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Psych 300A final


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Polysubstance Abuse
using multiple substances
Psycoactive substances
alter mood and behavior
DSM definition of substance abuse
A maladaptive pattern of substance use leads to clinically significant impairment or distress, as manifested by one or more A) failure to fulfill major role obligations B) Physically hazardous abuse C) legal problems D) Persistent use despite recurrent social and interpersonal problems
Substance Dependence
1 definition: person needs increasing amounts to to experience same affect (tolerance) & will respond in a negative way when the substance is no longer ingested
Alcohol Withdrawal Delirium (DTs)
person experience frightening hallucinations and body tremors
Mood disorder that correlates with substance abuse
anxiety (cause or correlation?)
substances result in behavioral sedation and can induce relaxation. -They include alcohol, anxiolytic drugs, barbiturates, benzodiazepines
substances cause us to more active and alert and can elevate mood - amphetamines, cocaine, nicotine,
major effect is to produce analgesia temporarily (reduce pain), and euphoria - heroin, opium, codeine, morphine, oxycodone
Alter sensory perceptions and can produce delusions, paranoia, hallucinations - Marijuana, LSD
Alcohol\'s affect on the brain
Affects a number of neuroreceptors. GABA system (which is an inhibitory nt) blocked, making it easier for other nts to fire
Consequences of long-term drinking
liver disease, pancreatitis, cardiovascular disorders and brain damage
Wernicke\'s disease
long-term alcohol abuse: confusion and loss of muscle coordination, and unintelligible speech
Fetal Alcohol Syndrome symptoms
fetal growth retardation, cognitive deficits, behavioral problems, learning difficulties, characteristic facial features
reduce anxiety, also suppresses GABA
Amphetamine intoxication symptoms
significant behavioral problems, changes in sociability anxiety, sensitivity, anger, hr and blood pressure changes, chlls, nausea or vomiting
Amphetamines affect of the nervous system
affect the CNS- enhancing the activity of norepinephrine and dopamine- too much can lead to hallucinations and delusions
High doses of nicotine can
blur your vision, cause confusion, lead to convulsions
Caffeine affects which neurotransmitters?
blocks Adenosine (associated with energy) uptake, and serotonin
withdrawal symptoms from opiates
nausea, vomiting, chills, diarrhea, muscle aches, insomnia
Opiates affect on the brain
just increases the amount of natural opiates we have, that normally produce that \"feel good\" effect
comes from a fungus -ergotism= constricted the flow of blood to the arms or legs and eventually results in gangrene -convulsions, delirium, hallucinations
Influences of substance abuse
evidence of genetic predisposition.
Alcohol Dehydrogenase
enzyme that breaks down alcohol, many asians do not have it produce averse affects (flushing, hotness, nausea)
Expectancy Effect
oftentimes people who take substance and expect to react in a certain way will do it regardless of their physiological response
Agonist substitution
treatment: poving a safer drug that has a chemical makeup similar to the abused drug ex: Methadone for heroin -strategy of treatment called harm reduction
Antagonist drugs
treatment that block or counteract the effects of psychoactive drugs. -Opiate antagonist= naltrexone= removes the euphoric effects of the opiates
Aversive Treatment
Substance abuse treatment: prescribe drugs that make ingesting the abused substances extremely unpleasant -Ex: Antabuse or Disulfiram (alcohol)
Describe AA
- person admits they are powerless to alcohol -make amends -
Controlled Drinking
Sobell did a study - subjects assigned to a group where they either drank in a more limited, controlled matter or not at all= results drinkers were much more functional,
Contingency management
client and therapist decide on behaviors that need to change and decide on the reinforcers that will reward reaching goals
Relapse Prevention
Marlatt; therapy involves stopping drug use, examining beliefs about positive aspects of the drug and neg consequences of its use. High-risk strategies developed
Most effective substance abuse treatment
Occurs with a combination biological and psychological treatment. * note only a minority are successful
Psychotherapists argue that alcohol abuse is caused by?
fixation on the oral stage, rage versus fear, allows individual to express true feelings without being inhibited
1960s belief of alcoholism
 Alcoholism is a disease, not moral defect or intrapsychic conflict  Arises from predisposing genetic/biological factors
Civil Commitment Laws
under Mental Health Acts (each province)m that detail when a person can be legally detained in a psychiatric institution-against their will
3 criteria for being committed
1. the person has a \"mental disorder\" 2. the erson is dangerous to himself or others and 3. the person is in need of treatment
The government can detain someone under two authorities
1) police- threat to society 2) parens patriae where citizens are not likely to act in their own best interest
What are CCT\'s
Compulsory community treatments: goals are to: prevent relapse, to provide care in a les restrictive environment . In canada you can only receive this if you have already received inpatient treatment
Mental illness (legal definition)
severe emotional or thought disturbances that negatively affect an individual\'s health and safety. Note* not synonymous with psychological disorder
2 main causes of people involuntarily committed in Canada
1- increase in the number of people who are homeless 2- de-institutionalization
the movement of people with severs mental illness from large psychiatric hospitals to nursing homes or other group residences
Criminal Commitment
the process by which people are held because a) they have been accused of comitting a crime and are detainedin a mental health facility until they can be assessed b) they have been found not criminally responsible on account of a mental disorder
M\'Naghten rule
common defense insanity standard - not guilty if they do not know what they are doing or if they don\'t know that what they are doing is wrong
Gender identity disorder
a person\'s physical gender is inconsistent with that of the person\'s sense of identity, Transexualism, different from transvestic fetishism, and intersex individuals
Describe the 5 stages of sexual arousal in humans
1. Desire 2. Arousal 3. Plateau 4. Orgasm 5. Resolution
Hypoactive Sexual Desire Disorder
person has little or no interest in any type of sexual activity, many times the most common sexual complaint in females
Sexual Aversion Disorder
The thought ofsex may evoke fear, panic, or disgust -must rule out panic disorder or PTSD
Male erectile disorder & female sexual arousal disorder
-problem is not desire , they have sexual urges and fantasies -their problem is becoming arouse, male= erection, female= achieving lubrication
-sexual pain disorder with no medical disorder
sexual pain disorder in women where the pelvic muscles in the outer third of the vagina undergo involuntary spasms when intercourse is attempted. Many report it as ripping or burning
3 major aspects of sexual disorder diagnosing
1. interviews (questionnaire) 2. A thorough medical evaluation 3. Psychophysiological Assessment (penile strain gauge, photoplethysmograph)
sexual attraction to nonliving things
Covert desensitization
paraphilia treatment - changing the associations and contexts of sexual arousal patterns,
Orgasmic Reconditioning
Paraphilia treatment -patients are instructed to masturbat to their usual fantasies but to substitute more desirabble ones just before ejaculation. And then work their way to elimination
⬢ Pedophilia
o 1. Recurrent, Intense sexually arousing fantasies, urges, or behaviors involving sexual activity with prepubescent children o 2. At least 16 years old and 5 years older than child o Subtypes  1. 66% heterosexual • Preferred age 8-10 • 15% are rapists (versus seducers) • Majority are married • Known to victim • Incest refers to sexual activity within one’s family (usually tend to prefer girls from 10-14, and come from religious and conservative family)  2. 33% homosexual • Preferred age 12-14 • More often strangers t child • Tend to be chronic
Personality Disorders
\"enduring patterns of perceiving relating to , and thinking about hte environment and oneself that are exhibited in a wide range of social and personal contexts\" -inflexible and maladaptive -MAY distress the affected person
Treatment for personality disorders
tends to be poor
2 clusters of personality disorders
Cluster A: Odd or Eccentric Disorders (ex schizoid) Cluster B: Dramatic, Emotional, or Erratic Disorders (ex Dependent PD)
Paranoid P.D.
people are excessively mistrustful and suspicious of others. without any justification -often mistrust those close to them (worry about a partner cheating) -difference b/w schizo= no delusions or hallucinations, person functional other than paranoia
Schizoid Personality Disorder
People show a pattern of detachment from social relationships and a very limited range in emotions in interpersonal situations -These people appear cold, and aloof and detached
Schizotypal Personality Disorder
People are typically socially isolated -in addition to symptoms of schizoids, they behave in ways that would seem unusual to most of us -tied to ideas of reference= they think insignificant events relate directly to them -engage in magical thinking (however they admit it is unlikely they are experiencing what they are unlike a schizophrenic)
Antisocial Personality Disorder
-failure to comply with social norms -psychopath -lack of remorse from actions -lie, cheat, steal, aggressive -superficial charm and good intelligence -**poor judgement and failure to learn from experience -genetic component found
2 hypothesis on what causes antisocial pd
Underarousal: abnormally low levels of cortical arousal Fearlessness: psychopaths have a higher threshold for experiencing fear
Psychopaths and MAOA
MAOA: an enzyme that helps break down neurotransmitters , specifically those involved with fight-or flight
Borderline Personality Disorder
-their moods and relationships are unstable and they usually have a poor self-image, great risk of suicide and self-mutilation, impulsive individuals -strongly correlated with bulimia & mood disorders & childhood abuse and neglect
Treatment of Borderline PD
-respond well to tricyclic antidepressants & lithium -Dialectal Behavior Therapy (DBT) helps people deal with stressors, taught to identify and regulate their emotions
Histrionic Personality Disorder
-Individuals seem to be overly dramatic and often as if they are acting -express emotions in an exaggerated manner -vain, self-centred -associated with antisocial personality disorder
Narcissistic PD
-unreasonable sense of self-importance, lacking sensitivity and compassion towards others -sense of grandiosity: overestimate thier abilites -sensitive to criticism
Avoidant Personality Disorder
-extremely sensitive to the opinions of others -Very low self-esteem coupled with fear of rejection -dependent on those they are comfortable with -theory=extremely high behavioral inhibition -Treatment: social skills training- becoming more confident and assertive
Dependent PD
-extremely dependent on those close to them -rely on others to make important decisions for them -fear of abandonment -timid, submissive, *lack of confidence similar to those with avoidant PD -theory: if early bonding is interrupted, child will always be anxious about abandonment
Obsessive-Compulsive Personality Disorder
-characterized by a fixation on things being \"done right way\", or in certain detail -genetic component weak
Cluster C PD
Anxious or fearful
Problems with diagnosing Personality Disorders
-absence of discriminate validity -comorbidity -heterogeneity withing categories -interrater agreement low -dimensional nature of symptoms -links with normal personality traits
Psychodynamic theory on histrionic pd
fixation at the oedipal stage manipulation and seduction have a \"childlike\" quality
⬢Lack of guilt and empathy -early onset -propensity towards violence, instrumental (calcualted with the aim of getting something in return) -criminal careers (repeat offences more often)
Treatment for psychopaths
could possible make it worse (by giving them the skills to manipulate others and fake empathy)
Characteristic Symptoms: 2 of the following -delusions -hallucinations -disorganized speech -grossly disorganized or catatonic behavior -negative symptoms
alternating immobility and excited agitation
Associative Splitting
schizophrenia early diagnosis, concept the \"breaking of associative threads\"
-describes many unusual beliefs, mostly though delusions and hallucinations in the absence of external events
disorder of thought content -Cotards syndrome: person believes that a part of his or her body has changed in some impossible way
Experience sensory event without them actually occurring (auditory hallucination)= hearing voices usually
Negative Symptoms
indicate an absence or insufficiency of normal behavior -emotional and social withdrawal -poverty of thought and speech
the inability to initiate and persist in activities (apathy) including performing daily activities such as grooming
relative absence of speech
presumed lack of pleasure experienced by some ppl with schizo such as eating, sleeping
Flat Affect
2/3 ppl with schizo, do not show emotion when you would normally expect them to
Paranoid type of schizophrenia
stand out because of their delusions and hallucinations. -cognitive skills are relatively intact
Disorganized type of schizophrenia
-show a marked disruption in speech and behavior -show flat or inappropriate affect -seem self-absorbed
Catatonic type of schizophrenia
remain in fixed positions, engage in excessive activity
Undifferentiated type of schizophrenia
people who have the major symptoms of schizo but who do not meet the criteria of paranoid, disorganized or catatonic
Residual Type of Schizophrenia
experience residual or leftover symptoms, such as unusual ideas, social withdrawal inactivity and flat affect
Crows types of schizophrenia
I- Positive symptoms: hallucinations and delusions, a ood response to medication, an optimistic prognosis and absence of intellectual impairment II: Negative symptoms: flat affect, poverty of speech, pessimistic prognosis and intellectual impairments
Schizophreniform Disorder
people experience the symptoms of schizo for a few months only; they can usually resume normal lives.
Schizoaffective Disorder
People who had the symptoms of schizo and who also exhibited the characteristics of mood disorders
Delusional Disorder
persistent belief that is contrary to reality, in the absence of other characteristics of schizophrenia -grandiose type: believing one\'s inflated worth, power, knowledge or special relationship with a deity or famous person -Late onset (40s)
Brief Psychotic Disorder
presence of one or more positive symptoms such as delusions, hallucinations and disorganized speech
Shared psychotic Disorder
(Folie a deux)individual develops delusions simply as a result of a close relationship with a delusional individual
Schizophrenia is chronic?
true, generally
Ratio of men-women with schizophrenia
= womens onset is a little later, and prognosis is usually better too
Family studies in schizophrenia proved
the severity of the parents\' schizophrenia influenced the likelihood of child\'s development
Dopamine & Schizophrenia
system too active (D2 of interest especially) -treatment is sometimes dopamine antagonists (reduce the negative symptoms)
Glutamate and schizophrenia
(NMDA) receptors, excitatory nt deficiency
Difference in brain structures of schizophrenics
-Large ventricles in some
Viral causes of schizophrenia
no reported cases before 1800 -possibility that prenatal exposure to influenza causes it
term to describe a mother whose cold, dominant, and rejecting nature was thought to cause schizo. -double bind: parents sends conflicting messages to the child
Expressed emotion and schizophrenia
- study followed people released from the hospital and now living or not living with their parents. -those living with parents with EE that was critical, hostile, and emotionally overinvolved tended to relapse
-drug treatment for schizophrenics -dopamine antagonists -h/w they also effect the serotonergic system -called antipsychotics -clozapine, risperidone etc.
Side affects of antipsychotics
-akinesia: expressionless face -slwo motor activity -monotonous speech -tardice dyskinesia: involuntary face movements & is irreversible -sensitivity to light -fatigue
Token economy
used at inpatient facilities -residents are given rewards for good behavior that can be attained through accumulated tokens, or taken away -teaches social skills -motivates normal behavior -usually doesn\'t have lasting effects once the person is released from the hospital

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