UCSB PSY 103 Final Exam

eating disorder NOS: definiton

(not otherwise specified): disorders that do not fit either category

types of involuntary commitment: 5150 Hold, 5250 Hold, and conservatorship

*5150 Hold*: 72-hour Treatment and evaluation, instituted by county-designated "5150- certifed" personnel: police officer, registered nurse, medical doctor, in a facility or on a mobile mental health crisis team. Patient is discharged from 5150 hold early if treating psychiatrist finds no grounds for continuance. Patient is discharged automatically if not approved for additional hold. *5250 Hold*: 14-day additional hold for intensive treatment related to a mental disorder or alcoholism when the patient is: (1) a danger to self or others, or is gravely disabled, and (2) treatment is required but the patient has refused. This hold is certified by two professionals, patient's representative is notified, and hold is subject to prompt judicial review. If the patient's status remains unchanged, additional 14-day "post-certification holds" can be amended for a total period not to exceed 180 days; each is subject to review for necessity. Any failure of certification results in prompt discharge of patient. *conservatorship*: the patient who is "gravely disabled as a result of a mental disorder or impairment by chronic alcoholism" may be placed in the hands of a conservator temporarily (30 day "T-Con") or long-term ("LPS Conversatorship," renewable indefinitely at 1-year periods). The conservator is responsible to the appointing court for a comprehensive living and treatment plan for patient.

DSM-IV classical schizophrenia subtypes and problems with subtypes: disorganized, catatonic, undifferentiated, paranoid, residual

*Disorganized*: (Hebephrenic. characterized by disorganized behavior and speech and includes disturbance in emotional expression. Hallucinations and delusions are less pronounced with disorganized schizophrenia) *Catatonic*: (involve disturbances in a person's movement. Affected people may exhibit a dramatic reduction in activity, to the point that voluntary movement stops, as in catatonic stupor.) *Undifferentiated*: (when a person exhibits behaviors which fit into two or more of the other types of schizophrenia, including symptoms such as delusions, hallucinations, disorganized speech or behavior, catatonic behavior.) *Paranoid*: (auditory hallucinations (hearing voices) and paranoid delusions (believing everyone is out to cause the sufferer harm)) *Residual*: (characterized by a previous diagnoses of schizophrenia, but no longer having any of the prominent psychotic symptoms. There are some remaining symptoms of the disorder however, such as eccentric behavior, emotional blunting, illogical thinking, or social withdrawal.) -*problem with subtypes*: Individuals can change subtypes over time Subtypes may instead reflect course and intensity of illness Treatment not specific to subtype

Prohibited conduct: sexual violence, sexual harrassment, other prohibited behavior

*Sexual Violence*: -Sexual Assault - Penetration or genital contact/ Unwanted non-genital touching -Dating and domestic violence -Stalking *Sexual Harrassment*: Unwelcome advances or sexual requests, or conduct indicating: -that performance on the job or in class is dependent upon sexual favors. -The existence of a "hostile work environment" that is intimidating or offensive. *Other Prohibited Behavior*: -Invasions of Sexual Privacy (Voyeurism, making/publishing audios/videos w/o consent, sexual blackmail with photos, etc. -Sexual intercourse with a person under the age of 18. -Exposing genitals in a public place for sexual gratification. -Retaliation for report of prior Prohibited Conduct

acute stress disorder and PTSD: definition, symptoms, risk factors, treatment.

*acute stress disorder*: If symptoms of stress disorder last for less than a month. *PTSD*: If symptoms of stress disorder last for over a month. *Symptoms*: nearly identical in both. Symptoms include re-experiencing the traumatic event (recurring dreams/nightmares/thoughts/memories, flashbacks), avoidance (avoid activities that remind them of event), reduced responsiveness (feel detached from others or lose interest in activities; some experience dissociation, which entails daziness, forgetting, or derealization), and increase arousal, negative emotions, and guilt (may feel hyperalertness, be easily startled, have trouble concentrating or may have sleep problems. May display anxiety, anger, or depression or may show guilt for surviving) *Risk Factors*: Can occur at any age. Women are at least 2x more likely to develop a stress disorder. Most common among combat, disaster, and abuse survivors (domestic violence, rape, terrorism, torture survivors), but any traumatic event can turn into a stress disorder. Although experiencing a traumatic event is the main risk of developing a stress disorder, there are biological and genetic factors at work as well. abnormal levels of cortisol and norepinephrine have been found in survivors of extreme stress. continuing arousal can damage key brain areas. the hippocampus and amygdala seemed to be tied to stress disorders (dysfunctional hippocampus may help produce the intrusive memories and constant fear arousal, while a dysfunctional amygdala may produce the repeated emotional symptoms and strong emotional memories). Certain personalities can also affect the development of a stress disorder. people who view life events as more negative and out of their control develop more stress disorders. People who also have had a more poverty-ridden childhood, who have weak family support systems, and are Hispanic are more likely to have an SD. Severity and nature of trauma also can determine the onset of an SD. *risk factors named in lecture include Depression or anxiety disorder at the time of trauma, Early (prenatal) traumatic conditioning (meaney effect), Severity and chronicity of trauma, poor social support (esp. combat veterans but also rape and assault victims), and family history of depression, anxiety disorders, or PTSD- perhaps these reflect common inheritance* *Treatment*: -drug therapy: (Anxiolytics for anxiety, panic attacks. Antidepressants (mainly SSRIs) for depression, irritability. Antipsychotics for any paranoia, social estrangement etc. Sleep meds for insomnia. Antihypertensive for anxiety spikes, flashbacks (prazosin). Experimental (Post-stressor propranolol is an anti-hypertensive drug that blocks adrenalin; may affect memory consolidation after stress and reduce intensity of subsequent PTSD symptoms. Shown to reduce bodily post-stress symptoms short-term, but unproven in long-term clinical studies. Post-stressor ketamine infusion shows promise for rapid PTSD symptom reduction. Do NOT consider these post-stressor treatments if you are in a legal case and are trying to recollect what happened to you.) -behavioral exposure techniques (suggest every treatment plan should have this but still controversial due to risk of re-traumatization, flood memories and images until anxiety stops, then switch to positive images. EMDR is also popular; clients move eyes in a rhythmic manner from side to side while flooding their minds with objects/images they normally try to avoid. sublimation AKA find meaning in tragedy) -insight therapy (must come to terms with what happened, accept what happened and what they did) -family therapy (go to therapy with family who is affected, helps examine impact on others) -group therapy (rap groups. meet with others with an SD and share experiences. gain insight and support).

Classical / atypical antipsychotic medications (effects, side effects, possible motor and metabolic side effects) side effects to explain: neuroleptic malignant syndrome, metabolic syndrome, akathisia, acute dystonias, pseuoparkinsonism, tardive dyskinesia

*classical*: affect DA mostly through D2 receptor. control only + symptoms. Thorazine, Haldol, Stelazine, Prolixin *new*: reduce both DA (several DA receptors) and serotonin treat both - and + symptoms. Abilify, Latuda, Zyprexa, Clorazil, Invega, Risperdal, Seroquel, Geodon *side effects*: -Drowsiness / sedation (can be beneficial in agitated patients) -Neuroleptic malignant syndrome (rare) - delirium, fever, tremor -"Metabolic syndrome" (Weight gain (especially in abdomen), elevated blood lipids (cholesterol & triglycerides), Type 2 Diabetes (blood glucose dysregulation)) -Motor side effects (much greater w/classical antipsychotics like Thorazine and Haldol): Akathisia ("cruel restlessness") e.g., rocking "Thorazine shuffle", Acute dystonias (lock-jaw, oculogyric crisis aka eyes roll back), Pseudoparkinsonism (Resting Tremor, Slowness of movements, Muscular rigidity), Tardive dyskinesia (rare with 2nd-generation medications. early "rabbit sign". eventually, tongue and limb writhing)

confidentiality and duty to warn or protect

*confidentiality*: mental health information cannot be released without patient consent except in specific circumstances: -Only can release if patient is a danger to themselves or identifiable others, if there is child or elder/dependent adult abuse involved, patient has agreed to release records within a managed care environment, court order demands therapist to release records, or a FISA court order is issued (foreign intelligence surveillance act). *duty to warn/protect*: -There must be an identifiable victim, a serious threat of physical violence imminent), or information given from immediate family member. If clients dangerousness is due to a mental disorder, can offer hospitalization. -Duty to protect or warn others does *NOT* apply when someone other than patient is dangerous party, Someone other than an immediate family member reports danger, there are no identifiable victims, and patient threatens suicide

Risk factors: Genetic predisposition/ consanguinity, concordances, infectious agents, birth trauma, sperm, birth issues, seasonality of birth, geographic clustures, drug use

*genetic predisposition/consanguinity*: Odds of a child becoming schizophrenic are 15% if one parent is schizophrenic and 46% if both parents are schizophrenic. Risk applies even if children are adopted early into new homes. more common among families. adopted children with biological parents of schizophrenia are more likely to develop the disease than their adoptive relatives. chromosomes 1,2,6,8,10,13,15,18,20, and 22 on the X chromosome appear to be affected. most likely a polygenic (caused by combination of gene defects) disorder. *Twin concordances*: monozygotic twins have higher concordance (48%) than fraternal twins (17%). *infectious agents*: Maternal exposure to influenza virus (Risk greatest at 6th month of gestation. Viral exposure may explain MZ / DZ difference). Other infectious agents may be involved (Rubella (German measles). Toxoplasmosis spores: greater prevalence of cat ownership among parents of schizophrenics. Endogenous retroviruses eg herpes simplex II). *birth complications*: protracted labors, forceps deliveries *seasonality of birth*: 10-15% likelier w/ winter births *geographic clustures*: 4-6% incidence *old sperm*: odds of schizophrenic child are: - About 1 in 200 if father is 25 - About 1 in 120 if father is 40 - About 1 in 70 if father is 50 *drug use*: especially cannabis - risk is enhanced with certain genotypes. can cause psychotogenic effects. Do NOT use marijuana if it has given you a psychotic reaction, or if there is psychosis in your family.

moral vs medical (disease) views of addiciton

*moral*: Addicts are morally weak, choose to yield to temptation, and are consciously self-destructive and uncaring about the damage they cause others. They need to start making good choices and "get their act together." *medical*: Possibly aided by a genetic predisposition and/or social learning, addicts begin using voluntarily, but then have their brains biologically "hijacked" by the addictive substances. They need treatments that block the hijacking, restore normal brain function, and thereby give them back their "will."

Anorexia nervosa: -Nature of body distortion -Susceptible populations -Altered eating habits -"Two P's" of anorexia -How anorexia nervosa is treated, and typical treatment outcome

*nature of body distortion*: person feels fat even when obviously underweight. this is confirmed with trick-lens studies. *susceptible populations*: lifetime prevalence of .25% to 1%. more prevalent in female atheletes and dancers, along with male wrestlers, jockeys, runner, and models who must make weight. peaks at ages 13 to 18. runs in families. children who are picky eaters and are socially avoidant tend to develop anorexia in later years. people who have hypothalamic and pituitary abnormalities, abnormalities in serotonin levels, or emotional reactivity and obsessive personality traits are more likely to get this disorder. *altered eating habits*: fail to maintain normal weight. sometimes defined as less than 85% of ideal body weight. Development of obsessive thinking about food (how much did I eat, how much can I let myself eat) • Establishing irrational rules about food (eat only green foods, eat only X% of what's on my plate, eat only the insides of fruits or vegetables and leave the outsides) • Food rituals (sipping water between bites, chewing X times before swallowing) • ½ of all anorexics binge and "purge," although the binges are usually small, and the "purging" is most often via excessive exercise. • Up to 70% of patients with anorexia nervosa also have OCD, and some researchers consider it an OCD spectrum disorder *two Ps of anorexia*: -Powerlessness -Perfectionism -"If can control my body, then I can have a "perfect body" and a "perfect life. *treatment and outcome*: -Patient's denial of illness is a major impediment. • Medical management of any physical illnesses that may have resulted from starvation • Hospital re-feeding if necessary (intravenous at first, then progressing to feeding my mouth with social reinforcement). Hospitalization indicated if individual falls below 75% of body weight. • Inpatient → Outpatient family therapy: - Reassert parents' control of eating. - Begin a program of slow re-feeding. - Most kinds of outpatient longterm psychotherapy are helpful. • Medication? - Weak effectiveness so far, but most helpful have been the SSRI Prozac and the major tranquilizer Zyprexa. - Used to treat any accompanying depression, anxiety, etc. Treatment Effectiveness in Anorexia Nervosa • Mortality Rate in 10-25%, from illness or suicide. Most severe anorexics die of cardiovascular complications. • Fewer than 50% of people with anorexia nervosa ever achieve a normal weight, and among those who are "recovering" with anorexia nervosa, their social and occupational functioning is often poor. • Current thinking is that sustained food restriction causes brain adaptation to starvation, which induces treatment resistance.

Effects of alcohol (ETOH) ingestion: neurochemical, behavioral, cognitive

*neurochemical*: ethyl alcohol binds to neurons that normally receive GABA, an inhibitory neurotransmitter. this helps GABA shut down neurons, which in turn relaxes the drinker. ETOH also blocks glutamate receptors, the excitatory NT in the body. *behavioral*: alcohol first depresses areas of the brain that control judgement and inhibition. more alcohol makes it harder for the drinker to hear and speak. they become clumsy. *cognitive*: people who drink tend to feel more confident and tranquil. emotions become intense (can be loud and even aggressive), and they have a hard time remembering things or problem solving.

physical vs psychiological dependence

*physical*: substances work on neurotransmitter systems that affect mood & motivation. They may generate a temporary "buzz", euphoria, calm, and/or disinhibition, and these reactions help lend them strong potential for abuse. Once body is dependent, painful withdrawal symptoms can affect one's willingness to quit the drug. physcial pain, nausea, tremors, chills, diarrhea, and even death can occur. example is delirium tremens in people with alcohol use disorder. people have crazy hallucinations. *psychological*: emotional state after becoming dependent on a substance. Someone taking marijuana may think they need the drug in order to fall asleep evey night. thoughts can become all consuming if dependence is severe

Differences in positive (e.g. Type I) vs. negative-symptom-predominant (e.g., Type II or deficit syndrome) schizophrenias: -Premorbid histories and course of illness -Sex differences -Differences in age of onset, prognosis -Neuroanatomical / neurotransmitter changes -Differences in medication effectivenes

*positive*: -Childhood oddity, irritability, aggressiveness -Later age of diagnosis (20-25) -Females > Males -Better prognosis -DA abnormalities -Responds to classical antipsychotic meds -Less chance of observable brain damage *negative*: -Childhood withdrawal, passivity -Earlier age of diagnosis (16-18) -Males > Females -Worse prognosis -No DA abnormalities -Poor response to classical antipsychotic meds -Greater chance of observable brain damage

Positive vs. negative vs. psychomotor signs/symptoms of schizophrenia (range of symptoms)

*positive*: pathological excesses to a persons behavior. include delusions (ideas that are believed but not based in fact), disorganized thinking and speech (loose associations: rapidly shift from one topic to another), heightened perceptions and hallucinations (senses being flooded and get overwhelmed, not able to focus on anything. may see things that arent there or hear things that arent there) and inappropriate affect (expressing emotions that do not fit situation) are common positive symptoms. psychotic pos symptoms include halluinations and delusions, while disorganized pos symptoms include paranoid or silyl affect, bizzare/disorganized behavior, and disordered thought processes *negative*: pathological deficits in a person. poverty of speech (aka alogia. reduction of speech or speech content. think and say very little, or say a lot with little meaning), blunted and flat affect (blunted: show less emotion. flat affect: show almost no emotion at all. may have ahedonia or loss of pleasure in everything), loss of volition (avolition (apathy), feeling drained of energy and of interest in normal goals, not able to finish course of action), and social withdrawal (withdraw from social environment and attend only to their ideas and fantasies. withdrawal worsens symptoms of disease) are common negative symptoms. blocking, or stopping mid sentence. *psychomotor*: move slower, make awkward movements or repeated grimaces and odd gestures that seem to have private purpose. catatonia is name for extreme psychomotor symptoms. can stop moving all together, sitting and staring for as still and long as possible (stupor). catatonic excitment is when someone moves excitedly.

antisocial PD: Risk factors, Relationship between psychopathy and Antisocial Personality Disorder, Etiological hypotheses, Anxiety and physiological arousal, Treatments, "Successful" psychopaths, Course of disorder through childhood, adolescence and adulthood

*risk factors*: diagnosed after 18, ADHD precedes it usually, 4x more likely in men *relationship between psychopathy and antisocial PD*: psychopaths are smooth, manipulative, conscience-free, lie perfectly, not all psychopaths are diagnosed. no treatment, ADHD common diagnosis vs. sociopaths are 'normal' people reared into criminal environment (born into gangs or criminal family). APD is a diagnosis given to psychopaths or sociopaths. heterogeneous category *etiological hypotheses*: Genetics contribution is very strong, incompetent or depriving parenting, may be learned from modeling. may be taught by parents rewarding aggressive behavior. low arousal. *anxiety and physical arousal*: no guilt, insensitivity to reward/punishment *treatments*: incarceration or atypical antipsychotic drugs (psychotropic meds) sometimes work *successful psychopaths*: smart psychopaths get away with it, charming and intelligent and know how to get away with anything *Course of disorder*: -childhood = lying, stealing, resisting authority. psychopathic triad (fire setting, peeing randomly on things (enuresis), cruel to animals) - adolescence = unusual aggressive or sexual behavior, excessive drinking/drug use -adulthood = persistent adolescent behavior, can't hold a job, bad parents, illegal activities for jobs, no close relationships, manipulative, charming/intelligent,

borderline PD: Risk factors, Etiological hypotheses, Self-mutilation and dissociation, "Transient psychotic episodes" and "splitting", Psychodynamic and medicinal treatments

*risk factors/etiological hypotheses*: women 3/4. persons instability and risk o suicide peaks during young adulthood and wane as the person ages. people who had an early lack of acceptance by parents; people whose parents neglected, abused, or rejected them are at risk. overly reactive amygdala and an underactive prefrontal cortex are also risk factors. lower serotonin activity due to abnormality of 5-HTT gene. results from a combination of internal forces (difficulty id'ing ones emotions, social skills deficits) and external forces (environment where childs emotions are punished). more likely to emerge in rapily changing cultures. *self-mutilation and dissocatiaiton*: distracts from their emotional or interpersonal upsets (snapping them out of emotional overload). scars and brusies may provide them with a kind of concrete evidence for emotional distress. may use self destructuve behavior to prevent partners from leaving. *"transient psychotic episodes" and "splitting*: transient psychotic episodes marked by inappropriate intense anger and marked mood shifts. splitting is the failure in a person's thinking to bring together the dichotomy of both positive and negative qualities of the self and others into a cohesive, realistic whole. see things in black and white, all or nothing. *treatments*: psychotherapy helps to some degree. traditional psychoanalysis not helpful; contemporary therapy like relational psychoanalytic therapy more helpful (take a more supportive and egalitarian posture). Dialectical Behavior Therapy (DBT): four modules: - Mindfulness (accepting thoughts and feelings) - Distress tolerance (calmly recognizing current situations) - Emotion regulation (analyzing emotional reactions instead of becoming overwhelmed by them). - Interpersonal effectiveness (assertiveness & problem-solving). Gives therapists a structure by which to handle difficult patients.

Bulimia nervosa: -Susceptible populations -Types of compensatory behavior among bulimics -Bodily damage suffered in bulimia nervosa -How bulimia nervosa is treated, and typical treatment outcome

*susceptible populations*: -Adolescents and young adults, 90% female. Peak ages 15 to 18 in females, and 18 to 26 years for males. • Up to 60% of people with bulimia nervosa report histories of anorexia nervosa. • Among college students, point prevalence of bulimia nervosa may be 10% (or even higher) • High prevalence may relate to the "Freshman 15," the weight gain seen when starting college. Actually, on average: Students gain about 4 lb during their first 3 months of freshman yr, a rate 11X higher than typical for their age. BUT most don't gain 15 lb. During the first yr, men gain ~6 lb and women gain ~4.5 lb. *Types of compensatory behavior among bulimics*: -Purging: Self-induced vomiting (manual or with emetic medications), laxatives, or diuretics. - Non-purging: exercise and/or temporary fasting. They binge large amounts of foods and lose control. food is high in calories. Then they compensate by trying to get rid of all of it. *Bodily damage suffered in bulimia nervosa*: -Most of the damage is from repeated vomiting: Rupture of stomach or esophagus; blood in vomitus. Heart damage from loss of electrolytes (mainly, potassium). Osteoporosis (weakening of bones from Ca++ loss). Erosion of teeth, gums and fingernails. Broken blood vessels in the eyes. Swollen parotid (salivary) glands ("chipmunk faces"). Females: Menstrual irregularities (amenorrhea in 50%, irregular periods in remainder) and higher risk of pregnancy complications. • Also associated with: high (30 to 70%) rates of ETOH and/or drug abuse, smoking (in order to maintain weight), other impulsive behavior (sexual promiscuity, cutting, kleptomania). *treatment and outcome*: -Unlike anorexia nervosa, bulimia nervosa usually responds well to treatment. • 1st line treatment: high doses of SSRI's (such as Prozac), which have been shown to reduce bingeing by up to 70% and vomiting by up to 60%. • Therapy is also indicated: - Support groups - Cognitive-behavior therapy - Focus is on resisting impulses to binge or purge, healthy eating, and developing positive alternatives to food-centered behavior. • Treatment over several years is usually successful (70-90%), but relapse is common, and patients should not expect cures.

ETOH withdrawal symptoms and management

*symptoms*: "Shakes" (within 12-18 hrs after drinking), weakness, sweating, nausea & vomiting. Alcoholic seizures ("rum fits"). Alcoholic hallucinosis (vivid, unpleasant auditory hallucinations). Withdrawal delirium (delirium tremens or DT's) - confusion, disorientation, agitation, vivid visual hallucinations. Withdrawal is much more severe than opiate withdrawal, and can be fatal if unsupervised. *management*: -*Acute Management* (usually in inpatient detox facility): Treatment of acute withdrawal symptoms, often with physiologically similar medications. In ETOH dependence, use of benzodiazepines for "shakes" and delirium, antipsychotics for hallucinosis, and sometimes anticonvulsants for seizures. During inpatient stay, group and family therapy. -*Rehabilitation* (outpatient): outcomes guarded, and complicated by denial. Treat co-morbid conditions (e.g., depression, anxiety, pain), seen in up to 2/3 of addicted patients. Refer patient to therapy/education programs focusing on coping strategies and relapse prevention, or a "12-Step Program" (for ETOH, Alcoholics Anonymous). Therapist refer family to a support group (for ETOH, Al-Anon) for education and issues of "co-dependency."

use vs abuse and sociocultural norms

*use*: ingesting a drug in accordance within those sociocultural norms (e.g., peyote in "vision quests", ceremonial wine in communion, champagne at weddings, beer at frat parties) *abuse*: taking a drug outside of sociocultural norms, causing personal and social problems as a result. Abuse may lead to dependence. *norms*: Every culture has norms about the ingestion of substances that dictate: - what should be consumed. - when it can be consumed. - who can consume them. - how much should be consumed. - what range of reactions is permissible. some commonly abused drugs include alcohol, barbituates, benzodiazepines, opiates (heroin, morphine, codeine, oxycodone), stimulants (amphetamines, ritalin, cocaine, MDMA), hallucinogens (LSD, mushrooms, DMT), dissociatives (special K, PCP), cannabis, inhalants (glue, solvents, aerosols), nicotine, caffeine, and nitrate inhalants

treatment for ADHD: medication

- Psychostimulants: ~80% of ADHD children are helped by stimulant drugs (may unmask tic disorder/Tourette's) (Note: stimulants quiet everyone); not addictive when dosed for ADHD. Insomnia, headache, nausea are frequent initial side-effects. -Stimulant drugs leave children shorter at high doses (premature closure of bone growth plates), but this is alleviated with "drug holidays." -Use of stimulants lowers the rate of substance abuse in ADHD. - Non-stimulant alternatives (not controlled, but less effective): - Wellbutrin (especially ADHD adults) - Straterra (atomoxetine) - SNRI - Approved January, 2003 - spefic cognitive arousal agent with few bodily symptoms - Provigil / Nuvigil - originally intended to treat narcolepsy and other causes of daytime somnolence, may improve focus in some ADHD - Inattentive patients -Sometimes, SSRI's or Mood Stabilizers are helpful

Who is affected by ADHD (risk factors, sex differences, family and genetic contributions)

- found in all cultures and socioeconomic levels - more males than females have hyperactive type, more females than males have inattentive type - genetic: MZ twins hav higher concordances than DZ twins. half of people with ADHD have at least one 1st degree relative with ADHD - infants with prenatal complications, low birth weight and premature births - infants whose mothers had high anxiety during weeks 12-22 of pregnancy - children who had residence changes, whose parents divorced or had irresponsible fathers

Treatments for Autism Spectrum Disorders

-*Early Behavioral Intervention*: Educational: structured, 1:1 teaching environment; initial focus on language then more general academics; high reinforcement density - Self-care - Social skills *ASD:Autism*: play and group behavior, training to make eye-contact, facial expressions, and sustain attention *ASD: Asperger's*: Social-script training, management of relationships, vocational and sexuality counseling -*Medication*: Ritalin for "ADHD"-like behavior, Risperdal for irritability. Sometimes, Depakote (anticonvulsant) for violent outbursts. Medications (anticonvulsants, cannabinoids) for seizures and other medical problems (>30%). No other medications show reliable effects -Outcomes of treatment are unpredictable and vary on case-by-case basis -Long-term custodial care for lower-functioning cases -Financial and emotional costs of interventions and continuing care are often overwhelming or impossible for families

autism spectrum disorders: definiton

-A set of syndromes distinguished by: impairments in social interaction, impairments in communication, Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. - more often in boys than in girls.

Effectiveness of dieting as a weight-loss method.

-About 95% of diets fail as a means of weight loss. They can produce transient weight losses, but the weight is almost always quickly regained -- and more (due to resetting of metabolic rate). -The only long-term successful weight-loss method is a lifelong pattern of healthy food selection, meal planning, good sleep, and consistent exercise

General personality disorder treatment: symptomatic treatment

-Any therapy or treatment of a condition that only affects its symptoms, not its cause, i.e., its etiology. It is usually aimed at reducing the signs and symptoms for the comfort and well-being of the patient -therapy is most common treatment; medications rarely work. it's very hard to make most people with a PD go to therapy. psychodynamic, cognitive behavioral most common. antidepressants and antipsychotics sometimes used to treat patients who suffer from depressive or psychotic symptoms.

Comorbidities with ADHD

-Bipolar disorder -Conduct Disorder -> Antisocial PD -Depression -Obsessive-Compulsive Disorder -Oppositional-Defiant Disorder -Specific Learning Disorders -Tourette's Syndrome

who can you turn to confidentially on campus?

-CARE Advocates -Campus Ombudspeople -Licensed counselors in the Student Health Service and counseling centers. -Any person with a professional license requiring confidentiality (including health center employees but excluding campus legal counsel), or someone supervised by such a person. -There may still be mandatory reporting of issues related to Child Protective Services, Adult Protective Services, the Clery Act (crime and rape statistics reporting), and other law enforcement issues.

Pharmacological Addiction Treatment: Campral, Revia, Chantic, Suboxone, Provigil,

-Campral and Revia for alcohol dependence: Campral (acamprosate) seems to reduce the "glutamate surge" that accompanies alcohol withdrawal and produces cravings, and so promotes abstinence. Revia (naltrexone) blocks endogenous opiates in the brain, and reduces the pleasure associated with drinking. -Chantix (varenicline) for nicotine addiction; also, nicotine gums, lozenges and patches; and Wellbutrin. -Suboxone (buprenorphene / naloxone) or methadone for narcotics addiction. -Experimentally: Provigil (modafinil) for cocaine and amphetamine addiction. -Overall evidence is that these treatments are not cures, but are moderately successful in reducing relapse.

ASD: Asperger's Syndrome

-First identified by Austrian pediatrician Hans Asperger in 1944, but not well-known until 1980's. -Like autism (social impairment and repetitive interests and behavior), but intelligence is normal and speech is formally correct. However: Empathic responding is deficient, and social contacts are awkward and lacking in routine "manners." Routines are maintained insensibly and inflexibly. Speech patterns are stilted and lecture-like, monotonous, or fixated on certain interests (air travel timetables, weather patterns, automobile engine details). - Sometimes: odd posturing, nervous tics, hand-flapping, violent outbursts, sensory hypersensitivity. -No clear demarcation from "high-functioning autism," hence the combination with autism into ASD in DSM-5.

"Rule of thirds" and newer outcome estimates in schizophrenia

-Formerly, "Rule of thirds" - 1/3 improve, 1/3 stay same, 1/3 deteriorate - rule probably reflects misdiagnosed bipolar disorder -Now, outlook is considered more dismal. On 30-year follow-up: 20 % show good adjustment, 35 % show fair adjustment, 45 % incapacitated -Prognosis worse for - symptom schizophrenia -Newer medications may improve prognosis

Hyperactive-Impulsive Type ADHD

-Frequent fidgeting and squirming -Leaves seat frequently -Runs around or climbs excessively (in adolescence, feelings of restlessness) -Difficulty at quiet play -Excessive talking -Blurts out answers before Q is finished -Has difficulty waiting his/her turn -Frequently interrupts and butts in activities

General signs observed in ASD's

-Lack of "joint attention" -Withdrawn behavior -Unsocial behavior -Problems or delays in using language to communicate -Repetitive patterns of behavior -Problems with imaginative play -Difficulties in deviating from schedule -Self-stimulating behavior

Other disorders often treated with antipsychotic medications

-Major Depression -Bipolar Disorder (several antipsychotic medications such as Abilify are FDA-approved for both schizophrenia and bipolar disorder) -Paranoid, Schizoid and Schizotypal Personality Disorders -Borderline Personality Disorder -Acute and Post-traumatic Stress Disorder -Anxiety with psychotic features (e.g., Brief Psychotic Episodes, Depersonalization/Derealization Disorder, drug-related psycholses, encephalopathies, etc.) -Agitation in the elderly (especially at nightfall: "Sundowner's Syndrome")

Types of males who are especially susceptible to eating disorders

-Men in sports that emphasize thin-ness or weight control (wrestling, boxing, crew, jockeying), or in competitive body-building, rather than agility or strength, show rates of disordered eating comparable to females. -Many men in the gay social scene, who are subject to the same physical attractiveness pressures as heterosexual females, appear to have elevated rates of eating disorders. -Rates of eating disorders in males generally may be increasing.

ASD: childhood disintegrative disorder

-Normal development to age 3 or 4 or even later (up to age 10), then the child rapidly loses acquired skills such as language and self-care. -Control over bowel and bladder habits may be lost. -Declines may occurs rapidly (over days or weeks) or more slowly. -Older children may be able to vocalize concern ("Mommy, what's happening to me?") -Condition is very rare (< 2 per 100,000 children), and no cause has been found. -Result is profound autism and mental retardation, and patients become custodial; lifespan is normal if not complicated by seizures.

Hypotheses about defects that may occur in ADHD

-People with ADHD show 3-5 year delays in the growth of neurons, especially in the frontal lobes of the brain. - These areas are involved in attention, impulse control, and initiation and perception of movement. -Under-activation of frontal lobes -Abnormally low dopamine activity -Possible "sensory screen" which leads to less motivation by external events and less "capture" of attention -Differences in sensing passage of time: in ADHD, not noticing time passing until looking at the clock

Inattentive type ADHD

-Poor attention to detail, careless mistakes in schoolwork etc. -Can't sustain attention to normal range of tasks -Doesn't listen when spoken to directly -Doesn't follow through on instructions, fails to finish assignments -Has difficulty organizing tasks and activities -Avoids, dislikes tasks requiring sustained mental effort -Often loses things necessary for tasks -Easily distracted -Frequently forgetful

consequences of ADHD

-Poor school grades and conduct. - students w/ADHD have a concurrent learning disability. - ADHD children develop conduct disorder, delinquency and/or drug abuse. - Teenagers with Hyperactive-Impulsive ADHD are much more likely to have traffic accidents, get pregnant, develop an STD, commit arson, or run away from home. - ~50 % of imprisoned felons and ~50% of adolescents in juvenile facilities have untreated ADHD. - most ADHD children retain symptoms through adolescence and beyond. - Only about 5% of college students w/ untreated ADHD graduate.

Common signs of adult ADHD

-Prevalence is about 4 % of the U.S. adult population. -Up to 70% of ADHD children retain some symptoms through adulthood, and ~20% retain the full disorder. -By adulthood, the Male : Female ratio in ADHD approaches 1:1, possible due to a combination of Maturation of the Hyperactive males into an Inattentive presentation and increasing diagnosis of Inattentive ADHD females. *manifestations*: - Seeks noisy, busy places in order to get work done - Frequent changing of TV/radio stations; listening to only parts of songs - Difficulty waiting in lines - Tuning out in conversation and at intimate moments - Blurting, inability to withhold unwelcome remarks - Preference for highly stimulating situations - Often: Intuitiveness and Novel "out-of-the-box" approaches to problems

ASD: Autism

-Problems in verbal and nonverbal communication: No babbling, gesturing or pointing by 12 months, Failure to use single words by 16 months or 2-word phrases by 24 months, Echolalic (repeat) speech, Social withdrawal; no eye contact, social smiling or "joint attention" -Sensory problems: Hyper-sensitive to touch, normal sounds, Absence of startle to loud noises -Repetition and preference for sameness, Repetitive body movements (hand-flapping, finger-flicking), Perseveration (gets stuck on a specific topic or task), Very narrow set of interests, Sometimes, self-injurious behavior (head-banging, skinchewing) -many genes are involved with getting ASDs, as well as how many of those genes you have. older sperm and having an overabundance of neurons in utero can also cause ASDs.

ADHD treatment: non-medication

-Structuring school and home environments: Consistent daily scheduling, Breaking tasks into small chunks, Clear immediate rewards and punishments for target behavior, Best punishment is time out or withdrawal of privileges; spanking is ineffective and disruptive, Minimizing of distractions -Relaxation strategies: mindfulness, yoga, muscle relaxation exercises, etc.

General risk and safety profile of psychostimulants

-Students say it helps them concentrate and stay up late studying. - BUT ... experiments testing whether psychostimulants aid learning and memory have yielded mixed results. Most likely, underperformers are helped, but good performers are not helped or even impaired. -Surveys suggest that psychostimulants are 2nd-most used illicit substance in college, next to marijuana. -Long-term higher-than-normal dosing can create psychosis and paranoia. -Under prescribed regular dosing, for individuals in good health, psychostimulants for ADHD appear overwhelmingly safe and effective. -Prevalences of abuse and dependence are difficult to determine, but may approach 10-15% of users, and are most frequently associated with recreational use of ground-up pills to get "high" or "buzzed" via intranasal snorting or intravenous injection. This is potentially lethal. - Some students use psychostimulants so they can consume more alcohol, or mix them with drugs to prolong partying; this is also potentially lethal.

Consequences of ETOH use: physiological damage and fetal effects, including Fetal Alcohol Spectrum Disorders

1/2 of traffic fatalitites and 1/3 of all traffic injuries are related to ETOH. ETOH increases criminal behavior, domestic and community violence, family strain and work performance. ETOH can casue gastric irritation and bleeding, liver, testicular, and pancreatic disease, oral and intestinal tract cancer, anxiety, depression, suicide, peripheral neuropathy (nerve degeneration causing weakness and sensory loss). *FAPD*: Associated with heavy drinking in pregnancy -Craniofacial deformities -Physical and mental retardation -Learning disabilities and behavioral disorders (e.g., ADHD) -Skeletal (esp. hand and finger malformations)

UC mandated reporting of Title IX sexual behavior

Any University employee who is not a Confidential Resource and who receives, in the course of employment, information that a student (undergraduate, graduate, or professional) has suffered sexual violence, sexual harassment or other prohibited behavior shall promptly notify the Title IX Officer or designee. This includes Resident Assistants, Graduate, Teaching Assistants, and all other student employees, when disclosures are made to any of them in their capacities as employees. In addition, the following who, in the course of employment, receive a report of Prohibited Conduct from any other person affiliated with the University shall notify the Title IX Officer or designee: -Campus Police -Human Resource Administrators, Academic Personnel, and Title IX Professionals -Managers and Supervisors including Deans, Department Chairs, and Directors of Organized Research Units (ORU) -Faculty members

temporary gun seizure

Authorizes a court to issue a gun violence restraining order if a law enforcement officer asserts and a judge finds that there are reasonable grounds to believe that: • the subject of the petition poses an immediate and present danger of causing personal injury to himself, herself, or another by having under his or her custody and control, owning, purchasing, possessing, or receiving a firearm and/or ammunition • the order is necessary to prevent personal injury to himself, herself, or another person, as specified. The restraining order is issued without prior notice to the named person and without the benefit of a court hearing where the named person is present to defend himself before the order is issued and their firearms are seized. A hearing is held within 21 days following issuance of the gun violence restraining order.

General philosophy of 12-step recovery groups

Based in great part on "Moral View" of addiction. Groups are self-supporting and dependent upon donations. AA teachings, including the 12 Steps, are contained in the "Big Book," which stresses: - frank and total admission of one's alcoholism, - confessing an inability to handle one's alcoholism by himself. - vow to stay abstinent -"clean and sober" -one day at a time. - make personal amends for all the damage one has caused. - help others to achieve sobriety.

Contributors to current U.S. opioid crisis

Began in part by drug-company campaigns in 1990's stating that use of narcotics for pain was safe and non-addictive. ER visits for opioid OD's increased 30% from July 2016 to September 2017. This crisis is partly attributable to MD's who are inadequately trained in pain management: opioid prescriptions between 1991 and 2001 rose 300%, and have quadrupled since 1999. Opiate abuse, dependence and OD's most common among white, middle-class, young adults (ages 18-25).

Current strategies for dealing with opioid crisis

Better medical training on pain management (Opiates should rarely be used for >30 days). Development of abuse-deterrent formulations(ADF's); E.g., Suboxone = Buprenorphene (narcotic) + naloxone (narcotic agonist). Better patient education. Rapid-response opiate OD training and community treatment teams. Outfitting of rapid-response teams with naloxone auto-injectors for on-the-spot OD treatment. Development of new non-narcotic, non-addictive analgesics.

non-proven ADHD treatments

EEG Biofeedback, Elimination diets (sugar, food dyes and additives), Nutritional supplements

controversy about re-exposure therapy vs. thought neutralization.

Guided re-exposure and abreaction (controversial due to risk of re-traumatization) Cognitive skills training (thought neutralization)

World-wide trends in schizophrenia incidence and possible causes

Incidence of schizophrenia appears to be declining world-wide, perhaps due to better infant nutrition and childbirth methods.

From Text Addendum: Autism and Asperger's Syndrome: who first used the term autism? what distinguishes aspergers? what is rett syndrome? is autism rising or declining and why? what are some common signs of ASD? do ASD patients have normal brain scans? is there an autism gene? what disease that a pregnant mother can get is most likely to give a fetus ASD? what type of therapy is most affective for ASD?

Leo Kanner and Hans Asperger first used the term autism in the 1940s for kids who seem to live in their own self-created world. Aspergers syndrome is distinguished by an obsessive interest in a single topic or object to the exclusino of nearly any other. they are socially awkward and usually have delayed morot skills. Rett syndome, almost all girls, have poor expressive language and clumsy hand use. Autism has been on the rise. This rise has no reasoning; suggestions include changes in diagnostic criteria, diagnosing children at oyunger ages, and epigenetic influences. Common signs of ASD include failure to interact socially, insistence of sameness, impairments of langauge development. Their brains look normal on a scan; it it hypothesized that their brains are characterized by unusual neuronal maturation rates. The amygdala shows obvious abnormal brain volume. This suggests that connections between cerebral regions are abnormal, which would produce abnormal functioning. there is no autism gene. ASD is more likely to affect a fetus if the mother is exposed to rubella. no medical interventions exist for autism yet. behavioral therapies are the most effective.

general manifestations of schizophrenia

Loss of previous level of functioning, Disturbances of language and communication, Formal thought disorder (Altered thought boundaries: thought broadcasting, insertion, removal. Hallucinations: usually auditory, Delusional experiences, Delusional beliefs. Disordered emotionally: "flat", "paranoid", or "silly" affect), Disturbances of the will, Social withdrawal and autistic thinking, Motor abnormalities (Reduced spontaneity, Bizzare or stereotyped gestures and postures)

Trends in addiction treatment

Overall, in the U.S. addiction to ETOH has leveled off, tobacco and most illicit drug abuse is declining, but addiction to marijuana and to prescription drugs (mostly narcotics and stimulants) is increasing. 12 Step abstinence groups remain a mainstay of treatment. Greater willingness to treat co-morbid mental disorders even while the patient is using - although most common practice is still "detox first". More emphasis on early education, detection and community and school prevention programs: "the path to addiction is set by high school". Greater emphasis on pharmacological treatments: - Antagonists and "abuse-deterrent formulations." - prescribed dose-controlled substitutes for abused substances.

eating disorders: Prevalence as a function of sex and Westernization, and explanations

Overwhelmingly female. Overwhelmingly found in Western countries. Frequently accompanied by anxiety and substance abuse disorders. Apparently related to Western cultural conceptions about food and femininity. Co-morbid among family members at rates greater than general population. Increasing in non-Western countries as they Westernize; along with Westernization: more females join the workforce, thin-ness replaces obesity as a sign of wealth and status, disordered eating in non-Western cultures has been associated with exposure to Western television. *why are EDs mostly female?* Across Western cultures, males are more likely to be obese, but are less likely to care. Mass media emphasize dieting and body shape in women's magazines, but fitness and body-building in men's magazines. Weight-loss ads are 10X as frequent in women's magazines.

differential diagnosis of PTSD

PTSD symptoms may seem similar to those of anxiety disorders, such as acute stress disorder, a phobia, or obsessive-compulsive disorder. But in general, in anxiety disorders, there usually isn't a specific triggering traumatic event for the anxious feelings or worry. Or, in the case of something like phobias, it's a trigger that most people don't experience as anxiety-provoking. PTSD and obsessive-compulsive disorder (OCD) have recurrent, intrusive thoughts as a symptom, the types of thoughts are one way to distinguish these disorders. Thoughts present in obsessive-compulsive disorder do not usually relate to a past traumatic event. With PTSD, the thoughts are invariably connected to experiencing or witnessing a past traumatic event. While a person suffering from PTSD may also suffer from depression, typically the symptoms of PTSD precede the depressive episode (and may help explain such depressive feelings in a person with posttraumatic stress disorder).

Personality traits common among bulimia nervosa sufferers

People with bulimia nervosa are likelier to be emotionally impulsive and unstable, and diagnosable with borderline, histrionic or narcissistic personality disorders.

binge-eating disorder: definiton, symptoms, signs, and treatment

Recurrent binge eating without compensatory behavior. Frequent feelings of being unable to control what or how much is being eaten. • Several of these behaviors or feelings: - Eating much more rapidly than usual. - Eating until uncomfortably full. - Eating large amounts of food, even when not physically hungry. - Eating alone out of embarrassment at how much of food one eats. - Feelings of disgust, depression, or guilt after overeating. • Most people with binge-eating disorder are obese (>20% over ideal body weight) • Most common distinct eating disorder: - Point prevalence > 2% of all adults (~3.5% women, 2% men) - Among mildly obese people in weight-loss programs, 10-15% may have binge-eating disorder. - Occurrence rising amid the current "obesity epidemic" • Dieting, as expected, usually worsens binge-eating disorder. • Costs of binge-eating disorder are the costs of obesity: - Hypertension, heart disease, stroke - Diabetes - Sleep apneas - Acid reflux - Joint pain, arthritis, fatigue - Cancer - Early mortality • Psychological costs - Shame, guilt at bingeing behavior - Social avoidance in order to binge, and embarrassment at appearance • Treatment is similar to that for bulimia nervosa.

Consequences of college binge drinking

Related to alcohol, each year college students ages 18-24 face: - 1700 accidental deaths injuries (e.g., motor vehicle accidents) - ~600,000 accidental injuries - ~700,000 assaults - 97,000 sexual assaults / date rapes - 400,000 instances of unprotected sex Alcohol accounts for: - 83% of all campus arrests - 28% of college dropouts

TLE and dissociative phenomena

TLE: temporal lobe epilepsy. amygdala is hyperactive and people tend to attach too much meaning to events. TLE produces complex partial seizures (CPSD) that are confined to amygdala. produce weird sensory experiences that include odd tastes, pungent smells, and out of body sensations. amygdala is recruited with each successive seizure; it shows kindling, which means it stays slightly mor active than it did before the seizure. baseline increases. mechanism that attches meaning to objects goes into overdrive. tendency towards defensive aggression (feelings threatened by everyday events) is common. Crichton made a movie called terminal man that was about an out of control TLE patient. obsession with detail, hyper talking and writing, interpersonal viscosity (always have one more thing to tell you), hypermorality and diminished sense of humor, hyperreligiousity, and fetishism/sexual disinterest are common personality changes. one patient lost interest in wife was began to be aroused by paperclips.

comorbitities of EDs

The most common co-morbidities of eating disorders can include: depression bipolar disorder panic and anxiety disorders post-traumatic stress disorder(PTSD) obsessive compulsive disorder (OCD) obsessive compulsive personality disorder (which is different from OCD) borderline personality disorder sleep disorders substance abuse or dependence

addiction

The uncontrolled, compulsive use of a substance despite ongoing negative consequences to one's health, mental state, or social life.

MZ twin types and implications

Two types of MZ twins. -One placenta: monochorionic twins, one placenta, one blood supply to mom -Two placentas: dichorionic twins, two placentas, two different blood supplies to mom -Depends on how egg splits on 8th day of gestestion -Concordance: ~18% for dichorionic (same as separate siblings), ~50% for monochorionic.

involuntary commitment (LPS Act 1967)

When a patient's behavior warrants hospitalization, voluntary hospitalization is always preferred. Involuntary commitment should be considered only when: -the danger that a patient poses to self or others is imminent or the patient is gravely disabled. -the danger or grave disability is the result of a mental disorder or chronic alcoholism. -the patient has refused or is unable to comply with a recommendation to enter a psychiatric hospital voluntarily.

Critical Incident Stress Debriefing: Basic steps

a form of crisis intervention that has victims of trauma talk extensively about their feelings and reactions after a traumatic event occurs. provided to victims who have not displayed symtpoms of an SD yet in hopes to reduce stress reactions. counselors guide victims to talk about the details, vent, relive the emotions from the time of the event, and express their current feelings. Mobilizations get together to provide debriefing for large areas who have experienced trauma, like disaster areas. the effectiveness of this si being called into question though. a study showed that after debriefing, half of victims still showed symptoms of PTSD. some studies have showed that victims show a higher amount of SDs when debriefed; debriefing may encourage victims to dwell on traumatic events. high-risk individuals may profit from it, but other trauma victims should not receive it. *Stages*: 1. Fact phase: ask victims to tell story 2. Reaction phase: ask victims to report their thoughts and feelings about the incident 3. Symptom phase: solicit symptomatology and suggest coping strategies 4. Teaching phase: educate victim regarding traumas and typical reactions to trauma 5. Reentry phase: wrap-up, answer Qs, provide referrals, develop plan of actions

Role of psychotherapy in schizophrenia

adjunctive with meds - Adjustment to illness for Family, Friends, Work, and Love - Deal with secondary depression, anxiety - Symptom self-monitoring - Building compliance with medication

Comparative effectiveness of accepted ADHD treatments

although not controlled, non-stimulants are less effective than psychostimulants

Classical distinction between Autism and Asperger's Syndrome

aspergers kids have less debilitation and are more impaired by their social skills.

Compliance rates with antipsychotic medications

compliance is less than 30%

Korsakoff's syndrome

disease that accompanies chronic alcoholism *symptoms*: severe memory loss (anterograde and retrograde), tend to make up stories about past events they dont remember, but stories are plausible because they are based on real experiences. They have little insight into their memory loss and are indifferent to hearing they have a memory problem. Arent very aware of things going on around them.

Experiences of depersonalization and derealization.

dissociative symptoms are common in stress disorders. *They are also called psychic numbing*. Experiences include emotional detachment, being in a daze, dropping out of unusual activities, avoidance of topics related to trauma, forgetting or fogginess, feeling that current setting isn't real (derealization), feeling detached from one's body (depersonalization).

"Ego-dystonic" vs. "ego-syntonic" symptoms

egosyntonic refers to the behaviors, values, and feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one's ideal self-image. Egodystonic (or ego alien) is the opposite, referring to thoughts and behaviors (dreams, compulsions, desires, etc.) that are in conflict, or dissonant, with the needs and goals of the ego, or, further, in conflict with a person's ideal self-image.

reactions to extreme trauma

fear and arousal set in motion by the hypothalamus. It activates the ANS and the endocrine system. The ANS is an extensive network or nerve fibers that connect to the central nervous system. When provoked, the ANS increases involuntary activities like heart rate, breathing, and blood pressure. The endocrine system is a network of glands. These glands release hormones. The systems react to different stimuli in different ways; when we face a dangerous situation, our sympathetic nervous system activates (heart rate increases, breathing increases, adrenal glands get stimulated, and epinephrine and norepinephrine are released). when the danger passes, our parasympathetic nervous system activates (returns bodily processes to normal). The HPA pathway also produces arousal and fear reactions. The hypothalamus signals to the pituitary gland to release ACTH (major stress hormone). this stimulates the outer layer of the adrenal glands and this triggers the release of corticosteroids, including cortisol. When people have acute stress disorder or PTSD, these reactions do not easily go away; intrusive recollections and acute distress upon cues suggestive of the trauma may occur. They may experience aggression, chronic hyperarousal, or dissociative symtpoms

substance use disorder: general diagnostic criteria

involves abuse (harmful pattern of use) and dependence (habitual abuse, and development of withdrawal and tolerance). Maladaptive patterm of substance use leading to significant impairment or distress. Requires the presence of 2 or more of the symptoms listed in the DSM-5 within a 12 month period. Generally, people take too much or use it too often, want to stop but cant, let the substance get in the way of work and relationships, using the substance even when it puts you in danger, and needing more of the substance to get effect that you want (builidng a tolerance)

General effectiveness of treatment for common addictions

it varies, depending on what substance and what form of treatment is being used.

Risk factors for ETOH dependence; LR and predisposition to dependence

most common dependence in US. *younger drinkers* (onset between 16-30). people who drink before age 15 are 4X more likely to become an alcoholic than people who started drinking at 20+. *men* are 4X more likely to be alcoholics compared to women (but women suffer more health problems from it than men). *LR* (level of response) to alcohol. people with a low LR react less than high LR people to a given amount of alcohol. low LR people have a higher tolerance, and more readily become alcoholics. LR is related to genetic markers on chromsome 15, which may involved in the production of certain GABA receptors. *people with a family history of alcoholics* are more likely to become alcoholic themselves. children of alcoholics are 4X as likely to be alcoholics, even when raised by non-alcoholics. *ethnicity*. asians have low rates of ETOH abuse/dependence because 1/2 of asians have genetic variation that complicates metabolism of ETOH (unpleasant facial flushing response occurs). native americans, alaskan natives, and mexican hispanics have highest rates. *personality*. people who are impulsive and sensation-seeking *social factors* including peer pressure and availability of alcohol *education*, college kids drink more than kids their age that are not in school

Relationship between OCD and Obsessive-compulsive personality disorder

not OCD!! all OCPD symptoms are ego-syntonic (in harmony with thoughts and feelings). although the two disorders share some features, people with OCPD are more likely to have MDD, GAD, or a substance use disorder than OCD. no specific link between the two.

Typical signs and symptoms for each type of personality disorder: paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, obsessive-compulsive, passive aggressive

odd: *Paranoid personality disorder*: they deeply distrust other people and are suspicious of their motives. They shun close relationships because they think everyone is out to harm them. They trust their ideas to much. They find "hidden" meanings in everything, and these meanings are ususally threatening. They are cold and distant. Though their suspicions are bizzare and innacurate, they are not delusions. They are critical of weakness, and blame others for things that go wrong in their life. *Schizoid personality disorder*: persistently avoid and are removed from social relationships and demonstrate little in the way of emotion. No close ties with other people because they like to be alone. they are "loners", and make no effort to start or keep frienships. their social skills tend to be weak. they focus mainly on themselves and are unaffected by priase or criticism. They rarely show feelings and do not feel a need for attention or acceptance. Viewed as cold, humorless, or dull. *Schizotypal PD*: extreme discomfort in close relatioships, have very odd patterns of thinking and perceiving, snd have behavioral eccentricites. They seek isolation and have few close friends. no loneliness. They often have ideas of reference (think unrelated events pertain to them in some way) and bodily illusions (sensing external force or presence). They have great difficulty keeping their attention focused. eccentricities include arranging cans to align labelsm organizing closet extensively, or wearing odd assortment of clothing. likely to work undemaning jobs with little interaction to people. dramatic: *antisocial PD*: persistently disregard and violate other's rights. most closely linked with criminal behavior. lie repeatedly, cannot work a consistent job, and are careless with money and fail to pay their debts. They are impulsive and act without thinking. They can bee reckless, aggressive and irritable. Have little regard for their own safety or that of others, and cannot maintain close relationships. they lack moral conscience. They think of their victims as weak and deserving of being conned robbed or harmed. suffer with alcoholism a lot. *borderline PD*: great instability. major shifts in mood, unstable self-image, impulsivity. can swing in and out of very depressive, anxious, and irritable states that can last a few hours to a few days or more. always in conflict with world around them. prone to bouts of anger; can hurt others and inflict pain on themselves. self-destructive behaviors like alcoholism, drug abuse, cutting, unsafe sex, reckless driving. physical discomfort relieves emotional pain. suicidal threats and actions are common. form intense conflict-ridden relationships. may violate boundaries in relationships. quickly feel rejected and become furious when expectations are not met but remain attached in relaitonships. will avoid anything to not be separated from relationships. sense of self, goals, aspirations change rapidly. *histrionic PD*: extremely emotional. seek to be center of attention. always on stage, use theatrical gestures and mannerisms to explain everyday things. change themselves to attract and impress an audience. lack of sense of self. must have others approval. vain, self-centered, demanding. they overreact to any minor event that gets in their way of their quest for attention. exaggerate illnesses to get atteniton. obesses about how they look. get involved with people who may be exciting but do not treat them well. *narcissistic PD*: grandiose, need much admiration, feel no empathy with others. exaggerate accomplishments. choosy about friends and associates; believe their problems are unique and can be only appreciated by special people. rarely maintain long term relationships although they make good first impressions. not interested in others feelings and take advantage of peple to achieve their own ends. have periods of zest that alternated with periods of disappointment anxious: *avoidant PD*: very uncomfortable and inhibited in social situations. overwhlemed by feelings of inadequacy and sensitive of negative emotions. fear of being rejected; dont give anyone opportunity to reject them. avoid social contact. timid in social situations, and think they inferior to others. no or few close friends, but feel lonely and yearn for friends. fear social relationships while people with social anxiety disorder fear circumstances. *dependent PD*: pervasive need to be taken care of. clingy, obedient, rely on others to make every decision for them. have difficulty with separation. cling even to abusive relaitonships. rarely disagree with others and allow important decisions to be made for them. overly sensitive to disapproval and try to meet others wishes. feel distressed, lonely and sad. suicidal thoughts. *obsessive-compulsive PD*: preoccupied with order and perfection. lose all flexibility, openness, and efficiency. become so focused on organization they fail to grasp task on hand. work is behind schedule. super high standards for themselves and others. never satisfied with performance. work alone because they think others are too careless to do the job right. rigid and stubborn. live by strict personal code. trouble expressing affection. stingy with time and money. *passive aggressive PD*: provisional. continuous pattern of negative attitudes. passive resistance to demands, by procrastinating, forgetting intentionally, arriving late, sulking, arguing, stubbornness and exuse making. treatment is supportive therapy. this helps build their confidence and teach assertiveneess instead of being sulky and manipulative. SSRIs used for any associated anxiety or depression.

dementia praecox

one of the earlier interpretations of schizophrenia. translates to "premature dementia". A disused psychiatric diagnosis created by Emil Kraepelin in 1898. Said it begins after puberty and rapidly worsened until it led to irreversible mental weakness.

bulimia nervosa: definition

recurrent binge eating accompanied by compensatory behavior ("purging" via vomiting, laxatives, emetics, or non-purging behavior such as fasting and/or exercise)

anorexia nervosa: defintion and some symtpoms

self-starvation to precariously low body weight. intense fear of weight gain, persistant behavior that interferes with weight gain. amenorrhea (no menstrual cycle) and loss of sexual desire in men. dry skin, thinning hair, brittle nails, feeling cold, chronic constipation, no longer eating with family, guarded about why they feel anxious or depressed, going on an unnecessary diet.

Advantages of atypical antipsychotic medications

treat more symptoms, have less side effects, less likely to produce tardive dyskinesia