Abnormal Psych

What is Abnormal Behavior

• normal

  • functioning well by societal standards

    • objective

• abnormal

  • culturally inappropriate

  • subjective distress

  • psychological impairment

• cultural relativity

  • perspective that different cultures use different standards in defining abnormality

• subjective distress

  • emotional experience that is distressing but cannot be directly observed by others

  • manics may deny subjective distress

  • psychopaths experience little remorse or distress associated with anti-social behaviors

Historical Context of Abnormal Behavior

• abnormal behavior has been a part of human condition in all times/cultures

• demonology (evil) vs naturalistic (illness)?

• ancient writings of convulsive fits (epilepsy)

  • mania and depression

  • schizophrenia

  • phobias

• demonology - the belief that possession by demons or spirits explains abnormal behavior

  • pre-historic

  • trephining - procedure where rock was used to make a hole in skull with intent to let trapped demons escape

  • alive in US today

    • 1980s - ritualistic abuse by Satan worshipers became popular explanation for Dissociative Identity Disorder

    • investigated. by FBI

• hippocrates

  • greek physician (460-375 BE)

  • advocate for naturalistic explanations for disturbed behavior

  • medical approach to treatment (naturalistic approach)

    • abnormalities caused by imbalances of bodily fluids

    • four humors

      • yellow bile

      • black bile

      • blood

      • phlegm

• middle ages

  • dance manias - apparent mass madness where groups of people danced in streets

    • “tarantism” (italy) caused by bite of tarantula

  • St. Vitus dance (western europe) - dance until collapse

• witchcraft

  • end of the 15th century

  • lasted 200+ years

  • physicians/clergymen become extreme in efforts to drive out devils

    • floggings, starving, hot water immersion, torture

• dark ages positives

  • 792 CE Baghdad, humane hospital established for mentally disturbed

  • Johnathan Weyer (1515-88)

    • natural causes for abnormal behavior

  • Reginald Scott (1538-99)

    • denied the role of demons in mental disorders

Contemporary Views

• psychoanalytic perspective

  • sigmund freud

    • mental disorders based in unconscious sex or death conflicts

    • levels of awareness

      • unconscious - material out of awareness

      • preconscious - material that is generally out of awareness but recalled rather easily

      • conscious - material that we are aware of

    • psychoanalytic theorists believe that therapists will focus on transference (client relates to therapists like family) and work to make unconscious become conscious

• cognitive behavior therapy

  • most empirical evidence of any theory

    • Aaron Beck

    • Albert Ellis

  • irrational thoughts/beliefs guide emotion

    • A - antecedent/triggering event

    • B - belief

    • C - consequence (emotional)

  • work to identify/change irrational belief

  • help clients change maladaptive behavior

• humanistic/existential

  • carl rogers (humanistic)

    • every person has ability to achieve positive change, with three conditions

      • unconditional positive regard

      • genuine (therapists)

      • congruence (compassion and caring)

Malingering and Factitious Disorder

• malingering disorder

  • “malum”, latin means bad/harmful

  • intentional production of false or grossly exaggerated physical or psychological symptoms motived by external incentives (DSM5)

    • might fake for disability benefits, financial compensation, evading prosecution

  • feigning, faking (exaggeration of symptoms)

  • suspect-effort (someone isn’t trying)

  • ganser’s syndrom

    • approximate answers

    • clouding of consciousness

    • somatic conversion

    • hallucinations

  • 13% in metropolitan ER

  • 25-30% of those seeking workers comp

  • 30% of those seeking disability

  • common symptoms

    • rare symptoms, improbable symptoms, symptom combination, symptom severity, indiscriminate symptom endorsement, obvious vs. subtle symptoms, reported vs. observed symptoms

• factitious disorder

  • voluntary production of symptoms to assume the patient role

  • by proxy

    • imposed on another with the intention of deceiving others

  • present as sick, claim to need medical attention, usually involves parent harming child

Anxiety Disorders

• fear and anxiety

  • all mammals born with innate capacity to experience fear

  • fear is adaptive state for dealing with a real threat or danger

  • anxiety is chronic fear sensation that is not clearly associated with any specific stimulus (maladaptive)

  • 2:1 female to male ratio for anxiety

    • females may seek treatment more often

    • underreported in men

    • women subjected to more traumas

    • biological explanations (hormones related to reproductive system)

  • anxiety disorders affect in three ways

    • physically (ex. tension in body)

    • psychologically (ex. worry/intrusive thoughts)

    • behaviors (ex. avoidance)

  • panic disorder

    • ANS (autonomic nervous system) response

    • characterized by recurrent, spontaneous and unexpected panic attacks

    • not due to medical condition or the effects of a substance

    • followed by a month or more of persistent concern that attacks will recur

    • symptoms

      • increased heart rate

      • chest pains

      • shallow/rapid breathing (can lead to hyperventilation)

      • feeling faint

      • dizziness

      • headaches

      • seizure-like activity

      • profuse sweating

      • crying

    • may be followed by changes in behavior that are related to avoiding another attack

      • avoiding physical activities, responsibilities

    • worry about health can extend to co-morbity (depression, generalized anxiety, illness anxiety)

    • onset is tuypically between adolescence and mid-30s

    • fairly common, affects up to 5% of population

  • agoraphobia

    • greek for “fear of the marketplace”

    • anxiety about being in places/situations where escape would be difficult

    • comorbid with panic attacks

    • reluctant to leave home

  • specific phobia

    • intense persistent fear triggered by specific objects or situations

    • DSM-5 subtypes

      • animal

      • natural environment

      • blood-injection

      • situational

      • other

      • lifetime prevalence 12%

  • social anxiety

    • fear of being in crowds, public speaking

    • occurs when exposed to unfamilar people/scrutiny of others

    • 12.1% lifetime prevalence

  • generalized anxiety disorder

    • constant state of worry

    • on edge, worry about minor and major events

    • comorbid with depression and panic disorder

  • obsessive compulsive disorder (OCD)

    • obsession - intrusive thought that is difficult to stop or control

      • common obsessions include disease, religion, sexual issues

    • compulsion - action that one feels compelled to perform

      • common compulsions include checking, rituals, handwashing

    • individuals with obsession attempt to ignore or suppress them

    • can lead to ritualized behavior in order to suppress obsessions

    • can be time consuming at least an hour per day or frequently much longer periods

    • may become incapacitated by rituals

    • moderate genetic link

    • higher levels of activity in the orbital frontal lobe

    • increased risk in kids who have been exposed to trauma

  • hoarding

    • collect items that t hey are later unable to discard

    • persistent difficulty in parting with personal possessions regardless of the actual value of those possessions

    • subtypes: animals, everyday objects

  • trichotillomania

    • pull out hair band, noticeable hair loss

    • centered on any part of the body

    • involves scalp, eyebrows, eyelashes

    • involves an increasing tension that precedes the act

    • pulling associated with pleasure, gratification, or relief

    • associated with mood disorders and OCD

  • TREATMENT (anxiety disorders overall)

    • psychotherapy

      • cognitive behavioral therapy - inference based CBT (OCD)

    • medication - benzodiazepines

      • xanax, valium, klonopin

        • addictive

        • impairs working memory

      • SSRI, anti-depressants

        • paxil, wellbutrin, celexa

        • takes 30-45 days to work

        • lexapro - works immediately

Childhood Disorders

• common disorders:

  • communication disorders (verbal)

  • learning disorders, highly comorbid with adhd

    • expressive communication

    • disorder of reading (word recognition and reading comprehension)

    • disorder of written expression (Dysgraphia)

    • math disorder

  • behavioral disorders

    • oppositional defiant disorder

    • conduct disorder

  • neurodivergent disorders

    • ADHD

    • autism spectrum disorders

• Attention Deficit / Hyperactivity Disorder (ADHD)

  • most common diagnosed childhood behavior disorder

  • come into prominence in 70s

  • diagnosing and treatment has improved over past 20 years

  • clinical presentation

    • used to be thought of developmental problems in the womb

    • 1980 - attention deficit began to be viewed as cornerstone of the disorder

    • 1994 - DSM-IV combined symptoms of hyperactivity, impulsivity, and inattention

    • three main presentations:

      • ADHD - predominately inattentive

        • most common in girls and adults

      • ADHD - predominately hyperactive

      • ADHD - combined

        • most common mainly in boys

    • very different from child to child

    • easily recognizable in kids who are physically active and viewed by others as impulsive/disruptive

    • may become isolating as they get older

  • ADHD - Inattentive

    • more difficult to diagnose

    • does better with peers, may struggle with academic problems

    • show inattention but not hyperactive/impulsive

    • symptoms:

      • careless mistakes in school work

      • easily distracted

      • difficulty following instructions

      • not listening when spoken to directly

      • trouble organizing tasks and possessions

      • fails to finish school work/chores

  • etiology

    • not clear

    • predominant thinking is that it is neurological, limited environmental influence

    • no clearcut genetic evidence

  • brain (children)

    • smaller occipital lobes

    • smaller brain volumes

    • decreased cortical thickening in the anterior cingulate cortex

  • environmental

    • low birth weight

    • traumatic brain injury

  • ADHD - Hyperactive

    • symptoms:

      • fidget or squirm

      • trouble staying in seat

      • runs and climbs where is inappopriate

      • has trouble playing quitely

      • extremely impatient

      • excessive talking

• Reactive Attachment Disorder

  • rare

  • serious

  • infant/young child does not establish healthy attachments with parents or caregivers

  • may develop if the child’s basic needs for comfort, affection, and nurturing aren’t met

• Autism Spectrum Disorders

  • developmental

  • marked by difficulty with social communication and interaction

  • restricted/repetitive patterns of behavior, interests, or activities

  • characterized by inadequate social understanding

    • repetitive, restrictive behavior

    • may line up toys rather than playing with them

  • wide range of presentation

    • intellectual disability / superior intelligence

    • nonverbal / verbal

    • nonsensical speech / hold conversation

    • total assistance / living alone

  • Asperger’s Disorder

    • once considered as a separate confition along the autism continuum

    • changed in DSM-5, removed

    • now referred to as “high-functioning”

  • Autism Assessment

    • mild cases can be difficult to diagnose

    • evaluation usually conducted in an interdisciplinary setting

      • medical

      • psychological

      • speech

      • OT

      • PT

    • applied behavioral analysis

Somatization Disorders

• somatic symptom disorders

  • involve bodily symptoms, psychological cause

  • psychological distress worsens physical symptoms

  • lower diagnostic reliability than anxiety or mood disorders

• somatic symptom disorder

  • multiple physical complaints that disrupt daily life

  • may or may not be underlying condition

  • tend to worry about illness and interpret their symptoms as overly serious

• ego-defense mechanism?

• DSM criteria

  • somatic symptoms result in excessive thoughts, behaviors or feelings as evidenced by the following:

    • anxiety related to health

    • excessive amount of energy and time devoted to health concern

    • persistent and disproportionate thoughts about the seriousness of one’s symptoms

• psychogenic - originating from psychological factors

Dissociative Disorders

• Conversion Disorder - where physic energy or stress is converted into physical symptoms

• Symptoms

  • Partial or complete paralysis

  • Selective loss of function

  • Abasia (the ability to move legs when lying or sitting but not to stand or walk)

  • Speech disturbances mutism

  • Disturbances in vision/hearing

  • Anesthesia

  • Analgesia

  • Paresthesia

  • Lump in throat

• Causal Factors

  • Essentially considered a form of autosuggestion to express and relieve conflict

  • Could also produce secondary gain by allowing the sufferer to avoid responsibilities or undesired situations 

• Co morbid with

  • Panic disorder

  • Anxiety

  • Depression

  • Somatic symptom disorder

• Dissociative Disorder

  • Involve certain altered states of consciousness and disruptions of memory and identity

  • Generally rare

  • Associated with stressful or traumatic experiences

  • Very low diagnostic reliability

  • Symptoms can be easily feigned, and they are perhaps overrepresented in situations in which malingering should be carefully considered. 

Three types of dissociative disorders

• dissociative amnesia

  • Unexplained inability to recall important personal information

  • More common among females

  • Idiopathic transglobal amnesia

  • Involves loss of memory for certain period of time

  • sudden onset

  • may be delayed from the precipitating stressor

  • course is variable, spontaneous recovery/chronic recovery

• dissociative fugue

  • sudden unexpected travel with inability to recall one’s past

  • assume new identity

  • more often brief duration

  • remits spontaneously

• dissociative identity disorder

  • formerly called multiple personality disorder

  • most with condition also develop PTSD, depression, somatic symptom disorders, substance related disorders

  • suicide risk increased

  • personalities may range between 2-100 but in half the cases there are 10 or less identities

  • affect women more than men

  • features:

    • lost time

    • 2 or more personalities

    • women display more personalities than males

    • 1.1% of female population in Turkey

    • rise in incidents over past few decades

  • various personalities show physiological variations

    • ex. handedness may change, glasses/no glasses

    • EEG differences in patients during personality switching were greater than those produced by stimulating subjects

Mood Disorders

• Major Depressive Episode

  • involves 2-week period of constant depressive symptoms

    • sadness, loss of interest/pleasure, changes in weight, sleep, loss of energy, agitated/slow movement (AKA anhedonia), difficulty concentrating, guilt, thoughts of death, social withdrawal

  • MDD characterized by duration and severity

  • vegetative symptoms

    • disturbance of appetite

      • not hungry at all / eat more (comfort foods)

    • disturbance of sleep

      • less sleep / sleeping too much (16-20hrs)

  • can develop psychotic symptoms

  • physical pain

  • chronic illness

• Manic Episode

  • a distinct period (at least one week) of expanisve, elevated, or irritable mood

  • enjoyable/euphoric (elevated)

  • overly enthusiastic and intrusive in social interactions (expansive)

  • hypersexuality?

  • increased impulsive behavior

  • flight of ideas

    • tangential thought

    • circumstantial speech

  • engage in impulsive, maladaptive behavior

  • diagnostic criteria

    • distinct period of elevated, expansive, or irritable mood

    • increased goal-directed energy

    • inflated self-esteem

    • decreased need for sleep

    • talkative / pressure to keep talking

  • Bipolar 1 vs. Bipolar 2, cyclothymia

  • chronic, persistent mental illness

  • Hypomanic Episode

    • similar to but less severe than manic episode

    • elevated, expansive, irritable mood for 4 days, no psychotic symptoms to be diagnosed

• Persistent Depressive Disorder

  • formerly known as dysthymia

  • nearly a continuous state of depressed mood that lasts two years without much respite

  • requires fewer symptoms than are required for major depressive disorder

• Disruptive Mood Dysregulation Disorder

  • chronic severe irritability

    • temper outbursts for age 10

      • verbal or physical

      • outbursts myst be persistent 3 times per week or more

      • cross situational

    • not recommended for children under 8

  • prevalence 2-5%

• TREATMENT

  • medication

  • beneficial to about 50-70% for alleviating depression

    • tricyclics (oldest)

      • amitryptyline, nortryptyline

    • MAOI (monomine antioxidase inhibitors)

      • marplan

      • very rarely used, follow very rigid diet, no tyramine

    • SSRIs (selective serotonin reuptake inhibitors)

      • wellbutrin, paxil, prozac, celexa, effexor, lexapro, cymbalta

      • take 30-60 days to reach therapeutic level

      • lexapro works immediately/30-45 days

      • side effects

        • drowsiness, weight change, nausea, sexual disfunction

      • in children/adolescents

        • “Physician’s Desk Reference”

        • black box warning in children and teens due to increased risk of suicidal thoughts

    • electroconvulsive therapy (ECT)

      • shocks given to brain, strong enough to cause a seizure

      • 90% effectiveness rate for depression

      • terrible side effects

      • last resort

    • transcranial magnetic stimulation

      • use magnetic waves to impact the brain

      • close to ECT without bad side effects

    • psychotherapy

      • cognitive behavioral therapy (CBT)

        • identify patterns of thinking that contribute to depression

        • balance thoughts

Eating Disorders

• involve patterns of alters consumption , some of which affect the absorption og nutrient

• do not include obesity (not listed as mental disorder)

• anorexia nervosa

  • recognized for more than 100 years

  • rare until mid-20th century

  • three main features

    • restricted calorie intake insufficient to maintain normal body weight

    • intense fear of gaining weight

    • disturbance in the perception of body size

  • two eating patterns

    • restricting type - individual diets, fasts, or exercises excessively so that intake of food is inadequate to maintain current weight

    • binge-eating/purging type - the individual regularly consumes food, often in large quantities but then compensates by inducing vomiting or by misusing laxatives, enemas, or diuretics to produce weight loss

  • weight loss achieved by severe restriction in diet

  • certain food items/range of acceptable food is narrow

  • food become preoccupation, with obsessive-compulsive intensity

  • thinks of food a lot, may hoard food items or collect recipes

  • mortality estimates varies from 0.71 - 17.8

• bulimia nervosa

  • sense of lack of control related to recurrent episodes of eating large quantities of food

  • binge eating - amounts of food larger than others would normally eat in a given time, usually high in calories

  • more common than anorexia

    • 1.5% of females

    • female to male ratio 10:1

  • not related to social economic status

  • several negative physical consequences

Suicide Assessment and Intervention

• attempted suicide is a potentially self-injurious act committed with at least some intent to die

• solve problems of intense emotional pain with impaired problem-solving skills

• no typical suicide victim

• suicide is 4x higher in males than females

• male deaths make up about 79% of lethal suicides

  • firearms most commonly used among males

• females attempt more often than men, but men are more successful

• men suicide rates ranking

  • 75 yrs+

  • 25 - 44 yrs

  • 45 - 64 yrs

  • 65 - 74 yrs

  • 15 - 24 yrs

  • 10 - 14 yrs

• females more likely than males to have suicidal thoughts

  • attempt suicide 3x more often

  • poisoning is most common

• LGBT youth are 3.5x more likely to attempt than heterosexual peers

  • transgender kids 5.87x more likely to attempt

• by profession

  • healthcare professionals

  • first responders

  • military personnel

  • construction workers

  • farmers and ag workers

  • artists

  • legal profession

  • education sector

• warning signs

  • talking about attempting suicide

  • unbearable pain

  • recent fascination with death

  • feelings of hopelessness, worthlessness, quilt, shame, anger, like a burden

• suicide risk behavior

  • recent attempt

  • planning an attempt

  • increased alcohol/drug use

  • losing interest in personal appearance/hygiene

  • withdrawal from social life

  • giving away possessions

  • recent depression

  • changes in eating and sleep patterns

  • becoming violent

  • expressing rage and recklessness

Sexual Dysfunction

• sexual dysfunction

  • associated with disturbances of the sexual response cycle or with painful intercourse

  • Masters and Johnson’s Sexual Response Cycle

    • excitement phase - begins with whatever is sexually stimulating and arousing for the particular person phase of penile erection and vaginal lubrication

    • plateau phase - in which the sexual arousal is maintained and intensified

    • orgasmic phase - the shortest period of the cycle, consists of those few second when the bodily changes resulting from stimulation reach their maximum intensity

    • resolution phase - sexual tensions decrease as the person returns to the unstimulated state. males experience refractory period where arousal and orgasm are impossible

  • diagnosis requires clinical judgement that the impairment is not a normal variation in response

  • modifiers (dysfunction can be classified by)

    • lifelong vs. acquired

    • generalized vs. situational

    • severity (mild, moderate, severe)

  • female sexual interest/arousal disorder

    • low arousal or lack of desire may be generalized to all sexual activities or it may be situation, involving only one partner or a specific activity such as intercourse

    • typically does not seek or initiate sexual interaction, may participate reluctantly

  • male hypoactive sexual desire disorder

    • recurrent deficiency in or absence of sexual desire and erotic thoughts or fantasies

    • persists at least 6 months

    • does not initiate sexual activity

    • masturbation may continue in the absence of desire

    • affects about 2% of males 16-44 yrs.

  • erectile disorder

    • persistent recurrent difficulty in attaining an adequate erection for sexual activity or in maintaining the erection

    • some cannot obtain erection at onset

    • may be generalized to all situations or may be specific

  • causal factors

    • medical conditions, mental disorders, medications (SSRIs)

  • treatment

    • no medications that can create sexual desire

    • testosterone supplementation

    • psychotherapy is modestly effective, 50-70% of patients showing improvements

  • premature ejaculation

• paraphilic disorders

  • intense interest in or preference for unusual targets of sexual arousal

• gender dysphoria

  • in which there is a strong and persistent sense of incongruence between one’s assigned gender and one’s gender identity

Paraphilia

• intense interest in or preference for non-normative targets of sexual arousal

• must be distinguishable from non-pathological sexual fantasies

• exhibitionistic disorder

  • recurrence, fantasy, urge or behavior of exposing one’s genitals to an unsuspecting stranger

  • sexually arousing for the offender and last over a period of 6 month

  • occasionally the exhibitionist masturbates during the act of exposure or while fantasizing about the exposure later

  • one of the most commonly reported sexual disorders in the US

  • frequently introverted and quitely appropriate in ordinary social relationships

  • onset before age 18

  • 2-4% prevalence rate

  • how to respond:

    • try to leave

    • don’t show surprise or disgust, keep blank expression

    • call 911

    • point and laugh (last resort)

• fetishistic disorder

  • sexual interest becomes focused on objects not linked with sex

  • anything can be fetishized

    • ex. symphorophilia (car crash/disaster fetish)

  • partialsim

    • sexual interest with a focus on a specific part of the body

    • can be any part of the body

• necrophilia

  • sexual attraction to corpse

  • Jeffery Dahmer

    • killed 17 men and boys from 1978-1991

    • evaluated by Philip Resnick (renowned forensic psychiatrist)

    • violent sexual fantasies at an early age

    • sexual fantasies would involve dominance, turned into fantasizing about sex with a corpse

    • beat up when tried to impose dominance on other men

    • chemical lobotomy on alive victims

    • officially diagnosed with necrophilia

• Frotteuristic Disorder

  • intense sexual arousal from touching or rubbing against a non-consenting person

  • typically in crowded setting (subway, elevators, sporting events)

  • may rub genitals or hands against victims

  • almost always men

    • may wear protective cover over penis to prevent from staining clothes

  • sometimes fantasize about having relationship with victim

• pedophilia

  • intense sexual arousal to prepubescent children, persisting at least 6 month

  • ephebophilia - sexual attraction to post pubescent teens

  • offender must be at least 16, five or more years older than the child

  • girls are victims more often than boys

  • rationalize behavior as educational or pleasurable

  • may take or engage in hobbies or activities that bring them into contact with children

  • 3-5% prevalence rate

  • plethysmographic assessment - measure changes in penile circumference in response to visual and auditory stimuli of a sexual nature

• furries

  • an enthusiasm for animals characters with human characteristics, in particular a person who dresses up in costume as such a character or uses one as an avatar online

  • estimated to be about 150,000 in the US

  • not always sexual

  • no evidence that schools are encouraging (providing litter boxes, etc.)

• zoophilia

  • sexual fixation on non-human animals

  • beastiality is cross-species sexual activity between humans and non-human animals

  • zoophilia is attraction, beastiality is the act

• objectophilia

  • sexual or romantic attraction focused on particular inanimate objects

  • may have strong feelings of love and commitment to certain items or structures of their fixation

• sexual masochism disorder

  • intense arousal through fantasies, urges, or behaviors involving the act of being bound, beaten, humiliated, or forced to suffer

  • chronic

  • relatively mild, may increase in intensity and danger

  • asphyxiophilia

    • oxygen-depriving activities (choking, hanging, suffocating)

  • prevalence is about 2% in males, 1% in females (Austrailia)

• sexual sadism disorder

  • sadism comes from the name of the marquis de Sade (wrote stories about inflicting pain on sexual partners)

  • commit the act on nonconsenting person or is distressed by urges

• transvestic disorder

  • recurrent, intense, sexually arousing fantasies that involve cross-dressing

  • may range from occasionally wearing a single object of women’s clothing to complete cross-dressing with makeup, female mannerisms, and habits

  • experience sexual arousal by imagining themselves as females

• voyeuristic disorder

  • people with VD experience does not seek sexual contact with observed person

  • violation of privacy

  • usually begins by age 15

  • chronic course

Gender Dysphoria

• gender dysphoria - strong and persistent cross-gender identification and persistent discomfort with ones assigned sex or associated gender role. person experiences clinically significant distress or impairment in functioning

• complete a year of life experience in opposite gender

• DSM-5 estimates that between 0.005-0.014% of adult males

  • 0.002-0.003% of adult females have gender dysphoria

Substance Abuse

Drug Classifications

• depressants (ex. alcohol)

• sedatives (barbiturates, sleep-inducing drugs)

• anti-anxiety (xanax, valium)

• opioids (morphine, oxycontin)

• stimulants (adderall, meth, cocaine)

• hallucinogenics (LSD, mushrooms)

types of addiction

• physiological dependence

  • body becomes used to having drugs in the system and becomes sick when drug is absent

  • withdrawal - physical symptoms that become present due to lack of drug

  • tolerance - consume more of drug to get same desired affect

  • hangover: fatigue, thirst, nausea, headache, etc.

• psychological dependence

  • intense mental craving for drug

Alcohol

• world’s oldest recreational drug

• occurs naturally and frequently in environment

• created through fermentation

• common since first colonies were established

  • intoxication was both common and accepted

  • temperance societies began addressing in 1833

• alters two important neurotransmitters (GABA and glutamate)

Personality Disorders

• personality is the stable and enduring pattern of relating to oneself and to the world

• DSM distinguishes normal from abnormal personality

  • takes a long time to diagnose

  • complex process

  • disturbances in areas of global functioning (eg. mood, cognition, social interaction, impulse control)

• Personality Clusters

  • Cluster A

    • 5.7% meet criteria for at least one cluster A diagnosis

    • not intense enough for delusions/hallucinations

    • sufficient stress triggers brief psychotic states

    • Paranoid Personality Disorder

      • extreme distrust and suspicion

      • no sense of humor

      • rarely relax

      • easily take offense/hold grudges

    • Schizoid Personality Disorder

      • detached from social relationships

      • restricted range of emotional expression

      • appear cold/aloof

      • few relationships, prefer to be alone

    • Schizotypal Disorder

      • magical thinking

      • eccentric behavior

  • Cluster B

    • difficult interpersonal relationships

    • anger

    • manipulative

    • Antisocial Personality Disorder

      • routinely violate the rights of others

      • show no empathy/sympathy/concern

      • begins before age 15

      • very manipulative

      • threaten violence, suicide

    • Borderline Personality Disorder

      • view others/world as all good or bad

      • extremes

      • motivated by deep fear of abandonment

      • poorly developed sense of self

      • excessive idealization

      • chronic feelings of emptiness

      • unstable active emotions

      • underlying motive of manipulation

      • occasional self-harm or suicidal ideation

      • may show dissociative symptoms

    • Histrionic Personality Disorder

      • extreme attention seeking

      • excessive emotionality

      • rapidly shifting emotions

      • more prevalent in females

    • Narcissistic Personality Disorder

      • self-centered, require admiration of others

      • exaggerate self importance

      • fantasies about own success, brilliance, etc.

      • feels entitled to special treatment

      • lack empathy and exploits others

Cognitive Disorders

• delirium - characterized by a disturbance of consciousness and change in cognition that develops over short period of time

  • caused by physical conditions

  • changes can include difficulties with attention, memory, orientation, language

  • perception, the sleep-wake cycle, personality, mood

• dementia - chronic cognitive disorder

  • confused, vegetative victim

  • impair independent functioning

  • affects over 5 million americans

  • Alzheimer’s

    • common form of progressive, degenerative, and fatal dementia

    • approximately 70% of all dementia cases

  • Vascular Dementia

    • caused by stroke

  • Fronto-temporal lobe dementia

    • begins in early 40s

    • quickly progressing

  • Leuex Body Dementia

    • causes bizarre behavior

    • Robin Williams

Schizophrenia

• characterized by psychosis

  • delusions (beliefs not attached to reality)

  • hallucinations

  • grossly impaired speech or movement (catatonia)

• delusions

  • false belief that is firmly held, contrary to evidence adn the consensus of other people

    • bizarre delusions - false beliefs that could not possibly be true

    • delusional jealousy - involves the incorrect conviction that a person’s spouse or partner is being unfaithful

    • erotamanic delusions - false beliefs that another person, often someone famous or higher status, is in love with

    • grandiose delusions - grossly inflates self-importance, fame, power, wealth, or knowledge

    • delusions of being controlled - belief that some external force of agent is manipulating one’s movements, thoughts, speech, or emotions

    • delusions of reference - events, people, or things in the immediate environment have a special significance for the individual

    • persecutory delusions - theme of being plotted against, attacked, cheated, threatened, or persecuted in some way

    • thought broadcasting delusions - belief that others can hear or receive one’s thoughts

    • somatic delusions - false convictions that concern the body

    • thought insertion delusions - some external person or agency is inserting thoughts into one’s consciousness

• disturbances in sensation and perceptions

  • auditory hallucinations - hearing voices that may condemn, praise, direct, or accuse

  • visual hallucinations - seeing things that others do not see. can include lights, moving objects, places, people

  • gustatory hallucinations - involve the perception of taste, such as blood

  • olfactory hallucinations - involve odors, usually unpleasant

  • somatic hallucinations - sensations coming from inside the body, like electricity or pressure

  • tactile hallucinations - feeling of being touched or feeling something beneath the skin

• hallucinations can be mood congruent or mood incongruent

• drug induced hallucinations are usual visual or tactile

• gustatory and olfactory hallucinations more likely to be result from brain damage