Abnormal Psych Test 2 Ch. 6-10

Amphetamines

Benzedrine, Dexedrine, Adderall • Used initially for weight loss - now to treat ADHD and narcolepsy • Also used by WWII pilots to stay awake • Repeated use -> hostility, grandiosity, amphetamine psychosis • Withdrawal = depression, fatigue, anxiety, irritability

Dissociative Anesthetics:

- e.g., PCP (angel dust - rocket fuel), ketamine alter the distribution of glutamate - can lead to glutamate toxicity

Marijuana

- Chronic use affects learning, memory, motivation - especially when use begins in adolescence

Agoraphobia:

A person whose life is impaired because they feel they must avoid places or situations that might trigger panic has developed: an anxiety disorder characterized by persistent avoidance of situations that might trigger panic symptoms or from which help would be difficult to obtain -About half the people with BLANK, report having had a panic attacks or panic disorder before developing blank. -chronic mental disorder, persisting over time unless treated -more than 1/3 of people with this disorder are completely housebound -Women are 2x as likely as men to be diagnosed with BLANK. Neurological factors: 1. heightened sensitivity to breathing changes, which in turn leads to hyperventilation, panic, and a sense of needing to escape 2. Too much norepinephrine (produced by an overreactive locus coeruleus), which increases heart and respiration rates and other aspects of the fight or flight response 3. a genetic predisposition to anxiety disorders, which makes some people vulnerable to panic disorder and BLANK Low threshold for detecting suffocation: - Can be stimulated by hyperventilation (increased CO2), which simulates SUFFOCATION, also by caffeine, sodium lactate • Norepinephrine dysregulation (mimics sympathetic activation) • Genetic predisposition - concordance rate - the more genes in common, the higher the concordance rate 24% concordance rate in identical twins; 11% in fraternal twins Psychological Factors • Learned Panic - Conditioned response to "true alarm" - Leads to "false alarms" associated with panic attacks Respond to interoceptive and external cues of initial episode - Fear of fear • Cognitive Influences - Catastrophic thinking • Assume that physiological changes (HR, RR) signal eminent danger, e.g., heart attack -> vicious cycle - Anxiety Sensitivity • Fear bodily sensations related to anxiety - Nocturnal panic attacks - when transitioning into slow wave sleep (deeper, slower breathing) Social Factors • Needing a "safe person" i.e., friend or family, to go into anxiety provoking situations - Dependent on others and unable to be alone • Cultural influences: - Dangers Middle East - Dangers in the US related to terrorism, crime, food safety Treatment: • Long term: SSRIs, SNRIs, • Short term: benzodiazepines (Xanax, Klonapin) • CBT for panic attacks, therapist or self-help • Exposure: long walks -> running; imagined exposures -> actual exposure • Interoceptive exposure: Induce HR and RR increases and notice that absence of catastrophe

Anxiety:

A sense of agitation or nervousness, which is often focused on an upcoming possible danger

.08

According to your textbook, a blood alcohol concentration of _______ percent of blood volume is the legal limit for driving in the United States, Canada, and Mexico.

Frequency Quantity Duration

Age: the younger at starting age the more likely to abuse and develop dependency • Quantity: The more used the more likely to develop dependence

Depressants

Alcohol Barbiturates slow people down - decreasing awareness and activity 54% genetics; 14% family environment influence Psychosocial Factors • Observational learning • Operant conditioning • Classical conditioning • Dysfunctional family • Peer pressure • Perceived norms (media) • Economic hardship

Korsakoffs

An alcohol-related deficiency of vitamin B (thiamine) may be the cause of ___________________ syndrome, which is a disease marked by extreme memory loss, confusion, and other neurological symptoms.

Alcohol

Binge drinking is when blood alcohol reaches 0.08 in 2 hrs 4 drinks/women 5 drinks/men Effects dependent upon: - Number of drinks per unit time - Presence of solid food - Body weight - Gender Binge drinking is when blood alcohol reaches 0.08 in 2 hrs Craving • Loss of control - can't stop • Physical dependence • Tolerance • Blackouts - memory of episode lost • Cirrhosis of the liver Hangover/Withdrawal • Kidneys remove "toxin" by changing water balance -> dehydration • Liver removes "toxin" by converting alcohol to acetaldehyde, which is another toxin, which is converted to acetate (harmless) • Alcohol withdrawal: delirium tremens - headache, weakness, tremor, anxiety, high BP, HR, &RR, seizure, fever, agitation, irritability, convulsions, hallucinations Binge Drinking & Alcoholism • Binge drinking: blood alcohol reaches 0.08 in 2 hrs - > 4 drinks/women - > 5 drinks/men • Alcohol Use Disorder - Craving - Loss of control - Physical dependence - tolerance One of the effects of long term alcohol use disorder is enlarged ventricles (the cavities in the brain filled with cerebrospinal fluid). The ventricles in this mri scan are normal size (b) the enlarged ventricles are those of a man with alcohol disorder. The enlargements reflects the reduced size of a number of brain areas. These neurological changes may explain some of the memory problems associated with alcohol use disorder Treatment: Abstinence achieved by minimizing withdrawal symptoms and blocking high - Medically supervised detox'; Replacement therapy, Blocking agents • Minimize harm with needle exchange Readiness - Precontemplation, Contemplation, Preparation, Action, Maintenance • Motivational Enhancement Therapy - Pros and Cons to establish readiness • CBT - Understanding thoughts, feelings, behaviors - Understanding consequences of substance use - Alternative behaviors (use reinforcement e.g., money, methadone at home • Self-monitoring, cognitive restructuring, problem solving, relaxation techniques Options • Residential treatment - e.g., Betty Ford Center • Community based treatment - Day treatment programs using CBT, individual therapy, methadone clinics • Self help groups - AA, AA sponsors, Women for Sobriety, Rational recovery • Family therapy - Standard for adolescents

Starvation Study 1940's

Caloric restriction for 6 mos => 25% decrease in body weight • Sensitive to light, cold, noise • Insomnia • Decreased libido • Depression • Anxiety • Obsessed with food

Narcotics:

Exogenous opiates (opioids) or opium derivatives - e.g., methadone, heroin, codeine, morphine, synthetic derivatives (OxyContin, Vicodin, Darvon) - Heroin begins with snorting, popping, then mainlining leading to liver disease, AIDS, hepatitis from contaminated needles

traumatic event

Even witnessing someone else experiencing actual or threatened serious injury qualifies as a

Bath Salts

Not Epsom salts • Family of drugs related to cathinone/amphetamine/ecstasy • Contents vary • Highly addictive even when unpleasant • Activate dopamine reward pathway and kill neurons

Panic disorder:

PANICING ABOUT PANICING--> an anxiety disorder characterized by frequent, unexpected panic attack, along with fear of further attacks and possible restrictions of behavior in order to prevent such attacks. KEY: RECURRING PANIC ATTACKS-- periods of fear and discomfort along with physical arousal symptoms or cognitive symptoms. BLANK may be cued by particular stimuli (usually internal sensations) or they may arise without any clear cue. BLANK also involves fear of further attacks and, in some cases, restricted behavior in an effort to prevent further attacks Half people with BLANK also develop agoraphobia--avoiding situations that might trigger a panic attack or from which escape would be difficult, such as crowded locations or tunnels Frequent panic attacks and fear about having another panic attack and loosing control resulting in a change in behavior (e.g., avoiding unfamiliar) Neurological factors: 1. heightened sensitivity to breathing changes, which in turn leads to hyperventilation, panic, and a sense of needing to escape 2. Too much norepinephrine (produced by an overreactive locus coeruleus), which increases heart and respiration rates and other aspects of the fight or flight response 3. a genetic predisposition to anxiety disorders, which makes some people vulnerable to BLANK and agoraphobia Psychological factors: -Conditioning of the initial bodily sensations of panic (interoceptive cues) or external cues related to panic attacks which leads them to become learned alarms and elicit panic symptoms. Some people then develop a fear of fear and avoid panic-related cues. -Heightened anxiety sensitivity and misinterpretation of bodily symptoms of arousal as symptoms of a more serious problem, such as a heart attack, which can in turn lead to hypervigilance for--and fear of --further sensations and cause increased arousal, creating a vicious cycle Social factors: -greater than average number of social stressors during childhood and adolescence -cultural factors, which can influence whether people develop panic disorder. -the presence of a safe person, which can decrease catastrophic thinking and panic Treatment: -for neurological factors: benzodiazepines for short term relief and antidepressants for long term use -CBT is the BEST treatment for blank and targets psychological factors. Behavioral methods focus on the bodily signals or arousal, panic, and agoraphobic avoidance. Cognitive methods (psychoeducation and cognitive restructuring) focus on the misappraisal of bodily sensations and on mistaken inferences about them. -treatments that target social factors include group therapy focused on panic disorder and couples or family therapy particularly when a family member is a safe person

flashbacks.

Psychosis is one possible after effect of LSD use. The other possible after effect is:

trance

Some cultures purposely create a _____ state that resembles dissociation.

Methamphetamine

Stronger and longer lasting than amphetamine -->overworks every vital system in the body so you age faster blank has a greater and longer-lasting effect on the central nervous system than amphetamines.

how long the symptoms have lasted

The difference between acute stress disorder and posttraumatic stress disorder is:

narcotic analgesics

Which of the following drugs are derived from the opium poppy plant or chemically related substances, and are sometimes referred to as opiates or opioids?

Polysubstance abuse:

a behavior pattern of abusing more than one substance 1/2 with alcohol abuse/dependence have another disorder • ¾ with other drug abuse/dependence have other disorders • Polysubstance abuse: 64% alcoholics have other drug abuse/dependence • Self medicating?-->negative reinforcement: removal of anxiety with alc makes you dependent on alc • Mood disorders • PTSD • Schizophrenia • ADHD

those that block the "high" of the substance

To help patients achieve abstinence, pharmaceutical companies have focused their efforts on developing two types of medications: (1) those that minimize withdrawal symptoms, and (2):

negative reinforcement

Using a substance because it eliminates the unpleasant withdrawal symptoms can be explained as:

Antabuse:

a medication for treating alcohol use disorder that induces violent nausea and vomiting when it is mixed with alcohol.

Exposure with response prevention:

a behavioral technique in which a patient is carefully prevented from engaging in his or her usual maladaptive response after being exposed to a stimulus that usually elicits the response. For ex: if someone with OCD was afraid of touching dirt, he would touch dirt but would not then wash his hands for a while. By not being able to respond to the dirt, the patient learns that nothing bad happens if compulsive behaviors aren't performed James has obsessive-compulsive disorder. He has intense fear of dirt and he is always washing his hands and wiping off anything he has to touch. His therapist brought a box of dirty objects into the office and had James touch them. He could not wipe them off or wash his hands for the rest of the session. This is an example of: In cognitive-behavior therapy for bulimia, the _____________ method generally involves exposing the patient to anxiety-provoking stimuli, such as foods she would typically eat only during a binge, and having her eat a small amount without purging. Foods only eaten in a binge ... ...are eaten in controlled portions in a normal way

Exposure:

a behavioral technique that involves repeated contact with a feared or arousing stimulus in a controlled setting, bringing about habituation

Interoceptive exposure:

a behavioral therapy method in which patients intentionally elicit the bodily sensations associated with panic so that they can habituate to those sensations and not respond with fear for ex: breathing through a narrow straw--> feeling of suffocation and then surviving it Decrease reaction to bodily sensations associated with panic

In vivo exposure:

a behavioral therapy method that consists of direct exposure to a feared or avoided situation or stimulus

Somatic symptom disorders:

a category of psychological disorders characterized by symptoms about physical well-being along with cognitive distortions about bodily symptoms and their meaning; the focus on these bodily symptoms causes significant distress or impaired functioning Somatic symptom disorder (SSD): a somatic symptom disorder characterized by at least one somatic symptom that is distressing or disrupts daily life, about which the person has excessive thoughts, feelings, or behaviors The neuropsychosocial feedback loop in somatic symptom disorders includes genetic risk, catastrophic thinking, and reinforcement of symptoms by others. Treatment of blank may use biofeedback along with medication and cognitive-behavioral therapy to change the type of attention paid to bodily sensations. disorders focus on identifying irrational thoughts and moving attention away from body symptoms. MD can't find any medical basis-->all in your head More confidence that this is a real psychological disorder Such symptoms have been recorded for millennia 1. BODILY PREOCCUPATION 2. SYMPTOM AMPLIFICATION Symptoms rarely meet diagnostic criteria (1%) but real SD is 9 x as costly for outpatient medical services • Comorbidity includes anxiety disorder (panic), depression, and borderline personality disorder • Some surveys show 10x more common among women • By restricting activity and becoming out of shape - they enter of vicious cycle People with blank often have other psychological disorders, most frequently an anxiety disorder (particularly panic) or depression Neuropsychosocial Factors • Twin studies show genetic link - but could be related to temperament not SSD • Bodily preoccupation, symptom amplification, catastrophic thinking = mental processes associated with SSD - Often provides coping strategy after death of a loved one • Ill parent -> observational learning, modeling illness behavior, or behavior reinforced with special food, attention Treatment: • SSRI's • St. John's wart • Muscle relaxa5on • Biofeedback • CBT MOST EFFECTIVE • Relieve social stressors • Family therapy

Dissociative disorders:

a category of psychological disorders in which consciousness, memory, emotion, perception, body representation, motor control, or identity are dissociated to the point where the symptoms are pervasive, cause significant distress, and interfere with daily functioning Dissociated consciousness, memory, emotion, perception, body representation, motor control, or identity that causes distress and interferes with daily functioning • Dissociative amnesia • Depersonalization-Derealization disorder • Dissociative identity disorder Different from "spacing out" or culturally condoned "trance"

Anxiety disorder:

a category of psychological disorders in which the primary symptoms involve fear, extreme anxiety, intense arousal, and/or extreme attempts to avoid stimuli that lead to fear and anxiety--> Fear, agitation, nervousness that impairs functioning in all spheres of life involves such intense fear and arousal, and such extreme efforts to avoid things that cause these feelings, that it interferes with a person's life. Tripartite model--3 systems work together -sympathetic fight or flight response releases norepinephrine into the nervous system -Adrenal medulla releases adrenaline into blood -HPA axis causes adrenal cortex to release cortisol into blood HIGH CO-MORBIDITY BETWEEN ANXIETY AND DEPRESSION Co-morbid with... Mood disorders • Somatization disorder • Body dysmorphic disorder • Anorexia nervosa • Depression • Alcohol dependence Symptoms of anxiety often secondary to larger issues

Psychoactive substance:

a chemical that alters mental ability, mood, or behavior

Body dysmorphic disorder:

a disorder characterized by excessive preoccupation with a perceived defect or defects in appearance and repetitive behaviors to hide the perceived defect. Ex: Michael Jackson With repetitive behaviors: Seek Reassurance/Avoid - Looking in the mirror - Working out (in the extreme) - Skin picking - Trying out beauty products - Weighing - DieBng • Avoid social situations to avoid scrutiny Repeated surgeries on nose chin cheeks but did not admit it Usually emerges during adolescent years-->can't stop thinking about an imperfection that isn't there Cognitive/Behavior • Cognitive bias • Catastrophic thinking Excessive fear of being evaluated negatively (like social anxiety disorder) Repetitve behaviors (like OCD)

Obsessive compulsive disorder (OCD):

a disorder characterized by one or more obsessions or compulsions Obsessions DRIVE compulsions so treat with CBT TO KEEP OBSESSION FROM DRIVING COMPULSION seems to happen largely because of abnormal function in brain circuits. Most recognize that their "beliefs" are not valid. Males have early onset (6-15) Females have late onset (20-29) Normal circuitry is overworked Frontal cortex fails to cut off signal BASAL GANGLIA important for "habit memory"-->motor behaviors ORBITAL FRONTAL CORTEX connected to basal ganglia Brain scans have shown that the frontal cortex and the basal ganglia function abnormally in people with blank Different countries have about the same rate of blank, but the thoughts and behaviors may have different content because of religious and cultural influences. may be too little of the neurotransmitter SEROTONIN: Neuropsychosocial Factors • Genetics - Anxiety disorders in general run in families - 65% concordance in identical twins - 15% fraternal twins • Operant conditioning - Temporary relief from anxiety (discomfort) reinforces compulsions • Stress influences the onset and course of blank Specific Treatments • Exposure with Response Prevention - Survive the anxiety and learn to exert control over the compulsion • CBT: Cognitive Restructuring-->restructure thoughts - Reduce irrational / frequent intrusive thoughts and obsessions by challenging their accuracy and predicted consequences Studies of eye movement desensitization and reprocessing treatment (EMDR) show that EMDR: is effective, but no more effective than standard cognitive-behavioral therapy.

Separation anxiety disorder:

a disorder that typically arises in childhood and is characterized by excessive anxiety about separation from home or from someone to whom the person is strongly attached Excessive, impairs Functioning (can't go to school or work) and persists 6 mos or more for adults Child follows parent from room to Room, can't fall asleep alone, won't go on sleepovers or to summer camp -emerge after some kind of stressful event -CHildren realize they are SEPARATE from their mom - common in children, sometimes can occur in adults - moderately heritable--overprotective family members may inadvertently reinforce behaviors associated with BLANK and punish behvaiors associated with appropriate separation -treatment: CBT that includes exposure and cognitive restructuring along with family therapy

Dissociative identity disorder (DID):

a dissociative disorder characterized by the presence of 2 or more distincy personality states, or an experience of possession trance, which gives rise to a discontinuity in the person's sense of self and agency. BLANK disorders may include symptoms of amnesia, derealization, depersonalization, and identity problems. is easy to act out and can be difficult to tell from MALINGERNG Previously known as multiple personality disorder Linked to severe, chronic child abuse Number of cases increased after 1976 release of movie "Sybil" -->made clinicians./ people see it when it wasn't there everyone was influenced by the movies Posttraumatic Model - Sufferers of severe physical abuse report "leaving their bodies" - promoting a dissociative state that develops its own memories, identity, i.e., "alter" - But there are few cases of childhood DID • Sociocognitive Model - Therapist unintentionally causes patient to act DID Problems • Hard to diagnose accurately because of ambiguity in the diagnostic criteria • Shares features with Dissociative amnesia and Bipolar disorder • Incidence increased after Sybil was released Neuropsychosocial Factors • Orbital frontal cortex appears to influence the ability to recall specific events depending on which "alter" is dominant • Each "alter" has a different "sense of self" and brain responds differently to stories of trauma depending on which alter is dominant • Stress related hormones influence frontal lobe and hippocampus Twin studies show clear genetic component for BOTH - pathological dissociative experiences - and nonpathological experiences (lost in a book) - on a continuum with normal experience • Hypnotizability • Therapist bias influences diagnosis Treatment: These disorders are rare and usually improve without treatment - very few studies • No medication recommended - except for comorbid disorders • Reduce stress by: - reinterpreting symptoms - coping strategies - addressing dissociated memories • Post-traumatic Model - Map each alter - Hypnosis • Sociocognitive Model - Extinguish alters Using hypnosis to treat blank may be risky because the therapist may accidentally cause an increase in symptoms.

Dissociative amnesia:

a dissociative disorder in which the sufferer has significantly impaired memory for important experiences or personal information that cannot be explained by ordinary forgetfulness Impaired memory for important experiences or autobiographical information - Typically violent or stressful in nature-->experience was too difficult to take in • Anna O forgot the German language • Can be: - Localized (time - most common) - Selective (episode) - Generalized (everything - rare) Neuropsychosocial Factors • Hippocampus? Cortisol? • Dissociation theory: Strong emotions narrow attention, disrupt integration • Neodissociation theory: Executive monitoring system (frontal lobe) disconnected from other cognitive processes - amnestic barrier • Abuse: 3 x more often

Depersonalization derealization disorder:

a dissociative disorder, the primary symptom of which is a persistent feeling of being detached from one's mental processes, body, or surroundings The presence of persistent or recurrent experiences of depersonalization, derealization or both. Feeling of being detached from mental processes, body, or surroundings Only when they occur independent of anxiety symptoms Comorbid with anxiety Neuropsychosocial Factors • Dissociated perceptions due to changes in temporal (personal narrative) and parietal lobe (sense of where you are in space) activity • increased Frontal lobe activity suppress emotions • decreased Limbic system activity-Capgras syndrome--> person thinks that most important people in their life are imposters • decreased norepinephrine less autonomic activation)= • Impaired attention -> short-term memory, spatial reasoning problems • Severe and chronic emotional abuse may lead to depersonalization-->separate from themselves when abused, disconnects conscious awareness of yourself because you can't endure it Severe stress appears to be the trigger

Identity problem:

a dissociative symptom in which a person is not sure who he or she is or may assume a new identity

derealization

a dissociative symptom in which the external world is perceived or experienced as strange or unreal. external world seems unreal -person feels "detached"

Depersonalization:

a dissociative symptom in which the perception or experience of self—either one's body or one's mental processes—is altered to the point that the person feels like an observer, as though seeing oneself from the "outside" experience of self is as an observer looking from the outside e.g., "under water," "floating" -->out of body experience

Motivational enhancement therapy:

a form of treatment specifically designed to boost a patient's motivation to decrease or stop substance use by highlighting discrepancies between stated personal goals related to substance use and current behavior; also referred to as motivational interviewing Which therapy is specifically designed to boost patients' desire to decrease or stop substance use?

Hypervigilance:

a heightened search for threats

Substance abuse:

indirect effects of excessive use leading to harm or adverse effects

Stages of change:

a series of five stages that characterizes how ready a person is to change problematic behaviors: precontemplation, contemplation, preparation, action, and maintenance

Illness anxiety disorder:

a somatic symptom disorder marked by a preoccupation with a fear or belief of having a serious disease in the face of either no or minor medical symptoms and excessive behaviors related to this belief According to the DSM-5, a person with no medical symptoms or minor medical symptoms who keeps fearing they have a serious disease and engaging in excess behavior related to this fear may be diagnosed with: somatic symptoms are mild in intensity Shared Features Those with a least one medical symptom and excessive psychological response now diagnosed as SSD (%75 of what used to be called hypochondriasis) • No medical symptoms but preoccupied and fearful of serious disease • Two thirds comorbid with anxiety or depressive disorder • Like OCD because patients obsess about illness and disease May recognize excess or have Poor insight Negative Reinforcement • Engage in behaviors that temporarily reduce anxiety OTC tests, feeling body parts, taking blood pressure, doctors visits • Sustains anxiety in the long term Treatment: CBT is most effective. Pilot studies have adapted interpersonal therapy to treat blank, and initial results are promising

Conversion disorder:

a somatic symptom disorder that involves sensory or motor symptoms that are incompatible with known neurological and medical conditions Like SSD but limited to sensory or motor symptoms or pseudoseizures that appear neurological Symptoms Unrealistic Medically-->top down thinking-->thinking has an impact on motor skills • Seizures without hitting head, biting tongue, incontinence • Example, nun who eventually left the church, went blind in one eye because she "didn't want to see" • As many as half of patients with conversion disorder may actually have medical problems Avoidance Unintended self-hypnotic suggestion (to resolve unacceptable personal conflict)-->brain can change the way the body reacts Can be triggered by stressors such as combat Treatment: insight-oriented treatment is sometimes used to help patients with blank understand the meaning of symptoms. ONce the meaning is understood, the symptoms may improve spontaneously One study has shown that educating patients with leg paralysis due to blank about the true nature of their symptoms has been known to result in the patient: immediately walking with no paralysis

Panic attack:

a specific period of intense fear or discomfort, accompanied by physical symptoms, such as a pounding heart, shortness of breath, shakiness, and sweating, or cognitive symptoms, such as a fear of losing control SENSATIONS OF SHORTNESS OF BREATH OR SMOTHERING

Biofeedback:

a technique in which a person is trained to bring normally involuntary or unconscious bodily activity, such as heart rate or muscle tension, under voluntary control

Acute stress disorder:

a traumatic stress disorder that involves (A) intrusive re experiencing of the traumatic event, (b) avoidance of stimuli related to the event, (c) negative changes in thoughts and mood, and (d) dissociation, and (e) hyperarousal and reactivity, with these symptoms lasting for less than a month Symptoms appear in 1 month • Last 3 days but not more than 1 month • Cause distress or impair functioning • Slightly different DSM V criteria than PTSD

Obsessions:

intrusive and unwanted thoughts, urges or images that persist or recur and usually cause distress or anxiety For example: germs is blank

Posttraumatic stress disorder (PTSD):

a traumatic stress disorder that involves persistent (a) intrusive re experiencing of the traumatic event, (b) avoidance of stimuli related to the event, (c) negative changes in thoughts and mood, and (d) hyper arousal and reactivity that persist for at least a month Symptoms may emerge even months or years after event One brain structure that is abnormal in people with blank is the hippocampus, a key structure in memory. Influencing factors: Kind of trauma (violence worse than natural disasters) Severity of event, duration, proximity (also multiple traumas, e.g., war veterans Treatment: • SSRIs - medication not address psychological and social factors, which are considerable • Propranolol - alpha adrenergic blocker-->break cycle of re-experiencing • Transcranial magnetic stimulation (TMS) • Exposure (habituation) • CBT (can prevent acute stress disorder from becoming PTSD - some programs available on line) • Cognitive restructuring and psychoeducation • Family and couples therapy The early focus of treatment for blank is to help the person feel as safe as possible. Trauma results from horrific events that challenge basic assumptions: - Fair and just world - Possible to trust others and be safe - Possible to be effective in the world - Life has purpose and meaning

Family therapy:

a treatment that involves an entire family or some portion of a family

opiods

also called narcotic analgesics. are most often used medically to relieve pain. Best characterized as endogenous blank -->arising from an outside source: include methadone and heroin (strongest and most addictive) Heroin slows down activity in central nervous system -->reduces the body's natural pain relieving ability-->when withdrawal symptoms arise and their endorphins shouldve kicked in they dont and they feel even worse than normal medications used to treat blank disorder are generally chemically similar to the abused drugs, but reduce or eliminate the high.

Specific phobia:

an anxiety disorder characterized by excessive or unreasonable anxiety about or fear related to a specific situation or object Greater-than-normal fear of a situation or object can indicate the diagnosis of blank a) marked anxiety or fear related to specific stimulus that b) is disproportional to the actual danger posed c) leads to attempts to avoid that feared stimulus A person may have a neurological risk of developing a specific phobia because of their __genes___, and what they fear may be a result of seeing others ___model__ the same fear. The amygdala is often overactive in anxiety disorders, and seems to be especially sensitive in people with blank. Medication is usually not necessary for the treatment of blank DSM5 specifies 5 types of blank: Animal e.g., snakes, spiders • Natural Environment: e.g., hydrophobia, heights, water, storms • Blood, injection, injury: e.g., seeing blood, having injections, bodily injuries, watching surgery • Situational: airplane, elevator, enclosed space, driving a car, tunnels • Other (e.g., clowns, vomiting) -people are biologically prepared to develop blank to certain stimuli as well as to resist developing phobias to certain other stimuli Neurological factors: -overly reactive amygdala. GABA is one neurotransmitter that is involved. -Research suggests tht some genes are associated with blank generally, whereas other genes are associated with particular types of blank. Psychological factors: -classical conditioning (rarely) -operant conditioning (negative reinforcement of avoiding the feared stimulus) -Cognitive biases related to the stimulus -Observational learning--a social factor can influence what particular stimulus a person comes to fear Treatment: -medication--benzodiazipine -medication is not usually necessary because of CBT--extremely effective particularly when exposure is part of the treatment

Social Anxiety disorder:

an anxiety disorder characterized by intense fear of public humiliation or embarrassment; also called social phobia. intense fear of or anxiety about being in any of 3 types of social situations: social interactions (conversations), being observed (eating or using public rest rooms) and performing (givng a speech). when such social situations cannot be avoided, they trigger panic or anxiety. • Social interactions (conversation) • Being observed (wedding)-->center of attention • Performing (speech) fear/anxiety disproportionate to danger posed A treatment as effective as medication, that has been shown to work for people with blank is _cognitive behavioral____ therapy.-->both resulted in changes in brain activity. From the neuropsychosocial viewpoint, factors that contribute to BLANK include genetics, neurotransmitters, shy temperament, and: classical or operant conditioning. Fear of scrutiny, criticism Rarely have panic attacks alone TWICE AS COMMON IN FEMALES THAN MALES the anxiety about performing poorly and being evaluated by others, can in turn impair a person's performance, creating a vicious cycle. The symptoms of BLANK may lead people with this disorder to be less successful than they could otherwise be because they avoid job related social interactions that are required for advancement. Neurological factors: -an amygdala that is more easily activated in response to social stimuli, too little dopamine and serotonin, and a genetic predisposition toward a shy temperament (behavior inhibition) Psychological factors: Cognitive biases & distortions - Heightened focus on critical facial expressions than normal (perceive neutral faces as critical and recognize them in a larger group) - Distorted "emotional reasoning" • adjust performance by amount of anxiety • Ambiguous cues become negative • Classical conditioning - Conditioned response generalizes beyond original experience • Operant conditioning - Avoidance reinforces reclusiveness by reducing anxiety Social factors: -parents encouraging a child to avoid anxiety inducing social interactions -Cultural differences - taijin kyofusho in Korea (Fear of offensive body odor or blushing) - vs western fear of blunder Treatment: medication for neurological disorders--specifically beta-blockers for periodic performance anxiety and SSRIs and SNRIs for more generalized blank. Propranolol for short term effects, e.g., performance anxiety • SSRIs & SNRIs - For longer term treatment, higher doses than depression, longer time to act (6 mos), (decreased activity in amygdala and LC) • CBT (combined with pharma) - Identify irrational thoughts + exposure to threats • Cognitive behavior group therapy targets the heart of the problem -CBT is the treatment that targets psychological factors, specifically exposure and cognitive restructuring. Group CBT and exposure to feared social stimuli are the treatments that target blank

Generalized anxiety disorder (GAD):

an anxiety disorder characterized by uncontrollable worry and anxiety about a number of events or activities, which are not solely the result of another disorder. persistent and excessive worry about a number of events or activities that are not solely the focus of another disorder. Most people with BLANK also have comorbid depression ANXIOUS ALL THE TIME-->AFRAID TO BE ANXIOUS Three factors seem to contribute to the development of BLANK. They are _____, _____, and_____. neurotransmitters; learned behaviors; stress brain function is affected by problems with several neurotransmitters neuropsychosocial model Neurological factors associated with BLANK: 1. decreased arousal because the parasympathetic nervous system is extremely responsive (this is unlike most other anxiety disorders) 2. Abnormal activity of serotonin, dopamine, and other neurotransmitters, which in turn influences motivation, response to reward and attention. 3. a genetic predisposition to become anxious and/or depressed. This predisposition however is not specific to BLANK Psychological factors: hypervigilance for possible threats, a sense that the worrying is out of control and the reinforcing experience that worrying prevents panic. Out of control worrying • Worry staves off panic (negative reinforcement) - but is not problem solving (nonproductive thinking) -->worrying makes them feel better-->reinforces worrying Social factors: stressful life events, which can trigger the disorder Triggers: - Death - Friction in relationships - Troubled employment • People with BLANK see themselves as having troubled relationships when they don't Treatments: -Medication can reduce the symptoms -medication (which targets neurological factors) such as buspirone or an SNRI or SSRI when depression is present as a comormid disorder. Buspirone: serotonin agonist - decreases serotonin release, may affect activity in amygdala • SNRIs and SSRIs work on both anxiety and depression • Benzodiazpines -CBT (targets psychological factors) which may include breathing retraining, muscle relaxation training, worry exposure, cognitive restructuring, self monitoring, problem solving, psychoeducation and/ or medication • Breathing retraining • Muscle relaxation with biofeedback Habituation with exposure therapy (imagined, virtual, in vivo)

Anorexia nervosa:

an eating disorder characterized by significantly low body weight along with an intense fear of gaining weird or using various methods to prevent weight gain similar to OCD because obsessive thoughts triggering compulsive behavior ADDICTED TO THE FEELING OF STARVATION -onset: ages 14-18 -highest mortality rate of any psychological disorder -fewer than 50% of those who survive fully recover co morbid with anxiety, depression, and personality disorders Ritualistic eating habits - OCD like e.g., must eat at a certain time, in a certain way, only certain foods 15% below expected body weight; methods to prevent weight gain -->still feel fat at this point 10 - 15% die of the disorder Image of whole body is distorted, not just a part. They also overestimate how much food is in a portion Medical Consequences • Muscle wasting (muscle breakdown as a source of nutrition) - Skeletal appearance - Cardiomyopathy - thinning heart walls • Exercise does not build muscle - can be lethal • Low HR, BP • Abdominal bloating • Constipation • Loss of bone density • Slow metabolism • Low body temperature • Trouble tolerating cold • Lanugo hair • Brittle nails and hair • Dehydration from purging Often regarded as a lifestyle choice Neuroimaging research has shown that serotonin receptors function abnormally in patients with anorexia nervosa and bulimia.

Hysteria:

an emotional condition marked by extreme excitability and bodily symptoms for which there is no medical explanation

Phobia:

an exaggerated fear of an object or a situation, together with an extreme avoidance of the object or situation

Panic:

an extreme sense (or fear) of imminent doom, together with an extreme stress response

Excoriation disorder:

an obsessive compulsive related disorder skin picking

Trichotillomania:

an obsessive compulsive related disorder hair pulling

Hoarding disorder:

an obsessive compulsive related disorder characterized by persistent difficulty throwing away or otherwise parting with possessions—to the point that the possessions impair daily life, regardless of the value of those possessions

Somatoform disorders:

bodily symptoms with no medical cause Anno O developed vision problems that could not be diagnosed and a cough with no apparent cause... ....she was not pretending or intentionally inducing these symptoms Somatic symptom disorder Conversion disorder Illness anxiety disorder

Dissociative anesthetics

club drugs

Substance dependence:

compulsive use despite negative effects (work, relationships, health, legal) -->can't resist behaviors are thoroughly engrained

Barbiturates & Alcohol

decrease excitability in the brain Interact with GABA receptors - increasing CL- influx and decreasing neuronal excitability Barbiturates: Lorazepam (Ativan), triaxolam (Halcion), cholordiazepoxide (Librium) diazapam (Valium), aprazolam (Xanax) very good for short term anxiety treatment Benzodiazepine Just seeing the alcohol can activate the limbic sustem (and dopamine reward system) CUE

Substance use disorders:

destigmatization of the word addiction-->psychological disorders that are characterized by loss of control over urges to use a psychoactive substance, even though such use may impair functioning or cause distress smoking, swallowing, snorting, injecting recreational drugs (not the extent of effect of substance) "Addiction" (negative moral ImplicatiAons) use for pleasurable effects or relief from negative emotions Focus on behaviors devoted to obtained the drug as well as consequences and cravings

Anna O

diagnosed with "hysteria" which is no longer an official diagnosis -->Freud coined this term experienced daily periods of "sleep walking" when she was destructive -could not remember these periods Traumatized by her father's death

Hallucinogens:

e.g., LSD, mescaline, psilocybin (all affect serotonin pathways)

Stimulants

have the most direct effects on the dopamine reward system.Act on nervous system in many different ways Cocaine/Crack Amphetamines Methamphetamines Ritalin MDMA (Ecstasy) Nicotine

Drug culture of the 1960s

less potent/ strong drugs than we have now Mostly marijuana and hallucinagens-->less harmless than drug use now

Detoxification:

medically supervised discontinuation of substances for those with substance use disorders; also referred to as detox The gradual decrease in the dosage of the drug taken over time to prevent potentially lethal withdrawal symptoms, such as seizures is called:

Amnesia:

memory loss, which in dissociative disorders is usually temporary but in rare cases may be permanent

MDMA (Ecstasy - "e")

methylenedioxymethamphetamine • Properties of both amphetamine and mescaline • Heightened empathy and sense of touch • Sense of well being and warmth, reduced anxiety, time warp • Withdrawal = poor concentration, poor mood depression, fatigue, anxiety, decreased appetite -reducing serotonin in cortex-->damaging diffuse modulatory system. 7 years later still not back to normal

Bulimia nervosa:

normal/over weight an eating disorder characterized by binge eating along with vomiting or other behaviors to compensate for the large number of calories ingested in late adolescence or early adulthood. Binge eating and vomiting Binge eating followed by inappropriate efforts to limit weight gain: - Purging: vomiting, diuretics, laxatives, enemas - Nonpurging: fasting, excessive exercise - (May not be a meaningful difference) • People with bulimia are often normal weight or overweight • 2-3 x as prevalent as anorexia Medical Effects of purging • Swelling of the parotid and salivary glands and erosion of tooth enamel - Due to chronic vomiting • Heart and muscle problems - Due to use of ipecac syrup • Permanent loss of intestinal functioning - Due to regular laxative use • Constipation, abdominal bloating, and discomfort, fatigue, and irregular menstruation • Dehydration and electrolytic imbalance All that distinguishes binge eating/ purging type of anorexia from bulimia is low weight

Compulsions:

repetitive behaviors or mental acts that a person feels driven to carry out and that usually must be performed according to rigid "rules" or correspond thematically to an obsession For ex: laying down paper towels on his bed or take a newspaper from the middle of the stack

Cocaine

stimulant derived from coca leaf - snorted as powder - smoked as crystalline form • Rapid tolerance -> higher doses -> paranoia, delusions, hallucinations • Crack more intense and dependence develops more rapidly-->worse • Both increased HR, BP -> heart attack Long-term effects of blank include irritability, mood changes, restlessness, __________, and auditory hallucinations. ->paranoia

Dissociative Fugue:

sudden unplanned travel and difficulty remembering past amnesia for their identity and move away from home.

Fight or flight response:

the automatic neurological and bodily response to a perceived threat; also called the stress response. arises when people perceive a threat; when the arousal feels out of control--either because the person has an overreactive stress response or because he or she misinterprets the arousal--the person may experience panic. In response to the panic, some people develop a phobia of stimuli related to their panic and anxiety symptoms response underlies the fear and anxiety involved in almost all anxiety disorders. Sympathetic Activation • Quicker deeper breathing • Increased blood flow to muscles and brain • Decreased blood flow to skin • Slowed digestion • Glucose released from liver into blood • Sweaty palms • Pupil dilation Underlies the fear and anxiety involved in anxiety disorders

Tolerance:

the biological response that arises from repeated use of a substance such that more of it is required to obtain the same effect Body always seeking homeostasis-->need more drug to get back to original state-->withdrawal process requires medical help

Reward craving:

the desire for the gratifying effects of using a substance

Relief craving:

the desire for the temporary emotional relief that can arise from using a substance

Common liabilities model:

the model that explains how neurological, psychological, and social factors make a person vulnerable to a variety of problematic behaviors including substance use disorders; also called problem behavior theory Research has found that adolescents who later developed substance abuse were likely to exhibit problem behaviors, such as drug and alcohol use and early sexual intercourse, and delinquent behaviors, such as stealing and gambling. This is known as: Vulnerable to problem behaviors - drug/alcohol use, early sexual intercourse, delinquent behaviors plus • Impulsivity

Concordance rate:

the probability that both twins will have a characteristic or disorder, given that one of them has it

Habituation:

the process by which the emotional response to a stimulus that elicits fear or anxiety is reduced by exposing the patient to the stimulus repeatedly

Psychoeducation:

the process of educating patients about research findings and therapy procedures relevant to their situation

Gateway Hypothesis:

the proposal that use can become a use disorder when "entry" drugs serve as a gateway to (or the first stage in a progression to) use of "harder" drugs No biological foundation No increased addiction to people who have thc exposure but tolerance increased Rat video: exposure to cannabis will obtain more heroin and work harder but disappeared with increased effors

Substance intoxication:

the reversible dysfunctional effects on thoughts, feelings, and behavior that arise from the use of a psychoactive substance direct effects on judgment, behavior, cognition; reversible dysfunction The case of The Beatles described in the text clearly showed a pattern of reversible dysfunctional effects on thoughts, feelings, and behavior that arise from the use of a psychoactive substance. This is a classic example of:

Dissociation:

the separation of mental processes—such as perception, memory, and self-awareness—that are normally integrated separation of perception - memory - self-awareness (individual mental processes are not disturbed)

Withdrawal:

the set of symptoms that arises when a regular substance user decreases or stops intake of an abused substance requires medical help

Drug cues:

the stimuli associated with drug use that come to elicit conditioned responses through their repeated pairing with use of the drug

Delirium tremens (DTs):

the symptoms of alcohol withdrawal that include uncontrollable shaking, confusion, convulsions, visual hallucinations, and fever

Dopamine reward system:

the system of neurons, primarily in the nucleus accumbens and ventral tegmental area, that relies on dopamine and gives rise to pleasant feelings Classic study by Olds and Milner '54 showed that rats would lever press to death for stimulation of the dopamine reward pathway originating in the ventral tegmental area All stimulants (and alcohol) directly activate this pathway

Worry exposure

treatment for someone who has GAD, First involves evoking a particular worry as vividly as possible and trying to imagine the worst case scenario related to that worry "Imagine wife is dead in a car crash for half hour" this habituates to the anxiety caused by the worry -Once patient has habituated somewhat to the worry, the patient and therapist generate possible rational alternatives to the worst case scenario Cognitive restructuring--other reasons why wide isn't home yet

Sedative-Hypnotics

• Anti-anxiety: Reduce pain, anxiety, relax muscles, lower blood pressure, slow RR & HR, induce sleep drugs are legally prescribed to treat: anxiety, sleep problems, and muscle pains. • Cognitive: Memory problems, confusion, poor concentration, fatigue, respiratory arrest Combined sedative/alcohol => lethal

Brain Systems Involved in Addiction

• Dopamine • GABA • Glutamate • Serotonin Work together to SHIFT REWARD CONTINGENCIES e.g., drugs become more rewarding than food

Nicotine

• Increased alertness • Dizziness • Increased BP • Irritability • increased Carbon monoxide and tar in lungs • Withdrawal = insomnia, anxiety, irritability, decreased concentration behaviors have been rewarded by stimulant in the system

Ritalin

• Methylphenidate hydrochloride used to treat ADHD OVERUSED: - OVER-PRESCRIBED BY PEDIATRICIANS - DESIRED BY PARENTS SO THEIR CHILDREN WILL EXCEL - SHARED BY COLLEGE STUDENTS • Similar to cocaine but slower: abusers swallow, inhale, inject • Can lead to addiction, heart problems, stroke - requires MD monitoring