psyc 331 exam 2 study guide
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Loyola Abnormal Psych Exam 2 Study GuideTRANSCRIPT
Psyc 331 Exam #2 Study GuideChapter 7 10/27/14 11:54 AM
Chapter 7 and Related Materials
Changes from DSM-IV to DSM-5
Term Somatoform Disorders has been dropped – category is now called: Somatic Symptom
and Related Disorders
Reduced number of disorders in this category
Moved Body Dysmorphic Disorder from this category to Obsessive-Compulsive and
Related category (we will talk about this disorder now, however) Body Dysmorphic
Disorder
Somatic Symptom and Related Disorders (Somatic symptoms associated with significant distress and
impairment)
Somatic Symptom Disorder
Illness anxiety disorder
o No clear symptoms
o We believe that we have illness and freak out
Conversion disorder
Psychological factors affecting other medical conditions
Factitious disorder
Factitious Disorder – Munchausen Syndrome
Clearly in the Somatic symptom category
People are faking it – Faking a psychological problem
Induction of injury (deception) to deceive others
No clear external reward for this
o Differs from malingering (faking illness to get rewards)
Munchausen syndrome = The extreme and chronic form of factitious disorder
Munchausen Synndrome by Proxy
o inducing disease on others
Parent make up or produce illness in their children
Mother making her children ill (Child abuse)
Body Dysmorphic Disorder (BDD) – now in Obsessive-Compulsive and Related Disorders category
Imagined disease
Case of the one girl that is convinced that she looks horrible (Case study)
Into the obsessive compulsive disorder category
Preoccupation with physical signs
Plastic surgeon to plastic surgeon in searching for something
A disorder marked by excessive worry that some aspect of one’s physical appearance is
defensive
Conversion Disorder
Psychological needs meet through body symptoms
Freud’s classical
Psychological stress Body symptoms
No clear cause
Might have an indifferent attitude – Not as upset
Mucha and Reinhart (1970) study
o 56 naval aviators developed conversion symptoms (blurred vision, some hearing
problems)
o family oriented family
o Cannot quit what so ever
o Some family member shared their same psychological symptoms
Psychodynamic theory
Primary Gain
o Never had to face any pressure of quitting
o Might be to avoid having to face or acknowledge a troubling psychological conflict
Secondary Gain (more behavioral)
o When their hysterical symptoms further enable them to avoid unpleasant
activities or to receive empathy from others
o Didnt have to actually do the flying or training (escaped something they didn’t
want)
o More behavioral; to get out of it
Integrative Model of Somatic Symptom Disorders
Physiological Emotional
Disturbance Arousal
o Attention to Body
o Illness Attribution
o Illness Worry, Castrophizing
o Help seeking
o Distress, avoidance, disability
o Social Response
Other Factors
Personality characteristics
o Neuroticism – Extreme worrier
o Absorption – more focused about their body
Family Illness experience – family is focused abt lllness
Dissociative State (Amnesia)
Isolation of memory and affect from normal states of consciousness
Disturbance in sense of identity or self
Intense absorption
Dissociative Disorders
Some lose of memory
“Highway hypnosis” – don’t know how you got somewhere (driving)
Dissociative Amnesia (Not due to organic causes)
o Localized (Common)
Losing memory for a particular time period
o Selective
Losing memory for selective aspective
Ex: If Marie had remembered doing everything else other than just the
accident
o Generalized (least common)
Lose most of her memory
Dissociative Identity Disorder
o Subpersonalities
o Disorders marked by major changes in memory that do not have clear physical
changes
o Have two or more separate identities that may not always be aware of each
other’s thoughts, feelings, and behavior
o Patterns of relationships among subpersonalities
o Ways in which subpersonalities may differ
Depersonalization-Derealization Disorder
people with this problem feel as though they have become detached form their own
mental processes or body and are observing themselves from the outside
The memories and identities of people with depersonalization disorder seems to remain
intact
It is their sense of self that changes: their
o Depersonalization disorder: a disorder marked by a persistent and recurrent
feeling of being detached from one’s own mental processes and body
Dissociative fugue
A dissociative disorder in which a person travels to a new location and many assume a new
identity, simultaneously forgetting his or her past
Videotape: case of Elizabeth
Theories of Dissociative Disorders
Psychodynamic theory
o Massive repression
Repressed and make another personality ***
o Motivated forgetting
o Defensive – keep threatening material from awareness
Cognitive view – information processed in a way that is not easily accessible to awareness
o Our emotional state can make personalities (cannot be easily accessed)
Motivation
Attention
Emotional state
State Dependent learning
Iatrogenic (Unintentionally produced by therapist)
Dramatic increase since 1980
Large # of cases reported by small number of clinicians
Cultural bound syndrome – rare in some cultures
Treatment of DID
Integrating subpersonalities: fusion
Hypnotic therapy: a treatment in which the patient undergoes hypnosis and is then guided
to recall forgotten events or perform other therapeutic activities
Fusion: the final merging of two or more subpersonalities in multiple personality disorder
Chapter 8 and 9 10/27/14 11:54 AM
Chapter 8 and Related Materials
Emotion, affect, mood
Emotion
o State of arousal defined by subjective feelings
o Im sad, Im anger
Affect
o Broader category
o When we are sad, we may do things that communicate to other that we are sad
Mood
o Can color one’s perception of the world
Mood disorders
o Moods: Depression and elation (happiness)
Depression – symptoms
Depression
o Less activity
o Negative view of themselves
o Loss of motivation and loss of desire to pursue activities
o Delusion is parallel with her mood
o Sad
o Loss of desire to pursue activities
o Negative view of self, pessimistic, poor concentration
Mania – symptoms
Mania
o Elated and happy
o High level of motivation to pursue activities
o Very inflated view of self
o Poor judgment = carrying out sexual or dangerous activities
o Hypomania = Mini manic state (not as extreme)
o Motivated to seek excitement
o Very active
o Inflated view of self, poor judgment
Changes from DSM IV to DSM-5
DSM-5 Mood Episodes
Depressive Episode
Manic Episode
Hypomanic Episode
DSM-5 Depressive Disorders
Major Depressive Disorder
Persistent Depressive Disorder (Dysthymia)
Premenstrual Dysphoric Disorder
Disruptive Mood Dysregulation Disorder
DSM-5 Bipolar and Related Disorders
Bipolar I
o One or more manic episodes
Bipolar II
o One or more depressive episodes
o No manic episodes
Cyclothymic Disorder
o Mild depression
o Kind of depression going up or down
Reactive (exogenous) versus endogenous depression
Reactive exogenous depression follows clear cut stressful events
Endogenous depression seems to be responsible to internal factors
Stress and mood disorders
Brown and Harris (1978)
114 women treated for depression
Random sample from community
Interview about stressful events in past year
Increased incidence - severe, long-term consequences
Model = vulnerability factors, provoking events
Theories of depression
Biological factors
o Genetic factors – family pedigree, twin studies
o Biochemical –
Neurotransmitters - low serotonin and the permissive hypothesis
Norepinephrine = a neurotransmitter whose abnormal activity is
linked to depression and panic disorder
Serotonin = A neurotransmitter whose abnormal activity is linked
to depression, OCD, and eating disorder
Hormones - cortisol
People with unipolar depression has a lot of cortisol released
during stress
Psychodynamic views - Freud
o Oral dependency
o Oral stage fixation = greater risk for developing depression
Child at the time of breastfeeding
The child is very dependent for all their needs
The needs are met or not met
Dependent on others and when they lose someone they dependent on,
then they are at a greater risk for developing depression
o Loss or Symbolic loss - things in our life that symbol things for us, like a job
o Anger turned inward
Behavioral views
o Loss of reinforcement – social rewards
o Behavioral Model: Depression
Lewinsohn
Depression results from reduction in response-contingent reinforcement
Why might this happen –
Reinforcement not available from environment
Going to college and not having a network of
reinforcement such as your friend
Person lacks skills
Lacks social
Reinforcement available, but person not able to experience it
Low rates of reinforcement = low rates of responding
o
Cognitive views
Beck – diathesis stress model
Negative schemas (organizes the view of the world) – maladaptive attitude about the world
o Stress triggers the negative schemas
Negative Triad (Cognitive Triad)
o Negative views of self, experiences, future
Automatic thoughts
o I failed again, nobody will love me
Cognitive Bias – errors in thinking
o Arbitrary inference – errors in thinking
Something happens and you think too much of it after that error
Ex: someone didn’t see you and you think that that person hates you
o Overgeneralization
o Minimization or magnification
o Learned helplessness – Seligman
The perception, based on past experiences, that one has no control over
one’s reinforcements
1) people think that they no longer have control over the reinforcements
(rewards and punishments) in their lives
2) That they themselves are responsible for this helpless state
Gender differences in depression
Women are more depressed than men due to society stress
Women have hormones that trigger unipolar depression
Body dissatisfaction
Rumination theory – thinking too much
Lack of control theory – Thinking that everything is out of control
Biological causes of bipolar disorder
Neurotransmitters – high norepinephrine, low serotonin
Ion activity
o Sodium and potassium ions across membrane = neurons firing
o Improper transport may cause neurons to fire too fast or too slow
Genetic factors
o Predospition to unipolar depression is inherited
o Twin studies:
Identical twins had 46% of having depression for both
Fraternal twins had 20%
Severe depression is more likely than mild depression to be caused by
genetic factors
Permissive Hypothesis = serotonin is low so other neurotransmitters are varying a lot
Chapter 9 and Related Materials
Treatments for unipolar depression
Behavioral approaches –
o 1) Reintroduce depressed clients to pleasurable events and activities
o 2) Appropriately reinforce their depressive and non-depressive behaviors
o 3) help them improve their social skills
o 4)Behavioral activation = better mood
o Contingency management = ignoring the depressive behaviors and praising the
good things in life (going to work)
o increase responding and reinforcement, improve social skills
Cognitive therapy of Beck – know 4 phases
o 1) Increasing activity and elevating mood
o 2) Challenging automatic thoughts
o 3) Identifying negative thinking and biases
o 4) Changing primary attitudes
Interpersonal psychotherapy
ECT – history and changes in procedure
o Effectiveness
o Side effects
Drugs – know actions, side effects, effectiveness data for each of the following:
Antidepressant drugs: MAO Inhibitors
o Slow down the body’s production of MAO
MAO breaks down norepinephrine
MAO inhibitors stop this breakdown from occurring
Rise in norepinephrine activity
o The blood pressure can spike to a certain level if they eat something (like cheese,
banana) – they contain tyramine
o They have to watch diet or it can cause serious damage
Antidepressant drugs: Tricyclics
o Relapse a risk if immediately stop when symptoms remit
o Patients who take tricyclics for 5 additional months (“continuous therapy”) have a
significantly decreased risk of elapse
o Patients who take antidepressant drugs for three or more years after initial
improvement (‘maintenance therapy”” may reduce the risk of relapse even more
Selective Serotonin Reuptake Inhibitors
o Second-generation antidepressant drugs
SSRIs – Ex: Prozac and Zoloft
Only act on serotonin
Medications are becoming more selective in which neurotransmitter
effecting
Research – effectiveness of cognitive, interpersonal, and biological therapies
Treatments for bipolar disorders
Lithium – know action of drug and difficulties with treatment, effectiveness data
o Bipolar Disorder – Lithium Therapy
Bipolar I – You must have manic at least once
Issue: Controlling the mania, and keeping them from going into
depression
How operates???
Affect a neuron’s second messengers
Changing sodium and potassium ion activity in neurons
30-60% respond well; 30-50% respond partially; 10-20% have poor
response
For those who do respond, maintaining an adequate dose can prevent
recurrence of manic episode in 60%
Issue: Monitor levels in bloodstream closely
Low levels – Not effective
High levels – poisonous
Adjunctive psychotherapy
o Medication management – teaching about the importance of medications and
encouraging them to stay on it
o Family and Social relationship = it can be damaging to the relationship with family.
So education the family on to deal with patient
o Education = Teach them how to take care of themselves. What warning signs are
there to tell you that you are entering manic mode
o Problem solving
Chapter 10 and 11 10/27/14 11:54 AM
Chapter 10 and Related Materials
Suicide
Leading cause of death in the world
8th Leading cause of death in US
Many more unsuccessfully attempt suicide than actually succeed – “parasuicides”
Difficult to obtain accurate figures on suicide rates
Parasuicide
A suicide attempt that does not result in death
Retrospective analysis
Studying people who survive their suicide attempts
Sociological, psychological, biological perspective
Sociocultural perspective – Durkheim
Egoistic suicides -people over whom society has little or no control
o Isolated from society, not well integrated into society
o They feel left out
Altruistic suicides - so well integrated into their society that they intentionally sacrifice
their lives for its well-being
o Ex: Suicide bombers
o People that sacrifices
Anomic suicides - people whose social environment fails to provide stable structures that
support and give meaning to life
o After a catastrophe, you don’t have support system for a whole group of people
Age and suicide
The likelihood of committing suicide increases with age, but people of all ages may try to
kill themselves
3 groups (children, adolescents, and the elderly) have been the focus of much study
because of the unique issues that face them
Elderly and suicide
In Western society the elderly are more likely to commit suicide than people in any other
age group
o There are many contributory factors:
Illness
Loss of social support
Loss of control over one’s life
Loss of social status
Modeling – contagion
Social contagion effect – when family or friends commit suicide, you are more likely to be
affected by it and commit suicide
Celebrities = Marylin Monroe
Coworkers and colleagues
Psychological factors: Common characteristics identified by Shneidman
Shneidman – 10 common characteristics
Common purpose is to seek a solution
Common goal is to end distressing thoughts, pain
Common emotion is hopelessness-helplessness
Common cognitive state is ambivalence
Common perceptual state is constriction – tunnel vision.
Risk factors
Depression or other mental disorder
Alcohol or substance use
Suicidal thoughts, preparation
Prior attempts
Lethal methods
Social withdrawal/isolation/lack of support
Hopelessness
Impulsivity
Family history
Losses/stressful life events
Crisis intervention steps
Treatment and Suicide
Treatment after suicide has been attempted
Suicide prevention
o Treating the underlying mental disorder
o Treating suicidality directly
Suicide prevention programs and suicide hot lines provide crisis intervention
The general approach includes:
o Establishing a positive relationship
o Understanding and clarifying the problem
o Assessing suicide potential
o Assessing and mobilizing the caller’s resources
o Formulating a plan
Call to action by Satcher – 3 categories of action
Surgeon General David Satcher (USPHS, 1999)
3 categories of action
o Awareness
o Intervention
o Methodology
Chapter 11 and Related Material
Eating disorders: historical perspective
Anorexia – first defined in 1870s as a clinical syndrome in Europe
o Refusal to eat
o Amenorrhea – Low menstrual cycle
o Low pulse
o Constipation
3 aspects of ED that are more recent
o Chronic refusal of food – Over a period of years
o Emphasis on over activity – Way of compensating for binging can be over
exercising
o Bulimia – Purging, binging
Brumberg and Striegel-Moore’s 2 stage model – recruitment, career
Joan Brumberg – historian
o Complex interplay of cultural forces, gender and family influences, biological and
psychological aspects of individual
Brumberg and Striegel-Moore: 2 stage model
o Recruitment
Those aspects of society to pull one in
Cultural and social forces
o Career
Lead that person into making decisions that will lead to eating disorders
Changes from DSM-IV to DSM-5
• General category now called “Feeding and Eating Disorders” - includes childhood feeding
disorders
• Criteria changes for both anorexia and bulimia
• Addition of binge eating disorder
Anorexia nervosa: symptoms and diagnostic criteria
Anorexia Nervosa
Restriction of energy (calories) intake relative to requirements, leading to significantly low
body weight
o 85% less than the weight chart in DSM 4 but now we look at Body Mass Index (of
17)
Intense fears of gaining weight or becoming fat, or persistent behavior that interferes with
weight gain, even though significantly underweight
Disturbance in way one’s weight or shape is experienced, undue influence of body weight
or shape on self evaluation, or persistent denial of seriousness of current low weight
Anorexia Nervosa
Two main subtypes:
o Restricting type
Alice: Restricting food intake
o Binge-eating/purging type
Binge and purge to keep body weight lost
Must lose a LOT of body weight as compared to Russ
Anorexia Nervosa
About 90%–95% of cases occur in females
Peak age of onset is between 14 and 18 years
Anorexia Nervosa: The Clinical Picture
Key goal: becoming thin
Motivation: fear
Extremely preoccupied with food
Think in distorted ways
Anorexia Nervosa: The Clinical Picture
May also display certain psychological problems:
o Depression (usually mild)
o Anxiety
o Low self-esteem
o Insomnia or other sleep disturbances
o Substance abuse
o Obsessive-compulsive patterns
o Perfectionism
Anorexia Nervosa: Medical Problems
Caused by starvation:
o Amenorrhea
o Low body temperature
o Low blood pressure
o Body swelling
o Reduced bone density
o Slow heart rate
o Metabolic and electrolyte imbalances
o Dry skin, brittle nails
o Poor circulation
o Lanugo
Amenorrhea = cessation of menstrual cycles and absence of menstrual cycles
Bulimia nervosa: symptoms and criteria
Bulimia Nervosa
Recurrent episodes of binge eating
o Eating in a discrete period of time an amount of food that is definitely more than
most people would/could eat in a similar period and under similar circumstances
o A sense of lack of control
Bulimia Nervosa
Recurrent inappropriate compensatory behaviors to prevent weight gain – e.g., vomiting,
Misusing laxatives, diuretics, or enemas, Fasting, Exercising excessively
Binge eating and compensatory behaviors both occur, on average, at least once a week for
3 months
Self evaluation unduly influenced by body shape and weight
Symptoms do not occur exclusively during episodes of anorexia nervosa
Bulimia Nervosa
Generally of normal weight
o Often experience weight fluctuations
About 90%–95% of bulimia nervosa cases occur in females
Peak age of onset is between 15 and 21 years
Bulimia Nervosa vs. Anorexia Nervosa
Both often appear after period of dieting and involve disturbed attitudes toward eating and
preoccupation with food, weight, appearance—BUT
People with bulimia tend to:
o be more worried about pleasing others, being attractive to others, and having
intimate relationships
o be more sexually experienced
o display fewer of the obsessive qualities, but be more likely to have histories of
emotional and behavioral instabilities
o have different medical complications
Binge-Eating Disorder
NEW DIAGNOSTIC CATEGORY!!
Recurrent episodes of binge eating
Episodes are associated with 3 or more of following: eating much more rapidly then
normal, eating until uncomfortably full, eating large amounts when not hungry, eating
alone because embarrassed by how much eating, feeling disgusted, depressed, or guilty
afterward
Binge-Eating Disorder
Marked distress regarding binge eating is present
Binge eating occurs, on average, at least once a week for 3 months
Not associated with recurrent use of inappropriate compensatory behaviors or anorexia
Binge and Binge-Eating Disorder
Binge-Eating Disorder
o NEW DIAGNOSTIC CATEGORY!!
o Recurrent episodes of binge eating
o Episodes are associated with 3 or more of following: eating much more rapidly
then normal, eating until uncomfortably full, eating large amounts when not
hungry, eating alone because embarrassed by how much eating, feeling disgusted,
depressed, or guilty afterward
Binge-Eating Disorder
o Marked distress regarding binge eating is present
o Binge eating occurs, on average, at least once a week for 3 months
o Not associated with recurrent use of inappropriate compensatory behaviors or
anorexia
Compensatory behavior
After binging, people vomit to undo the effects. But vomiting actually fails to prevent the
absorption of half of the calories consumed during a binge. Furthmore, repeated vomiting
affects one’s general ability to feel satisfied; thus it leads to greater hunger and more
frequent and intense binges. The use of laxatives largely fails to undo the caloric effects of
bingeing.
Intense dieting turns to anorexia nervosa
Medical complications from anorexia and bulimia
Biological Factors
Serotonin – regulatory function
Dysfunction of the hypothalamus (controls hunger)
Two separate areas that control eating:
o Lateral hypothalamus (LH) – produces sense of hunger
o Ventromedial hypothalamus (VMH) – Shuts down hunger
LH and VMH may be responsible for weight set point – a “weight thermostat”
o For people who aren’t eating enough, their metabolism is changing to keep them
from losing too much weight (to get along with less food)
o Throwing off brain and system of hunger
Comparison of anorexia and bulimia – similarities and differences
Similarities
o Begin after a period of dieting by people who are fearful of becoming obese
o Heightened attempts at suicide
o Substance abuse may accompany either disorder
o They think they weight too much
Differences
o Bulimia nervosa
Tend to be more concerned about pleasing others, being attractive to
others, and having intimate relationships
More likely to be sexually active
Easily frustrated and irritate
Have amenorreheic – abnormal menstrual cycle
Dental problems
Potassium deficiencies lead to weakness, intestinal disorders, kidney
disease, heart damage
Multidimensional risk perspective
Sociocultural factors – epidemiological support
o Emphasis on thinness and beauty
o Prevalence risen in recent decades
o More common in women than in men
o More common in Western societies
o More common among middle and upper class whites
o More common in fields that emphasize weight and appearance
o More likely to develop during adolescence and young adulthood
Hormonal changes
Peer pressure
Sexualized body – sexual attraction
We are trying to be automous- trying to be an individual and creating a
view of themselves – Autonomy and control
o Culture bound syndrome Bulimia (this requires a lot of food)
Family – enmeshed family pattern
o Family pressure = leading to bulimia and anorexia
Ego deficiencies and cognitive distortions way of thinking
o Hilde Bruch – know her theory
She argues that disturbed mother-child interactions lead to serious ego
deficiencies in the child (including a poor sense of independence and
control) and to severe perceptual disturbances that jointly help produce
disordered eating
Effective parents accurately attend to their children’s biological and
emotional needs, giving them food when they are cyring from hunger and
comfort when they are crying out of fear
Ineffectively parents fail to attend to their children’s needs, deciding
that their children are hungry, cold, or tired without correctly interpreting
the children’s actual condition
Biological factors
o Hypothalamus – lateral (LH) and ventromedial (VMH)
Dysfunction of the hypothalamus (controls hunger)
Two separate areas that control eating:
Lateral hypothalamus (LH) – produces sense of hunger
Ventromedial hypothalamus (VMH) – Shuts down hunger
o Serotonin– regulatory function
o Weight set point
LH and VMH may be responsible for weight set point – a “weight
thermostat”
For people who aren’t eating enough, their metabolism is changing
to keep them from losing too much weight (to get along with less
food)
Throwing off brain and system of hunger
Depression and eating disorders
Eating disorders may lead to depression
Treatment – general aims and strategy
Treatments
o The initial aims of treatment are to:
Restore proper weight
In anorexia, recover from malnourishment
Restore proper eating
o Lasting change - overcome their underlying psychological problems
o Address issues that have led to problem
Autonomy and self esteem
Distorted cognitions
Maladaptive family interaction patterns
Chapter 12 10/27/14 11:54 AM
Chapter 12 and Related Material
Psychoactive drug
Substances that affect mood or behavior
Classifications:
o CNS Depressants – alcohol, sedative-hypnotics, opioids
o Stimulants – cocaine, amphetamines, caffeine
o Hallucinogens and cannabis
Drugs of Abuse – for the following types of drugs, know the general effects of drugs in each category
Depressants - alcohol, sedative-hypnotics, opioids
o Alcohol = ethyl alcohol
Binds to GABA, slows down functioning of brain and body. GABA carries an
inhibitory message (a message to stop firing). When alcohol binds to
receptors on those neurons, it apparently helps GABA to shut down the
neurons, thus helping to relax the drinker
5 or more drinks = binge drinking
o Sedative-hypnotics (anxiolytic)
Produce feelings of relaxation and drowsiness
Sleep inducers and hypnotic
Barbiturates = addictive sedative-hypnotic drugs that reduce anxiety and
help produce sleep
Benzodiazepines = the most common group of antianxiety drugs, which
includes Valium and Xanax
o Opioids
Opium or any of the drugs derived from opium, including morphine, heroin,
and codeine
Opium: A highly addictive substance made from the sap of the opium
poppy
Morphine: A highly addictive substance derived from opium that is
particularly effective in relieving pain
Heroin: One of the most addictive substances derived from opium
Endorphins: Neurotransmitters that help relieve pain and reduce emotional
tension. They are sometimes referred to as the body’s own opioids.
Stimulants- cocaine, amphetamines, caffeine
o Cocaine:
An addictive stimulant obtained from the coca plant. It is the most
powerful natural stimulant known.
Cocaine induced psychotic disorder from intoxication
High norepinephrine and serotonin for addicts
o Amphetamines:
A stimulant drug that is manufactured in the lab.
Increases energy and alertness and reduce appetite
o Caffeine
Increased arousal, motor activity, and reduces fatigue
Hallucinogens and Cannabis
o Hallucinogens
A substance that causes powerful changes primarily in sensory perception,
including strengthening perceptions and producing illusions and
hallucinations. Also called psychedelic drug.
o Cannibis:
Drugs produced from the varieties of the hemp plant Cannabis Sativa.
They cause a mixture of hallucinogenic, depressant, and stimulant effects
Problems with use of drugs
Physical problems- short term
o Intoxication
o Overdose
Physical problems – long term
o e.g., alcohol – Korsakoff’s syndrome, cirrochis of the liver, fetal alcohol syndrome
Psychological concerns – undermine self control, self esteem
Social concerns – interfere with activities, relationships
Legal concerns – you cannot use them illegally
Changes from DSM-IV to DSM-5
DSM IV – Substance Related Disorder
Substance intoxication
Substance withdrawal
Substance Abuse
Substance Dependence
DSM 5 Changes
Substance Use and Addictive Disorders – include Gambling
Eliminate abuse, dependence distinction – Substance Use Disorder
See handout with DSM-5 criteria for Alcohol Use Disorder
Added: Sexual and Internet addiction
Substance-Related disorders in DSM-5 – know general features and criteria for
Substance-induced disorders
o Immediate effects of substance use, called intoxication
Substance intoxication person develops a reversible set of symptoms
due to recent use of substance use
Substance withdrawal Causes by abrupt reduction of substance use
Substance Use Disorder –indicate patterns of substance misuse
o Catalog negative consequences of continuous and frequent use of substance, over
time addiction
Substance Abuse and Substance Dependence – addiction eliminated. Now
you rate the disorder on mild, moderate, severe rating
Gambling Disorder
o Focus on brain’s dopamine rich reward center as a key to addiction
Case of Cathy discussed in class
Isolation, Worthless, Inferiority, alcohol (social)
Also depressed
Primary treatment goal: stop drinking
Tolerance
The adjustment that the brain and the body make to the regular use of certain drugs so
that ever larger doses are needed to achieve the earlier effect
Withdrawal
Unpleasant, sometimes dangerous reactions that may occur people who use a drug
regularly stop taking or reduce their dosage of the drug
Alcohol
Effects of
o Delirium Tremens
A dramatic withdrawal reaction experienced by some people who are
alcohol-dependent. It consists of confusion, clouded consciousness, and
terrifying visual hallucinations.
o Korsakoff’s syndrome
An alcohol related disorder marked by extreme confusion, memory
impairment, and other neurological symptoms
o Fetal alcohol syndrome
A cluster of problems in a child, including low birth weight, irregularities in
the head and face, and intellectual deficits, caused by excessive alcohol
intake by the mother during pregnancy
Sedative-hypnotic drugs – anxiolytic
Produce feelings of relaxation and drowsiness
Sleep inducers and hypnotic
Barbiturates = addictive sedative-hypnotic drugs that reduce anxiety and help produce
sleep
Opioids – morphine, heroin
Opium or any of the drugs derived from opium, including morphine, heroin, and codeine
Opium: A highly addictive substance made from the sap of the opium poppy
Morphine: A highly addictive substance derived from opium that is particularly effective in
relieving pain
Heroin: One of the most addictive substances derived from opium
Stimulants - cocaine, amphetamines, caffeine
Cocaine:
o An addictive stimulant obtained from the coca plant. It is the most powerful natural
stimulant known.
o Cocaine induced psychotic disorder from intoxication
o High norepinephrine and serotonin for addicts
Amphetamines:
o A stimulant drug that is manufactured in the lab.
o Increases energy and alertness and reduce appetite
Caffeine
o Increased arousal, motor activity, and reduces fatigue
Hallucinogens - LSD
Lysergic acid diethylamide (LSD) a hallucinogenic drug derived from ergot alkaloids
General strengthening of perceptions, particularly visual perceptions, along with
psychological changes and physical symptoms
Effects serotonin levels
Synesthesia = colors are “heard” and you confuse sense of cold or hot. U can see every
pore in skin.
Cannabis- marijuana
At low doses, the smoker typically has feelings of joy and relaxation. Some smokers
become anxious, suspicious or irritated. Sharpened perceptions and fascination with the
intensified sounds and sights around them. In high doses, cannabis produces odd visual
experiences, changes in body image, and hallucinations
Combinations:
Cross-tolerance
o Tolerance for a substance one has not taken before as a result of using another
substance similar to it
o Can reduce symptoms of withdrawal from one drug by taking the other
Synergistic effect
o In pharmacology, an increase of effects that occurs when more than one substance
is acting on the body at the same time
o Additive effect when you take two separate drugs together
Polysubstance-related disorders
o A long-term pattern of maladaptive behavior centered on abuse of or dependence
on a combination of drugs
o For pleasure, people are mixing two drugs on purpose for synergistic effect
Sociocultural factors and substance use
Exposure
Attitudes about use
Stresses or social conditions that encourage use
Properties of drugs that influence effects and addictive potential
Route of administration – how quickly to brain
Ability to enter brain – cross blood-brain barrier
Rate of deactivation – duration of effect
Biological factors
genetic evidence for alcoholism
o identical twin are more likely to be alcoholics than fraternal twins or others
endorphins
o Neurotransmitters that help relieve pain and reduce emotional tension. They are
sometimes referred to as the body’s own opioids
reward center, dopamine, reward-deficiency
o Reward center: A dopamine-rich pathway in the brain that produces feelings of
pleasure when activated
o Dopamine: Dopamine released = Pleasure
o Reward-deficiency syndrome: a condition, suspected to be present in some
individuals, in which the brain’s reward center is not readily activated by the usual
events in their lives
Learning
Operant conditioning – positive and negative reinforcement
o Positive reinforcement = drugs have a positive effect so you want more
o Negative reinforcement = Tension reduction. You want it when it taken away so
you will like you really need it
Opponent process theory
o Initially, it is a good feeling. After a while, you feel really and when you stop
o In drugs, give diminishing returns after prolonged use yet the effects of withdraw
become more intensified and unpleasant
Classical conditioning and craving
o Craving or desiring to use drugs when you see something related to it.
o Ex: When you see the place you smoke everyday or the needle used for heroin
Psychodynamic or personality factors – oral dependent, antisocial personality
Antisocial = More impulsive and will use drugs badly mostly
Oral dependent =
Detoxification
Systematic and medically supervised withdrawal from a drug
1) smaller doses until they stop
2) give clients other drugs that reduce the symptoms of withdrawal
Approaches to treatment – know different types under categories discussed in class
Societal interventions
o Prohibitions and elimination of the drug
o Implement severe penatlies for use
o Legalize use
Physiological interventions – antagonist drugs, methadone
o Methadone
No other kind of prevention
No Plan so when do you decrease methadone ?
Intended for long term use of heroin
An approach to treating heroin dependence in which clients are given
legally and medically supervised doses of a substitute drug, methadone
o Antagonist Drug
Drugs that block or change the effects of an addictive drug
Antabuse or disulfiram = you get sick when you take antabuse and drink
Psychological interventions
o Self control
o Alcoholics Anonymous
A self-help organization that provides support and guidance for persons
with alcohol abuse or dependence
o Synanon = a group of committed addicts getting therapy at the same time, getting
better together and encouraging each other
Behavioral therapies – aversion therapy
o Behavioral self control training
Relapse-prevention training = a cognitive behavioral approach to treating
alcohol abuse and dependence in which clients are taught to keep track of
their drinking behavior, apply copping strategies in situations that typically
trigger excessive drinking, and plan ahead for risky situations and
reactions
o Aversion therapy = a treatment in which clients are repeatedly presented with
unpleasant stimuli while performing undesirable behaviors such as taking a drug
Factors Affecting Course/Outcome of substance abuse treatment
Severity of abuse/dependence
Presence of other substance – polysubstance use (more than one substance)
Other Axis I or II disorder (another problem like depression)
Stages of changes
Precontemplative
o Not yet acknowledging that there is a problem that needs to be changed
Contemplative
o Acknowledging that there is a problem but not yet ready or sure of wanting to
make a change
Preparation
o Getting ready to change
Action
o Changing behavior
Maintenance
o Maintaining the behavior change
Controlled drinking controversy – Sobell research
Issue between abstinence vs. controlled drinking
Abstinence good for people with longterm dependence on alcohol
Controlled drinking = good for younger drinkers whose pattern does not include physical
dependence
10/27/14 11:54 AM