Abnormal Psych Exam 3

behavioral medicine

knowledge derived from behavioral science is applied to prevention, diagnosis, and treatment of medical problems

health psychology

study of psychological factors that promote and maintain health, as well as health care systems and health policy

2 primary paths psychological and social factors influence health

- psychological factors influence biological processes
- behavioral patterns increase disease risk

______ % of the leading causes of death in the US are linked to behavioral/lifestyle patterns

50%

examples of lifestyle patterns that can lead to death

* smoking
* poor eating habits
* lack of exercise
* insufficient injury control

General adaptation syndrome (GAS) - theory of stress response

* Phase 1 - alarm response (to immediate danger)
* Phase 2 - resistance (attempt to cope with stress)
* Phase 3 - exhaustion (body suffers damage with stress that lasts too long)

Physiology of stress

- Stress activates HPA axis
- hypothalamus releases corticotropin-releasing factor (CRF) and stimulates pituitary gland
- pituitary gland activates adrenal gland, secreting cortisol
- hippocampus turns off stress response

what happens to hippocampus by chronic stress

it becomes damaged by chronic secretion of cortisol

social status in animals

- subordinate animals have chronically high levels of stress, which compromises ability to respond to stress over time, and leads to compromised immune system
- benefit of high social status: predictability and controllability of environment

diagram of contributions to stress response

as sense of control or ability to cope increases, our feelings range along continuum from depression, anxiety, stress, to excitement

psychoneuroimmunology

psychological influences on neurological component of immune response

what happened when rats where given sugar water

- rats given sugar water with a drug that suppresses immune system
- later, sugar water along suppressed immune system

immune system function

identify and eliminate foreign materials (antigens)

2 parts of immune system

- humoral
- cellular
includes white blood cells (leukocytes), B and T cells (lymphocytes), and macrophages

macrophages

- body's first line of defense
- surround antigens and destroy them
- signal lymphocytes

lymphocyte B cells

- in humoral
- release molecules that seek antigens in blood with purpose of neutralizing them
- produce immunoglobulins that act as antibodies, which combine with antigens to neutralize them

memory B cells

created so next time antigen is encountered, immune response is faster

lymphocyte T cells

- cellular part
- don't produce antibodies
- killer T cells destroy viruses and cancer cells
- memory T cells created to speed up response to same antigen
- T4 cells (helper T cells) enhance immune response by signaling B cells to produce antibodies and tell other T cells to destroy antigen
- suppressor T cells suppress production of antibodies by B cells when not needed

what happens with too many T4 cells

helper T cells overreact and attack normal cells

in developing world, most die within _______ of AIDS

1 year

what is best treatment for AIDS

- highly active antiretroviral therapy (HAART)
- suppresses virus, slows progression and decreased mortality
- severe side effects

US AIDS cases by mode of transmission
- male to male sexual contact: _____%
- heterosexual contact: ______ %
- injection drug use: _________%
- other: _______%

50%; 32%; 17%; 1%

what exacerbates AIDS progression

- high stress
- low social suppor

outcomes of cognitive-behavioral stress-management (CBSM) in those with AIDS

- increased T-helper cells
- lower antibodies
- enhanced psychological adjustment

psychoncology

study of psychological factors in cancer

psychological and behavioral contributions to etiology and maintenance of cancer

- perceived lack of control
- poor coping responses
- stressful life events
- life-style risk behaviors

psychological factors impact cancer risk by impacting functions such as

- immune function
- viral actviity
- DNA repair processes
- Gene expression

psychosocial treatments for cancer improve

- health habits
- treatment adherence
- endocrine function
- stress response/coping

what is hypertension

high blood pressure

hypertension increases the risk for

- heart disease
- kidney disease

because it taxes blood vessels

hypertension prevalence

- 27.6% of North Americans aged 35-64
- African Americans have 2x greater risk because of experiences of stereotype threat o

risk factors for hypertension

- excessive sodium intake
- sympathetic arousal
- stress level
- expressed anger
- hostility

psychological factors that have been used to explain individual differences in blood pressure

- personality
- coping style
- level of stress

psychological factors that contribute to cardiovascular disease

- loneliness
- depression
- feelings of uncontrollability

coronary heart disease

blockage of arteries supplying blood to heart

psychological and behavioral risk factors associated with coronary heart disease

- stress, anxiety, anger
- poor coping skills
- low social support

what is CHD linked to

- type A behavior pattern (anger, excessive drive and competitiveness, impatience, accelerated speech, agitated motor activity)
- chronic negative affect, low socioeconomic status, and stressful experiences

what factors reduce risk of CHD

positive emotions and optimistic style

reverse capacity model for risk factors for CHD

acute pain

follows an injury and disappears once injury heals/effectively treated

chronic pain

may begin with acute episode but doesn't decrease over time

pain behaviors

limping, complaining, avoiding activities

why is severity of pain not a good predictor of one's reaction to it

some experience intense pain and continue to work productively, rarely seek medical service, and lead normal lives

chronic pain is worsened by

- low perceived control
- negative emotion
- poor coping skills
- low social support

pain behaviors may be increased by

- compensation (e.g., paid time off)
- social reinforcement (sympathy)

gate control theory of pain

neurological processes (anxiety, fear, intense concentration) affect the degree to which pain is detected
- negative emotions - message from brain is to be vigilant against danger
- positive emotions - brain sends inhibitory signal to close gate

endogenous (natural) opioids

- pain-inhibiting natural chemicals that may be increased by exercise
- called endorphins

why do females have additional pain-regulation mechanisms

- to facilitate childbirth
- neurochemistry may be based on estrogen-dependent neuronal system

nature of chronic fatigue

- lack of energy and fatigue that doesn't improve with adequate sleep
- may have aches and pains or low fever

symptoms of chronic fatigue syndrome

- subjective memory impairment
- sore throat
- tender lymph nodes
- muscle pain
- joint pain
- headache
- unrefreshing sleep
- malaise lasting more than 24 hours

causes of chronic fatigue syndrome

- unknown
- may be response to stress

treatment of chronic fatigue syndrome

- medications ineffective
- CBT helpful (includes increasing activity, regulating rest, and stress reduction)

Core beliefs of someone with chronic fatigue syndrome

I am inadequate

lifestyle of someone with chronic fatigue syndrome

- achievement-oriented and hard working
- puts on brave face
- doesn't ask for help

thoughts of someone with chronic fatigue syndrome

- I must be physically ill
- i'm making myself worse
- there's nothing I can do
- I should try harder to cope
- I can beat this

biofeedback

- psychosocial treatment of physical disorder
- monitor and control bodily responses (heart rate, blood pressure, muscle tension, EEG rhythms)
- increase sense of control
- improves patient's ability to control bodily processes

relaxation and meditation

- psychosocial treatment of physical disorder
- progressive muscle relaxation
- transcendental meditation: focuses attention on repeated mantra
- increased sense of control and mastery
- may improve headache, hypertension, acute and chronic pain

comprehensive stress and pain reduction program

- monitor and identify stressful events (times, intensity, triggers)
- monitor somatic symptoms
- muscle relaxation
- cognitive therapy
- increase coping strategies (time management, assertiveness training)
- more effective than individual components

drugs vs. stress reduction programs

- medication decreases efficacy of comprehensive programs
- high relapse when stopped
- tolerance built over time

coping through denial

- denial about physical condition can be helpful
- helpful at early stages
- later, more helpful to face situation

what is the leading cause of death from ages 1-45

accidents

injury prevention

- repeated warnings not enough
- programmatic efforts needed (teach children to escape fires and cross streets)

AIDS prevention

- preventable by changing behaviors (safe-sex, sanitary use of needles, regular check-ups, strong peer support programs)

smoking cessation in China

- capitalize on family relationships (children persuade fathers to stop)
- distribute anti-smoking literature
- target at-risk populations

stanford three community study

- looking to reduce risk factors of CHD
- conducted in 3 similar communities
- each community either got: no intervention, media blitz, media blitz plus face-to-face intervention
- highest benefit from media blitz plus live intervention

what is abnormal sexual behavior?

- normative facts and statistics
- cultural considerations
- gender differences in sexual behavior and attitudes

how many partners in a lifetime and past year

- 15 or more (lifetime): men = 21.4%, female = 8.3%
- 4 or more (past year): men = 6%; female = 2.9%

homosexual sex attraction or behavior statistics

men = 10%
women = 9%

sex in age 75-85 statistics

men = 38.5% active
female = 16.7% active

gender differences in masturbation

men = 72% report ever masturbating
female = 42% report ever masturbating
- males masturbation may be easier and physical gratification more emphasized for men

gender differences in casual premarital sex

men are more permissive, but the gap is shrinking

gender differences in elements of satisfaction

- women are more likely to seek demonstrations of love and intimacy
- men are more likely to focus on arousal

no differences in gender differences of

- acceptability of homosexuality
- acceptability of masturbation
- importance of sexual satisfaction

sexual self-schemas

beliefs about one's own sexuality

gender differences in sexual beliefs

- females more likely to value experience of passionate and romantic feelings
- minority of females hold embarrassed, conservative, or self-conscious views toward sex
- males have fewer negative core beliefs about sex
- men are more likely to emphasize dominance and aggression

cultural differences on views on sexuality in children

- Sambia believe receiving semen contributes to development in children (emphasize homosexual oral sex between young boys)
- Munda emphasize mild heterosexual activity (mutual masturbation) among cohabitating children

development of sexual orientation

- bio-psycho-social influences
- homosexuality (only small genetic component: 50% of identical twins raised together do NOT share same sexual orientation)

why did DSM III remove homosexuality as a disorder

- no physiological differences in arousal between gay and straight
- no difference in rate of psychological disturbance
- gender identity confusion no more common in homosexuals
- lack of full societal acceptance and different behaviors, homosexual sexual concerns differ from heterosexuals' concerns

sexual dysfunctions

- involve desire, arousal, and/or orgasm
- pain associated with sex can lead to additional dysfunction

sexual dysfunction present for how long to make a diagnosis

6+ months

desire phase

sexual urges occur in response to sexual cues or fantasies

arousal stage

sense of sexual pleasure and physiological signs of sexual arousal

plateau phase

brief period occurs before orgasm

orgasm phase

- in males, feelings of inevitability of ejaculation, followed by ejaculation
- females, contractions of walls of lower third of vagina

resolution phase

decrease in arousal after orgasm (particularly in men)

prevalence of sexual dysfunctions

- common and not always distressing
- 40% of men have difficulty with erection/ejaculation, 63% of women have problems with arousal/orgasm

classification of sexual dysfunctions

- lifelong vs. acquired
- generalized vs. situational
- psychological factors alone
- psychological factors combined with medical condition

lifelong

chronic condition present during person's entire sexual life

acquired

disorder begins after sex has been normal

generalized

occurs every time individual attempts sex

situational

occurs with some partners or at certain times

desire disorders in men/women

- men: hypoactive sexual desire
- women: female sexual interest/arousal disorder

arousal disorders in men/women

- men: erectile disorder
- women: female sexual interest/arousal disorder

orgasm disorder in men/women

- men: erectile disorder
- women: female sexual interest/arousal disorder

pain disorder in women

- genito-pelvic pain/penetration disorder (ex: vaginismus)

male hypoactive sexual desire disorder statistics

- accounts for half of all complaints at sexuality clinics
- affects 5% of men

DSM-5 for male hypoactive sexual desire disorder

1. persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity
2. symptoms have persisted for minimum of 6 months
3. symptoms cause distress in individual
4. sexual dysfunction not better explained by nonsexual disorder or consequence of relationship distress or other stressors and isn't attributable to medication or other medical condition
specify whether: lifelong or acquired type
specify whether: generalized or situational type

erectile disorder

- difficulty achieving or maintaining erection
- sexual desire intact

statistics for erectile disorder

- most common problem for which men seek treatment
- prevalence increases with age (60% of men over 60 experience erectile dysfunction)

female sexual interest/arousal disorder prevalence

prevalence decreases with age