Exam 3 - Substance-Use Disorders + Eating and Sleep-Wake Disorders

an overview of personality disorders

"Normal" personality vs. personality disorders Cluster A Personality Disorders Cluster B Personality Disorders Cluster C Personality Disorders

2 subtypes of anorexia nervosa

(a) Restricting type (b) Binge-eating/purging type

DSM-5 definition of personality disorder

**"An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment" ->from an early age, the person is having personality conflicts, intra or inter conflicts, something awry consistently ->mostly seen in adolescence, post-puberty

blood alcohol concentration part 3

**1 standard drink = .5 oz of ethanol (~ 15 ml) FOR A 160 LB. INDIVIDUAL, EACH DRINK = .02 BAC% **Body can metabolize about .5 oz (.02 BAC%) per hour •THERE IS NOTHING THAT SPEEDS THIS!

blood alcohol concentration part 2

**1 standard drink = ~ .5 oz of ethanol (almost 15 ml) ->One drink equivalent is the amount of alcohol that the average body metabolizes in 1 hour **Young drinkers also often lack knowledge regarding standard drink servings, particularly for spirits, which can result in over pouring—that is, pouring greater volumes than used for standard drink servings. Over pouring can increase the likelihood of high-volume consumption, rapid intoxication, and risk for certain alcohol-related harms, such as blackouts.

Cluster A: Schizotypal Personality Disorder

**A range of interpersonal problems, marked by extreme discomfort in close relationships, odd (even bizarre) ways of thinking, and behavioral eccentricities •Symptoms may include ideas of reference and/or bodily illusions •Difficulty keeping attention focused; conversation is typically digressive and vague, and sprinkled with loose associations •Socially withdrawn, people with schizotypal personality disorder prefer isolation and have few social supports •Prevalence rate = 2 - 4%; slightly more males than females

anorexia nervosa

**AN Lifetime prevalence = .8% (1.4% females, 0.1% males) **Restriction of calorie intake below energy requirements for age and sex (in BMI terms, which determines severity) **weight and shape being definitely one of the main aspects of self-evaluation

eating disorders: an overview: DSM-5-TR eating disorders

**AN and BN - Severe disruptions in eating behavior - Weight and shape have disproportionate influence on self-concept - Extreme fear and apprehension about gaining weight - Strong sociocultural origins - Westernized views - Emphasize on thinness -variety of biogenetic risk factors **Binge-eating disorders - involves disordered eating behavior but may involve fewer cognitive biases about weight and shape

alcohol statistics

**According to the 2015 National Survey on Drug Use and Health: •86.4% of people ages 18 or older reported that they drank alcohol at some point in their lifetime; •70.1% reported that they drank in the past year; •56.0% reported that they drank in the past month ->40-50% of college students are not drinkers **Overall: •Most adults consider themselves light drinkers •Alcohol use is highest among Euro/White Americans (56.8%) •Males use and abuse alcohol more than females •23% of Americans report binge drinking •Violence is associated with alcohol But alcohol alone does not cause aggression **Major public health concern: 80,000 deaths per yr attributable to alcohol in US in 2020; problem drinking in the US costs an estimated $249 billion per year and is the fourth-leading cause of preventable mortality

neurochemical effects

**Alcohol has both specific and nonspecific effects on neurotransmitters (NT): •GLUTAMATE -- major excitatory NT in CNS. ethanol reduces glutamate activity in brain's memory centers Decreased ability to consolidate memory (i.e., "blackouts") Rebound hyperexcitability caused by up-regulation of NMDA (N-methyl-D-aspartate) receptors (e.g., withdrawal symptoms) •GABA INCREASES - major inhibitory NT agonist on the GABAa receptor in a similar fashion to benzodiazepines (i.e., alcohol increases GABA activity) increases Cl- influx thus increasing neural inhibition. ->symptoms start to go out (lights turn out) •DOPAMINE INCREASES - in brain's"reward centers" Chronic ETOH use produces down regulation of DA receptors = distress and depression when ETOH use stops HOW DOES THIS CHANGE REASONS FOR USE OVER TIME? ->long term alcoholics seem to have withdrawal

physical effects

**Alcohol increases blood circulation to the skin **Increase in loss of body heat (hypothermia) ->hot in bar, try to walk back **Sweat response is suppressed **Heart rate decreases **Stimulation of acid and pepsin in stomach **Reduced release of antidiuretic hormone = increased urination = dehydration ->bad things happen at downside of alcohol curve ->depressing effects of alcohol start to occur

what is alcohol?

**Alcohol is a solvent characterized by a hydroxyl group (-OH) **Ethyl alcohol is the only form that can be safely consumed. **It is produced by fermentation: the interaction of yeast with sugar **The type of sugar determines the type of beverage: •Grapes = ? •Grain = ? •Rice = ? **Types 1. methyl alcohol 2. ethyl alcohol 3. isopropyl alcohol -> figured out that the people who died at resorts in rooms with booze they had been spike with methyl alcohol -> causes cardiac failure ->cheap alcohol name in bottle

alcohol metabolism

**Alcohol molecules are hydrophilic and lipophilic **ABSORPTION: •Small amounts are absorbed in the mouth •Most absorbed in the small intestine -> SI ideal place for alcohol **Alcohol metabolism is a two step process. •Alcohol travels to the liver via capillaries in small intestine and portal vein (1) The enzyme alcohol dehydrogenase (ADH) converts ethanol to acetaldehyde. ->some genetics with coding for this (2) Aldehyde dehydrogenase (ALDH) breaks down acetaldehyde into acetic acid and water ->humans gifted with large amounts of ethanol ->have more of these enzymes than any other mammal **Women have less alcohol dehydrogenase •Women become more intoxicated than men on equal doses

alcohol metabolism

**Alcohol molecules are hydrophilic and lipophilic ->goes through cell membranes, SI, **ABSORPTION: •Small amounts are absorbed in the mouth •Most absorbed in the small intestine Alcohol metabolism is a two step process. •Alcohol travels to the liver via capillaries in small intestine and portal vein (1) The enzyme alcohol dehydrogenase (ADH) converts ethanol to acetaldehyde. (2) Aldehyde dehydrogenase (ALDH) breaks down acetaldehyde into acetic acid and water Women have less alcohol dehydrogenase •Women become more intoxicated than men on equal doses

substance use disorders etiology and treatment

**Alcohol use disorders are not a result of any individual weakness or moral failing, but arise from a complex interaction of individual, social, cultural, and biological factors **Developmentally, alcohol use rapidly increases during adolescence, peaking in the early-mid 20s, and then gradually decreasing over the course of adulthood •AUDs show roughly a similar pattern •Need to address the developmental processes that can help explain this strong, age-graded phenomenon •Processes responsible for desistence are important for understanding the population prevalence and persistence ->people who can only use it a little and be fine, not abstaining, just do it a little

countries that have moved to prescription format

**Another option, more common in other countries (Canada, UK, Spain, Portugal, Netherlands): •Prescription heroin - associated with steep drops in street heroin use •Randomized controlled trial pub'd in New England Journal of Medicine (2009) - 67% reduction in use in prescription heroin group vs 47% in methadone group

treatment of antisocial personality

**Antisocial behavior is predictive of poor prognosis for any treatment approach •Few seek treatment on their own •Emphasis is placed on prevention and rehabilitation **Some emerging evidence to suggest that CBT approaches may be useful •Direct, focused, goal-directed, less insight-oriented

breaking down opioid use

**As a result, the pills were often diverted: •To teens rummaging through parents' medicine cabinets •Family members •Friends •....black market: gets harder to claim pain in an ER **Roughly 21-29% of patients prescribed opioids for chronic pain misuse them ->Between 8-12% develop an opioid use disorder

binge-eating disorder

**BED Lifetime prevalence = 1.3% (1.5% for females, 0.3% for males) **For BN, BED, & PD, provide Severity ratings

prevalence of bulimia nervosa

**BN Lifetime prevalence = 0.28% (0.46% for females, 0.08% for males) - Most within 10% of normal weight

prevalence of self-reported obesity among US adults by state and territory

**BRFSS Methodological Changes Started in 2011 -New sampling frame that included both landline and cell phone households. -New weighting methodology used to provide a closer match between the sample and the population **Exclusion Criteria Used Beginning with 2011 BRFSS Data -Records with the following were excluded: -Height: <3 feet or ≥8 feet -Weight: <50 pounds or ≥650 pounds -BMI: <12 kg/m2 or ≥100 kg/m2 -Pregnant women

drinking episodes defined

**Binge Drinking - 5 or more drinks per occasion for men, 4 for women, on at least 1 day in the past 30 days •pattern of drinking that brings blood alcohol concentrations (BAC) > 0.08 ->multi-hour period of time -> likely to put you in impaired state **Heavy Episodic Drinking = binge drinking on 5+ days in past month **High Intensity Drinking = drinking at levels far beyond binge threshold •2 or more times the gender-specific binge drinking thresholds (i.e., 10 or more standard drinks for men, and 8 or more for women). **Binge drinking is strikingly prevalent in the United States •66.7 million (24.9%) Americans age 12 or older report binge drinking in the past month (National Survey on Drug Use and Health, NSDUH, 2016)

binge drinking episodes common age groups

**Binge drinking is most common among younger adults aged 18-34 years, but more than half of the total binge drinks are consumed by those aged 35 and older.5 **Binge drinking is twice as common among men than among women. Four in five total binge drinks are consumed by men.

etiology of eating disorders: body dissatisfaction

**Body dissatisfaction, desire for thinness, binge eating, and weight preoccupation all heritable ->adoption studies needed

alcohol in modern societies part 2

**By late 1990's alcohol use started to steadily increase •New products to initiate nondrinkers •Enhanced alcohol marketing •Increases in female drinking (skyrocketed in 1990s, theories suggest that women entered worse while entering the workplace, more stress, more likely to be coping response, ways to hide drinking) •Cocktails in a can •2020: Dog Brew "You'll never drink alone again" •Pandemic shifts? -getting alcohol from around world -dec in our age -women continuing -some people stopped altogether

alcohol's effect on the body

**CENTRAL NERVOUS SYSTEM: 1 dk/hr = BAC .02: little change **2 dk/hr = BAC .05: drinker "buzzed", judgment center of brain affected, inhibitions lowered **3 dk/hr= BAC .10: judgment very poor, muscle coordination depressed, staggered gait, slurred speech **10 dk/hr = BAC .20: severe impairment, emotions erratic, poor memory **Hurray you're 21! •21 drinks = 315 ml ethanol/hr = BAC .35 - .40: coma, brain center which controls heart & lungs partially anesthetized •How common? Rutledge et al. (2008): 12% of both male and female 21st birthday drinkers reported consuming exactly 21 drinks an additional 22% of male birthday drinkers and 12% of female birthday drinkers reported consuming more than 21 drinks 35% of female and 49% of male birthday drinkers had BACs of 0.26 or higher (a level associated with potential serious medical outcomes)

treatment of substance use disorder: alcohol use disorders

**CLINICAL PRESENTATION •Among disorders w/ lowest treatment prevalence Only 20-25% who have mod-sev AUD receive treatment Treatment often sought very late in the disorder's emergence ->often when treatment is delivered, it is the wrong one (usually meds and psychotherapy) **Factors impacting treatment uptake Stigma about patients with AUDs - such as? ->weak-willed, morally responsible, personal or family problem vs public health, embarrassment, social standing, humiliation, clinicians possess same stigma Clinicians not well-trained in screening for AUDs/SUDs Little formal links between medical presentation , screening, and connection to treatment providers May explain proliferation of private, for-profit 'rehab centers'

Cluster A: Schizoid Personality Disorder

**Characterized by persistent avoidance of social relationships and limited emotional expression •Highly self-focused; often regarded as aloof, cold, humorless •The disorder is estimated to affect fewer than 1% of the population Slightly more likely to occur in men

bulimia nervosa

**Compensatory behaviors: self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise **4 uncontrollable binge eating episodes per month with compensatory episodes **weight and shape being one of the main aspects of self-evaluation

contraindications

**Contraindications: •Acetaminophen (e.g. Tylenol) Alcohol use increases certain liver enzymes that convert acetaminophen into a toxic substance - NO DRINKING IF YOU'VE TAKEN TYLENOL!! **Delirium tremens (DTs) •Can occur when blood alcohol levels drop suddenly •Withdrawal from alcohol leads to long periods of hyperexcitability ->tachycardia:v high risk for heart attack and stroke ->put alc on board biochemical w/out being real alcohol •Seizures can also occur, with peak seizure risk 8-12 hrs after last drink ->racing heart, anxious, GI upset, no sleep ->If untreated: -seizures •Results in: Deliriousness Tremulousness Hallucinations (know who and where they are) Primarily visual; may be tactile ->happens when stop drinking cold turkey

opiod facts

**Deaths from drug overdoses soared to more than 107,000 for 2020-2021, according to provisional data from CDC - a staggering record that reflects the pandemic's toll on efforts to quell the crisis and the continued spread of the synthetic opioid fentanyl in the illegal narcotic supply **However, 87% of people with opioid use disorder (OUD) do not receive evidence-based treatments -Utilization of medications for OUD (MOUD), esp. buprenorphine, has risen across most states over past decade, but cannot keep pace with use -> Before we can treat your problem, you need to be free of the problem -> Shortage of medications

definition for adults

**Definition of Obesity and Overweight in Adults •BMI under 18.5: Underweight •BMI 18.5 - < 25: Healthy weight •BMI 25 - < 30: Overweight •BMI 30 or higher: Obese **Obesity is frequently subdivided into categories: •Class 1: BMI of 30 to < 35 •Class 2: BMI of 35 to < 40 •Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as "extreme" or "severe" obesity.

5 main categories of substances

**Depressants •Behavioral sedation (e.g., alcohol, sedative, anxiolytic drugs) **Stimulants •Increase alertness and elevate mood (e.g., cocaine, nicotine) **Opiates •Produce analgesia and euphoria (e.g., heroin, morphine, codeine) (things shut down in every sensory modality) ->opioid epidemic **Hallucinogens •Alter sensory perception (e.g., marijuana, ketamine, LSD) **Other drugs of abuse •Include inhalants, anabolic steroids, OTC medications

neurobiological systems

**Different patterns of neurocircuitry / anatomy across three phases of addiction. - Each of these phases entails neuroadaptive changes in specific brain networks, which might progress over the course of the disorder: 1.Binge/Intoxication -esp dopamine & endorphins ->describes people that are new to the drug, people that do not have a lot of experience ->drinking to cope with endorphins 2.Withdrawal/Negative Affect -dopamine depletion and stress hormones ->drinking b/c you don't like the way it feels w/out alcohol ->entire neurochemical/brain structures being activated ->not doing to have fun, doing to asuage brain chemicals 3.Preoccupation/Craving -glutamate; executive fcng alterations ->person now in phase where its almost like OCD ->thinking about drug, ways to obtain it, cravings

Cluster B: Borderline Personality Disorder

**Display significant instability, including major shifts in mood (anger at core), an unstable self-image, unstable interpersonal relationships, and impulsivity **Good overview of the disorder (interviews with clients and well-known clinical researchers)

shift from low ethanol drinks to distilled spirits

**Distilled alcohol is recent -- became widespread in China in the 13th century and in Europe from the 16th-18th centuries ->running through machines with coils **Example: Early Greeks watered down their wine; drinking it full-strength was, they believed, barbaric—a recipe for chaos and violence •Fallen grapes that have fermented on the ground are about 3% alcohol by volume. •Beer and wine run about 5 and 11 % •Modern liquor is 40-50% alcohol (most people did not use to consume these v often)

opioids: an overview

**Effects of opioids •Activate body's enkephalins and endorphins •Low doses induce euphoria, drowsiness, and slowed breathing •High doses can result in death •Withdrawal symptoms can be lasting and severe **Mortality rates are high for opioid addicts •High risk for HIV infection due to shared needles See how this recently impacted a small Indiana community

effects of opioids

**Effects of opioids •Activate body's enkephalins and endorphins •Low doses induce euphoria, drowsiness, and slowed breathing •High doses can result in death •Withdrawal symptoms can be lasting and severe ->sweating, things come out of every oraface (massive diarrhea, water coming out of eyes, nose, mouth, can lead to fatal dehydration) ->tolerance develops rapidly because these substances mimic enkephalins and endorphins this drug just does it better and for longer than your own body ->feel like floating on warm salt water ->not always easy to sleep, but will feel sleepy **Mortality rates are high for opioid addicts •High risk for HIV infection due to shared needles Movie: train spotting

how much sleep is enough?

**Eight hours is often quoted, but the optimum sleeping time varies between people and at different times of life **7-9 hours for adults, and 8-10 hours for teenagers •Younger children require much more, with newborn babies needing up to 17 hours each day (not always aligned with the parental sleep cycle!)

Causes of Substance-Related Disorders: Social and Cultural Dimensions

**Exposure to drugs is prerequisite for use of drugs •Media, family, peers •Parents and the family appear critical Consistent finding: more alcohol supply by parents à higher rates of adol. drinking, negative consequences, and AUD symptoms •Influences how people use substances as well as how people think about substance users Permissiveness Expectations of reward/punishment **Additional Risk Factors: •STRESS, especially within family; economic stress •Higher rates of substance problems correlated with greater experiences of stress due to racial discrimination, gender and/or sexual minority stress (Rose et al., 2018; Slater et al., 2017)

Portugal decriminalization of ALL drugs

**Faced with a massive crisis associated with illicit drug addiction, Portugal de-criminalized ALL drugs in 2001 •Results aren't perfect, but huge reductions in HIV and drug-related crime ->supervised by medical staff, use as step to get people into vocational trainings

Cluster B: Antisocial Personality Disorder (ASPD)

**Failure to comply with social norms **Violation of the rights of others **Irresponsible, impulsive, reckless **Chronic lying and deceitfulness **Evidence of Conduct Disorder before age 15 •e.g., truancy, running away, cruelty to animals or people, destroying property

alcohol: fermentation process

**Fermentation process - yeast consumes glucose which produces 2 byproducts •2 byproducts of glucose metabolism = CO2 and ethanol •200 quintillion ethanol molecules (very small, right through blood-brain barrier, right through sample) in .5 oz ethanol **Typical fermentation produces a maximum alcohol content of around 15% **To get a higher alcohol content one has to "distill" the alcohol from the water •Distilled alcohol became widespread in China in 13th century and in Europe from 16th-18th centuries

Hx: Gobleki Tepe in eastern Turkey - dates back to about 10,000 BCE

**For the past 25 years, archaeologists have been working to uncover the ruins of Göbekli Tepe, a temple in eastern Turkey. **Dates to about 10,000 B.C.—making it about twice as old as Stonehenge. It is made of enormous slabs of rock that would have required hundreds of people to haul from a nearby quarry. As far as archaeologists can tell, no one lived there. No one farmed there. **What people did there was party. - images of festivals and dancing, remains of brewing vats abound **The promise of food and drink would have lured hunter-gatherers from all directions, in numbers great enough to move gigantic pillars. Once built, both the temple and the revels it was home to would have lent organizers authority, and participants a sense of community **Over time, groups that drank together would have cohered and flourished, dominating smaller groups—much like the ones that prayed together. Moments of slightly buzzed creativity and subsequent innovation might have given them further advantage still. In the end, the theory goes, the drunk tribes beat the sober ones.

what mediates genetic risk for AUD?

**Genetic differences in alcohol metabolism •Alcohol dehydrogenase (ADH) and mitochondrial form of aldehyde dehydrogenase (ALDH2) are liver enzymes •ALDH2 gene has two primary alleles: ALDH2*1 and ALDH2*2 Carriers of ALDH2*2 allele have impaired alcohol metabolism If they drink alcohol, acetaldehyde accumulates, leading to the emergence of flushing, headache, sweating, tachycardia, nausea, and vomiting (which serve to protect against AUD) This polymorphism is carried by ~40% of East Asians individuals but is rare in European people •Polymorphisms in ADH genes (eg, ADH1B*2) protect against alcohol use disorders •In 2019, the largest genome-wide association meta-analysis of AUD risk found 10 risk loci - POLYGENIC transmission-> NOT sure how all these things go together

etiology of eating disorders: family and twin studies

**Heritability rates: Genetic factors account for 50-75% risk for AN; BN: 54-84%; BED: 39-57% (independent of obesity) **First degree relatives of individuals with both disorders more likely to have the disorder **Higher MZ concordance rates for both AN and BN

heroin

**Heroin (diacetylmorphine) is processed from morphine -> Heroin is available medically in some limited circumstances, particularly in Europe and Canada. **Originally synthesized by English chemist C.R. Alder Wright in 1874 -Heinrich Dreser at Bayer Labs continued to test heroin -Bayer marketed it as an analgesic and cough suppressant in 1898; when its addictive potential was recognized Bayer ceased production in 1913

alcohol

**How much is too much? Is alcohol actually that bad? •The answer: depends not only on how much you drink, but on how and where and with whom you do it **Bigger question: ->Why do we drink in the first place? -Part of the answer is "Because it is fun." Drinking releases endorphins, not just a depressant, its a stimulant, sedative, and dissociative experiences for some -most consistently as time progresses, alcohol is a depressant ->Another part of the answer is "Because we can" Natural selection has endowed humans with the ability to drink most other mammals under the table While many species have enzymes that break alcohol down and allow the body to excrete it (avoiding death by poisoning), about 10 million years ago a genetic mutation left our ancestors with a souped-up enzyme that increased alcohol metabolism 40-fold (alcohol is a poison) ->Historians also suggest that alcohol fostered social connection -alcohol is sometimes center piece of people's social connectedness

quality of sleep importance

**However, quality of sleep matters, as does SWS v REM. •Some people may survive on less sleep because they sleep well •But below seven hours / night: compelling evidence for negative impacts on health **Too much sleep is also bad, but few people appear to be afflicted by this problem

global prevalence of obesity

**In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese. **39% of adults aged 18 years and over were overweight in 2016, and 13% were obese **Most of the world's population live in countries where overweight and obesity kills more people than underweight. **40 million children under the age of 5 were overweight or obese in 2020. **Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.

acute behavioral effects of alcohol traced to "inhibitory" properties

**Inhibition of frontal lobe: •Loss of behavioral inhibition, loss of planning, loss of impulse control = increased aggression, increased use, poor judgment. **Inhibition of amygdala: •Fearlessness/Loss of anxiety **Euphoria: •Dopamine release in ventral tegmental area of nucleus accumbens (reward areas) ->go out and do things, be with people **Analgesia: •Inhibition of motor areas: slowed reaction time, poor coordination, decreased sexual performance **Learning/memory disrupted: -Attention, encoding, short-term memory become inhibited -Reduced ability to retrieve info from long term memory (e.g., knowing where one lives)

classification criteria for threshold and subthreshold eating disorders: OSFED

**Other Specified Feeding and Eating Disorders (OSFED): Subthreshold levels of 3 eating disorders + Purging Disorder + Night Eating Syndrome -Girls with both threshold and subthreshold eating disorders show significantly greater functional impairment, emotional distress, suicidality, unhealthy body weights, and mental health services utilization compared to those without eating disorders - Adolescent girls with threshold vs. subthreshold eating disorders do not significantly differ on these impairment indices - 30% of adol girls with subthreshold ED's subsequently develop threshold eating disorders

the opioid crisis: the second wave: heroin and fentanyl made the crisis worse

**Over time, especially as prescription opioids became more scarce, opioid users began moving towards more potent opioid derivatives •Approx. 4-6% of people who misuse prescription opioids transition to heroin •About 80% of people who use heroin first misused prescription opioids **Increased heroin supply and decreased painkiller supply •Prescription opioid painkiller deaths have leveled off (more associated with suicide risk) while fentanyl (especially) and synthetic opioid deaths have increased

the "pilgrims" and Plymouth Rock

**It may sound difficult to believe, but this fractured history lesson — prompted by those aboard the Mayflower who recorded their experiences — is rooted in truth. With the beer supply running low, the Mayflower captain decided to land at Plymouth Rock (rather than sailing further south) and winter there. That would cut off the supply to the passengers and leave more for the crew. Beer, it seems, is America's founding beverage. So much so that one passenger, William Bradford, complained that he and other passengers "were hastened ashore and made to drink water, that the seamen might have the more beer." And even though the pilgrims discovered clean streams ashore, they were suspicious of the New World liquid and not altogether fond of its taste. As one colonist was quick to write, "I dare not prefere it before good beere" **Turns out, to those aboard the Mayflower, beer had become an essential part of daily life. Even the children drank beer, although it was probably a weaker version of what we experience as beer today. "Ship's beer" as it was known, did not have high alcohol content. Neither did the even weaker "small beer," of which passengers drank a quart per day. **The brews weren't necessarily crafted with an eye toward imbibing alcohol - they were actually a workaround to storing water on board the ship. Stored for long periods of time, a ship's water would become a contaminated, germy affair. Beer, on the other hand, could be stored and ingested for weeks and months without ill effect, making it the ideal beverage for a lengthy journey — as long as there was enough to go around

shift to drinking distilled spirits alone

**Just as people were learning to love their gin and whiskey, more of them started drinking outside of family meals and social gatherings ->whiskey cheaper than milk) **In US, industrial revolution saw large-scale population shifts from rural to urban settings •Cheap liquor easy to obtain (esp. whiskey, rum) •Jobs were scarce, people were lonely, stress was high & drunkenness became epidemic **During this time, alcohol use became less leisurely •Drinking establishments started to feature long counters (a "bar"), enabling people to drink on the go, rather than around a table with other drinkers •Dramatic break from tradition: in nearly every era and society, solitary drinking almost unheard‑of among humans according to anthropologists ->young people drinking into oblivion in 1840, no comraderie, stress, young boys from country ->drinking on your own among others

long-term effects of alcohol

**Malnutrition •Calories from alcohol lack nutrients •Alcohol interferes with digestion and absorption of vitamins from food **Deficiency of B-complex vitamins •Amnestic syndromes Severe loss of memory for both long and short term information (Wernicke-Korsakoff Syndrome)-disruption in brain's ability to create long-term memories; only short-term; permanent ->people with this syndrome drink 30-40 drinks per day w/out remission **Cirrhosis of the liver •Liver cells engorged with fat and protein impeding functioning •Cells die triggering scar tissue which obstructs blood flow •Liver disease and cirrhosis rank 12th in US causes of death. ->seeing huge increase in cirrhotic livers in young adults (25-40 y/o) **Damage to endocrine glands and pancreas **Heart failure **Erectile dysfunction **Hypertension **Stroke **Capillary hemorrhages •Facial swelling and redness, especially in nose and face ->faces seem flushed, red veins in cheeks and nose ->big bags under eyes **Destruction of brain cells ->less than previously thought, but some loss in memory areas

treatments for OUD

**Medication-Assisted Treatment (MAT) ->Using other drugs to combat opioid cravings ->methadone clinics ->most effective **methadone, buprenorphine, naltrexone (table on slide 17)

monitoring the future for last 50 years

**Monitoring the Future is an annual drug use survey of eighth, 10th and 12th grade students conducted by researchers at the University of Michigan, Ann Arbor, and funded by the National Institute on Drug Abuse. **Trends in Use ->Among 12th graders, binge drinking peaked in 1981 along with overall illicit drug use. The prevalence of binge drinking then declined substantially from 41% in 1983 to 28% in 1992, a drop of almost one third (also the low point of any illicit drug use).

4 stages of sleep

**NREM Stage 1 **NREM Stage 2 **NREM Stage 3 then REM

prevalence of self-reported obesity among US adults by state and territory BRFS 2011

**No state or territory had a prevalence of obesity less than 20%. **The District of Columbia had a prevalence of obesity between 20% and <25%. **8 states had a prevalence of obesity between 25% and <30%. **22 states and Guam had a prevalence of obesity between 30% and <35%. **17 states (Alabama, Arkansas, Indiana, Iowa, Kansas, Louisiana, Mississippi, Missouri, Nebraska, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee and Texas ), Puerto Rico and Virgin Islands had a prevalence of obesity between 35% and <40%. **2 states (Kentucky and West Virginia) had a prevalence of obesity of 40% or greater.

obesity affects some groups more than others

**Non-Hispanic Black adults (49.9%) had the highest age-adjusted prevalence of obesity, followed by Hispanic adults (45.6%), non-Hispanic White adults (41.4%) and non-Hispanic Asian adults (16.1%)

obesity prevalence in 2021 by education and age

**Obesity prevalence decreased by level of education •Adults without a high school degree or equivalent had the highest self-reported obesity (37.8%), followed by adults with some college (35.6%) or high school graduates (35.5%), and then college graduates (26.3%). **Young adults were half as likely to have obesity as middle-aged adults •Adults aged 18-24 years had the lowest self-reported obesity (20.7%) compared to adults aged 45-54 years who had the highest prevalence (39.3%)

prevalence of self-reported obesity among US adults

**Obesity: BMI of 30 or higher ->BMI: a measure of an adult's weight in relation to height-calculated by using the adult's weight in kg divided by the square of his or her height in meters **BMI is a screening tool, not a diagnostic tool -does not measure body fat directly, research has show BMI is moderately correlated with more direct measures of body fat -no gender or age distinctions **in children, BMI is gender and age specific, so BMI-for-age is used b/c the amount of body fat changes with age and the amount of body fat differes between girls and bouys

what is usually the only viable alternative to treatment for ASPD?

**Often incarceration is the only viable alternative •May need to focus on practical (or selfish) consequences (e.g., 'if you rob someone, you'll have to serve time') **kid with bee sting in ER

REM periods

**every 90 - 120 minutes •First REM period is shortest •Most REM occurs late

therapy for paranoid personality disorder

**Patients with this disorder do not typically see themselves as needing help •As a result, therapy for this disorder, as for most of the other personality disorders, has limited impact and moves slowly ->mostly referrals from criminal justice, family, etc.

Substance Use Disorders in DSM-5-TR

**Pattern of substance use leading to significant impairment and distress **Symptoms (need 2+ within a year): •Taking more of the substance than intended •Desire to cut down use •Excessive time spent using/acquiring/recovering •Craving for the substance •Role disruption (e.g., can't perform at work) •Interpersonal problems •Reduction of important activities •Use in physically hazardous situations (e.g., driving) •Keep using despite causing physical or psychological problems •Tolerance/Withdrawal **Also provide severity rating based on # of symptoms

cluster A: "odd" personality disorders

**People with these disorders display behaviors similar to, but not as extensive as, schizophrenia •Behaviors include extreme suspiciousness, social withdrawal, and peculiar ways of thinking and perceiving things •Such behaviors leave the person isolated •Some researchers believe that these disorders are actually related to schizophrenia, and thus label them "schizophrenia-spectrum disorders"

alcohol in modern societies

**Per capita alcohol use hit a modern peak in early 80's - response? •Change in drinking age •More alcohol taxes •Warning labels •Increased DUI penalties •Alcohol use dropped by 20% ->prohibition ->right side of graph

hangovers

**Possible causes: •Acetaldehyde buildup •Gastric irritation •Rebound drop in blood sugar •Dehydration •Toxic effects of congeners (whatever added to distilled spirit to change it from clear to dark)->some people could be sensitive to specific congeners. **Possible cures: •There are no scientifically verified cures other than rehydration and rest

etiology of eating disorders: possible linkages on chromosomes

**Possible linkages on chromosomes 1, 4, 11, 13, 15 **Recent GWAS studies have not replicated candidate gene studies **Identified risk associated with abnormalities on chr. 12

pharmacological vulnerability

**Premise: Genetically based individual differences in alcohol effects are related to risk for developing Alcohol Use Disorders (AUDs) Those with a family history of AUDs show less sensitivity to the effects of a given dose of alcohol Schuckit and colleagues (Schuckit & Smith, 2001) have demonstrated that low sensitivity predicts alcohol use disorders prospectively in young adulthood. Some of their data... ->BAC less with family hx of alcoholism, less subjective intoxication, less body sway -> these people are going to drink more b/c they have to to acheive the same desired effect ->none of participants currently dx with AUD

prevalence of BPD

**Prevalence = 1.5% - 2.5% •~75% of those diagnosed are women -High comorbidity with PTSD, MDD, substance-related disorders, eating disorders, and schizotypal p.d.

specific treatments for substance use disorders: alcohol use disorders

**Research using both clinical and non-treatment-seeking samples has shown that the majority of individuals who develop AUD reduce or resolve their problem over time ->guided self-change, getting arrested, over course of year people will show reduction in alc use •The pathways to improvement are heterogeneous, may occur with or without participation in treatment or mutual help groups, and involve improved functioning and well-being with or without reductions in drinking (Witkiewitz et al. 2020) **Important to make an informed decision and avoid the "1-size-fits-all" approach •Abstinence may be valued is not a requirement Studies support adoption of a more flexible definition of recovery that focuses on improvements in areas of functioning adversely affected by drinking and enhanced access to non-drinking rewards **Important to make an informed decision and avoid the "1-size-fits-all" approach •Abstinence may be valued is not a requirement Studies support adoption of a more flexible definition of recovery that focuses on improvements in areas of functioning adversely affected by drinking and enhanced access to non-drinking rewards **NIAAA Treatment Navigator website •Basic premise: different patients with different patterns of AUD will need different treatments •Guides patients, providers to evidence-based treatments that match specific client backgrounds / needs Includes tele health and online options ->good for patients and providers ->telehealth equally as effective

schizotypal personality disorder is like schizophrenia

**Similar underlying risk factors as schizophrenia •Share similar genetic/biological risk markers e.g., dysregulated dopamine activity

the importance of sleep

**Sleep deprivation affects all aspects of daily functioning - energy, mood, memory, concentration, attention **Sleep loss may bring on feelings of depression in non-depressed individuals •Paradoxically, can have antidepressant effects in depressed individuals

etiology of eating disorders: the dual pathway model

**Stice & Van Ryzin (2019): Data from a community sample of 496 adolescent girls who completed annual diagnostic interviews over an 8-year follow-up -showed good evidence to support dual pathway model

why is slow-wave sleep important?

**Strong evidence that deep sleep is important for the consolidation of memories, with recent experiences being transferred to long-term storage. **This doesn't happen indiscriminately though - a clear-out of the less relevant experiences of the preceding day also appears to take place. A 2017 study revealed synapses shrink during sleep, resulting in the weakest connections being pruned away and those experiences forgotten

toxic environment: risk factors for eating disorders

**THESIS: WE LIVE IN A TOXIC ENVIRONMENT THAT ENCOURAGES OVEREATING AND DISCOURAGES EXERCISE •Remarkable increases in portion sizes •Widespread access to pre-packaged, calorie dense foods anytime, anywhere Marketplace processes and corporate profiteering Co-opts evolutionary-based preferences for calorie-dense, high-fat foods •Declines in physical activity, especially among children •When combined with a vulnerability for overweight, obesity more likely **HOWEVER, SOCIETAL ATTITUDES STRONGLY BIASED AGAINST OVERWEIGHT & OBESITY •PEOPLE WILL GO TO GREAT & OFTEN UNHEALTHY LENGTHS TO STAY THIN ->EATING DISORDERS BECOME MORE COMMON

consequences of weight stigma

**evidence suggests that weight stigma can trigger physiological and behavioral changes that lead to increased weight gain **in lab experiments, when participants are manipulated to experience weight stigma: -eating increases -self-regulation decreases -cortisol

perspectives on substance-related disorders

**The nature of substance use disorders •Wide-ranging physiological, psychological, and behavioral effects -psych factors (craving) -behaviorally (what you are willing to get into) •Associated with impairment and significant costs ->distress can be a precursor, so the biggest issue tends to be functional impairment **Some important terms and distinctions

global prevalence

**The past 12-months prevalence of AUDs varied by WHO region (Figure 4.10), with the prevalence of AUDs being the highest in the European Region (66.2 million people aged 15+ years, representing 8.8% of the population of that age group) and in the Region of the Americas (63.3 million, representing 8.2% of the population aged 15 years and older), and the prevalence of AUDs being the lowest in the Eastern Mediterranean Region (3.4 million, representing 0.8% of the population aged 15 years and older). **Alcohol dependence (the most severe form of AUD) occurred in 2.6% of people of aged 15+ years in 2016; it was most prevalent in the Region of the Americas (4.1%) and the European Region (3.7%), and least prevalent in the Eastern Mediterranean Region (0.4%).

blood alcohol content

**The rate of absorption, distribution, and clearance of alcohol are affected by many factors so behavioral effects are described based upon Blood Alcohol Content (B.A.C.) •B.A.C. = # milligrams ETOH per 100 milliliters of blood **In general, measurable behavioral effects begin to occur at a B.A.C. of 0.04% -when we start seeing psychological changes (slightly buzzed) ->assuming there is nothing in your stomach ->anything fatty and full of protein, but don't overdo alcohol first

therapy for schizotypal personality disorder

**Therapy is challenging (as is true of all Cluster A disorders) •Most therapists agree on the need to help clients "reconnect" and recognize the limits of their thinking and powers

the sociocultural perspective

**There is a "Culture of the Ideal Body": A body that is desirable, attractive, attainable, infinitely malleable, and associated with success **Effects of 'pro-ana' websites, 'thinspiration'/'thigh-gap' Instagram posts? **Dieting, especially among young women, has become more prevalent •Often precedes onset of eating disorders **If the body ideal is unrealistic or is rigidly enforced, self-perceived investment in and/or failure to achieve this body will result in a continuum of problems ranging from body dissatisfaction to full clinical syndromes. -> from distress to eating disorder

toxic environment: risk factors for eating disorders part 2

**There is significant stigma related to overweight and obesity - this has long been known: •Classic study from late 1950s:, 10-11 year-olds were shown 6 images of children and asked to rank them in the order of which child they 'liked best' - the 6 images included a 'normal' weight child, an 'obese' child, a child in a wheelchair, one with crutches and a leg brace, one with a missing hand, and another with a facial disfigurement. Across six samples of varying social, economic, and racial/ethnic backgrounds from across the United States, the child with obesity was ranked last **Weight stigma: •the social rejection and devaluation of those who do not comply with prevailing social norms of adequate body weight and shape •Highly prevalent in US and spreading globally; women report higher stigma •Stigma reported across multiple sectors: employment, education, media, relationships

Cluster A: Paranoid Personality Disorder

**This disorder is characterized by deep distrust and suspicion of others •As a result of their mistrust, people with paranoid personality disorder often remain cold and distant •Critical of weakness and fault in others

shift to drinking distilled spirits alone part 2

**This trend helps us understand this finding: people who drink lightly or moderately are happier and psychologically healthier than those who abstain •Dunbar (2022): those who regularly visit pubs are happier than those who don't not because they drink, but because they have more friends -alcohol is secondary in this situation •it's typically the pub-going that leads to more friends, rather than the other way around **ITALY: Despite high alcohol consumption, Italy has low rate of alcoholism •Italians drink mostly wine and beer, almost exclusively over meals with other people •When liquor is consumed, it's usually in small quantities, either right before or after a meal •Alcohol is seen as a food, not a drug Drinking to get drunk is discouraged, as is drinking alone; helps limit its harms

what happened that led to some increases in obesity?

**We eat out now more than ever •In 2015, for the first time ever, Americans spent more on going out to eat than on groceries •We eat 20-40% more calories eating away from home than eating home •PANDEMIC CHANGES **More sugary drinks •esp. "energy" drinks **Increased portion sizes:

blue light

**We have photoreceptors in the eye that only respond to changes in light and dark, which are used exclusively to regulate circadian rhythms •Melanopsin receptors; not specialized for visual functioning •Sensitive to wavelengths in the 484-500 nm (blue light) •They work even in the blind •Tells us about how the environment is changing (light to dark) •Computers, phone screens, e-readers, TV •Our circadian systems interpret these as daylight and our sleep is postponed •Research: those assigned to read an ebook before bed released less melatonin and were less sleepy; less alert the next AM

toxic environment: risk factors for eating disorders part 3

**Weight stigma: •Evidence suggests that weight stigma can trigger physiological and behavioral changes that lead to increased weight gain •In lab experiments, when participants are manipulated to experience weight stigma: their eating increases self-regulation decreases, and cortisol (an obesogenic hormone) levels are higher relative to controls, particularly among those who are or perceive themselves to be overweight.

what is personality?

**a unique and long-term pattern of inner experience and outward behavior

Note:

**all of these terms overlap ->cannot keep changing dx, so now one term: substance use disorder

obesity

**considered a symptom of some eating disorders but not a disorder in and off itself

the sleep cycle

**cyclic nature of sleep is reliable

etiology of eating disorders: the dual pathway model AN

**different variables will change **AN: maybe person started with low BMI and there is psychosocial impairment

when does most deep sleep occur?

**early in the cycle •80% of sleep is this slow-wave sleep (SWS)

etiology of eating disorders: genetics

**family and twin studies support genetic link **body dissatisfaction, desire for thinness, binge eating, and weight preoccupation all heritable

defining binge drinking episodes

**in chart **Ireland - 6 or more drinks **US - 5 or more drinks

long-term consequences of weight stigma

**more weight stigma, more likely to show later obesity

prevalence of APSD

**most common pathway is biogenetic ->set of genes that codes for lack of empathy and fear **Prevalence = 2% - 3.5% • 4 times more common in men than women • Higher rates of alcoholism and substance-related disorders - externalizing and antagonistic personality traits

Evidentiary bases for sociocultural perspective: mass media

**role of social media **Western society not only glorifies thinness but also creates a climate of prejudice against excess weight

toxic environment: risk factors for eating disorders part 4

**significant stigma to overweight and obesity ->10-11 y/o shown 6 children and asked to rank which one they like the best ->child with obesity ranked last ->leading to weight stigma

FDA/EMA - Approved Medication Treatments for AUD

**slide 15 ->bias against giving another substance to someone with a substance-use disorder

'Second-Wave' Medication Treatments for AUD

**slide 16

difference b/w BN and AN binge-purging type

**substantially below weight in AN but NOT in BN **person goes to EXTREME lengths to lose weight and keep it off in AN

weight stigma

**the social rejection and devaluation of those who do not comply with social norms of body weight and size **highly prevalent in the US and spreading globally; women report higher stigma **stigma reported across multiple sectors: employment, etc.

Beer Street/GinLane, Hogarth, 1751 painting

**two prints issued in 1751 by English artist William Hogarth in support of what would become the Gin Act. Designed to be viewed alongside each other, they depict the evils of the consumption of gin as a contrast to the merits of drinking beer. **On the simplest level, Hogarth portrays the inhabitants of Beer Street as happy and healthy, nourished by the native English ale, and those who live in Gin Lane as destroyed by their addiction to the foreign spirit of gin; but, as with so many of Hogarth's works, closer inspection uncovers other targets of his satire, and reveals that the poverty of Gin Lane and the prosperity of Beer Street are more intimately connected than they at first appear. Gin Lane shows shocking scenes of infanticide, starvation, madness, decay and suicide, while Beer Street depicts industry, health, bonhomie and thriving commerce. ->England's enemy was France, ban on exporting alcohol -75% ethanol, easy to make ->government propaganda ->if people drink too much distilled spirits, really terrible things would happen

why is our food environment toxic?

**we eat out now more than ever **more sugary drinks ->diet drinks send signals to brain for you to eat sweet stuff **increased portion sizes

prevalence of personality disorders

1 in 10 adults in the US

role of alcohol in Western Societies

1)Shift from low ethanol drinks to distilled spirits 2)Shift from drinking as social bonding to drinking alone ->even puritans thought alc was a gift from God ->centerpiece of births, marriage, raise a toast, someone died, someone sick

Americans consume more opioids than any other country.

- CDC: enough opioids prescribed in 2015 to medicate every American around the clock for 3 weeks ->every 4-6 hours

defining features of insomnia

-Approx. 6-10% prevalence rate; 25% in elderly -30% of adults report insomnia symptoms -Often associated with medical and/or psychological conditions -75-90% of pts. w/ insomnia have medical conditions, such as illnesses causing hypoxemia and dyspnea, gastroesophageal reflux disease, pain conditions, and neurodegenerative diseases -40% of pts. w/ insomnia have comorbid psychological disorders (esp. depression) -Affects females twice as often as males

more treatment of alcohol use disorders

-Effective treatments are available -Focused treatments more effective than unstructured conversations -MOST EFFECTIVE: motivational enhancement therapy, community reinforcement approach, guided self-change, behavior contracting, social skills training, some pharmacological interventions

binge-eating disorder: extreme

-Extreme: an average of 14 or more episodes of inappropriate compensatory behaviors per week

binge-eating disorder mild

-Mild: an average of 1-3 episodes of inappropriate compensatory behaviors per week

binge-eating disorder moderate

-Moderate: an average of 4-7 episodes of inappropriate compensatory behaviors per week

binge-eating disorder severe

-Severe: an average of 8-13 episodes of inappropriate compensatory behaviors per week

associated features of insomnia

-Unrealistic expectations about sleep -Believe lack of sleep will be more disruptive than it usually is

NREM Stage 2

-body temp drops -hr slows -brain begins to produce sleep spindles -approx 20 minutes

REM

-brain becomes more active -body becomes relaxed and immobilized -dreams occur -eyes move rapidly

NREM Stage 3

-muscles relax -bp and breathing rate drop -deepest sleep occurs

NREM Stage 1

-transition period b/w wakefulness and sleep -around 10-15

prevalence of paranoid personality disorder

0.5 - 3%; more men than women

3 waves of the rise in opioid overdose deaths

1. rise in prescription opioid overdose deaths 2. rise in heroin overdose deaths 3. rise in synthetic opioid overdose deaths **-The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999

how are personality disorders organized in DSM-5?

10 specific personality disorders organized into 3 clusters

the opioid crisis: the second wave

2. rise in heroin overdose deaths **The second wave began in 2010, with rapid increases in overdose deaths involving heroin -- New cheap heroin supply flooded the US in 2000's in response to opioid demand. ->powerful, even easier to digest, readily available, cheaper **new population with opioids

the opioid crisis: the third wave

3. rise in synthetic opioid overdose deaths **-- The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl -Fentanyl dispersion continues to change; found in combination with heroin, counterfeit pills, cocaine

parasomnias

Abnormal behavioral and physiological events during sleep

parasomnia examples

Abnormal behavioral and physiological events during sleep Non-Rapid Eye Movement Sleep Arousal Disorder Nightmare Disorder Non-Rapid Eye Movement Sleep Behavior Disorder Restless Legs Syndrome Substance/Medication Induced Sleep Disorder **if occur in REM sleep, probs remember weird things

how much sleep is enough for adults and older adults?

Adults (26-64): 7-9 hours each day. Older adults (65+): 7-8 hours each day.

Cluster B: "Dramatic" Personality Disorders

Antisocial personality disorder Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder

substance use disorders (overall) in DSM-5-TR

DSM-5-TR has separate disorders for: •Substance intoxication from the different types of substances (e.g., alcohol, stimulants) •Substance use disorders for the different types of substances •Withdrawal from the different types of substances ->distressing, lead to a lot of functional impairment

more on DBT

Developed by U-Washington clinical psychologist Marsha Linehan (1992): Help clients build a life that they experience as worth living, decrease harmful behaviors and replace them with effective, life-enhancing behaviors. http://behavioraltech.org/resources/whatisdbt.cfm Client and the therapist work together to set meaningful goals using a mix of CBT, exposure therapy, contingency mgmt., and discussions of eastern philosophy (e.g., importance of 'suffering', the role of dialectics)

dyssomnias examples

Difficulties in amount, quality, or timing of sleep Insomnia Disorder Hypersomnolence Disorder Narcolepsy Obstructive Sleep Apnea Hypopnea Central Sleep Apnea Sleep-Related Hypoventilation Circadian Rhythm Sleep-Wake Disorders

dyssomnias

Difficulties in amount, quality, or timing of sleep •Parasomnias

binge-eating/purging type

During last 3 months, individual has engaged in recurrent episodes of binge eating or purging ->motivation is for WEIGHT LOSS (where it differs from BN)

restricting type of anorexia nervosa

During last 3 months, individual has not engaged in recurrent episodes of binge eating or purging; weight loss is accomplished primarily through dieting, fasting and/or excessive exercise

problem example

If an individual weighing 160 lbs. consumes 2 drinks per hour, what will their BAC level be at the end of five hours of drinking? SOLUTION Hour 1: .02 + .02 = .04 - .02 = .02% Hour 2: .02 + .02 = .04 - .02 + .02 = .04% Hour 3: .02 + .02 = .04 - .02 + .04 = .06% Hour 4: .02 + .02 = .04 - .02 + .06 = .08% DUI Hour 5: .02 + .02 = .04 - .02 + .08 = .10%

substance intoxication

Immediate physical reaction to a substance ->not always associated with impairment, substance-specific

how much sleep is enough for infants?

Infants (4-11 months): 12-15 hours each day.

microsleeps

Most last around 3 sec. - the amount of time it takes to drive the length of a football field!

how much sleep is enough for newborns?

Newborns (0-3 months): 14-17 hours each day.

Individuals with which disorder are often afraid that what they do will be inadequate, so they procrastinate and excessively ruminate about important issues and minor details alike?

OCD

how much sleep is enough for preschoolers?

Preschoolers (3-5): 10-13 hours each day.

how much sleep is enough for school-age children?

School age children (6-13): 9-11 hours per day.

how much sleep is enough for teenagers?

Teenagers (14-17): 8-10 hours each day.

other disorders

Substance-Related and Addictive Disorders •Stimulants •Other hallucinogens Gambling Disorder Other Impulse-control disorders

Substance use

Taking moderate amounts of a substance in a way that doesn't interfere with functioning ->not automatically impairing -> will eventually have an impact on functioning

prevalence of DSM-5 Alcohol Use Disorder - US

The authors conducted face-to-face interviews with a representative US noninstitutionalized civilian adult (18 years) sample (N = 36,309) as part of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III).

what types of disorders have schizotypal personality disorders been linked to?

The disorder has also been linked to mood disorders, esp. depression •30%-50% meet criteria for major depressive disorder

what are the consequences of a personality disorder?

The rigid traits of people with personality disorders may lead to psychological pain for the individual and often result in social or occupational difficulties The disorder may also bring pain to others

How is the temporal course of personality disorders best described?

They begin in childhood and continue throughout life

how much sleep is enough for toddlers?

Toddlers (1-2 years): 11-14 hours each day.

Cannabis use more heritable than AUD.

True

global prevalence of opioid use disorder +notes from graphs

US is high ->not high school students to blame **related highly to phentynal that was being added into other kinds of drugs **not a heroin problem, use peaked and then gone down -> issue is heroin being cut with things like phentynal **cocaine being cut with phentynal **men much more than women, american indian, alaskan, black populations, 35-64, black individuals overtaking white individuals in taking over drug-induced deaths **not enough Narcan to go around (shortage even for paramedics and ER) ->intranasally, it will have immediate impact for short-term ->blcosk opioid receptors, brough back for brief period

substance abuse (used to use diagnostically, not anymore)

Use in a way that is dangerous or causes substantial impairment (e.g., affecting job or relationships)

how much sleep is enough for younger adults?

Younger adults (18-25): 7-9 hours each day.

psychopathy

a collection of personality traits characterized in part by shallow emotional responses, lack of empathy, impulsivity, and an increased likelihood for antisocial behavior - 2 dimensions ->not everyone who has this has APSD and vice versa

experiences with weight stigma correlate with ...? of exercise.

avoidance

Kristofer, aged 15, has been using inhalants since age 9 (heavily since age 12), and is experiencing one of the more common outcomes associated with the prolonged use such compounds. Which of the following Kristopher most likely experiencing?

brain damage

factor 1 of psychopathy: interpersonal/affective

callousness/lack of empathy/dont rly care about people getting hurt

schizotypal personality disorder vs schizophrenia

can bring this person back to reality vs a schizophrenic or psychotic who wont believe you ->schizotypal can slip to schizophrenia ->no hallucinations, but some delusional thinking ->schizotypals KNOW that the voice in their head is their own

Joseph, aged 11, is widely regarded as a difficult problem. He seems devoid of empathy and is cruel to his peers and animals, and he has been caught drinking alcohol several times. He is openly defiant of authority and has engaged in theft, assault, and, recently, set a fire at the home of a neighbor who had reported Joseph to the police for vandalism. The juvenile court has ordered that Joseph undergo a psychological evaluation. Given his history, which disorder might Joseph be diagnosed with?

conduct disorder NOT antisocial personality disorder

shifts in substance use over time

early life -> adolescence -> adulthood (look slide) **Motivation shifts from positive to negative reinforcement **Importance of Gene-Environment Interactions re: stress •Polymorphism in PRKG1 gene moderated influence of traumatic life events on alcohol misuse in two independent cohorts •Epigenetic mechanisms (histone mods., DNA methylation) also implicated

the components of personality are described in terms of "traits"

enduring features of personality that are: (a) culturally universal, (b) heritable, (c) linked to specific neurobiological structures and pathways, (d) well-characterized in terms of content and course, and (e) valid for predicting a wide range of life outcomes, and (f) amenable to reliable assessment" (Fowler et al., 2018) •Traits are why we are relatively consistent in who we are and what we do from situation to situation

obesity trends among US adults b/w 1985 and 2021

it keeps getting worse

factor 2 of psychopathy: chronic antisocial lifestyle

need for stimulation/criminal/hurting other people

Alayna acknowledges that she drinks alcohol in order to feel less anxious and depressed and, in fact, looks forward to using alcohol because doing so gives her a break from these very distressing and uncomfortable feelings. In this way, psychoactive substances act as which of these for Alayna?

negative reinforcer -> taking away the anxiety and depression leads to reinforcement of behavior

Data regarding cannabis tolerance suggest which of the following

neither tolerance or reverse tolerance occur

opioids and opioid use disorder

new section

DSM 5 Hypersomnolence Disorder

picture

The brain's pleasure pathway, which has been implicated in the development and maintenance of substance use disorders, is made up of neurons that are responsive to which neurotransmitter?

serotonin

blood alcohol curve

shows impact of different kinds of ethanol -> light blue line: 4 drinks

FINISH SLEEP NOTES

start at slide 16!

What are the most commonly used psychoactive substances used in the United States?

stimulants

Personality is also flexible, allowing us to adapt to new environments, but for people with personality disorders...?

that flexibility is usually missing

can psychopathy be related to APSD?

yes

cannabis use disorder prevalence

•12-month prev. rate = 2.54%; lifetime = 6.27% (Hasin et al., 2016) •A common assumption about the risk for CUD among users is that it is rare, based on findings from 25 years ago that few cannabis users developed CUD (Anthony et al, 1994; Joy et al, 2017) •However, Hasin et al. (2016) found that 19.5% of lifetime cannabis users met criteria for DSM-5 CUD, of whom 23% were symptomatically severe (⩾6 criteria) Of these, 48% were not functioning in any major role (e.g., work, school) •Thus, CUD in users is not rare and can be serious

Just a few hours of sleep deprivation decreases immune functioning:

•2017 review of 28 existing studies found that permanent night-shift workers were 29% more likely to develop obesity or become overweight than rotating shift workers. •Findings based on more than 2 million individuals found that working night shifts raised the risk of a heart attack or stroke by 41%

dreaming

•Accounts for 20% of our sleeping time •Length of dreams can vary from a few seconds to closer to an hour. •Dreams tend to last longer as the night progresses and most are quickly or immediately forgotten. •During REM sleep, the brain is highly active, while the body's muscles are paralyzed and heart rate increases, and breathing can become erratic.

Dreaming is also thought to play some role in learning and memory:

•After new experiences we tend to dream more •But it doesn't seem crucial either: case of a 33-year-old man who had little or no REM sleep due to a shrapnel injury in his brainstem -- no significant memory problems

prevalence of self-reported obesity among US adults: overall as of March 2020

•Among adults aged 20 and over, the age-adjusted prevalence of obesity was 41.9% and the age-adjusted prevalence of severe obesity was 9.2% •Among children and adolescents aged 2-19 years, the prevalence of obesity was 19.7%

treatment options for BPD

•Antidepressant medications provide short-term relief • •Dialectical behavior therapy (DBT) most promising and effective treatment

cluster b personality disorders - dramatic, emotional, erratic cluster

•Antisocial, borderline, histrionic, narcissistic

linehan's diathesis-stress model of BPD etiology

•Because a fear of abandonment tortures so many people with the disorder, theorists look to early parental relationships - Parental separation, verbal and emotional abuse during childhood •Linehan's Diathesis-Stress Theory (1992) - Individuals with BPD have difficulty controlling emotions (emo. dysregulation) -- Possible biological diathesis -Family invalidates or discounts emotional experiences & expression - Interaction between extreme emotional reactivity and invalidating family → BPD

cannabis

•Cannabis sativa/indica (marijuana and hemp are two varieties) contains over 450 different chemical compounds 100 different cannabinoids, which interact with the body's own endogenous (internal) cannabinoid system ->they are already in there, they just do it better 2 widely studied: 9-Tetrahydrocannabinol (THC) - technically, a mild hallucinogen, but effects variable Cannabidiol (CBD) THC's analgesic effects modulated by activating CB1 and CB2 receptors In contrast, CBD does not activate CB1 or CB2 - acts at multiple receptor types •While THC is classified as a mild hallucinogen, its effects are quite variable May include euphoria, mood swings, time slowing, paranoia, hallucinations, reduced concentration - all dose dependent

the opioid crisis: the first wave

•Doctors became increasingly aware of the burden of chronic pain •Pharma saw an opportunity and began to heavily market opioids Misled doctors about the safety and efficacy of drugs such as OxyContin (produced by Purdue Pharma; not related to Purdue University!) •The drugs proliferated, making America the world's leader in opioid prescriptions

2 major types of sleep disorders

•Dyssomnias *parasomnias

Chronic sleep problems mostly due to POOR SLEEP HYGIENE like

•Fall asleep faster when we exercise and have regular mealtimes •Schedule changes of any kind disrupt sleep Regular sleep schedules predict higher GPA and better mood

Heroin and meth cut with more potent synthetic opioids

•Fentanyl - 80-100x more potent than morphine •Carfentanil - 10,000x more potent than morphine; 100x more potent than fentanyl

course of BPD varies widely

•In the most common pattern, instability and risk of suicide reach a peak during young adulthood and then gradually wane with advancing age ->heather in 9 highland road

cannabis use disorder

•Is cannabis addictive? If we define addiction as an acquired, chronic, relapsing disorder that is characterized by a powerful motivation to continually use the substance despite persistent negative consequences, then the answer is a clear YES However, the addictive potential for cannabis is lower than for alcohol, cocaine, and tobacco Much of the addictive process involved in cannabis use disorder relates to psychological processes associated with craving as well as physiological processes associated with reward processes (i.e., the dopamine system) •Can you overdose on cannabis? Yes, but it doesn't necessarily mean death Ingesting cannabis can lead to severe and life-threatening health consequences for children ->kids younger than adolescence For adolescents and adults, an overdose looks like a more severe and unpleasant version of cannabis intoxication (e.g., confusion, paranoia, anxiety/panic, fast heart rate, delusions, hallucinations, nausea, vomiting) ->it is pretty difficult to do this these can land people in the ER, or can dangerously interact with preexisting health problems - more often though it just leads to a bad time

substance dependence (used to use diagnostically, not anymore) OR the presence of certain behaviors

•May be defined by tolerance and withdrawal (twin signs) •Sometimes defined by drug-seeking behavior (e.g., spending too much money on substance) ->EX: would be leaving infant alone in cold apartment to drug seek

tolerance

•Needing more of a substance to get the same effect / reduced effects from the same amount ->people dependent constantly chase it throughout lifetime and always come up short of it

cluster c personality disorders - fearful or anxious cluster

•Obsessive-compulsive, avoidant, dependent

facts and statistics of hypersomnolence

•Often associated with medical and/or psychological conditions •Only diagnosed if other conditions don't adequately explain hypersomnia, which should be the primary complaint

dysssomnias: insomnia

•One of the most common sleep disorders •Problems initiating/maintaining sleep e.g., trouble falling asleep, waking during night, waking too early in the morning •35% of adults report daytime sleepiness •Only diagnosed as a sleep disorder if it is not better explained by a different condition (e.g., GAD)

an overview of cannabis

•One of world's most widely used psychoactive substances •Most frequently used psychotropic drug in the U.S. after alcohol Proportion of young adults who reported past-year marijuana use = 43% in 2021, a significant increase from 34% in 2016 Marijuana use in the past month = 29% of young adults in 2021 vs. 21% in 2016 •37 states and DC have enacted medical marijuana legalization, and 19 states and DC have enacted recreational marijuana legalization ->still on par with drugs like methamphetamine and heroine

the nature of opiates and opioids

•Opiate - natural chemical in the opium poppy with narcotic effects •Opioids - natural and synthetic substances with narcotic effects ->adding other natural or manmade chemicals ->where we get morphine, phentynal, heroine •Often referred to as analgesics Analgesic = painkiller

withdrawal

•Physical symptom reaction when substance is discontinued after regular use ->body adjusts itself to present status ->withdrawal effects tend to be opposite of drug effects EX: withdrawal effects from cocaine include depression, big crash

average number of PD dx per pt

•Ranges from 2.8 to 4.6

cluster a personality disorders - odd or eccentric cluster

•Schizotypal, schizoid, paranoid

Hypersomnolence Disorder

•Sleeping too much or excessive sleep May manifest as long nights of sleep or frequent napping •Experience excessive sleepiness as a problem

causes of substance-related disorders: family and genetic influences

•Substance abuse has a notable genetic component Concordance rates of AUD in identical twins = 50% Among fraternal twins, closer to 30% In studies of adopted children, risk for substance-related disorders most closely follows substance use patterns of biological parents Heritability estimates range from 40-64% with no sex diffs

Evidentiary bases for sociocultural perspective: mass media: role of social media

•Survey of 248 adolescent girls (Latzer et al., 2011): higher rates of eating disorders and body dissatisfaction corr. with social network / internet use and time spent watching TV 69% of young girls said that pictures of women that they see in social media influences their views on the ideal body shape and make them want to lose weight (NEDA, 2020)

Survey data reveal that experiences with weight stigma correlate with avoidance of exercise

•The long-term consequences of weight stigma for weight gain have also been found in large longitudinal studies of adults and children: self-reported experiences with weight stigma predict future weight gain and risk of having an 'obese' BMI, independent of baseline BMI **Leads to social pressure to incite weight loss efforts, no matter how drastic

Evidentiary bases for sociocultural perspective: Western society not only glorifies thinness but also creates a climate of prejudice against excess weight

•This prejudice is deeply-rooted **Prospective parents shown pictures of a chubby child and a medium-weight or thin child rated the chubby child as less friendly, energetic, intelligent, and desirable **Preschoolers who were given a choice between a chubby and a thin rag doll chose the thin one, although they could not say why **60% of elementary school girls express concern about their weight/becoming overweight - rates of eating disorders among girls <12 are increasing (NEDA, 2020)

origins and course of personality disorders

•Thought to begin in adolescence/early adulthood •Chronic

"kind" vs. "degree"

•Throughout the history of DSM, Personality Disorders have traditionally been assigned as all-or-nothing categories •Dimensional model: Individuals are rated on the degree to which they exhibit various combinations of personality traits •DSM-5 retained categorical diagnoses but also introduced additional dimensional descriptors of personality disorders ->continuous vs discreet measure ->traits raised on continuum

treatment for schizoid personality disorder

•Treatment: CBT-thinking about emotions and teaching social skills Group therapy can be useful Drug therapy not found to be very beneficial

cannabis withdrawal disorder

•Well-recognized - affects 33% of daily users and 50-95% of heavy users in treatment upon cessation of use begins 1-2 days after cessation, peaks at 2-6 days; remits at 1-2 weeks •Defined in DSM-5-TR as 3 or more of the following: ->anxiety, restlessness ->depression, irritability ->insomnia, odd dreams ->physical symptoms, tremors ->decreased appetite