Abnomal Psychology Final

What are Substances?

What are Substances?

Any ingested materials that cause temporary cognitive,
behavioral, and/or physiological symptoms within the
individual

What is substance intoxication?

The changes observed directly after or within a few hours of ingestion of a substance
• Symptoms vary and depend on the substance

What are the properties of substance abuse?

• Repeated use of these substances, or frequent substance intoxication that
results in a long-term problem where the individual consumes the substance
for an extended time, or must ingest large amounts of the substance to get the
same effect a substance provided previously (aka tolerance)
• Tolerance often comes with other physical and psychological symptoms which
cause significant disturbances in an individual’s life
• Individuals spend a significant amount of time engaging in activities that
involve their substance use
• There may be a desire to reduce or abstain from substance use, but
cravings and withdrawal symptoms prevent this change
• Symptoms include cramps, anxiety attacks, sweating, nausea, tremors, and hallucinations
• Extreme withdrawal symptoms could lead to seizures, stroke, or even death

Substance Use Disorder

Individual must experience at
least two symptoms of
significant impairment or
distress over the course of 12-
months due to their use of a
substance
Examples of
impairment/distress: inability
to participate at
work/school/home, increased
time spent engaging with
substance use related
activities, tolerance

Diagnosing Substance Intoxication

Individual recently ingested a
substance and immediately
observed significant behavioral
and/or psychological changes
that resulted from the
substance ingested

Substance Withdrawal

Diagnosed when there is a
cessation or reduction of a
substance that has been used
for a long period of time

Depressants

Effect: depress or inhibit one’s
central nervous system and thus
alleviates tension and stress; in
large amounts, can impair
judgment and motor activity
• E.g., alcohol, sedative-hypnotic
drugs, opiods

Alcohol

Most used substance

45% of college age students report engaging in
binge drinking (and often, they engage in other
behaviors like skipping meals that puts them at risk
for medical complications of alcohol intoxication)

Ethyl alcohol

• The chemical absorbed from alcohol which binds to
GABA receptors that then sends inhibitory signals to
neurons
• Effect: impaired reaction time, disorientation,
slurred speech, blurred vision, difficulty walking,
personality changes
• Which effects you experience depends on the
quantity of alcohol consumed and one’s ability to
metabolize ethyl alcohol
• Absorption and metabolism depends on food,
gender, body weight, medication (e.g., eating
slows absorption; lower body mass increases
metabolism rate)

Sedative-Hypnotic Drugs

• Aka anxiolytic drugs
• Calming, relaxing effect often used to treat anxiety
disorders
• Types: Barbiturates and Benzodiazepines

Alcohol and Benzos are usually…

the only substances that need medical supervision to
come off of due to potential of seizures and other
life threatening effects and generally the only
substances that insurance will pay for
hospitalization

Barbiturates

introduced in the early 20th
century, highly addictive and often caused
respiratory distress

Benzodiazepines

(e.g., Xanax, Ativan, Valium) –
less addictive replacement either for
temporary or long-term use but they can affect
tolerance; increase GABA activity

Opioids

• Analgesic (pain-relieving) effects, but can also produce
euphoria and drowsiness; easy to build tolerance to
opioids and therefore incredibly addictive
• Withdrawal symptoms include restlessness, muscle pain,
fatigue, anxiety and insomnia and can persist for months
or years
• Types
• Morphine
• Heroin
• Oxycodone & hydrocodone

Morphine

derived from opium in the 1800s, found
to be addictive during the Civil War and replaced
by heroin

Heroin

synthesized in 1898 to be a cough
suppressant and pain reduction until it was found to
be even more addictive

Oxycodone & hydrocodone

the increased number
of prescriptions for these directly impacted the early
2000s rise of abuse and misuse of opioids

Stimulants

• Increase the activity in the central nervous system; increase blood pressure,
heart rate, pressured thinking/speaking, and rapid or jerky behaviors;
produces euphoria, reduces appetite, and prevents sleep
• E.g., cocaine, amphetamines

Cocaine

• Extracted from the coca plant
• Can be ingested in numerous ways
• Freebasing – most common method of ingestion where
cocaine is heated with ammonia to produce almost 100%
pure cocaine
• Effects occur within 10-15 seconds of ingestion
• Produces energy and euphoria, feelings of excitement,
talkativeness; and at higher doses, breathing quickens, blood
pressure increases, and excessive arousal can be observed
• This is because cocaine increases dopamine, norepinephrine,
and serotonin
• Features a rapid high of cocaine intoxication followed by rapid
crashing
• During intoxication, there might be poor muscle
coordination, grandiosity, compulsive behavior, aggression,
and possibly hallucinations/delusions
• During the crash, there might be headaches, dizziness, and
fainting
• Crack is a more affordable, highly addictive and fast-acting
derivative of cocaine

Amphetamines

E.g., Ritalin, Adderall, Dexedrine
Manufactured in a laboratory
Increase energy and
alertness, reduce
appetite; when taken at
higher doses, behaviors
like psychosis
Chemically increases
dopamine,
norepinephrine, and
serotonin
Methamphetamine – a lower-cost derivative of
amphetamine with serious health
consequences; causes drastic physical
changes like teeth damage and facial lesions

Methamphetamine

a lower-cost derivative of
amphetamine with serious health
consequences; causes drastic physical
changes like teeth damage and facial lesions

Caffeine

-Most widely consumed
substance in the world
(about 90% of Americans
consume some type
every day)
-Intoxication and
withdrawal are possible,
and can be severe
enough to warrant an ER
visit

Hallucinogens

• Come from natural sources although they can be made synthetically (e.g., PCP, Ketamine, LSD, Ecstasy)
• Produce hallucinations, changes in color perception, distortion of objects, etc.
• Not addictive but one can develop tolerance and can lead to psychosis, mood, or anxiety disorder

Cannabis

• E.g., marijuana, hashish
• Derived naturally from the hemp plant
• Potency depends on growing climate, preparation, storage duration
• Tetrahydrocannabinol (THC) is the active chemical agent (there is a low concentration of this in marijuana)
• Produces feelings of peace, relaxation, increased hunger, pain relief and sometimes anxiety, paranoia,
dizziness, and increased heart rate
• Use during adolescence increases risk of developing cognitive effects from the drug

Combination

This can be very dangerous and can result in death

Depressants Epidemiology

Alcoholism is found more often in men and in Native Americans
Roughly 1% of the population abuses opioids

Stimulants Epidemiology

Nearly 1.1% of all high school seniors have used cocaine in the past month
Cocaine is mostly found in suburban and higher socioeconomic communities
17% of college students reportedly abuse stimulant medications

Hallucinogens Epidemiology

Up to 14% of general population have used LSD or another hallucinogen
Nearly 20 million adults and adolescents report current use of marijuana

Substance Comorbidity

High comorbidity
with itself
(meaning there is
abuse of multiple
different
substances)

Believed to be
secondary to
other mental
health disorders
to “self-
medicate”

Twice as likely to
be found in those
with anxiety,
affective, and
psychotic
disorders than
the general
public

Disease Concept or Biological Model

An individuals genetic pre-disposition

Behavioral or Learning Concept

Addictions are learned behavior or habit as a way to cope or meet some need

Illness Anxiety Disorder (Hypochondriasis)

Involves the excessive preoccupation with having or acquiring a
serious medical illness but the patient does not typically present
with any somatic symptoms
 If there is a medical diagnosis, the anxiety about the severity of
their disorder is excessive or disproportionate for the actual
diagnosis
Anxiety is not relieved with reassurance, even if cleared medically
Patients will often research rare illnesses that could possibly be
linked to their symptoms
In rare case, some cases of invalidism have been reported

Difficulty with Somatic Disorders

1. symptoms can be
   localized/diffused and
   specific/nonspecific,
   but they are treated as
   authentic

2. Often diagnosed when
   another medical
   condition is present, as
   these two diagnoses
   are not mutually
   exclusive

3. Significant worry about
   the illness is often
   present and because of
   this, patients will
   oftentimes “shop” at
   different doctors’
   offices to confirm the
   seriousness of their
   symptoms

Functional Neurological Symptom
Disorder (Conversion Disorder)

Symptom Types:
Functional  symptoms that stem from a neurological
disorder
Psychogenic  symptoms that are not rooted in biology
and are thus psychological in nature
Diagnosis requires that the symptoms not be explained by a
neurological disease and there must be evidence of incompatibility
of the medical disorder and the symptoms
Symptoms include:
Weakness
Paralysis
Abnormal gait or other movements
Altered, reduced, or absent skin sensations
Vision or hearing impairment

Factitious Disorder

The DSM -5-TR states,”
“Whereas some aspects of
factitious disorders might
represent criminal behavior,
such criminal behavior and
mental illness are not
mutually exclusive”

Features intentional
falsification of medical or
psychological symptoms of
oneself or another, with the
overall intention of
deception
Can be present in another
individual, oftentimes a child
or an individual with a
compromise mental status
who is unaware of the
deception
Behaviors include altering
tests, falsifying medical
records, ingesting a subject
that would show up as
abnormal on lab results,
injuring oneself or inducing
illness
Possibly due to depression, a
lack of parental support
during childhood, or an
excessive need for social
support

Somatic Disorder Epidemiology

Females report more somatic symptoms than males, and therefore are
more likely to be diagnosed with somatic symptom disorder

Facticious Disorder Epidemiology

Prevalence is unknown and health care professionals infrequently record
the diagnosis

Illness anxiety Epidemiology

Illness anxiety disorder is equal among males and females

Somatic Disorder Comorbidity

Somatic disorders in general have a high
comorbidity with other psychological
disorders
◦ Half have an additional medical disorder
◦ 35% have an undiagnosed medical condition
◦ Approximately 20% report medical problems
caused their mental condition
◦ 60% comorbidity estimated with somatic
disorders and other physical disorders classified
as central sensitivity syndromes

Somatic Psychodynamic Etiology

• Suggests that somatic symptoms
present as a response against
unconscious emotional issues
• What initiates and maintains somatic
symptoms?
• Primary gain  produce internal
motivators and provides protection
from the anxiety or emotional
symptoms
• Secondary gain  can range from
attention and sympathy, to missed
work, to obtained financial
assistance, etc.

Somatic Cognitive Etiology

• Somatic related disorders are a result
of negative beliefs or exaggerated
fears of physiological sensations (i.e.,
patients catastrophize)

Somatic Behavioral Etiology

• Propose that somatic related
disorders develop and are
primarily maintained by
reinforcers (usually attention or
receiving disability)
• This is different from the
psychodynamic school of
thought which lists attention
and receiving disability as
secondary gains

Somatic Sociocultural Etiology

• Family members or close friends
of those with somatic symptom
disorder, or at least over-
attentiveness to somatic
symptoms, are more likely to
develop the disorder themselves
• Western cultures focus less on
somatic complaints than Eastern
cultures

Somatic Disorder treatment

Two types
◦ Multidisciplinary  symptoms are managed by many providers, oftentimes including a physician,
psychiatrist, and psychologist
◦ Interdisciplinary  harder to find, multiple disciplines interact and identify a treatment goal
Psychotherapy
◦ Psychodynamic  aka interpersonal psychotherapy; focuses on the relationship between self-experience
and the unconscious, and how these factors contribute to body dysfunction
◦ CBT  aims to have patients accept their medical condition by addressing avoidance behaviors and
mediating expectations of treatment
◦ Behavioral  involves bringing attention to physiological symptoms
Psychopharmacology

Psychologic
al Factors
Affecting
Other
Medical
Conditions

Primary focus is on the physical disorder that is being caused or
exacerbated by biopsychosocial factors
Common psychophysiological disorders identified by the DSM-5-TR:
◦ Headaches
◦ Migraines  throbbing and localized pain accompanied by
nausea, vomiting, light sensitivity, vertigo, etc.
◦ Tension  dull, constant and localized ache
◦ Gastrointestinal
◦ Ulcers  painful sores in the stomach lining caused by digestive
acids burning a hole in the stomach lining due to bacteria and
exacerbated by stress, growing focus on link between stress and
peptic ulcurs
◦ Irritable Bowel Syndrome (IBS)  functional disorder, involves
abdominal pain and extreme bowel habits (diarrhea and/or
constipation) often linked with anxiety and/or depression
◦ Insomnia
◦ Difficult falling or staying asleep due to anxiety, depression,
and/or overactive arousal systems; and with decreased sleep,
there can be even more psychological distress
◦ Occurs in more than one third of the US population
◦ Cardiovascular related disorders
◦ Coronary Heart Disease  features a five-fold increase of
depression; anxiety and anger are early predictors of cardiac
events
◦ Hypertension  elevated blood pressure often affected by constant stress, anxiety, and depression

Coronary Heart Disease

features a five-fold increase of depression; anxiety and anger are early predictors of cardiac events

Hypertension

elevated blood pressure often affected by constant stress, anxiety, and depression

Treatments for these
Biopsychosocial Factors

Relaxation training  teaches
individuals how to relax
muscles on command
Biofeedback  where an
individual is connected to a
machine that allows for
continuous monitoring of
involuntary physiological
reactions, may utilize
computer programs like Wild
Devine (Unyte)
Hypnosis  an extreme sense
of relaxation
Group therapy  usually
involve CBT and other
cognitive/behavioral strategies
in a group setting to
encourage acceptance of
disease while also addressing
maladaptive coping strategies

Anorexia Nervosa

Involves the progressively
stricter restriction of food
which leads to significantly
low body weight relative to
the individual’s age, sex,
and development
Oftentimes this restriction
corresponds with an altered
perception of self and an
intense fear of gaining
weight or becoming fat
Symptoms are broken into
two categories:
Emotional/Behavioral 
dramatic weight loss;
preoccupation with food,
weight, calories, etc.;
frequent comments about
being “fat”; eating a
restricted range of foods;
avoids mealtimes; rarely
eating in public
Physical  dizziness,
difficulty concentration,
feeling code, sleep
problems, fine hair/hair loss,
muscle weakness

Bulimia Nervosa

Involves recurrent binge eating behaviors
• Binge eating  a discrete period where the amount of
food consumed is significantly more than most people
would eat during a similar time period and during which
the individual feels out of control and often disgusted
with oneself
• Compensatory behavior  results from self-disgust; an
attempt to rid the body of the excessive calories (e.g.,
vomiting, use of laxatives, fasting or severe restriction,
excessive exercise)
• On average, this cycle happens at least once a week for
three months
Symptoms are like anorexia nervosa’s
symptoms, but they tend to appear in late
adolescence/early adulthood
• Emotional/Behavioral  hiding food wrappers or
containers after binge episodes, feeling uncomfortable
eating in public, developing food rituals, disappearing to
the bathroom after eating meals, drinking excess
amounts of water or non-caloric beverages)
• Physical  weight fluctuations, difficult concentrating,
dizziness, sleep disturbance, and possible dental
problems due to purging

Binge Eating Disorders

Like bulimia nervosa in that
there are binge eating
episodes with feelings of
being out of control
Unlike bulimia nervosa
because there aren’t
compensatory behaviors
(although they may still feel
shame, embarrassment and
guilt)
On average, happens at least
once a week for three months
Individuals with BED are at
risk for obesity and other
related health disorders
Rarely eat in public due to
embarrassment over the
quantity of food they eat, and
therefore, they will secretly
binge and discretely dispose
of wrappers and containers

Onset seems to be later than
that of anorexia nervosa and
bulimia nervosa (i.e., most
patients are middle-aged) and
about 1/3+ are male
(although the gender different
is smaller than that of
anorexia nervosa and bulimia
nervosa)
More phasic than persistent
Often comorbid with bipolar
disorder, depressive
disorders, and anxiety
disorders

Anorexia nervosa epidemiology

Prevalence rate: 0.3-0.4% in young women; 0.1% for men; most prevalent in
postindustrialized, high-income countries like the United States, Australia, New Zealand, Japan
and many European countries. In the US, prevalence is lower among Latinx and non-Latinx
Black Americans than non-Latinx Whites.

Bulimia nervosa epidemiology

Prevalence rate: 1.0% in young women; 0.1% of men; Another study shows between 1.1% and
4.6% of females and 0.1% of males will develop bulimia and subthreshold bulimia occurs in
2.0% to 5.4% of adolescent females. DSM reports 12 month prevalence ranges from 0.14% to
0.3% with higher rates in females and high-income countries. Rates are similar across
ethnoracial groups.

Binge eating disorder epidemiology

Prevalence rate: three times more common than anorexia and bulimia and it more common
than breast cancer, HIV and schizophrenia. Between 0.2%-3.5 % of females and 0.9%-2.0% of
males will develop BED with subthreshold occurring n 1.6% of adolescent females. 12 month
prevalence of 0.44% to 1.2% with rates 2-3 times higher in women, similar rates across
ethnoracial groups in the US and between most high income industrialized countries.

Anorexia nervosa comorbidty

Bipolar, depressive, and anxiety disorders;
Obsessive-compulsive disorder is more often seen in
those with the restricting type of anorexia nervosa,
Alcohol use disorder and other substance use disorders
are more commonly seen in those with anorexia who
engage in binge-eating/purging behaviors.

Bulimia nervosa comorbidity

Bipolar, depressive, and anxiety disorders; social anxiety;
Substance use disorder; often borderline personality
disorder

binge eating comorbidity

Major depressive disorder and alcohol use disorder; About
25% of those with BED have shown suicidal ideation

Eating Disorder Biological etiology

Genetics

• Relatives of those diagnosed with an eating disorder
are up to SIX times more likely to be diagnosed
themselves that other individuals
• Supported by twin studies (i.e., if an identical twin is
diagnosed with anorexia nervosa, the other twin has a
70% chance of developing the disorder)
• Fraternal twins’ concordance rate – 20%
• Bulimia, identical twins’ concordance rate – 23%
• Bulimia, fraternal twins’ concordance rate – 9%

Disruptions in the neuroendocrine
system

• Hypothalamus – responsible for regulating body
functions (e.g., hunger and thirst)
• Lateral hypothalamus – initiates hunger cues which
cause an organism to eat
• Ventromedial hypothalamus – sends signals of
satiation which causes an organism to stop eating

Eating Disorder Cognitive Etiology

Possibly a variant of
Obsessive-Compulsive
Disorder (OCD) because of
the associated obsession
with body shape and weight

Eating Disorder Sociocultural Etiology

• Media – constant exposure to photoshopped pictures of thin
celebrities can lead individuals to become dissatisfied with their
own physical image
• Ethnicity – although eating disorders are possible across
ethnicities, anorexia is more likely to be found in Caucasian
populations
• Why? Research indicates that black men prefer heavier
women than white men do. Therefore, black women are less
driven to thinness.
• What problems are there with this generalization? It
doesn’t account for socioeconomic statuses. High-income
black women were found to be equally dissatisfied with their
physique as high-income white women. Also, there is not
much of an ethnic discrepancy in binge-eating disorder.
• Gender – males only account for roughly 5-10% of diagnosed
eating disorders
• Why? Cultural desires for thinness seem to target women.
• What problems are there with this generalization?
Males might not be diagnosed as frequently due to
stigmatization and fear of seeking help.
• Family – we habitually praise or comment on family members’
appearances which can indirectly perpetuate an eating disorder
• Also, mothers with eating disorders are more likely to have
children who develop some type of feeding/eating disorder
than mothers without eating disorders.

Eating Disorder Personality Factors

Perfectionism – the belief that one must be
perfect

• Can often magnify normal body imperfections, leading an individual to go to excessive or restrictive behaviors to
remedy them

Self-esteem – one’s belief in their own worth
or ability
• Transdiagnostic model – suggests that overall low self-
esteem increases the risk for over-evaluation of body,
which can lead to negative eating behaviors that can then
lead to eating disorder

Treatments for Anorexia

Goal: weight gain and recovery from malnourishment
• Behavioral strategies: recording eating behaviors and emotional
behaviors
• Addresses maladaptive thought processes in order to change the fear
of gaining weight
Cognitive-Behavioral Therapy (CBT)
• Effective: up to 50-60% of weight restoration in one year; weight
maintenance 2-4 years post-treatment; fewer hospitalizations; cost
effective
• Often used with children and adolescents
• 16-18 sessions, 3 phases
• (1) Parents take charge of weight restoration
• (2) Clients gradually begin to control eating
• (3) Address developmental issues including fostering autonomy in
parents
Family-Based Therapy (FBT)
• Best if caught early
• Mortality rate over the first 10 years from presentation is about 10%,
usually due to medical complications from the disorder or suicide

Outcomes
• Mortality rate over the first 10 years from presentation is about 10%,
usually due to medical complications from the disorder or suicide

Treatments for Bulimia

CBT
Patients may journal eating habits, but
especially changes in sensations of hunger
and fullness
Exposure and Response Prevention –
especially effective in helping individuals
stop performing compulsive behaviors by
literally preventing them from engaging in
the behavior while also engaging in
relaxation strategies
Also aims to change maladaptive thoughts
toward food, eating, weight, and shape
Interpersonal
Psychotherapy (IPT)
Particularly effective if CBT has not worked
Goal is to improve interpersonal
functioning (e.g., social isolation and self-
esteem problems)
3 phases: (1) engage the patient in
treatment, provide psychoeducation, and
identify interpersonal problems; (2) focus
on solving the interpersonal issues with
the help of a supportive clinician; (3)
maintain the changes by spacing out
sessions and having the patient practice
Outcome:
Often worse for those who experience
childhood obesity, low self-esteem, and
those with a personality disorder

Treatments for Binge Eating Disorder

Goal: eliminate binge eating
episodes and to reduce body
weight
Like that of
bulimia nervosa
(e.g., CBT, IPT,
dialectical
behavioral therapy
or DBT)
Antidepressant
medications
Used due to the
high comorbidity
of eating
disorders and
depressive
symptoms
Not effective for
treating the
eating disorder
itself
Outcome:Remission rates are much higher than that for
anorexia or bulimia

Complex Attention

Sustained, divided, or selective attention and processing speed

Executive Function

planning, decision-making, overriding habits, mental flexibility,
and responding to feedback/error correction

Learning and Memory

includes cued recall, immediate or long-term memory, and
implicit learning

Language

Includes expressive language and receptive language

Perceptual Motor

Includes any abilities related to visual perception, gnosis,
perceptual-motor praxis, or visuo-constructiona

Social Cognition

Includes recognition of emotions and theory of mind

Delirium

Characterized by a significant disturbance in attention or
awareness (i.e., difficulty sustaining, shifting, or focusing attention)
and cognitive performance (i.e., confusion) that is significantly
altered from one’s usual behavior
• Also may feature disorganized thinking, incoherent speech, and
hallucinations and delusions
• Abrupt onset (happens over the course of several hours) and can
last days to months
• Symptoms can be mild to severe

Major Cognitive Disorder

An individual would show significant
decline in both overall cognitive
functioning as well as the ability to
independently meet the demands of
daily living such as paying bills,
taking medications, or caring for
oneself
Includes dementia, which is a major
decline in cognition and self-help
skills due to age
Not a good term to describe those
with similar symptoms caused by
injury or illness

Mild Cognitive Disorder

1.Individuals
demonstrate a modest
decline in cognition
2. Do not have trouble independently engaging
in daily activities although
they may require
extra assistance
or extra time
3. Patients can recover from
major neurocognitive disorders
and be diagnosed
with a mild neurocognitive disorder
• In other words, they may have a sequential relationship

Delirium Epidemiology

Prevalence in
general
community is 1-
2%
For older individuals:
8-17% for those
presenting to emergency
departments
20-22% for those in
nursing homes or post-
acute care
88% for those with
terminal illnesses

MAJOR AND
MILD NCD :
EPIDEMIOLOGY

Higher prevalence in
women

ALZHEIMER’S DISEASE

CAUSES
• Abnormal brain structures responsible for
neuron death, inflammation, and loss of
cellular connections
• Beta-amyloid plaques – appear before onset between
neurons
• Neurofibrillary tangles – appear after onset inside
neurons
• Genetics
• Apolipoprotein E (ApoE) – helps to eliminate beta-
amyloid by-products
• e4 allele reduces ApoE production
• Other
• Hypothalamus, thalamus, and locus ceruleus shrink
• Acetylcholine-secreting neurons with the basal
forebrain shrink or die
• Environmental toxins (e.g., zincs)
ONSET
• Early-onset occurs before
age 65 and in those
individuals with more of a
genetic influence
• Late-onset occurs after age
65 and has less of a familial
influence (only 30% have
the failing ApoE gene)

TRAUMATIC BRAIN INJURY (TBI)

• Occurs after a significant trauma or injury to the head when symptoms
appear (e.g., loss of consciousness, posttraumatic amnesia,
disorientation and confusion, or neurological impairment)
• Severity depends on the location of the injury and the intensity of the
trauma
• Effects can be temporary or permanent and can include headaches,
disorientation, confusion, irritability, fatigue, poor concentration, as
well as emotional and behavioral changes
• In severe cases, individuals may experience seizures, paralysis, and
visual disturbances
• Most common type of TBI is a concussion
• Symptoms are temporary but can become permanent if injury is
repeated (Chronic Traumatic Encephalopathy or CTE)

TBI: EPIDEMIOLOGY

About 2.87 million Traumatic Brain Injuries (TBIs) happen
each year in the US, 40% of which occur in males
• Most commonly include falls followed by collision with a
moving or stationary object, automobile accidents, and
assaults
• It has also become increasingly recognized that concussion in
sport causes mild TBI (APA, 2022)

VASCULAR DISORDERS & STROKES

• Vascular disorders generally begin with atherosclerosis (the clogging of
arteries due to a build-up of plaque)
• When these arteries are completely obstructed by plaque, a stroke occurs
which then results in the death of neurons and loss of brain function
• Two types of strokes
• Hemorrhagic Stroke – occurs when a blood vessel bursts within the brain
• Ischemic stroke – occurs when a blood clot blocks the blood flow in an artery
within the brain
• Most strokes occur age 65+
• Symptoms depend on the location of the stroke in the brain and the
extent of damage

Hemorrhagic Stroke

occurs when a blood vessel bursts within the brain

Ischemic stroke

occurs when a blood clot blocks the blood flow in an artery

DEMENTIA WITH LEWY BODIES

Features significant fluctuation in attention and alertness, recurrent visual
hallucinations, impaired mobility, and sleep disturbance
• Develops more rapidly than Alzheimer’s disease, but prognosis is the same
(survival periods are both 8 years)
• Lewy bodies are irregular brain cells that result from a buildup of abnormal
proteins in the nuclei of neurons which then deplete the cortex of acetylcholine
which causes the cognitive symptoms
• Motor symptoms are caused by the depletion of dopamine by Lewy body brain
cells in the brain stem

Lewy Bodies

irregular brain cells that result from a buildup of abnormal
proteins in the nuclei of neurons which then deplete the cortex of acetylcholine
which causes the cognitive symptoms

FRONTOTEMPORAL NCD

Causes progressive
declines in language
or behavior due to
the degeneration in
the frontal and
temporal lobes of the
brain
Symptoms include
significant changes
in behavior and/or
language, apathy or
disinhibition, loss of
empathy and
sympathy,
compulsive
behaviors
Also includes a
decline in executive
functions (e.g., poor
planning and
organization,
distractibility, and
poor judgement)

PARKINSON’S DISEASE

2nd most common
neurodegenerative
disorder in the US
(affects about 630,000
individuals)
Symptoms include
tremors, rigidity of the
limbs and trunk,
slowness in initiating
movement, drooping
posture, and impaired
balance and
coordination
Motor symptoms occur
about 1 year before
the cognitive decline
although there are
individual differences

HUNTINGTON’S DISEASE

A rare, genetic disorder which involves involuntary
movement, progressive dementia, and emotional instability
Onset is often in middle adulthood
Symptoms include facial grimaces, difficulty speaking, and
repetitive movements
Death typically occurs 15-20 years post-onset of symptoms
and there is no treatment

HIV Infection

Symptoms include slower
mental processing, difficulty
with complex tasks, and
difficulty
concentrating/learning new
information
Antiretroviral therapies used to
treat HIV have been found
effective in reducing and
preventing the onset of severe
cognitive impairments although
symptoms still occur in about
50% of patients

PHARMACOLOGICAL Treatment of Neurocognitive Disorders

Medications target acetylcholine and glutamate
• Drugs specific to treating Alzheimer’s disease include donepezil
(Aricept), rivastigmine (Exelon), galantamine (Razadyne), and
memantine (Mamenda) and they are often prescribed in early/middle
stages
• Levodopa is a medication used for treating Parkinson’s disease because
increases dopamine availability
• Unfortunately, side effects include hallucinations and psychotic
symptoms

PSYCHOLOGICAL Treatment of Neurocognitive Disorders

Most effective type of treatment
• Includes computer-based cognitive stimulation
programs, reading books, and following the
news
• May also involve social skills and self-care
training
• Focuses on breaking down complex tasks into
smaller, more attainable goals and simplifying
the environment (i.e., labeling, removing
clutter)

SUPPORT FOR CAREGIVERS

Nearly 90% of all individuals with
Alzheimer’s disease is cared for by a
relative
• The demands on these caretakers is
often extreme, so it is important to
routinely assess the state of these
individuals and encourage them to
participate in support groups or
therapy

Substance/Medication-Induced Mental Disorders

The substance/medication-induced mental disorders are potentially severe, usually temporary,
but sometimes persisting CNS syndromes that develop in the context of the effects of substancesof abuse, medications, and
some toxins. They are distinguished from the substance use disorders, in which a cluster of cognitive, behavioral, and
physiological symptoms contribute to thecontinued use of a substance despite significant substance-related problems. The
substance/medication-induced mental disorders may be induced by any of the 10 classes of
substances that produce substance use disorders, or by a great variety of other medications used
in medical treatment

Unspecified

This category applies to presentations in which symptoms characteristic of a disorder that cause
clinically significant distress or impairment in social, occupational, or other important areas of
functioning predominate but do not meet the full criteria for any specific disorder in the specific
category or any of the disorders in the substance-related and addictive disorders diagnostic class.

Tobacco

Tobacco use disorder can develop with use of all forms of tobacco (e.g.,
cigarettes, chewing tobacco, snuff, pipes, cigars, electronic nicotine
delivery devices such as electronic cigarettes [ecigarettes]) and with
prescription nicotine-containing medications (nicotine gum and patch). The
relative ability of these products to produce tobacco use disorder or to
induce withdrawal is associated with the rapidity of the route of
administration (smoked over oral over transdermal) and the nicotine
content of the product. The name of this substance category was changed
from “nicotine” in prior editions of DSM to “tobacco” in DSM-5 on the basis
of harms from addiction being associated mostly with tobacco and much
less with nicotine.

The diagnostic class other (or unknown) substance–related disorders applies to substances that are
not included within any of the nine substance classes presented earlier in this chapter (i.e., to
alcohol; caffeine; cannabis; hallucinogens [phencyclidine and others]; inhalants; opioids; sedatives,
hypnotics, or anxiolytics; stimulants; or tobacco). Such substances include anabolic steroids;
nonsteroidal anti-inflammatory drugs; corticosteroids; antiparkinsonian medications; antihistamines;
nitrous oxide; amyl-, butyl-, or isobutyl-nitrites; betel nut, which is chewed in many geographic
regions to produce mild euphoria and a floating sensation; and kava (from a South Pacific pepper
plant), which produces mild euphoria, sedation, incoordination, and weight loss, as well as health
effects (e.g., mild hepatitis, lung abnormalities). Note that gaseous substances are included with the
inhalant category only if they are hydrocarbon agents; other gaseous substances (including nitrous
oxide mentioned above) are included in the other (or unknown) substance category. Unknown
substance–related disorders are associated with unidentified substances, such as intoxications in
which the individual cannot identify the ingested drug, or substance use disorders involving either
new, black market drugs not yet identified or familiar drugs illegally sold under false names.