Exam 3 (Ch 10 to 14)

Female sexual interest/ arousal  disorder

Female sexual interest/ arousal  disorder

• Lack of or significantly reduced sexual interest/arousal 

• 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

Male hypoactive sexual desire disorder

• Little or no interest in any type of sexual activity 

• Masturbation, sexual fantasies, & intercourse are rare 

• Affects approximately 5% of men  

• As w/ other disorders: Not better explained by something else

Genito-pelvic pain/penetration disorder

• FEMALE-SPECIFIC

  • In females, difficulty w/ vaginal penetration during intercourse, associated w/ 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 anticipated of sexual activity

Note:

• Can be → Actual pain or Anxiety regarding Sex

• Can also happen w/ pelvic muscle spasms involuntary

Erectile disorder

• MALE-SPECIFIC 

  • Difficulty achieving or maintaining an erection 

  • Sexual desire is usually intact 

  • The most common problem for which men seek treatment 

  • Prevalence increases w/ age 

    • 50% of those over 60 experience erectile dysfunction 

      • Only 2% under age 40

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

if there is Relationship stress

if there is a Divorce

Any other outside reasons that could explain less sexual interest

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

Why would providers not bring it up?

• Minimally education 

  • they don’t feel competent in addressing these problems 

• Time crunch/constraint  -> @ most 15-minute window 

  • Address other/bigger issues 

• Personal factors

psychological disorders that may make someone more vulnerable to sexual dysfunction

• Anxiety regarding Sex

• Depression can cause less sexual interest

• Substance Abuse can lead to sexual disfunction

 social/cultural influences on sexual functioning

• Learned negative attitudes toward sex & sexuality (Erotophobia)

• Negative sexual experiences 

• Relationship challenges; dissatisfaction w/in romantic relationships

 how physical disorders/disability can impact sexual functioning

• Physical disability often increases the likelihood of sexual functioning problems 

• People w/ more severe physical disability report on average lower sexual satisfaction

 treatment options for sexual dysfunction.

• Education 

• Masters & Johnson’s Psychosocial Intervention 

  • Sensate focus & non-demand pleasuring 

    • Sexual activity w/ the goal of focusing on sensation w/out trying to achieve orgasm 

• Use of dilators to help women w/ painful intercourse 

• Exposure to erotic material for problems w/ low sexual desire 

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

• Referral to appropriate medical professionals (ex PCP, PT)

distinguish between substance use and abuse

• Substance abuse -> Use in a way that is dangerous and substantial impairment (e.g. affecting job or relationships) 

DIFF - ABUSE is dangerous use affecting you & your functioning (job)  while USE is moderate amounts but doesn’t affect functioning 

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

 distinguish between tolerance and withdrawal

• Tolerance -> needing more of a substance to the same effect/reduced effect from the same amount 

DIFF - Tolerance is needing a higher dosage to get the same effects @ the beginning & Withdrawal is physical discomfort after stopping/not regularly use 

• Withdrawal -> physical  symptom reaction when a substance is discontinued after regular use 

 5 main categories of substances  common features of each, and examples of drugs that belong to each category

1. Depressants 

   1. Behavioral sedation -> alcohol, sedative, anxiolytic drugs

   2. Depress CNS -> reduce anxiety & make us sleepy 

2. Stimulants 

   1. Speed up body systems 

   2. Increase alertness & elevate mood -> cocaine, nicotine, caffeine 

3. Opiates 

   1. Produced analgesia (masking of pain) and euphoria 

      1. heroin, morphine, codeine, oxycodone 

   2. Opioids, narcotics, pain killers -> same category 

4. Hallucinogens 

   1. Alter sensory perception 

      1. LSD, Marijuana

5. Other drugs of abuse 

   1. Include inhalants, anabolic steroids, medications

 clinical features of substance use disorders

• Pattern of substance use leading to significant impairment & distress

• Symptoms (need 2+ w/in year)

  {side note: 2-3 Mild, 4-5 Moderate, 6+Severe} 

  • Taking more of substance than indented 

  • Desire to cut down use 

  • Excessive time spent using/ acquiring/recovering 

  • Craving for the substance 

    • Took the place of legal problems related to substance 

  • Role disruption (eg can’t perform @ work 

  • Interpersonal problems 

  • Reduction of important activities 

  • Use in physically hazardous situations

common comorbid diagnoses with substance use disorders

• Approx 75% of ppl in addition to treatment meet the criteria for at least 1 other psychiatric disorder 

  • Mood disorder (40% or more) 

  • Anxiety disorder & PTSD (25% or more) 

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

 long-term effects of heavy drinking.

• Tremors 

  • In hands 

  • Withdrawal 

• Nausea/vomiting

  • Part of withdrawal 

• Hallucinations 

• Agitation

• Insomnia 

• Seizures 

• Delirium tremens (DTs) in severe cases 

  • Small %’s  -> 3-5% w/ severe hx 

  • Involves disorientation

    • Mental confusion

    • Hallucinations 

    • The body starts shutting down

      • Effect regulation 

        • HR & respiration 

• Liver disease 

  • Cirrhosis  of the liver 

    • Permanente scarring of the liver 

• Pancreatitis 

• Cardiovascular disorders 

• Depression 

• Certain cancers 

  • Esophageal 

  • Colon 

  • Breast 

• Brain damage 

  • Dementia 

    • Cognitive decline 

  • Wernicke-Korsakoff Syndrome

Describe what delirium tremens (DTs) are.

•  the most severe form of alcohol withdrawal. It causes your sympathetic system to go into overdrive which then causes an irregular cardiovascular system. As a result people get really bad confusion, shaking, high blood pressure, fever, and hallucinations. This can be fatal. 

what counts as a standard drink for beer, wine, and liquor.

• 12 fl oz of regular beer 

  • Assuming 5% proof

• 5 fl oz of table wine

  • Assuming 12%  proof

• 1.5 fl oz shot of distilled spirits (liquor)

  • gin, rum, tequila, vodka, whiskey, etc. 

  • Assuming 40% proof

 what is meant by moderate, heavy drinking, and binge drinking for men and women.

• Moderate

  • no more than 2 drinks/day (men) 

  • No more than 1 drink/day (women) 

  • Some ppl (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+ for men w/in 2 hr period 

    • Amt of alcohol blood level gets to 0.80

questions asked on the CAGE alcohol use disorder screening tool

• Cutting down 

  • Ex: have you ever felt that you should CUT down on your drinking 

• Annoyed

  • Ex: Have you ever become ANNYOYED by criticisms of your drinking  

• Guilty 

  • Ex: Have you ever felt GUILTY about your drinking 

• Eye opener 

  • Ex: Have you ever had a morning EYE OPENER to get rid of a hangover

what is meant by prescription drug misuse/abuse

Taking medication in a way that it was not originally intended

Describe how opioids have their effect

• Opioid drugs bind to opioid receptors in the CNS 

  • Bind to receptors 

• Inhibit production of GABA 

  • GABA -> neurotransmitter -> helps regulate amt of dopamine 

• Allows more dopamine to be available in the brain 

  • Feel good, pleasure, ect (when it’s active in body)

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

They lose tolerance -> become too much (dose)

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

• Naltrexone 

  • FDA-approved for opioid & alcohol use disorders 

  • Blocks pleasant effects of drugs; reduces cravings 

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

• Methadone 

  • FDA-approved for opioid use disorders 

  • Blocks pleasant effects of drugs; reduces cravings 

  • Potentially addictive 

• Suboxone

  •  FDA-approved for opioid use disorders 

  • Blocks pleasant effects of drugs; reduces craving 

  • Potentially addictive 

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

• Lower the risk of fatal overdoses by approx 50%

• Lower risk of non-fatal overdoses 

• Reduce drug-injecting 

• Reduce HIV transmission 

• Reduce criminal activity by opioid users 

general nature of personality disorders (PDs)

• The nature of personality disorders

  • Enduring, inflexible predispositions

  • Maladaptive, causing distress and/or impairment

  • High comorbidity 

  • Poorer prognosis 

Don’t tend to show up for treatment on own or stick with  

More likely to show from other paths (ordered, fam)

 3 personality clusters and be able to identify PDs belonging to each cluster

• Cluster A 

  • Personality disorders 

    • Odd or eccentric cluster 

    • includes paranoid, schizoid, schizotypal 

• Cluster B 

  • personality disorders 

Intense, unpredictable

• dramatic, emotional, erratic cluster 

• Includes antisocial, borderline, histrionic, narcissistic 

• Cluster C 

  • Personality disorders 

Diff than anxiety -> stable across time ingrained personality 

• Fearful or anxious cluster 

• Includes avoidant, dependent, obsessive-compulsive 

  • Ob-comp -> diff than OCD

 common focus of treatment for Cluster A PDs.

 

• Focus on interpersonal skills

  • Using cognitive strategy to combat 

    • What's the evidence 

• Building trust where paranoia is a factor 

• Address comorbid conditions

Targeting interpersonal, and social skills, basically trying to reduces paranoia

CBT - focus on positive behaviors & reduce anxiety

 clinical features of antisocial PD.

• Antisocial PD  -> CLUSTER B 

  • Failure to comply w/ social norms 

  • Violation of the rights of others 

  • irresponsible, impulsive, and deceitful 

  • Lack of a conscience, empathy, & remorse 

    • Lack of remorse -> Engage in deceitful but don’t feel guilty 

  • May be very charming, interpersonally manipulative 

    • Likable -> until known 

    • Used car sales men (idea -> want the sale) 

  • Most often diagnosed in males 

common features of early/family history of antisocial PD

• Common of Early & Fam hx 

  • Relation w/ early behavior prob & conduct 

    • Early hx of behavioral problems, including conduct d/o 

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

Youth-> set fire, hurt animals -> NEED TO HAVE EVIDENCE CONDUCT DISORDER BEFORE AGE 18 -> to meet criteria to have antisocial personality disorder 

• Families w/ inconsistent parental discipline & support

• Families often have hx of criminal & violent behavior 

Can run on families

clinical features of borderline PD

• Borderline PD  - CLUSTER B 

More women than men have/been diagnosed 

• Unstable moods and relationships

  • Have a pattern of rocky short-lived relationships

• impulsivity, fear of abandonment, poor self-image 

  • Instability in moods (affect) 

    • Think of walking on eggshells 

  • Chronically feeling of emptiness 

    • Mood disorders -> MDD common (comorbidity)

• Self-mutilation & suicidal gestures

treatment options for borderline PD

• Antidepressant medications provide some short-term relief 

• Dialectical behavioral therapy

Marsha Linehnd - orig for Borderline PD 

4 main models -> can be done as a group or individually

• Mindfulness: the practice of being fully aware and present 

• Distress Tolerance: how to tolerate pain in different situations 

  • How can I ride a wave of intense emotion w/out being harmful (to others or myself)

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

  • Learn skills to more effectively relate w/ other ppl 

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

  • How can help ppl stay grounded & stable

 clinical features of obsessive-compulsive PD and how it differs from OCD.

• Obsessive-Compulsive PD  -> CLUSTER C 

  • Excessive & rigid fixation on doing things the right way 

    • This is the way it should be done and will always be done 

  • Highly perfectionistic and orderly 

  • Obsessions and compulsions are rare 

DIFF -> OCPD -> NOT HAVING OBSESSIONS & COMPULSIONS

DSM-5 criteria for schizophrenia

A. Two (or more)

• (1) delusions

• (2) hallucinations

• (3) disorganized speech

• (4) grossly disorganized or catatonic behavior

• (5) negative symptoms

B. 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. at least six months.

 what hallucinations are

• Hallucination 

  • Experience of sensory events w/out environmental input 

  • Can involve all senses 

    • Tasting something when not eating 

    • Having skin sensations when not being touched 

  • Most common: Auditory

types of hallucinations

• Auditory - hearing things that aren’t there 

  • Subtype: command hallucinations -> more safety risk -> voice telling to do something 

  • Feeding negative beliefs 

  • Running commentary 

    • Narration of daily behaviors 

• Visual - seeing things that aren’t there 

  • Animals or people 

• Olfactory - smelling things that aren’t there 

  • Smelling rotten eggs (common)

• Tactile - feeling things that aren't there 

  • A sensation of bugs crawling under the skin (common)

what delusions are and be able to recognize examples of delusions of grandeur and persecution

• Delusions 

  • Gross misrepresentations of reality 

  • Most common 

    • Delusions of grandeur 

      • having this special skill, talent, etc. 

        • I am the king of England 

        • I can speak directly to God 

    • Delusions of persecution 

      • Out to harm and get them 

        • “CIA is tracking me”

positive symptom clusters in schizophrenia

• Hallucination 

  • Experience of sensory events w/out environmental input 

  • Can involve all senses 

    • Tasting something when not eating 

    • Having skin sensations when not being touched 

  • Most common: Auditory 

• Delusions 

  • Delusions of grandeur 

    • having this special skill, talent, etc. 

      • I am the king of England 

      • I can speak directly to God 

    • Delusions of persecution 

      • Out to harm and get them 

        • “CIA is tracking me”

negative symptom clusters in schizophrenia

• The negative symptoms 

  • Absence or insufficiency of normal behavior 

• Spectrum of negative symptoms 

  • Avolition (or apathy)

    • lack of initiation and persistence

  • Alogia

    • relative absence of speech

  • Anhedonia  

    • lack of pleasure or indifference

  • Affective flattening

    • little expressed emotion

disorganized symptom clusters in schizophrenia

• Disorganized speech

  • Tangentiality - “going off on a tangent” 

    • Start in one place & ends at another 

  • Loose associations - a conversation in unrelated directions 

  • Blocking Speech -> halting, interrupted speech -> Robot reading, minor 2 pauses between thoughts 

• Disorganized affect

  • Inappropriate emotional behavior

    • someone says they feel one way but the face says something else

• Disorganized behavior

  • Includes a variety of unusual behaviors 

    • Pacing, inappropriate eye contact

  • Catalonia

clinical descriptions for schizophreniform

• Psychotic symps lasting btwn 1 & 6 months 

• Need 2+ symp 

  • Delusions, hallucinations, disorganized speech or catatonic behavior, neg symptoms

Note: Can develop into schizophrenia -> if symptoms keep occurring 6+months

clinical descriptions for  brief psychotic disorder

• Psychotic symptoms lasting less than 1 month 

• Need 1+ symptoms(s) 

  • Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior

Note: Some ppl can recover and never have another, others not so much

clinical descriptions for schizoaffective disorder

Note: mood disorder [depression type]  meets psychotic symptoms [schizophrenia] & Timeline & order matters  

NEED TO HAVE STANDALONE PSYCHOTIC SYMPTOMS

• Psychotic symptoms need to happen outside the mood disturbance 

• Prognosis symptoms must also occur outside the mood disturbance 

• Such persons don’t tend to get better on their own

clinical descriptions for catatonia

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

• Tends to be severe & quite rare 

• May be present in psychotic disorders or diagnosed alone 

• May include 

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

  • Opposition to lack of response to instruction 

  • Repetitive, meaningless motor behaviors 

  • Mimicking others’ speech or movement

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

• Personality disorders 

  • Cluster A 

• Substance use disorder 

• Bipolar disorder

  • Type I -> more severe 

• Major Depression Disorder 

  • Might have psychotic symptoms during a severe episode 

• Medical condition 

  • Parkinson’s Disease 

  • Lewy Body Dementia

 prevalence rate of schizophrenia, demographic patterns in the age of onset, and the relationship between schizophrenia and life expectancy

•  prevalence of schizophrenia worldwide 

  • Abt 1% of population 

  • Often in early adulthood 

• Demographic 

  • Males -> early 20s  

  • Females -> (bimodal) -> late 20s & mid 40s 

• Lower life expectancy 

  • Due to increased risk of suicide, accidents, & poorer self-care

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

Is the stage before diagnosis when there are psychotic behaviors that have developed but not enough to warrant a psychological disorder

alternative:

This is a phase of schizophrenia where individuals have intense mood swings, trouble with memory, depression, thoughts of suicide. This is basically a lot of the aspects of schizophrenia but no psychosis or hallucinations.

 causal factors and correlates of schizophrenia

• Genetics vs environment 

  • Pretty high genetic -> risk increase depending on how close they are (mom vs cousin, mom - the child has higher risk)

  • BUT a healthy environment is a protective factor

• 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

• Neurobiological 

  • structural & functional abnormalities in the brain

treatment options for schizophrenia and describe what “tardive dyskinesia” is

• antipsychotic medication + psychosocial interventions 

  • Social skills/living skills training 

  • Family therapy 

  • Vocational rehab 

• Noncompliance w/ meds is common issue 

• Meds have major & permanent side effects

  • Tardive dyskinesia -> a drug-induced side effect that causes involuntary muscle movements

inattentive symptoms of ADHD

• Not giving close attention to details 

• Difficulty maintaining attention 

• Trouble w/ follow-through

• Avoids tasks that require sustained mental effort 

• Often lose things necessary for tasks/activities 

• Easily distracted &/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 questions in completed 

• Difficulty waiting their turn

recognize someone with ADHD, predominately inattentive type

Inattentive type of ADHD is when a person has the symptoms

ex: Trouble focusing, Trouble with time management, ect.

recognize someone with ADHD, predominately hyperactive/impulsive type

Hyperactive/impulsive ADHD type is when only hyperactive symptoms are present

ex: “Driven by a motor”, blurting out answers, ect.

recognize someone with ADHD,  combined type

When both inattentive and hyperactive/ impulsive symptoms are present

ex. losing things & fideting ing seat

other diagnostic features of ADHD

• Several sympt must be present before age 12 

  • If older -> psych asks abt childhood 

• Symptoms present in 2 or more settings 

• Significant distress or impairment 

• Not better explained by another condition

prevalence rates/trends for ADHD

• This occurs in approx 5% of school-aged children

• Symptoms are usually present around the age of 3-4

• Children w/ ADHD have similar probs as adults 

  • Same criteria except hyper activity (restlessness) 

Gender diff

• Boys outnumber girls 3:1 

Childhood prevalence by Race or Ethnicity, according to large national sample 

• White, non-hispanic 78.8% 

• Hispanic 9.1% 

• Black 6.0%

• Asian 3.2% 

• Other 3.0%

prevalence rates/trends autism spectrum disorder (ASD)

Prevalence 

• 1 in 44 children in US meet criteria 

• More commonly in males 

  • 4x more common 

• IQ interaction 

  • Approx. 35% show intellectual disabilities 

  • Most are fine

• Worldwide prevalence = 1%

main areas of impairment in ASD and be able to recognize examples

• Communication & social interaction

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

Be familiar with relationship between ASD and intellectual disability.

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

 Be familiar with risk factors of ADHD

• ADHD seems to run in the family

• DAT1- Dopamine transporter gene has been implicated 

  • Some ADHD drugs work by inhibiting DAT1

• Neurobiological correlates of ADHD  

  • Smaller brain volume 

    • Hippocampus 

    • Amigdla 

  • Inactivity of the frontal cortex and basal ganglia (movement- voluntary- coordination)

  • Abnormal frontal lobe development & functioning  

    • Decision making 

    • Organization 

    • Planning

Be familiar with risk factors of ASD

Biological dimensions of autism 

• Significant genetic componet 

  • Familial component: if 1 child w/ austism, the 2nd w/ autism is 20% greater 

    • 100x greater risk than general population 

• Possible link btwn autism & levels of oxytocin (feel good/cuddle) receptor genes 

• Older pairent associated w/ increased risk 

  • Particularly fathers @ time of conception

Neurobiological influences 

• Amygdala - fear response  

  • Larger size @ birth = higher anxiety, fear 

  • Elevated cortisol 

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

• Oxytocin 

  • Lower levels 

    • Bonding hormone -> might explain why might not need ppl in same sense as avg person

• Vaccinations do not increase risk od autism 

  • Mercury in some vaccinations was rumored to increase ausitm risk 

  • Large-scale studies do not support this 

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

  • The health risk of not vaccinating is substantial

Be familiar with treatment options for ADHD

• Biological Treat.

  • Stimulant medications

    • Currently prescribed for approximately 4 million American kids 

    • Low doses of stimulants improve focusing abilities 

    • Ex include 

      • Ritalin, Dexedrine, Adderall 

• Behavioral treatment

  • Reinforcement programs 

    • To increase appropriate behaviors/decrease inappropriate behaviors 

      • Positive reinforcement -> token for good behavior

      • If bad -> token gets taken away  (neg reinforcement for bad)

    • May also involve parent training

• Combined bio-psycho-social treat 

  • Often recommended 

  • Maybe superior to medication or behavioral treatments alone

 Be familiar with treatment options for ASD

• Psychological 

  • Behavioral approaches 

    • Skill building 

    • Reduce problem behaviors 

    • Communication & language training 

    • Increase socialization 

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

• Biological treat 

  • Medical intervention has had little positive impact on core dysfunction

    • Sometimes in conjunction w/ psych-social

    • Manage symptoms -> if the child is causing harm to self -> banging head 

  • Some drugs decrease agitation 

    • Tranquilizers 

    • SSRIs 

  • Indicators or good prognosis 

    • High IQ, good language ability