PS 272 Final Exam

Substance use disorder

A maladaptive pattern of use leading to distress or impairment

number of symptoms/ time period for substance use disorder

2 or more symptoms within 12 months

Symptoms/signs of substance use disorder

* taken in larger amounts or over longer periods than intended
* persistent desire to cut down or unsuccessful efforts to reduce or control use
* excessive time spent obtaining, using, or recovering from effects
* craving or strong desire or urge to use
* failure to fulfill role obligations
* continued use despite interpersonal problems caused by use
* cessation or reduction of social, work, or recreational activities
* use in hazardous situations
* continued use despite awareness of physical or psychological problems
* tolerance
* withdrawal

Five main categories of substances

Depressants, stimulants, hallucinogens, cannabis, and other drugs of abuse

Depressants

slow the activity of the central nervous system

ex: alcohol, sedative-hypnotic drugs, opioids

Stimulants

increase activity of the central nervous system; increase alertness and elevate mood

ex: amphetamines, cocaine, caffeine, nicotine

Hallucinogens

later sensory perception

ex: mescaline, LSD, ecstacy

Cannabis

a mixture of hallucinogenic, depressant, and stimulant effects

ex: marijuana, hashish

Other drugs of abuse

inhalants, anabolic steroids, ketamine

Alcohol use disorder prevalence (US)

29% in adults (36% of men and 22.7% of women)

* 8.6% mild (2-3 symptoms)
* 6.5% moderate (4-5 symptoms)
* 13.9% severe (6+ symptoms)

Alcohol use disorder prevalence

Lowest: Asian Americans (10.6%)

Middle: White Americans, Hispanic Americans, African Americans (\~13-14%)

Highest: Native Americans

Binge drinking

a pattern of drinking that brings blood alcohol concentration levels to 0.08 g/dL

* \~ 4 drinks in 2 hours for women
* \~ 5 drinks in 2 hours for men

Cause of substance use disorders

Family/genetic influence, neurobiological influence, psychological dimensions, social and cultural dimensions

Family/genetic influences (substance use disorders)

* concordance rate in identical twins = 54%
* concordance rate in fraternal twins = 28%

Neurobiological influences (substance use disorder)

* Drugs that affect the pleasure or reward centers in the brain
* pleasure centers: dopamine is involved, midbrain, frontal cortex


* Inhibition of neurotransmitters that produce anxiety.negative affect

Psychological dimensions (substance use disorders)

role of negative and positive reinforcement

* positive reinforcement: keep using because it feels good
* negative reinforcement: keep using because it takes away the bad

Social and cultural dimensions (substance use disorders)

exposure to drugs is a prerequisite for use of drugs

* media, family, peers
* parents and the family appear critical
* cultural factors also affect use and abuse

Agonistic substitution

safe drug with a similar chemical composition as the abused drug (ex: methadone, nicotine gum/patch)

Antagonistic treatment

drugs that block or counteract the positive effects of substances (ex: naltrexone)

Aversive treatment

drugs that make the use of the substances extremely unpleasant (ex: Antabuse, silver nitrate)

Psychosocial treatments for substance use disorders

* inpatient/outpatient care
* community support programs
* balancing treatment goals (controlled use vs. abstinence)
* motivational interviewing
* motivational enhancement therapy
* comprehensive treatment and prevention programs

Gambling disorder

gambling larger and larger amounts of money and having symptoms of withdrawal (restless or irritable when attempting to stop); must cause significant impairment or distress

Internet gaming disorder

preoccupied with internet games; must cause significant impairment or distress

Kleptomania & pyromania

excessive stealing; setting fires

* increased tension/affective arousal prior to the act
* pleasure, gratification, or relief following the act

Intermittent explosive disorder

when a person engages in aggression on a regular basis

* impulsive verbal or physical aggression 2x per week for 3 months
* Three behavioral outbursts that cause damage to property or injuries to animals or people within 12 months

Types of eating disorders

Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder

Anorexia Nervosa defining features

* significant weight loss (15% below expected weight)
* restricted intake of nourishment
* intense fear of gaining weight or becoming fat
* disturbed body perception, undue influence of weight or shape on self evaluation or denial of seriousness of current low weight

Anorexia nervosa subtypes

Restricting subtype & binge-eating-purging subtype

Restricting subtype

limiting caloric intake via diet, fasting, and/or excessive exercise (with no recurrent binging or purging)

Binge-eating-purging subtype

recurrent episodes of binging or purging (e.g. vomiting, laxatives, diuretics, enemas); involve uncontrolled overeating

Bulimia Nervosa defining features

* recurrent episodes of binge eating
* recurrent inappropriate compensatory behaviors to prevent weight gain (ex: vomiting, laxatives, fasting, excessive exercise)
* self-evaluation is unduly influences by body shape and weight
* does not meet criteria for anorexia nervosa

Binge-eating disorder defining features

* recurrent binge eating episodes (at least once per week for 3 months)
* no inappropriate compensatory behaviors
* does not meet criteria for anorexia or bulimia
* 2/3 of people with this are overweight or obese

Causes of eating disorders

* dieting
* biological factors
* societal pressures

Anorexia nervosa treatment

* weight restoration
* family-bast therapy for adolescents
* behavioral and cognitive therapy (CBT-E
* 5% mortality rate (so treatment is important)

Bulimia Nervosa treatment

* medical and drug treatments (antidepressants)
* psychosocial treatments
* CBT-E
* Interpersonal psychotherapy (IPT)

Binge eating treatment

* Antidepressants
* psychological treatment
* CBT-E
* IPT
* Self-help form of CBT

Prevention of eating disorders

very hard to treat, but eating disorder prevention programs have show substantial reduction in the cases of eating disorders

Dissociative Identity Disorder (DID)

* Two or more distinct personalities/identities
* average of 1 in women and 8 in men
* memory gaps
* identities display unique behaviors

Alters

different identities or personalities

host

the identity that keeps other identities together

switch

quick transition from one personality to another

Causes of DID

* histories of trauma during childhood
* closely related to PTSD
* Mechanism to escape from the impact of trauma
* Genetics may play a role in dissociative symptoms
* several brain regions are being studied

Treatment of DID

* no controlled research studies
* focus on reintegration of identities
* identify and neutralize cues/triggers
* Hypnosis is often used
* Therapy is long term and prognosis is poor

Types of Neurodevelopmental disorders

* Attention deficit hyperactivity disorder (ADHD)
* Autism Spectrum Disorder
* Intellectual developmental disorder
* Specific learning disorder

Attention Deficit hyperactivity disorder (ADHD)

hyperactivity and impulsivity (present before age 12)

Inattention

* fails to give close attention to details, makes careless mistakes
* difficulty holding attention on tasks or play activities
* seems not to listen when spoken to directly
* does not follow through on instructions, tasks, homework
* difficulty organizing
* often loses things
* forgetful, distracted

Hyperactivity

* fidgets/taps hands or feet, squirms
* often leaves seat when they shouldn’t
* runs/climbs in inappropriate situation (restlessness)
* often unable to play or engage in leisure activities quietly
* “driven by a motor” or “always on the go”
* blurts out answers before the question is complete
* interrupts/intrudes on others’ games, conversations
* difficulty waiting for a turn

Causes of ADHD

* biological contributions
* runs in families
* genes relating to dopamine
* smaller brain volume
* frontal brain regions
* prenatal maternal smoking
* food additives
* psychosocial factors
* often viewed negatively by others
* not related to poor parenting
* peer rejection and social isolation

biological treatment of ADHD

goal: reduce impulsivity and hyperactivity and to improve attention

* stimulant medications
* non-stimulant medications

Stimulant medications

reduce core symptoms in 70% of cases (ex: Ritalin, Dexedrene, Adderall)

Non-stimulant medications

* Atomoxetine(Strattera): norepinephrine reuptake inhibitor (can lead to suicidal symptoms
* Imipramine (TCA)
* High blood pressure meds (ex: Clonidine, Guanfacine)

Behavioral treatment of ADHD

* reinforcement programs (operant conditioning): increase appropriate behaviors and decrease inappropriate behaviors
* Parent training: teach parents about operant conditioning principles so they can better discipline their children

Autism Spectrum Disorder (ASD)

* Deficits in social communication and social interaction
* restricted, repetitive patterns of behavior, interest, or activities
* can be with or without accompanying intellectual impairment (40-50% also have IDD)
* can be with or without accompanying language impairment (25% never acquire useful speech)

Causes of ASD

* genetic links
* amygdala and processing of social situations
* older parents = increased risk
* Vaccines do not cause autism!!!

Psychosocial "behavioral” treatments for ASD

* skill building
* reduction of problem behaviors
* target communication and language problems
* increase socialization
* early intervention is critical

Integrated treatments (preferred)

* focus on children, their families, schools, and home
* build an appropriate community and social support

Intellectual developmental disorder (IDD)

* deficits in intellectual function (IQ \~70)
* Deficits in adaptive functioning
* Onset in childhood
* Range of impairment varies greatly

Biological contributions for IDD

* Environmental: deprivation, child abuse
* Prenatal: exposure to disease or drug/toxin
* Perinatal: difficulties during labor and delivery
* Postnatal: head injury, toxins
* Genetic research: one or more related genes
* Down syndrome: trisomy 21
* Fragile X syndrome: abnormality on X chromosome
* Most cases have no known specific cause

Treatment of IDD

* Teach needed skills (often paired with applied behavior analysis
* foster productivity and independence
* educational and behavioral management
* living and self-care skills (task analysis)
* communication training
* Goals:
* participate in community life
* benefit from education
* hold a job or other productive pursuits
* build meaningful relationships

Specific learning disorders

Academic performance that is substantially below what would be expected given the person’s age, IQ, and education

* impairment in reading (most common)
* impairment in written expression
* Impairment in mathematics

Specific learning disorders (assessment and treatment)

Assessment: IQ test plus achievement test in specific areas to look for deficits

Treatment: educational interventions

Psychosis

Broad term; hallucinations, delusions

Schizophrenia

one of many psychotic disorders

Positive symptom cluster

extra things that people who aren’t psychotic don’t have

* delusions
* hallucinations

delusions

thoughts that do not have a basis in reality

delusions of grandeur

delusions that you are hold, famous, above all else, etc.

Delusions of persecution

delusions that people around you are trying to harm or kill you

hallucinations

experience of sensory events without environmental input; can involve all sensed but auditory hallucinations are most common

negative symptom cluster

the absence or insufficiency of normal behavior (5a’s)

Avolition (apathy)

lack of initiation and persistence and motivation

Alogia

relative absence or poverty of speech

Anhedonia

lack of pleasure

Affective flattening

little expressed emotion

Asociality

sever impairment in social relationships

Disorganized symptom cluster

disorganized speech, affect, and behavior

Disorganized speech

* cognitive slippage: saying words that are incoherent when strung together
* tangentiality: going off on a tangent
* loose associations: conversation in unrelated directions

Disorganized affect

inappropriate emotional behavior and responses

disorganized behavior

* includes a variety of unusual behaviors
* catatonia: not moving or responding to stimuli

Causes of Schizophrenia

* genetic research
* neurotransmitter influences
* neurobiological influences
* psychological/social influences

genetic research (Schizophrenia)

* twin studies: identical twins have a higher risk than fraternal
* adoption studies: risk is higher in cases where biological parent has schizophrenia

neurotransmitter influences (schizophrenia)

* dopamine hypothesis: drugs that increase dopamine (agonists) result in schizophrenic-like behavior


* drugs that decrease dopamine (neuroleptics) reduce schizophrenic-like behaviors

neurobiological influences (schizophrenia)

* structural and functional abnormalities in the brain
* enlarged ventricles and reduced tissue volume
* hyperfrontality: less active frontal lobes
* viral infections during early prenatal development

psychological/social influences (schizophrenia)

* role of stress: may activate underlying vulnerability and increase risk of relapse
* family interactions: families show ineffective communication patterns
* high expressed emotion (EE): family member is very critical and unkind towards the person with schizophrenia

Medical treatment of schizophrenia

* development of antipsychotic medications (neuroleptics): began in 1950s - most eliminate or reduce positive symptoms
* acute and long term side effects are common (ex: Parkinson-like motor issues, Tardive Dyskinesia, weight gain)
* Compliance with medication is often a problem

Psychological treatment of schizophrenia

* behavioral (token economies) in inpatient units
* community care programs
* social and living skills training
* behavioral family therapy
* vocational rehabilitation

Brief psychotic disorder vs. schizophreniform vs. schizophrenia

Brief psychotic disorder: symptoms persist between 1 day and 1 month

Schizophreniform :symptoms persist between 1 month and 6 months

Schizophrenia: symptoms persist for 6+ months

Schizoaffective disorder

symptoms of psychosis and mood episodes

* both disorders are independent of one another (psychotic times in the absence of mood symptoms)
* prognosis is similar to schizophrenia
* do not tend to get better on their own

Symptoms of personality disorders

* persistent patterns of inner experience and behavior
* inflexible and maladaptive, causing distress and/or impairment
* Onset traced back to at least adolescence
* High comorbidity

Cluster A Personality disorders

odd or eccentric cluster

* paranoid
* schizoid
* schizotypal

Cluster B personality disorders

dramatic, emotional, erratic cluster

* antisocial
* borderline
* histrionic
* narcissistic

Cluster C personality disorders

fearful or anxious cluster

* avoidant
* dependent
* obsessive-compulsive

Paranoid Personality Disorder

**Features**: pervasive and unjustified mistrust and suspicion

**Causes**: early learning that people and the world is a dangerous place

**Treatment**: focuses on development of trust and countering negativistic thinking (cognitive therapy)

Schizoid Personality Disorder

**Features**: pervasive pattern of detachment from social relationships; very limited range of emotions in interpersonal situations

**Causes**: causes are unclear, but preference for social isolation resembles autism

**Treatment**: focus on the value of interpersonal relationships, building empathy and social skills

Schizotypal Personality Disorder

**Features**: behavior and dress is odd and unusual; socially isolated and highly suspicious; magical thinking, ideas of reference, and illusions

**Causes**: possible genetic link with schizophrenia; generalized brain deficits

**Treatment**: address comorbid depression; main focus on developing social skills and evaluating thoughts; antipsychotic medications

Antisocial Personality Disorder

**Features**: failure to comply with social norms; violation of others’ rights; irresponsible, impulsive, and deceitful; lack a conscience, empathy, and remorse

**Causes**: relation with conduct disorder and early behavior problems; under arousal (need risk taking to feel more alive); cortical immunity

**Treatment**: emphasis on prevention and rehabilitation; antipsychotic medications

Borderline Personality Disorder

**Features**: unstable moods and relationships; impulsivity, fear of abandonment, very poor self-image; self-mutilation and suicidal gestures; high comorbidity rates

**Causes**: runs in families; early trauma and abuse play some role

**Treatment**: dialectical behavior therapy; antidepressant/anti-anxiety medications

Histrionic Personality Disorder

**Features**: overly dramatic, sensational, and sexually provocative; often impulsive and need to be the center of attention; thinking and emotions are perceive as shallow; more common in females

**Causes**: largely unknown

**Treatment**: focus on attention seeking and long-term negative consequences; target problematic interpersonal behaviors

Narcissistic Personality Disorder

**Features**: Exaggerated and unreasonable sense of self-importance; preoccupation with receiving attention; lack of sensitivity and compassion for other people; highly sensitive to criticism, envious, and arrogant

**Causes**: failure to learn empathy as a child

**Treatment**: focus on grandiosity, lack of empathy, unrealistic thinking

Avoidant Personality Disorder

**Features**: extreme sensitivity to the opinions of others; highly avoidant of most interpersonal relationships; interpersonally anxious and fearful of rejection; low self-esteem

**Causes**: difficult temperament and early rejection

**Treatment**: similar to those of social anxiety; target social skills and anxiety

Dependent Personality Disorder

**Features**: reliance on others to make major and minor life decisions; unreasonable fear of abandonment; clingy and submissive in interpersonal relationships

**Causes**: linked to early disruptions in learning independence; thoughts like “I am helpless”

**Treatment**: targets include skills that foster independence