families - associated with relapse

Describe treatment options for schizophrenia

• Typically involves antipsychotic medication plus psychosocial interventions such as

  • Social skills/living skills training

  • Family therapy

  • Vocational rehabilitation

• Noncompliance with medication is a common issue

• Meds can have major and permanent side effects

  • Eg. Tardive dyskinesia

What is tardive dyskinesia?

Tardive dyskinesia is caused by long-term use of neuroleptic drugs, which are used to treat psychiatric conditions.

Tardive dyskinesia causes repetitive, involuntary movements, such as grimacing and eye blinking.

Inattentive symptoms of ADHD

• Not giving close attention to details

• Difficulty maintaining attention

• Trouble with follow-through

• Avoid tasks that require sustained mental effort (reading intense book, often see procrastination)

• Often loses things necessary for tasks/activities

• Easily distracted and/or forgetful

Hyperactive/impulsive symptoms of ADHD

• Fidgeting in seat

• Often unable to engage in leisure activities quietly

• “Driven by a motor”

• Running/climbing in situations where inappropriate (or feelings of restlessness in adults)

• Blurting out answers before question is completed

• Difficulty waiting their turn

Prevalence rates/trends of ADHD

• Prevalence

  • It occurs in approximately 5% of school-aged children

  • Symptoms are usually present around age 3 or 4

  • Children with ADHD have similar problems as adults

• Gender differences

  • Boys outnumber girls 3:1

• Cultural factors

  • ADHD is most commonly diagnosed in the US but also diagnosed worldwide (2-7% prevalence rate)

• Diagnoses are increasing as the years go by

• Childhood prevalence by race or ethnicity, according to large national sample

  • White, non-hispanic 78.8%

  • Hispanic 9.1%

  • Black 6%

  • Asian 3.2%

  • Other 3.0%

Autism prevalence rates/trends

• 1 in 44 children in the US meet criteria

• More commonly diagnosed in males

• IQ interaction

  • Approx 35% show intellectual disabilities

• Worldwide prevalence = 1%

Biological Treatment Options for ADHD

• Stimulant medications

  • Currently prescribed for approximately 4 million American children

  • Low doses of stimulants improve focusing abilities

  • Examples include Ritalin, Dexedrine, Adderall

  • Problem: may increase risk for later substance abuse

Behavioral Treatment for ADHD

• Behavioral treatment

  • Reinforcement programs

    • To increase appropriate behaviors/decrease inappropriate behaviors

  • May also involve parent training

• Combined biopsychosocial treatments

  • Often recommended

  • May be superior to medication or behavioral treatments alone

Biological Treatment for ASD

• Biological treatments

  • Medical interventions has had little positive impact on core dysfunction

  • Some drugs decrease agitation

    • Tranquilizers

    • SSRIs

  • Indicators of good prognosis

    • High IQ, good language ability

Behavioral Treatment for ASD

• Behavioral approaches

  • Skill building

  • Reduce problem behaviors

  • Communication and language training

  • Increase socialization

• Early intervention is critical - may ”normalize” the functioning of the developing brain

Risk Factors of ADHD

• Genetic contributions

  • ADHD seems to run in families

  • DAT1 - Dopamine transporter gene has been implicated

    • Some ADHD drugs work by inhibiting DAT1

• Neurobiological correlates of ADHD

  • Smaller brain volume

  • Inactivity of the frontal cortex and basal ganglia

  • Abnormal frontal lobe development and functioning

Risk Factors of ASD

• Significant genetic component

  • Familial component: if one child with autism, the chance of a second child with autism is 20% (100x greater risk than general population

• Possible link between autism and oxytocin receptor genes

• Older parents associated with increased risk

• Neurobiological influences

  • Amygdala

    • Larger size at birth = higher anxiety, fear

    • Elevated cortisol

    • Neuronal damage in the amygdala results from high stress, which may affect processing of social situations

  • Oxytocin (helps explain social withdrawal)

    • Lower levels

  • Vaccinations do not increase the risk of autism

    • Mercury in some vaccinations was rumored to increase autism risk

    • Large scale studies do not support this

    • High rates of vaccinations do not increase risk for autism in the community at large

    • Health risk of not vaccinating is substantial

What are the main areas of impairment in ASD? What are some examples?

• Deficits in social communication and social interaction, including

  • social -emotional reciprocity

  • Nonverbal communication behaviors

  • Developing, maintaining, and understanding relationships

• Restricted, repetitive patterns of behavior, interests, or activities, including

  • Stereotyped or repetitive motor movements

  • Insistence on sameness; inflexible adherence to routines

  • Highly restricted, fixated interests

  • Hyper- or hyperactivity to sensory input

What is the relationship between ASD and intellectual disability?

Those w/ ASD can have intellectual disability bc of their slower development 

ADHD Central Features

• Central features - inattention, overactivity, and impulsivity

• Associated with various impairments

  • Behavioral 

  • Cognitive

  • Social and academic problems

• 3 symptom types

  • Inattentive

  • Hyperactive/impulsive

  • Combined

Diagnostic Features of ADHD

• Several symptoms must be present prior to age 12

• Symptoms present in two or more settings (home and school or work)

• Significant distress or impairment

• Not better explained by another condition (anxiety, substance use disorders, schizophrenia)