Abnormal Psych: Chapters 6-9

Dissociative Fugue: subtype of Dissociative Amnesia

"Amnesia on the run" o May flee to somewhere completely different, not have any memory of past life and cant connect to it o Sudden flight from regular life situation o Ends very abruptly o Travel to new location with new identity o Amnesia for personal info

ecstasy

(MDMA; 3,4 methylenedioxymethamphetamine) o Mild euphoria and hallucinations o Designer drug that is similar in structure to amphetamines o Can lead to depression, anxiety, etc

LSD

(lysergic acid diethylamide; synthetic drug) o Synthetic drug that creates differences in colors and hearing and whatnot o Calms some but others may have opposite reaction and panic

Psychosomatic Disorders

(not DSM diagnoses) · Disorders in which psych factors are believed to play a causal or contributing role o Headaches, including migraine o Asthma o Cancer o Cardiovascular disease o AIDS

Malingering

(not a DSM diagnosis) Faking of illness motivated by external rewards or incentives o Ex. Collecting disability to not go to work

Learning theory on Addiction

*Implied that these addictions are learned and can be therefore unlearned

sleep wake disorders

-Insomnia Disorder -Hypersomnolence Disorder -Narcolepsy

· Breathing-related sleep disorders

-Obstructive Sleep Apnea Hypopnea -Central Sleep Apnea -Sleep-Related Hypoventilation -circadian rhythm sleep wake disorder

Somatic Symptom Disorder

-One or more somatic symptoms (bodily sensations/physical) -Excessive thoughts, feelings, or behaviors related to somatic symptoms - Formally known as "hypochondriasis" -Preoccupation with physical complaints

Illness Anxiety Disorder

-Preoccupation with having or acquiring serious disease -Somatic symptoms either not present or mild -High anxiety level, easily alarmed about health -Excessive health related behaviors - Avoidance behaviors -Need to see symptoms for at least 6 months and rule out that it isn't another disorder

culture bound dissociative disorders

-amok= trancelike features -zar= people who show dissociative behaviors that are attributed with folk culture to spirit possession

Cognitive theory and depression

-beck focuses on role of negative or distorted thinking in depression -depression prone people hold negative beliefs about themselves, the environment, and future -cognitive triad of depression leads to specific errors in thinking (or cog distortions) in response to negative events, which in turn lead to depression -learned helplessness model

premenstrual dysphoric disorder

-characterized by clinically significant changes in mood in women during premenstrual period

Persistent depressive disorder (dysthmia)

-chronic forms of major depressive disorders or milder depression -varies in severity, but both are associated with impaired functioning in social and occupational roles

Treatment for Addiction

-detoxification -antidepressants -antabuse -nicotine replacement -metadone -suboxone -naltrexone -naloxone (narcan)

healthy sleep habits

-establish regular sleep wake cycle -limit activities in bed as much as possible to sleeping -get out of bed after 10 to 20 min if you are unable to fall asleep and restore restful state of mind -avoid daytime naps and ruminating in bed -establish daytime exercise schedule -avoid use of caffeine in later afternoon and evening -replace self defeating thoughts with adaptive alternatives

Casual factors in mood disorders: stress and depression

-exposure to life stress associated with increased risk of development and recurrence of mood disorders (especially major depression) -Some ppl more resilient in face of stress bc of psychosocial factors such as social support

Bipolar disorder

-fluctuating mood states that interfere w/ability to function -bipolar I and bipolar II

bio perspectives on substance use disorders and how cocaine affects the brain

-focuses on bio pathways that may explain mechanisms of physiological dependence -bio perspective spawns disease model, which says that alcoholism and substance dependence are disease processes -cocaine blocks reuptake of dopamine by the transmitting neuron, which means that more dopamine remains in synaptic gap

Causal factors in bipolar

-genetics -stressful life experience -best explained in terms of multiple causes acting together within diathesis stress framework -social support important in speedy recovery from mood episodes and reducing risk of recurrences

Treatment for Gambling Disorder

-harm reduction -cog behavioral therapy -medication (works for some) -inpatient, outpatient, group modalities

behavioral approaches to substance abuse

-help client change problem behaviors by using techniques such as self control training, aversive conditioning, and skills training approaches

behavior patterns are sign of drug dependence or addiction

-impaired control over behavioral -withdrawal symptoms such as anxiety or depression upon abrupt cessation of use

Psych perspectives on substance use disorders

-learning theory -cognitive -sociocultural -psychodynamic

Theoretical understanding of somatic symptoms and disorders: hypochondriasis

-linked to OCD (learning theory) -self handicapping strategies and cognitive distortions involving exaggerated perceptions of status of ones health (cognitive)

dissociative amnesia: 5 types of memory problems

-localized -selective -generalized -continuous -systematized

Risk factors in suicide

-mood disorders often lead to suicide -women more likely to attempt, men more likely to succeed/select more lethal means -older adults more likely to commit suicide -people who attempt are often depressed but in touch with reality -Low problem solving skills and see no other way of dealing with life stress than suicide -sense of hopelessness

Psychological factors affecting physical health: headaches

-most common type= tension headache (often stress related) treatment: -behavioral methods (relaxation training and biofeedback help)

predicting suicide

-never ignore threat -people who commit often signal intentions -get people to talk, be sympathetic, suggest coping mechanisms, asl about intentions, accompany to get professional help

Bipolar I

-one or more maniac episodes and by alternating episodes of major depression -maniac episodes -people in maniac episodes tend to exhibit pressured or rapid speech, "flight of ideas", and decreased need for sleep

major depressive disorder

-profound change in mood that impairs ability to function associative features -downcast mood -changes in appetite -difficulty sleeping -reduced sense of pleasure in formerly enjoyable activities -feeling fatigued/loss of energy -sense of worthlessness -excessive or misplaced guilt -difficulties concentrating, thinking clearly, or making decisions -repeated thoughts of death or suicide -suicide attempts -psychotic behaviors (hallucinations and delusions)

theoretical perspectives for dissociative disorders

-psychodynamic -learning and cognitive -social-cognitive

theory perspective on suicide

-psychodynamic model of anger turned inwards, role of alienation (and learning, social cognitive, bio based perspectives)

breathing related sleep disorders

-recurrent episodes of momentary cessation of breathing during sleep and often associated with daytime sleepiness -obstructive sleep hypopnea syndrome (most common)

Psychological factors affecting physical health: cancer

-relationship between stress and risk of cancer remain under study behavioral risks: -unhealthy dietary practices (high fat intake) -heavy alc uses -excessive sun exposure

Treatment of anorexia

-severe cases of anorexia (inpatient setting, refeeding regimen closely monitored) -behavior modification, psychotherapy, family therapy

Causal factors of eating disorders

-socio cultural -emotional -learning -cognitive -family -biological

Biochemical factors and mood disorders: treatment and antidepressant medications

-tricyclics -Monoamine oxidase inhibitors (MAOs) -Selective serotonin reuptake inhibitors (SSRIs) -Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Treatment of somatic symptom and related disorders: psychodynamic therapist

-uncover and bring awareness of underlying unconscious conflicts originating in childhood, believed to be at root of somatic symptom and related disorders -symptoms should disappear after conflicts are addressed and worked thru

culturally sensitive treatment of alcoholism

-use of counselors from persons own ethnic group, providing social support, incorporating culturally specific values and indigenous forms of healing in treatment programs -drawing upon clergy and church members

treatment of sleep wake disorders

-use of these drugs should be time limited bc of potential for psych and/or physical dependence -cognitive behavioral interventions emerged as treatment of choice for people with chronic insomnia -healthy sleep habits

Dhat syndrome

-young asian indian males -involves excessive factors over loss of seminal fluid in nocturnal emissions, in urine or thru masturbation

3 stages to drug dependence

1. experimentation 2. routine use 3. addiction/dependence

Cognitive theory and mood disorders: Burns

Cognitive distortions o Examples § Overgeneralizing § "should" · I should do this or I should do that · Can put pressure on individual § Magnification and minimization · Magnifying negative experiences and minimizing positive experiences

characteristics of DID

Disruption of identity: 2 or more distinct personality states · Recurrent gaps in recall of events, personal info, or traumatic events · Evidence of early and repeated abuse as cause · Clinically significant impairment or distress (Able to make person more aware of other personalities) · Not a normal part of cultural or religious practice · Symptoms not due to use of substance

Treatment of Eating Disorders

Hospitalization, behavioral therapy, cognitive-behavioral therapy, interpersonal therapy

Dissociative amnesia

Inability to recall important auto bio info o Usually of a traumatic or stressful nature, triggered by it o Inconsistent with ordinary forgetting, exhibits inability to recall important info as result of dissociative nature (not medical or physiological base) § More extensive than normal forgetting

Hallucinogen's aka psychedelics

LSD, PCP, Marijuana

dissociative amnesia: 5 types of memory problems- systematized

Loss of memory in certain category (ex. Forgetting about work life)

Theory on Addiction: biological

Neurotransmitter changes o Normally some dopamine would go through to receiving neuron and others would go into reuptake process § With cocaine, it blocks reuptake and stimulates neuron in pathway which leads to high o Over time, brain becomes less good at creating these neurotransmitters on its own Familial patterns suggest genetic influence

Psychological factors affecting physical health: AIDS

Psychologists involved in... -prevention programs to reduce risky behaviors -treatment programs (coping skills training and cog-behavioral therapy)

Psychodynamic theory (Freud): bipolar disorder

Shifting dominance between superego (depression) and ego (mania

Bipolar II Disorder: presence of hypomaniac episode

Symptoms less severe than a full-blown maniac episode, but with duration of 4 consecutive days

Treatment of eating disorders: behavioral therapy

Using behavioral modification to get individual to change their eating patterns

hyponogic hallucination

When falling asleep or in between period

Suicide trends

Women attempt more frequently, men complete more frequently

parasomnias

abnormal behavior patterns associated with partial or incomplete arousals during sleep -include two disorder occurring during non REM sleep (sleep terrors and sleepwalking) -two disorders associated with REM sleep disturbances (REM sleep behavior disorder and nightmare disorder)

narcolepsy

abrupt sleep attacks during waking hours -may involve genetics and loss of brain cells in hypothalamus that produce wakefulness regulating chemical

most widely abused substance

alcohol

Stimulants

amphetamines, cocaine, nicotine, caffeine, ecstasy

treatment of sleep wake disorders: most common

anti anxiety drugs

treatment of compulsive gambling

antidepressant and mood stabilizing drugs and cognitive behavioral therapy, used to correct cognitive biases that may contribute to compulsive gambling -many compulsive

Theoretical understanding of somatic symptoms and disorders: use of medication

antidepressant medication may be helpful in treating some cases of somatic symptoms and related disorder

Biomedical treatment to treating depression and bipolar

antidepressants and other bio treatments (ect) -antidepressants help normalize neurotransmitter functioning in brain -bipolar treated with lithium and anticonvulsant drug

Treatment of mood disorders: psychological, psychodynamic

approaches that are more direct, briefer, and focus more on developing adaptive means of achieving self worth and resolving interpersonal conflicts

learned helplessness model and depression

based on belief that people may become depressed when they come to view themselves as helpless to control the reinforcements in their environment or to change their lives for the better -combo of internal, global, stable attributions for negative events renders person most vunerable

Treatment of substance use disorders

bio approaches -detoxification -use of therapeutic drugs (disulfram, methadone, naltrexone, antidepressants) -nicotine replacement therapy

bipolar disorders

bipolar and cyclothymic disorder -mood swings

narcolepsy symptoms

cataplexy, sleep paralysis, hyponogic hallucinations -symptoms vary on individual -intrusions of REM sleep during transition from wakefulness to sleep

obstructive sleep hypopnea syndrome

caused by respiratory problems interfering with normal breathing

Bipolar II

characterized by occurrence of at least one major depressive episode and one hypo-maniac episode but w/o any fill blown manic episode

maniac episodes in Bipolar I

characterized by sudden elevation or expansion of mood and sense of self importance, feelings of almost boundless energy, hyperactivity and extreme sociability (often takes demanding and overbearing form)

Cyclothymic disorder

chronic pattern of mild mood swings that sometimes progresses to bipolar disorder

treatment of hypochondriasis

cognitive-behavioral: exposure with response prevention and cognitive restructuring

self focusing model

combine psychodynamic and cognitive aspects in explaining depression in terms of self absorption w/lost love objects

koro syndrome

culture bound syndrome found primarily in China and some other Southeast Asian Countries -characterize people who fear that their genitals are shrinking and retracting into their bodies

malingering

deliberate efforts to fake or exaggerate symptoms to reap personal gain or avoid unwanted responsibilities, not considered mental or psych disorder

barbituates

depressants/sedatives that have been used medically for short term relief of anxiety and treatment of epilepsy among other uses -can impair driving ability and also be dangerous in overdose situations, especially when use of barbiturates is combined with alcohol

opioids

derived from opium poppy (Morphine and heroin), others are synthesized -used medically for pain relief -strongly addictive, can result in lethal overdoses

depersonalization/derealization disorder

diagnosed when experiences become persistent or recurrent and cause significant distress or impairment

Psychodynamic theories of bipolar

disorder understood in terms of shifting balances between ego and superego

mood disorders

disturbances in mood that are unusually prolonged or severe and serious enough to impair daily functioning -divided into 2 major types (unipolar and bipolar)

hallucinogens

drugs distorting sensory perceptions and can induce hallucinations -lsd, psilocybin, and mescaline -cannabis and phencyclidine (deliriant that can induce state of mental confusion and delirum) -may not lead to physiological dependence but psych dependence may occur -concerns exist about potential for brain damage that affects learning and memory ability in heavier uses of weed

depressants

drugs that depress or slow down nervous system -alcohol, sedatives, minor tranquilizers, opioids -effects: intoxication, impaired coordination, slurred speech, and impaired intellectual functioning

causes of anorexia and bulimia

eating disorders begin in adolescence and affect more females than males -linked to preoccupations with weight control and maladaptive ways of trying

illness anxiety disorder (iad)

emphasis placed on the anxiety associated with illness rather than distress the symptom causes

Psych perspectives on substance use disorders: sociocultural

emphasize cultural, group, and social factors that underlie drug use patterns, including role of peer pressure in determining adolescent drug use

Relapse prevention

employs cognitive behavioral techniques to help recovering abusers cope with high risk situations and prevent lapses from becoming relapses by interpreting lapses in less damaging ways

Learned helplessness and mood disorders: situational factors...

enhanced attitudes that lead to depression

cocaine blocks reuptake of dopamine by the transmitting neuron, which means that more dopamine remains in synaptic gap creating...

euphoric high by overstimulating receiving neurons in brain networks that regulate feelings of pleasure

hypersomnolence disorder

excessive daytime sleepiness in people who, despite adequate amount of sleep, feel unrefreshed upon awakening and sleepy during day

Learning theory on Addiction: classical conditioning

explains cravings

diathesis stress model

explanatory framework illustrating how bio and psych diatheses may interact with stress in development of mood disorders such as major depression

factitious disorder

fake or manufacture physical or psych symptom, but w/o any apparent motive

Treatment of somatic symptom and related disorders: behavioral

focus on removing underlying sources of reinforcement that may be maintaining abnormal behavior pattern -help ppl learn to handle stressful or anxiety arousing situations more effectively

Psych perspectives on substance use disorders: cognitive

focus on roles of attitudes, beliefs, and expectancies in accounting for substance use and abuse

Treatment of mood disorders: psychological, learning theory

focuses on helping people with depression increases frequency of reinforcement in their lives by means of increasing rates of pleasant activities in which they participate

Coynes Interactional theory of depression

focuses on negative family interactions that can lead the family members of people w/depression to become less reinforcing toward them -behavioral based -social interaction problems influence how other people respond (reciprocal interaction) -depressed people often look for reassurance, people may not want to give it and make things worse

dissociative amnesia: 5 types of memory problems- generalized

forgets everything about entire life, rare

Münchausen syndrome

form of feigned illness in which a person either fakes being ill or makes him or herself ill -factitious disorder imposed on oneself is the most common form and characterizes this disorder

conversion disorder

functional neurological symptom disorder, characterized by symptoms or deficits that affect ability to control voluntary movements or that impair sensory functions

Biological factors in depression

genetics appears to play role in explaining major depression disorder -imbalances in neurotransmitters -diathesis stress model

chronic alc abuse associated with...

health risks including korsakoffs sundrome, cirrhosis of liver, fetal alc syndrome other physical health problems

Treatment of mood disorders: psychological

helping depressed person uncover and work through ambivalent feelings toward lost object, thereby lessening anger directed inward

biofeedback training

helps people gain control over various bodily functions by giving them info about these functions in the form of auditory signals or visual displays

residential approaches to substance abuse

hospitals for substance abuse

stimulants

increase activity of CNS -amphetamines and cocaine are stimulants that increase availability of neurotransmitters in brain -leads to heightened states of arousal and pleasurable feelings -high doses can produce psychotic reactions that mimic features of paranoid schizophrenia -habitual cocaine use can lead to variety of health problems and overdose can cause sudden death -repeated use of nicotine leads to physiological dependence

Bipolar I disorder: maniac episodes can lead to

increased risk of suicide

Treatment for Alcoholism

inpatient programs, relapse prevention, alcoholics anonymous

theoretical perspectives for dissociative disorders: learning and cognitive

involves ways of learning not to think about certain troubling behaviors or thoughts that might lead to feelings of guilt or shame -relief from anxiety negatively reinforces pattern of dissociation

Psychodynamic theories of depression

inward-directed anger and self focusing model -people who hold strongly ambivalent feelings toward people they have lost or whose loss is threatened may direct unresolved anger toward inward representations of these people who they have incorporated or introjected within themselves (producing self loathing and depression)

circadian rhythm sleep wake disorders

irregular sleep wake cycles, occur often as result of frequent shifts in work schedule or travel between time zones that disrupt bodys natural sleep wake cycle

cardiovascular disease (cvd)

leading cause of death in US, heart and artery disease

Learning theory on Addiction: observational learning

learn from watching others

Psych perspectives on substance use disorders: learning theory

learned patterns of behavior with roles for classical and operant conditioning and observational learning

Learning theory and depression

learning theorists explain depression by focusing on situational factors, such as changes in level of reinforcement -when reinforcement is reduced, person may feel unmotivated and depressed, which can occasion inactivity and further reduce opportunities for reinforcement -Coynes Interactional Theory

unipolar disorders

major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder -characterized by downward mood disturbance

Substance use and abuse

major types of substance related disorders in DSM-5 -substance induced (repeated episodes of drug intoxication or development of withdrawal syndrome) -substance use (maladaptive use of substance leading to psychological distress or impaired functioning)

bipolar 1 disorder and mania

mania is not a diagnosis in itself

theoretical perspectives for dissociative disorders: social cognitive

may represent form of role playing

Dissociative identity disorder

multiple personality disorder, most perplexing and intriguing of all psych disorders -grouping of psych disorders characterized by changes or disturbances in function of self (id, memory, consciousness) that make personality whole

REM sleep behavior disorder

nighttime thrashings or vocalizations during REM sleep

gambling disorder

nonchemical addiction in which people experience loss of control over behavior -state of high arousal or pleasurable excitement when behavior is performed -withdrawal symptoms when they stop gambling -frequently have comorbid conditions, especially substance use disorders and mood disorders

somatic symptom disorder (ssd)

not only have troubling physical symptoms but also are excessively concerned about their symptoms to the extent that it affects their thoughts, behaviors, feelings, and behaviors in daily life

Treatment for Alcoholism: alcoholics anonymous

o 12 step program led by peers who are in recovery o everyone is "alcoholic in recovery" no matter how long you've been involved o operate from disease model of alcoholism

Psychodynamic theory (Freud): depression

o Anger turned inward: to an extreme degree that it turns to murderous tendencies toward the self o Role of loss o Self-focusing style

Treatment for Addiction: naloxone (narcan)

o Antidote to opioids o Effective tool in reducing overdose

Illness Anxiety Disorder: avoidance behaviors

o Avoid preventative care or regular care, wont visit those in hospital because of fear they may be getting sick

Cognitive theory and mood disorders: beck

o Believes individuals focus on feelings, not their thoughts (Goal is to shift this) o Cognitive triad of depression § Negative view of... · Self · Environment (full of excessive demands) · Future (viewed with hopelessness)

Treatment for Addiction: naltrexone

o Blocks euphoric effect of alcohol and such o No abuse potential

· PCP or 'angel dust' (phencyclidine)

o Can cause relaxation o Developed in 80s as an anesthetic

· Marijuana (Cannabis sativa plant)

o Can produce sensual distortions o Can be relaxing in small doses, but cause anxiety in higher doses

Dissociative disorders theory: diathesis stress

o Certain personality traits (predisposition) o Experience of extreme stress

cyclothymic disorder

o Chronic pattern of mood swings less severe than those in bipolar disorder (Hypomanic symptoms and depressive symptoms) o Patient must have never met criteria for major depression, mania, or hypomania

Pathways to drug dependence: routine use

o Denial common, problems due to use of substance arise o Person typically isn't willing to acknowledge problems § If they are, stay in phase or quit

Learning theory/behaviorism and mood disorders: treatment

o Develop social and interpersonal skills ( 1st step may not involve any social interaction, but may just ask patient to take a walk outside to increase their mood) o Increase rewarding activities o Behavioral activation

Dissociative disorders theory: brain dysfunction

o Differences in structure, metabolic activity, and sleep o Brain structures in memory and emotion

Persistent Depressive Disorder (Dysthymia): presence of 2 or more symptoms

o Disturbed appetite o Disturbed sleep o Low self esteem o Low energy or fatigue o Poor concentration/decision making o Feelings of hopelessness

Medical complications of anorexia

o Emaciation § Body at very low weight o Amenorrhea § Cessation of menstrual cycle o Anemia § Reduced iron o Low blood pressure o Hypothermia o Bradycardia § Reduced heart rate o Dry, cracked skin, yellow skin o Lanugo § Fine downy hair covering · Body's attempt at keeping itself warm o Enlargement of salivary glands o Elevated suicide risk

Learning theory/behaviorism and mood disorders: Lewinsohn

o Explained reciprocal relationship between social withdrawal and lack of reinforcement (Social withdrawal reduces opportunities for reinforcement) · Reinforcement such as when you see people you like, it is enjoyable (Lack of reinforcement leads to social withdrawal)

Psychodynamic theory (Freud): treatment

o Explore underlying issues and ambivalent feelings toward "lost objects" (Whether there is a real loss of family or something or an interpreted one, they try to understand why it triggered such feelings) o Work through anger (Focuses on how important it is to express emotions) o Interpersonal psychotherapy (IPT)

Dissociative disorders theory: psychodynamic

o Extreme use of repression o Splitting off or blocking from conscious awareness

Medical complications to bulimia nervosa

o Fluid and electrolyte disturbances o Esophageal tears § If they force themselves to puke o Gastric rupture o Cardiac irregularities o GI complications o Mouth/skin irritation o Scars on back of hands o Damage to tooth enamel o Suicide risk elevated

Treatment for Alcoholism: relapse prevention

o Geared toward providing a supportive network, learning how to avoid high risk situation, skills training, identifying cues that may trigger cravings, etc o From behavioral perspective, this would be learning about social stuff

risk factors of alcohol abuse

o Gender § More likely if male o Age § Between 20-40 o Family history § Genetic, modeling o Sociodemographic factors § Seen in greater proportions with lower status, living alone, lack of education o Antisocial personality disorder § Increased risk of alcoholism

Illness Anxiety Disorder: excessive health related behaviors

o Going to doctors, reading about illness/disorders

Treatment for Addiction: nic replacement

o Gum or skin patches

Treatment for Addiction: antidepressants

o Have shown some success in reducing cravings for cocaine, but results vary

Physiological effects of alc abuse

o Heighten activity of inhibitory neurotransmitter GABA, leading to feelings of relaxation

Theoretical Views on Illness anxiety disorders: cognitive theory

o Hypochondriasis as self-handicapping -Misinterpretation of symptoms

treatment under cognitive theory

o Identify, challenge, modify distorted thoughts o Shifts focus from feelings to thoughts

Treatment of eating disorders: hospitalization

o If the person's health is at risk because of the disorder, then this method is utilized to stabilize them

· Cocaine

o Impacts the neurotransmitter dopamine o Repeated use can cause depression and anxiety § Also heart issues because it raises heart rate so much

Substance Use disorder: CHARACTERISTICS

o Impaired control o Social impairment- not being able to meet important responsibilities or roles bc of substance use, may continue to use despite social relationship problems § May lead to them giving up certain social involvement o Risky use § Continued use despite danger or physical/psych hazards made worse with substance § DUIs, work activities when under influence despite increased risk of accidents § Failure to abstain from use of substance when its putting themselves or others at risk o Pharmacological criteria § Tolerance- has to keep using more in order to feel the effects § Withdrawal

Bulimia: Recurrent episodes of binge eating

o In 2 hour time period, larger amount than is typical in most similar circumstances o Binge eating and compensatory behaviors occur, on average, at least once a week for 3 months

Dissociative disorders theory: social cognitive

o In amnesia or fugue, learned response of distancing self from disturbing memories or emotions o DID seen as form of observational learning or role playing (Spanos) § Reinforcement (attention/empathy) may have effect on behavior

· Sleep duration recommendations by age

o Infants= 12-15 hrs o As you age, recommendation of hours decreases o Older Adult= 7-8 hrs

Nicotine

o Legal substance most often in form of smoke/smokeless tobacco o Stimulates release of epinephrine and releases sugar into bloodstream o Can reduce appetite

Caffeine

o Legal substance present in a lot of things such as coffee, energy drinks, etc o Overuse can lead to insomnia, gastrointestinal issues, etc o Withdrawal symptoms are headache, fatigue, and such

Learning theory on Addiction: operant conditioning

o Looking at consequence of substance abuse § Particularly feelings that are produced from drug use o Negative reinforcement is huge through withdrawal

korsakoff syndrome

o Lose long term memories, unusual

Pathways to drug dependence: experimentation

o May lead to routine use, some stop here o Try it, determines it makes them feel good

Treatment for Alcoholism: inpatient programs

o Model based on 28 day inpatient stay o Not required, simply determined on individual basis if they go or not

Treatment in Gambling Disorder: cog behavioral therapy

o Monitor thoughts that may influence gambling and then modify behavior as a result

Theoretical Views on Illness anxiety disorders: brain dysfunction

o Neural connections involvement in conversion disorder o Early investigations- questionable

fetal alc syndrome

o Occurs in children who are born to women who heavily use alcohol during pregnancy o Facial deformities o Intellectual disability

Treatment for Addiction: detoxification

o Often first line of treatment o Process of ridding the individual's system of the substance (s) often under supervision

Causal factors of eating disorders: cognitive

o Perfectionism o Distorted thinking

pathways to drug dependence: dependence

o Powerless regarding substance use

Theoretical Views on Illness anxiety disorders: Psychodynamic theory

o Primary gains: keep internal conflicts repressed o Secondary gains: avoid responsibilities and acquire support

Treatment of eating disorders: interpersonal therapy

o Psychodynamic theory o Contemporary therapy, briefer in duration and focuses on resolution of personal issues and interpersonal/relationship problems, current and past relationships/conflict

REM Stage

o Rapid Eye Movement § Periods get longer as night progresses

Controversy of DID

o Rare o Intentionally produced? Reinforced by practitioners? o Prevalence rates are varied o Culture bound syndrome (north America?)

Treatment of eating disorders: cog behavioral therapy

o Recommended for bulimia o Goal is to identify reasons for disorder and then modify behaviors based on that

Treatment in Gambling Disorder: harm reduction

o Reducing the harm/amount of money that person is risking

Anorexia Nervosa

o Restricting food intake, leading to significantly low body weight (less than minimally normal) o Intense fear of gaining weight and becoming fat, even though at significantly low weight o Disturbance in body image o More prevalent in women, but number of males is growing

Anorexia Nervosa types

o Restricting type- use of dieting, fasting, excessive exercise to lose weight o Binge-eating/purging type- self-induced vomiting or misuse of laxatives, diuretics, or enemas

Bulimia: Recurrent inappropriate compensatory behaviors to prevent weight gain

o Self-induced vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise o Self-evaluation unduly influenced by body shape and weight

Causal factors of eating disorders: socio-cultural

o Social pressure/expectations § Pressure on women to have a particular shape/weight o More prevalent in high income, first world countries

Sleep wake disorder: sleep stages

o Stage 1 § Lightest sleep o Stage 2 § Deeper sleep o Stage 3 § Person begins to become more difficult to arouse o Stage 4 § All prior things § Restorative stage § Decreases as amount of sleep gets longer o After stage 1-4, go back up through 3,2,1 § And once they reach stage 1 again, they are then in REM sleep · Rapid eye movement · Most vivid dreams occur here § Then continues to go back up and down through stages

Treatment for Addiction: antabuse

o Substance developed to help treat alcoholics § Person drinks this and then when they drink alcohol it leads to negative effects and they become violently ill o Problems § Has to be in persons system for it to work, person has to be willing to take it § Person has to agree to it because it is a violent approach

Theoretical Views on Illness anxiety disorders: learning theory

o Symptom § Refinforcing § Facilitate avoidance o Sick role benefits o Link to OCD

Amphetamines

o Synthetic drug o Can be psychotic side effects

Treatment for Addiction: methadone

o Synthetic substance for heroin o Highly addictive but still considered more preferable than heroin § Doesn't produce high and is safer § Can increase level of functioning

Depersonalization

o Temporary loss of change in usual sense of reality o Feeling detached from self and surroundings o Ex. Feeling like you are watching yourself from outside of body

Treatment for Addiction: suboxone

o Type of opioid medication § Blocks effects of opioid o May be legal alternative

psych effects of alc abuse

o Vary from person to person o Interaction of § Physiological effects § Interpretation of effects

Causal factors of eating disorders: learning

o Weight phobia o Role of negative reinforcement

Treatment in Gambling Disorder: inpatient, outpatient, group

o Where and how it is provided depends on individual and resources provided to them

Illness Anxiety Disorder: high anxiety level

o Worried about problems that are less serious than they think

Bulimia: individuals feel out of control

occurs in secrecy

insomnia

pattern of difficulty falling asleep or remaining asleep -associated with worry and anxiety, especially performance anxiety associated with over concern about not getting enough sleep

Nonchemical addictions and other form of compulsive behavior

patterns of compulsive behavior, such as compulsive gambling and shopping, and perhaps even excessive internet use, may represent nonchemical forms of addiction -behavior patterns are sign of drug dependence or addiction

hypochondriasis

people with physical complaints who believed symptoms were due to serious, undetected illness, despite medical reassurance to the contrary

depersonalization/derealization

person experiences persistent or recurrent episodes of depersonalization/derealization of sufficient severity to cause significant distress or impairment in functioning

dissociative amnesia with fugue

person suddenly travels away from home or workplace, shows a loss of memory for his/her past and experiences identity confusion or takes on new identity

psychosomatic disorders

physical disorders in which psych factors believed to play causal or contributing role

Difference between physiological and psychological dependence

physiological= changes in body as result of regular use of substance, such as development of tolerance and withdrawal syndrome psychological= habitual use of substance to meet a psychological need, either with or w/o physiological dependence

bulimia nervosa

preoccupation with weight control and body shape, repeated binges, and regular purging to keep weight down

theoretical perspectives for dissociative disorders: psychodynamic

psych defense by which ego defends itself against troubling memories and unacceptable impulses by blotting them out of consciousness -link between disorder and early childhood trauma

Psychological factors affecting physical health: cardiovascular disease

psych factors increasing risk are... -unhealthy patterns of consumption, leading sedentary lifestyle, and persistent negative emotions

Psychological factors affecting physical health: asthma

psych factors triggering asthma attacks... -stress, anxiety, depression

Theoretical understanding of somatic symptoms and disorders: conversion disorder and psychodynamic theories

psychodynamic: represents the conversion into physical symptoms of leftover emotion or energy cut off from unacceptable or threatening impulses that the ego has prevented from reaching awareness -symptom is functional in sense that it allows person to achieve both primary and secondary gains

dissociative amnesia

psychogenic amnesia, a person becomes unable to recall important personal info, usually involving traumatic or stressful experiences

treatment for dissociative disorders

psychotherapy aimed at achieving reintegration of personality by focusing on helping people with dissociative identity disorder uncover and integrate dissociated painful experiences from childhood

Binge eating disorder

recurrent pattern of binge eating that is not accompanied by compensatory behaviors such as purging -tend to be older than those with anorexia or bulimia and are more likely to be obese -cog behavioral therapy and antidepressants are effective treatment

humanistic theories of depression

reflects lack of meaning and authenticity in persons life

Causal factors of eating disorders: emotional

refocusing emotions on food or body

Theoretical understanding of somatic symptoms and disorders: conversion disorder and learning theorists

reinforcements associated, ex. reinforcing effects of adopting "sick role"

sleep terrors

repeated episodes of sheer terror during sleep

sleepwalking

repeatedly walking about in ones sleep

anorexia nervosa

self starvation and failure to maintain normal body weight, intense fears of becoming overweight and distorted body image

derealization

sense of unreality about the external world involving odd changes in perception of one's surroundings or in passage of time

Causal factors of eating disorders: bio factors

serotonin

Psych perspectives on substance use disorders: psychodynamic

sign of oral fixation -ex. excessive drinking and habitual smoking

causes of anorexia and bulimia other factors

social pressures on young women to adhere to unrealistic standards of thinness, issues of control, underlying psych problems, conflict within family (especially over issues of autonomy)

somatic symptom and related disorders

somatoform disorder, may have physical (somatic) symptoms w/o identifiable physical cause or have excessive concerns about nature of meaning of symptoms

Type A Behavior Pattern

style of behavior characterized by ambitious, hard driving, impatient, and highly competitive

Treatment of mood disorders: psychological, cognitive

therapists focus on helping people identify and connect distorted or dysfunctional thoughts and learn more adaptive behaviors

treatment of bulimia

treated on outpatient basis with evidence supporting therapeutic benefits of cog-behavioral therapy, interpersonal psychotherapy, and antidepressant meds

psychodynamic treatment of substance abuse

uncovering and working thru inner conflicts originating in childhood that may lie at root of substance abuse problems

learned helplessness model and depression: reformulated version

ways in which people explain events (their attributions) determine their proneness toward depression in face of negative events

dissociative identity disorder: some theorists question...

whether DID is a true disorder or rather an elaborate form of role-playing of "multiple personality" that is reinforced by attention and interest from others, including therapist

Major depression and gender influences

women 2x as likely to get than men -greater stress burden -hormonal influences -gender differences in coping styles (rumination vs distraction) -greater influence in women of interpersonal relationships on self esteem -underreporting of depression in men

dissociative amnesia: 5 types of memory problems- selective

§ Able to remember some but not all events taking place in certain period of time

Sleep terrors

§ Abrupt arousal from sleep § Common in children · They wake up with a scream § Occur in lighter stages of sleep § There is usually something going on in the child's life that is particularly stressful, and the sleep terrors are a result

sleep-related hypoventilation

§ Decreased respiration during sleep § Directly related to another medical disorder

Somatic Symptom Disorder: One or more somatic symptoms (bodily sensations/physical)

§ Distressing and result in significant disruption of daily life §Exaggerated/overinterpreted symptoms, causing it to be distressing, not able to be medically defined § High degree

cataplexy

§ Experiences sudden loss of muscle tone, preceded by experience of emotions or humor, triggered by laughter or joking § Awake and aware during episodes

o Selective serotonin reuptake inhibitors (SSRIs)

§ Fewer side effects than other two meds and side effects are less severe · May even remit after people get used to meds

o Serotonin-norepinephrine reuptake inhibitors (SNRIs)

§ Fewer side effects than other two meds and side effects less severe · May even remit after people get used to meds

DID or multiple personality disorder: host and alter state

§ Host- original personality (appears more often) § Alter- other personalities § Each one has specific memories and thoughts, even physiological differences in bodily function (when in personality A, don't remember what happened in personality B) § Each personality is integrated (not the case in schizophrenia, often confused for DID) § Switching personalities happens suddenly and dramatically, sometimes they are aware or host, other times not

Henry Cider: Video

§ Hypochondria § Asthma, cardiac issues, respiratory problems § People in family had more serious illnesses (colon cancer, heart disease, etc) § Worry about health first thing in the morning (vitamins and taking meds) § Seen over 60-70 doctors § Fear of losing functionality or being sick § Ex. Had asthma attack (came on gradually), as a result he had chest pounding/lightheaded and nausea for anxiety but thought it was heart attack and went to ER

tricyclics

§ Increase norepinephrine and serotonin by interfering with the reuptake process § Significant side effects that often make it intolerable for a lot of people to take

dissociative amnesia: 5 types of memory problems- continuous

§ Individual forgets everything from identifiable, distressing time and onward, no end point

o Monoamine oxidase inhibitors (MAOs)

§ Inhibits the action of monoamine oxidase and therefore makes more of neurotransmitters available § Also have some severe side effects and there may be significant interactions with some foods and alcohol

Interpersonal psychotherapy

§ Lasts 9 to 12 months § Primary focus is on current relationships and helping person become more aware of how they are contributing to conflicts (May be discussion of resolution of grief and loss if it applies to the person)

dissociative amnesia: 5 types of memory problems- localized

§ Loses all mems that took place in certain period of time, begins with disturbing event/appearance

sleep paralysis

§ Not able to move when they are in "in between state" of being awake and asleep

Circadian rhythm sleep-wake disorder

§ Persistent disruption of their sleep-wake cycle § Ex. Someone who has to go across time zones often

Somatic Symptom Disorder: Excessive thoughts, feelings, or behaviors related to somatic symptoms

§ Persistent, high anxiety § Excessive time and energy spent

Nightmare disorder

§ Person must experience repeated nightmares § Occur during REM sleep when person is closest to awakeness · So, person is easily woken up

Parasomnias: sleepwalking

§ Repeated episodes of sleepwalking · Individual has blank face · Difficult to wake them § Occurs during deepest stage of sleep · Stage 4 · So person is not aware of their sleep walking and cannot remember it § Needs to be ongoing and repeated episodes of this

central sleep apnea

§ Same symptoms as previous one, but individual needs to experience the symptoms 5 or more times per hour during sleep

Learned helplessness and Seligman Research

§ Would take a dog in a box with two sides (dog was placed on one side of the box and the floor of that side could be electrified, but there was no escape and once they realized that they would just lay down) · Then for the second part of the study, there was an escape route and the dogs who had been through the first part just laid down without looking for an escape route, but the ones who did not participate in the first round just jumped out of the box

Chris video example- alcoholism

· Alcoholism · Started drinking at 12 years old · Peer pressure and sexual abuse resulted in alcoholism behaviors · Ended up drinking to get drunk and ease feelings, other issues he was feeling, frequently blacked out · Had higher tolerance, drank quicker than friends · Never got into trouble besides for personal life o Personal life problems came freshman year o Got in a lot of fights, got kicked out of college and lost scholarship o Left college and started landscaping business, catered to drinking · Coach offered him spot back on hockey team, went back to school but continued drinking · Drank case of beer, during the week 12 pack · Started smoking weed at 17 and then coke problem started at 21-22 o Was spending 1000 a week on cocaine o Mixing drugs and alcohol, coke to keep him up and drink more · Infidelity on wife · Benders without sleep and eating · Broken bones from fights during blackouts · Always chased first drinking high · Bad withdrawal when he stopped o Shaking, not able to sleep o Lockdown unit · Prevalent in family

Factitious Disorder (Self)

· Also called Munchausen Syndrome · Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception · Presents self as ill, impaired, or injured o Create problem and then seek attention or fake disorder · Deceptive behavior evident in absence of obvious external rewards o Motivation: being in patient role, desire to be connected with medicine and these fictious situations · Often very knowledgeable about medicine and disorders

Seasonal Affective Disorder (MDD with seasonal pattern)

· Applies to recurrent MDD · Full remission occurs at a characteristic time of the year (depression begins in fall and remits in spring) · In last 2 years, 2 episodes have occurred seasonally · More common in northeast · Associated with reduction in sunlight

Suicide help

· Ask about ideation, plan, and intent o Clinician must make sure person is able to keep themselves safe · How to help o Non judgmental listening o companioning

Dissociative disorders

· Characterized by disruption or dissociation of identity, memory, consciousness · Dissociative Identity Disorder, Dissociative Amnesia, Depersonalization/Derealization Disorder

Depersonalization/Derealization Disorder

· Characterized by persistent or recurrent episodes of depersonalization (own reality, internal) and/or derealization (external world) · Not abnormal if it is infrequent and transient · No damage in memory

U.S Deaths Attributed each year to cigarette smoking

· Claims lives of 450k Americans annually, mostly from lung cancer, heart disease, and chronic obstructive pulmonary disease

Major categories: drugs of abuse

· Depressants o Slow activity of CNS · Stimulants o Increase activity of CNS · Hallucinogens o Cause hallucinations

Heroin

· Developed in 1875 as replacement for morphine · Narcotic Derived from morphine · Highly addictive · Very powerful depressant o Initial high= 5 to 15 minutes o Can last for several hours after · Most widely used opiate

Substance Induced Disorders: Substance intoxication

· Disorder as result of substance used · Development of a reversible syndrome due to a recent ingestion of substance · Clinically significant problematic behaviors or psych changes · Symptoms specific to particular substance used o Impaired judgement o Affect on CNS o Disturbances of perception, wakefulness, attention, motor behavior o Short term intoxication looks different than long term

Learning theory/behaviorism and mood disorders

· Emphasize environment and situational influences · Role of reinforcement · Lewinsohn · Coyne Interactional Theory

Sociocultural theory on addiction

· Environment o That they grew up or are currently in · Norms · Culture o Can either promote or discourage use · Peer pressure

MDD with Peripartum Onset/Postpartum Depression

· Episode (s) have onset during or after pregnancy (peripartum; postpartum is after delivery only) · Estimated 3-6% of women · With or without psychotic features

DID Example Video

· Has 53 personalities · Tony the imposter, DD · Can't control it · Change can be cough, head hurts, lighting bothers him · Illness came younger · Exaggerated ability to focus · Biological differences in evoked electrical potentials in EEGS · Differences in galvanic skin response, ocular and hearing ability (Evidence of bodily changes with personalities) Goal: integrate host with alters

opioids: narcotics for pain relief

· Highly addictive · Naturally occurring (morphine, heroin, codeine) and synthetic (Demerol, Darvon) · Neural receptor sites o Lock and key Endorphins

Pre-menstrual Dysphoric Disorder

· In a majority of menstrual cycles, at least 5 symptoms present in week prior to menses with improvement within a few days of onset and minimal/absent in week post menses

Mania symptoms in bipolar 1

· Inflated self-esteem/grandiosity (Presenting oneself as perfect or invincible) · Pressured speech (Feel the need to get the words out) · Decreased need for sleep · Racing thoughts · Easily distracted · Increase in goal related activity · Excessive involvement in activities that have a high potential for painful consequences

DID Treatment

· Integrate alter personalities into cohesive personality structure · Uncover and reprocess memories of early trauma · Dissociative Amnesia and Fugue: typically end abruptly

Alcohol Heavy Use: Physical effects

· Liver disease (alcoholic hepatitis and cirrhosis) · Increased risk of cancer · Coronary heart disease · Neurological disorders (Korsakoff's syndrome) · Fetal Alcohol Syndrome*

Humanistic Theory and Mood disorders

· Mood disorders are seen as arising from a lack of meaning in an individual's life · Absence of self-fulfillment · Reduction in self esteem

Bipolar disorders treatment

· Mood stabilizing medications o Lithium § Reduces maniac components of bipolar disorder § Has many side effects o Tegretol and Depakote

Biochemical factors and mood disorders

· Neurotransmitters o Serotonin and norepinephrine o Depression is not across the board caused by reduction in neurotransmitters · Reduced metabolic activity in prefrontal cortex · Structural brain abnormalities

Gambling Disorder

· Non chemical addiction · New diagnosis in DSM 5 · Persistent and recurrent maladaptive gambling behavior that disrupts personal, family, and/or vocational pursuits

culture bound dissociative syndromes

· Not DSM Diagnoses · Common forms of superstition patterns · Rare or unknown in other cultures, not seen as abnormal in culture it is present in · Example: AMOK; Southeast Asian and Pacific Island Cultures o Trancelike state, highly excitable, violent attacks o No memory of episode

Conversion Disorder (Functional Neurological Symptom Disorder)

· One or more symptoms of altered sensory or voluntary motor function · Incompatibility between symptom and recognized conditions · Causes distress and or impairment · Not explained by another mental disorder · Symptoms viewed as transference or conversion of emotion distress, leads to motor or sensory domains (Arise suddenly and in light of traumatic event)

Electroconvulsive Therapy (ECT)

· Only for when the individual has severe depression and is not responding to any medication or treatment o Can also be used when person is in immediate danger of hurting themselves and there is not a lot of time to go through all of the other treatments · A 70-100 volt current is run through the person's brain and causes a seizure/convulsion and resets the electroactivity in the brain

Psychodynamic Theory for Addiction

· Oral fixation and Dependent personality o Substance abuse is seen as someone being stuck in oral fixation stage

Factitious Disorder (Imposed on other)

· Parent making child or older relative/disabled child get injured to seek medical help · Called Munchausen by Proxy · Falsification of physical or psychological signs or symptoms, or induction of injury or disease in another, associated with identified deception · Presents victim as ill, impaired, or injured · Deceptive behavior evident in absence of obvious external rewards · Crime, child/elder abuse · No anxiety or worry about symptoms, creation of symptoms is diff from hypochondria disorder · Motivation: to be caretaker, involved with patient care/medical attention

Substance Use disorder

· Pathological pattern pf behaviors related to use of substance · Underlying changes in brain circuits that may persist after detoxication

Substance Induced Disorder: Substance Withdrawal

· Pattern of repeated episodes of intoxication · Withdrawal syndrome o Dependence developed § Used so frequently that they feel need to continue substance, if they stop experience characteristic grouping of symptoms o Sudden reduction or cessation of used o Experience characteristic grouping of symptoms § Example: delirium tremens § Physiological effects, depends on substance · Significant impairment and distress

Treatment of Illness Anxiety Disorder

· Psychodynamic: bring unresolved conflicts into conscious awareness and work throughàsymptom no longer needed · Behavioral: remove secondary gains · Cognitive-Behavior o Cog restructuring o Exposure with response prevention

Bulimia Nervosa

· Recurrent episodes of binge eating · Recurrent inappropriate compensatory behaviors to prevent weight gain · Individuals feel very out of control

Cognitive Theory for Addiction

· Role of expectancies o What an individual believes will happen to them if they ingest substance o Drugs may increase self-efficacy

Depressant: Barbiturates

· Sedative drugs (amobarbital, phenobarbital, secobarbital) · Also sleep medications (hypnotics) and antianxiety medications (anxiolytics) · High potential for addiction

Suicide stats

· Stats differ bc suicide is so underreported o 10th leading cause of death in USA o 2nd leading cause of death among college students · Estimate o One death due to suicide every 17 minutes

genetics and mood disorders

· The closer the genetic relationship, the greater the chance of developing depression o Ex. If one twin is monozygotic twin pairing develops depression, the other twin has a greater chance of developing depression than parents do · Gene environment interactions

Mood disorders

· Unusually severe or prolonged disturbances of mood o Continuum § Severe mania, hypomania (mild to moderate), normal/balanced mood, depression (mild or moderate), severe depression § Looks at intensity § Dysthymic- lower/sad mood than typical of individual § Euthymia- higher/happier mood than typical of individual

Morphine

· Used during civil war, soldiers developed physiological dependence on morphine · Narcotic drug: relieves pain and induces feelings of well being · Restricted drug · Highly addictive

Everett Major Depression Video

· Wife and 3 kids, 6 grandchildren · Had major depression since age 2 · 3rd grade- wrote suicide note o Father called him foolish · Felt alone, worthlessness, no hope in future, believe everything is dissolving (relationships), feel stuck/never going to change · Not diagnosed until age 48 · Misused pills and alcohol · Wasn't functioning in work or social life · Hospitalized against will o 6 and ½ months

Mali: Sleep Disorder-Narcolepsy

· Worked east coast hours on west coast, busy career · Anytime someone would say something funny o She would fall/collapse, cataplexy Diagnosis o Narcolepsy with symptoms of cataplexy o Relief and made sense to her, textbook case with symptoms Symptoms o Cataplexy § Alert state, can still hear everything and repeat it back when you wake up § Unique to narcolepsy o Sleep paralysis § Conscious and awake yet muscles are still paralyzed § Hand in hand with hallucinations o Hypnogogic hallucination o Sleepiness § Could not wake out the door without taking a nap § Anytime you relax/sedentary leads to you to falling asleep

Dissociative disorders: patients dont have

· arousal symptoms, neg emotions, sleep disorders associated with trauma disorders o Don't experience anxiety regarding symptoms

Dissociative disorders: triggered by

· traumatic events, differ from trauma disorders o Dissociative symptoms intense and extensive, disruptive o Symptoms are main or only symptoms ppl experience