Exam 3

Openness->Experience

fantasy (preoccupied w/daydreams vs. unimaginative) aesthetics (culture/art appreciation) feelings actions (predictable routine vs. not) ideas (vs. reject new ideas) values (guiding belief systems vs. dogmatic/close-minded)

Agreeableness

trust (gullible vs. paranoid/suspicious) straightforwardness (self-disclosing vs. dishonest/manipulative) altruism (exploited/victimized vs. lacking regard for others) compliance (docile/submissive vs. argumentative, defiant) modesty (meek/self-denigrating vs. conceited, arrogant) tender mindedness (vs. callous, cold-hearted, ruthless)

Conclusions about Treatment of Substance Use Disorders

typically, treatment=>improvement (reduced drug use, abstinence, but also health/social/occupational functioning), but relapse is common little evidence that one form of treatment (ie. in/outpatient, professional/self-help, individual/group) is more effective -self-help groups actually favored for abstinence limited evidence that certain kinds of patients fare better in certain kinds of treatments increased amount of treatment & increased frequency of attendance in self-help meetings/aftercare counseling => better outcomes LT outcomes predicted by coping resources (ie. coping/problem-solving skills, social support, level of stress=>sustained improvement)

Extraversion

warmth (affectionate) gregarious (vs. being alone) assertiveness (domineering vs. resigned/ineffective) activity (driven, frantic, distractible vs. sedentary/passive) excitement seeking (reckless vs. dull) positive emotions

History of Alcohol

-public attitude changes: colonial times (integral in everyday life, drunkenness not social deviance), 19th cent temperance movement meant drunkards not tolerated due->morality/relig considerations and attributed->personality weaknesses -1919 18th Amendment banned the manufacture and sale, preparing for Prohibition (1922-1933)

Dimensional PD Model (Section III of DSM-5)

1) judging impairment in personality functioning: problems w/view of self (identity) & others (self-direction), difficulties maintaining interpersonal relationships (empathy, intimacy) replaces general criteria in categorical model severity of PDs=most relevant 2) rating pathological personality traits (FFM=>maladaptive domains): nature/what KIND of personality pathology? agreeableness=>antagonism trust=>suspiciousness gregariousness=>withdrawal modesty=>grandiosity >specific facets included in each domain (ie. manipulativeness, deceitfulness, grandiosity, callousness, hostility) FFM had depressivity, anxiousness, hostility (traits/personality dimensions) 25 core traits ie. schizotypal has traits under psychoticism (ie. Perceptual dysregulation) -advantages : recognizes continuous nature, > nuanced info about patient

Treatment for Alcohol Use Disorders

-no insight or don't seek professional help (unless forced to, @ which point they're reluctant), low compliance rates, high dropout rates, high comorbidity rates => complicated treatment plan & less likely for treatment to be effective -controversial goal: is it complete abstinence? or just moderation in use of legal drugs? should treatment address the social/occupational/medical problems too?

Etiology of Alcoholism

1. Initiation (under what circumstances the first exposure happened) & continuation 2. Escalation & transition->abuse 3. Development of tolerance & withdrawal *****MOST WHO DRINK SO NOT DEVELOP ALCOHOLISM Social Factors -religion -manner of consumption: continued use, sporadic consumption of strong drinks for purpose of becoming intoxicated; with/without food? -parental monitoring extroverted, rebellious whose parents/peers model/encourage use are most likely to experiment model drinking as coping mechanism under stress, promote attitudes/expectations regarding benefits, provide access alcoholic parents not only allow opportunities to access due->less careful monitoring but also create negative emotional climate at home -peer influence super strong among adolescent girls Bio Factors -flushed skin (30-50% Asians, due->genetic variants in ADH/ALDH genes involved in alcohol metabolism), irregular heartbeat, nausea can discourage—protecting factors Genetics -lifetime prevalence of alcoholism in parents, children, sins of alcoholics is 3-5x higher than rate in general pop. -Twin Studies: concordance rates when proband has substance dependence 56% in male MZ twins, 33% in DZ 30% in female MZ twins, 17% in D 2/3 VARIANCE IN RISK FOR ALCOHOLISM DUE->GENETICS -Adoption Study: biological parents were alcoholics but raised from early age by nonalcoholic adoptive parents freq of alcoholism is a function of primarily genetic factors BUT just being reared by alcoholic parent in the absence of other etiological factors doesn't lead to disorder for certain -ADH, ALDH, genes influencing novelty/sensation seeking (=>dangerous consumption patterns) Psychological Factors -placebo effects show the importance of expectations in drug effects BELIEVE INGESTED ALC, ACTUALLY RECEIVED TONIC WATER SHOWED EXAGGERATED AGGRESSION/REPORTED ENHANCED SEXUAL AROUSAL -positive effects = reinforcement -diminished self-awareness, stress reduction, improved mood expectations include having a positive experience (ie. optimism about future), enhancement of social/physical pleasure (ie. celebrate special occasions) & sexual performance, increases in power/aggression (ie. easier to fight), increases social assertiveness (ie. easier to talk->others), reduces tension (ie. sleep easier) adolescents who are first experimenting but have positive expectations go on to drink more (PLAY INTO THE ONSET OF THE PROBLEM EVEN BEFORE EXPERIENCING IT) negative expectancies are associated w/diminished use but MUCH less powerful Environmental Factors -fam, peers, media influence expectations/attitudes about the effects and also access

Psychopathy Checklist (PCL) (Robert Hare)

2 major factors/groups of symptoms: 1) emotional/interpersonal traits (MAIN DIFF BETWEEN DSM-5 ASPD & PSYCHOPATHY; DSM-5 does include being deceitful/failure to experience remorse tho) glib/superficial egocentric/grandiose lack of remorse/guilt lack of empathy deceitful/manipulative shallow emotions 2) social deviance (unstable/antisocial lifestyle) impulsive poor behavior controls need for excitement lack of responsibility early behavior problems adult antisocial behavior which is more useful in predicting repeated antisocial behavior following prison release? pervasive pattern of disregard for violation of the rights of others, occurring since 15 years, as indicated by 3+ of the following: failure to conform->social normals wrt lawful behaviors (performing acts on grounds for arrest repeatedly) deceitfulness (repeated lying, aliases, conning) for personal profit/pleasure impulsivity, failure to plan ahead irritability/aggressiveness (phys fights/assaults) reckless disregard for safety of self/others consistent irresponsibility (repeated failure to sustain consistent work behavior/honor financial obligations) lack of remorse (indifference/rationalization of having hurt, mistreated, stolen from another) individual is at least 18 y/o evidence of conduct disorder w/onset b4 15 y/o occurrence of antisocial behavior not exclusively during course of schizophrenia/BD

Antisocial Behavior Over Lifespan (Inconsistent)

2 primary forms: transient nontransient males usually engage in antisocial behavior/underlying disposition @ all ages (life-course-persistent antisocial behavior) w/expression changes as new social opportunities arise @ diff points in development ie. 4 y/o: biting, hitting 10: shoplifting, truancy 16: stealing cars 22: robbery, rape 30: fraud, child abuse 40-45: burn/mature out (usually for impulsive, socially deviant behaviors) (less "need for excitement")—is this decline in social deviance due->personality structure (improved impulse control, diminished risk-taking) or new outlets for aggression/impulsivity/callous disregard for others ***emotional-interpersonal factors on the PCL DO NOT decline over time (stable features)

Natural History of Alcoholism Study

456 inner-Boston adolescents (core city group, followed till 60) & 268 former undergrads from Harvard (followed til 70) initial data collection in 1940 when all adolescents follow-ups every other year by questionnaire, every 5th year by physical exam 21% college, 35% core city men met diagnostic criteria for alcohol abuse (presence of 4+ problem like employer complaints, marital/fam difficulties, medical complications, legal probs) mortality rate higher among men who abused heart disease/cancer 2x as high of risk repeated cycles of abstinence then relapse life course followed for 121 core city men and 46 college men social drinking: problem free drinking for 10+ years controlled drinking: 1+ drinks a month for @ least 2 years w/o problems avg age of onset was 40 years for college men & 29 for core city, but core city likelier to achieve stable abstinence (<1 drink/month for 1* years) P(continued alcohol abuse past 40 years) decreased, abstinence slowly went up the longer someone was abstinent, the likelier to stay abstinent (relapse uncommon for abstinence for @ least 6 years)

Prevalence of Alcohol Use Disorder

<25% males are abstinent and 2/3 drink socially/regularly out of all men/women who have used alc, 20% develop serious problems due->prolonged alcohol consumption NESARC (National Epidemiological Survey on Alcohol & Related Conditions): nationally representative sample of 43,000 lifetime prevalence of 30% only 24% assigned a diagnosis of alcohol dependence received treatment 60% US women drink occasionally but fewer develop alcoholism abuse/dependent—men>women by 2:1 -perhaps due->negative view/social disapproval of intoxicated women=>less heavy drinking bc situations where they won't get social disapproval are slim -perhaps due->standard dose of alc in proportion->body weight producing higher peak of alc levels in blood in women (less diluted in female body water)—if heavy drinker, > vulnerable to liver disorders

Veterans Affairs Study

> 3,000 patients but NOT randomly assigned naturalistic eval of substance abuse treatment programs administered @ 15 sites by Dept. Veterans Affairs CBT, 12-step programs, "eclectic therapy" (combo of approaches) patients in all 3 groups improved ito patterns of substance use, levels of social/occupational functioning received > treatment sessions? better outcomes 12-step favored again

Alcohol (Stimulant)

Absorbed through stomach, small intestine, colon membranes [], volume, rate of drinking, whether you ate before changes absorption rate (faster if distilled on avg, liver metabolizes 1 oz. 90-proof liquor/4 oz. wine/12 oz. beer per hr—EXCEED METABOLIC LIMIT? rise in blood alc disrupts relationships, blackouts (can function w/o passing out too but can't remember behavior), interference w/Jon performance (ie. sporadic attendance, fired, financial difficulties), probs w/law (arrests for drunk driving, child/spouse abuse), health probs (liver, pancreas, GI, cardiovascular, endocrine, CIRRHOSIS OF LIVER, neurocognitive, nutritional disturbances) MORE HEALTH PROBS THAN EVERYTHING BUT NICOTINE deaths from injuries commonest in young men, diseases in older men

Blood alcohol levels

Amt alc/unit blood 160 lb man who drinks 5 drinks in 1 hr has blood alc of 100 mg % (per 100 mL blood) toxic death/coma/potentially lethal (neurological/respiratory complications): 400 mg intoxicated: 150-300 mg legal limit: 80 mg slowed reaction times/driving interference beyond 80 mg

Comorbidities

Antisocial PD, mood, anxiety disorders conduct disorder (childhood manifestation of Antisocial PD) & alcohol use in adolescence/subsequent dependence (both represent predisposition toward behavioral disinhibition use of drugs=>depression/anxiety/guilt/interpersonal problems or the other way around if drugs are seen as options for self-medication (NOT EFFECTIVE, makes things worse)

Cluster B: dramatic, emotional, erratic

Antisocial: pervasive disregard for/frequent violation of rights of other persistent pattern of irresponsible behavior (ie. failure to perform responsibilities associated w/occupational/family roles) beginning in adolescence into adulthood irritable, aggressive, conflict-prone, impulsive, reckless, callous/exploitative behavior emotional/interpersonal problems EGOCENTRICITY extreme cases: genocidal war crimes, serial murders Borderline: pervasive instability of interpersonal relationships (intense, unstable, manipulative), self-image, emotions (mood swings, esp w/intense anger=>temper tantrums, physical assault, threats/gestures of taking one's life), impulse control identity disturbance: hard to maintain integrated image of self that incorporates both their + and - features (zone into 1 or other—ie. deflated/devalued sense of self importance), uncertain about personal values, sexual preferences, career alternatives; "exist from moment->moment w/o sense of continuity, predictability, meaning", experience life in fragments/discrete points of experience that don't flow chronic emptiness/boredom ppl should recognize my needs & do special favors Histrionic: pervasive pattern of excessive emotionality, attention-seeking self-centered, vain, demanding, approval-seeking manipulative sexually seductive/provocative shallow emotions that vacillate exaggerated reactions intact self of identity, better capacity for stable relationships overlaps most w/narcissistic, paranoid, dependent, avoidant, major depression (symptoms evident b4 onset of major depression—29% of 100 outpatients developed severe depression after diagnosis of BPD, 23% out of pure-BPD in longitudinal study in the 15-year follow up), substance use/eating disorders Narcissistic: pervasive grandiosity (exaggerated sense of own importance, preoccupied w/own achievements/abilities, self-absorbed, arrogant), need for admiration, lack of empathy marked difficulty in sustaining interpersonal relationships ppl should recognize my needs & do special favors (inflated sense of self-importance)

Cluster C: anxious/fearful

Avoidant: social inhibition/discomfort (timid but wanna be liked), feelings inadequate, hypersensitivity-> - evaluation/disapproval social anxiety disorder-like (2 ways to define same condition?) (although social anxiety is fear of being judged/performing in front of others in PARTICULAR KIND OF SITUATION) trouble initiating relationships Dependent: pervasive pattern of excessive need to be taken care of,/not being separated submissive/clingy unable to make decisions on own, feeling helplessness easily hurt by criticism, sensitive->disapproval, lack self-confidence trouble being alone/separating from others w/whom they have a close relationship Obsessive-Compulsive: preoccupation w/orderliness/rules/perfectionism and mental/interpersonal control @ expense of flexibility, openness, efficiency (ie. lose sight of main point of activity due->preoccupations w/details) (hard to finish projects to meet deadlines) conscientious, moralistic, intellectual, judgmental, intolerant of emotional behaviors in others unattainable, overly ambitious standards for own performance—workaholic; don't delegate responsibilities->others need for control, lack of tolerance for uncertainty lack of emotional warmth

Impulse Control Disorders (aka Disruptive + Conduct Disorders)

BPD & Antisocial (self-mutilation & theft/aggression, respectively) manic episodes—excessively pleasurable unrestrained buying/sexual indiscretions that have painful consequences -persistent, clinically significant impulsive behaviors not better explained by other disorders included pathological gambling (now substance use disorder) oppositional defiant disorder/conduct disorder for children preceded by tension, followed by pleasure/gratification/relief... pyromania: deliberate, purposeful setting of fires accompanied by fascination w/attraction->fire & associated not motivated by financial considerations (arson), social/political ideology, anger, vengeance, delusional beliefs kleptomania: stealing/theft of objects not necessary for personal use/financial value; not motivated by anger/vengeance intermittent explosive disorder: disproportionately (ito precipitating psychosocial stressors) aggressive behaviors resulting in serious assaultive acts/destruction of property dangerous, illegal, destructive acts explained ito these mental disorders but like why are the acts done? bc he has mental disorder and how you know he does is became of these acts (circular) -difficult bc problem behaviors may not be part of a broader syndrome that the symptoms that fall under a category are also under (problem behavior IS the disorder)

Gambling Disorder

DSM-IV: impulse control disorders (failure to resist temptation to engage in pleasurable behavior) addiction: performed in effort to relieve signs of withdrawal (physiological); ABSENCE OF RESPONSIBILITY FOR THE BEHAVIOR (seen in chemical but not behavioral (voluntary) addictions) included under this diagnostic category bc activate reward pathways in brain co-morbid w/substance use disorders, symptoms shared (ie. preoccupation w/activities related->gambling, frequent but unsuccessful attempts to quit) MOST GAMBLING ISN'T A MENTAL DISORDER BUT RECREATION, only pathological gambling is out of control, all-consuming, =>financial ruin/interpersonal consequences behavioral addiction maybe like excessive Internet gaming, sexual behavior, shopping, exercise (NOT included bc no repeated neural exposure->toxic chemicals, physiological mechanisms like tolerance/withdrawal; just loss of control, failure to anticipate/avoid negative consequences of self-damaging behaviors)

Problems w/Treatments for PDs

Ego-syntonic Premature termination of treatment Co-morbidity (less "pure" PDs, overlap w/categories of mental disorders)

Personality

Enduring patterns of thinking/behavior that define and distinguish someone from others includes emotional expression & patterns of thinking about ourselves and others

DSM-5 Personality Disorder Classification

Main body: traditional, categorical approach/definition (10 types w/characteristic symptoms organized into 3 clusters); the official approach Vs. Section III: dimensional definition (25 dimensional scales for personality traits)

Neuroticism

anxiety anger-hostility (hypersensitive, easily angered) depression self-consciousness (easily embarrassed vs. indifferent->others' opinions) impulsiveness vulnerability (overwhelmed by stress vs. oblivious->danger)

Personality Disorders

Exaggerated/excessive personality traits that persistently respond in ways unsuitable->social challenges faced -diagnosis: MUST fit general definition (applicable->all 10 subtypes) b4 specific criteria for a particular type general definition emphasizes duration of the pattern/social impairment associated w/the symptoms: "enduring pattern [of maladaptive] inner experience & behavior that deviates markedly from cultural expectations" that is evident in 2 of more: cognition (ways of thinking about self/others), emotional responses, interpersonal functioning, impulse control pattern is inflexible, pervasive across broad range of personal/social situations, source of clinically significant distress/impairment in social & occupational functioning, and stable/long duration (traced back->adolescence/early adulthood) -disrupt interpersonal relationships (ie. marital discord), increase risk for stressful life experience, increased risk for subsequent development of other mental disorders (ie. negative emotionality/high neuroticism => major depression/anxiety disorder, antisocial personality/impulsivity => alcoholism), predicts onset of serious disorders (ie. paranoid/schizotypal preceded schizophrenia), interfere w/treatment of co-morbid disorder -maladaptive variations of buildings blocks of personality: motives, cognitive perspectives regarding self/others, temperament, personality traits

Treatment of Schizotypal PD

antipsychotic drugs (low dose) for cognitive problems & social anxiety, antidepressants (SSRIs) educational approach for social skills is better than insight-oriented psychotherapy (SPD DO NOT see selves as having psychological problems/don't see own behaviors as sources of distress (ego-syntonic) and are uncomfortable w/close therapeutic relationships)

Hallucinogens

LSD PCP

Dialectical Behavior Therapy (DBT) for BPD

Marsha Linehan broadly based behavioral strats (appreciate/balance contradictory needs to accept negative emotions the way they are while working to change the thinking/behavior that contributes->problems in emotional regulation) & general principles of supportive psychotherapy learning to be comfy w/strong emotions (fear, anger, :(), integrated thought accepting both good/bad features of self/others cognitive behavioral: skill training, exposure, problem-solving help to improve interpersonal relationships, tolerate distress, regulate emotional responses therapist needs to be accepting of patients' demanding/contradictory behavior bc sensitive->criticism/rejection ie. women w/BPD who have attempts on lives/deliberate self-harm who underwent DBT instead of treatment as usual: TAU had 60% premature termination vs. 17% in DBT, DBT reduced freq/severity of attempts on own lives, spent fewer time @ psychiatric hospitals, rated higher on self-measure of social adjustment, NO diffs in depression/hopelessness tho (although this WAS indicated in other studies)

Social Motivation

Motive: desire/goal (explain why people behave like they do in virtue of the way people would like things to be) affiliation: desire for close relationships ***ABSENCE OF MOTIVATION FOR AFFILIATION (prefer isolation) power: desire for impact, prestige, dominance ***EXAGGERATED MOTIVATION FOR POWER/ACHIEVEMENT (preoccupation w/the need for admiration/praise due to seeing self as privileged/deserving of special treatment) lacking balance—ie. Devotion->work/professional achievement

Cluster A: odd/eccentric, asocial (schizophrenia spectrum disorders)

Paranoid: inappropriately/pervasively distrustful/suspicious of others' motives (inflexible but not delusional) -precautions to avoid exploitation -aggressive, antagonistic=>self-fulfilling prophecy (ie. paranoid person reacts this way in response->perceived threat and other person proceeds w/concern&caution, confirming original suspicions) -does not comprehend how own behavior affects others Schizoid: pervasive detachment/indifference from social relationships, restricted range of emotional expression, prefer social isolation (cold/aloof) Schizotypal: discomfort (anxiety) w/close relationships (social detachment), cognitive/perceptual distortion, eccentric behavior -patterns of behavior instead of emotional restriction/social withdrawal -speech hard to follow—vague/disjointed or use words oddly or in restricted way -NOT psychotic/outta touch w/reality symptoms in common w/schizophrenia (behavioral traits/interpersonal styles preceding onset of psychosis) -this cluster is very co-morbid and schizotypal w/avoidant & BPD too

Substance-Use Disorders by Country

SE Asia/Middle East: opium (poppy plants) S America: cocaine (cocaine trees) -Indians use for medicine, religious ceremonies, as cold/hunger/thirst relief cannabis is growable in multiple diff climates Japan: amphetamine bc avail land for cultivation is scarce frequent drug users doesn't imply drug dependence because culture shapes amount ingested, how administered, beliefs about drug effects important risk factor: age of first exposure -ie. Prevalence rate for males who consumed alc b4 14 is double that of those who began @ 18 (similar for tobacco, marijuana) -unclear if this is due->those predisposed just beginning to use earlier tho 2-3 years between initial use & addiction/onset of symptoms for substance use disorder

Depressants

alcohol meds to help sleep (hypnotics) meds to help w/anxiety (sedatives, anxiolytics)

Risk for Addiction Across Life Span

abstinence rates: 22% in 30s, 47% for 60s, 80% over 80 prevalence rates for alcohol-use disorder higher among young adults, low among elderly elderly have abuse/dependence on LEGAL DRUGS like prescription drugs/over the counter meds (ie. hypnotics, sedatives, anxiolytics, painkillers) 25% of over-55 use psychoactive drugs, enhanced sensitivity->drug toxicity (slower metabolism) -in elderly, tolerance risk is reduced BUT withdrawal are more severe/prolonged -less occupational impairment bc less employed, less social impairment too

Cannabis (marijuana (dried leaves/flowers), hashish (dried resin of top of female plant))

active ingredient: THC oral=>slow, incomplete absorption (2-3x larger dose to achieve same effect as smoking) metabolized in liver high/happiness/wellbeing OR anxious/paranoid mood is more influenced by others' behaviors intoxication & temporal disintegration (trouble retaining/organizing info), attentional lapses/concentration probs high doses over extended time is likeliest way to develop tolerance; reverse tolerance (more sensitive->effects over time)? withdrawal (irritability, restlessness, insomnia) after continuous large doses performance deficits on neuropsychological tests (attention, learning, decision making)

Biological Causes of ASPD (Genetic Factors)

adoption strat: people separated from biological parents @ early age & raised by adoptive fams INTERACTION OF GENETICS & ADVERSE ENVIRONMENTAL CIRCUMSTANCES offspring of antisocial biological parents raised in adverse adoptive environment ie. target group vs. control (separated from biological parents w/o history psychopathology) assessed for symptoms of conduct disorder (truancy, expulsion, lying, stealing), aggression, antisocial behavior adversity of adoptive home measured ito total # problems present (ie. marital adversity, drug abuse, criminal activity)—greater adversity, greater displays of above behaviors, with MORE pronounced harmful effects in target group ***BEING RAISED IN ADVERSE HOME ENVIRON DIDN'T SINGLE-HANDEDLY INCREASE P(PROBLEMATIC BEHAVIORS) OF CONTROLS

Temporal Stability of PDs: Appear in Adolescence, Persist into Adulthood

adult predictor for antisocial = conduct disorder in childhood (ie. theft, aggression) in longitudinal study, 17% adolescents qualified for @ least 1 PD, which maladaptive traits representing the core features of the disorders remained stable from adolescence->young adulthood schizotypal/BPD: impaired (ie. 1/4 still have BPD that they had in 20s in 40-50s) even if professional help unless high recovery for BPD symptoms ***social/occupational impairment > chronic/stable than symptoms ***schizotypal&schizoid have bad prognostics—remain socially isolated/occupationally impaired

Alcohol-Use Disorder

age of onset varies from childhood->early adolescence->throughout life course varies, but commonality is periods of heavy use alternating w/periods of relative abstinence and also defining stages of initial exposure, eventual onset of impaired control/social impairment/pharmacological symptoms

Traditional Categorical=>Dimensional Model of PDs

arbitrary thresholds suck overlap between categories sucks (meet criteria for >1 type/multiple diagnoses) now, based on personality traits—good for between/combinations of categories official system for clinical practice = traditional categorical diagnostic constructs

Temperament

basic, characteristic styles of relating->world esp in 1st year of life activity level/emotional reactivity dimensions ie. lack of control when younger precipitates hyperactivity, distractibility, conduct disorder shy — anxious, socially inhibited

Impulsive vs. Compulsive

both repeated, hard to resist I: goal of pleasure C: avoid anxiety

Only the Paranoid Survive (Andrew Grove)

business management: corporate leaders must be vigilant & anticipate negative events/competition misused/informally used "paranoid"—being cautious toward others' motives vs. chronically suspicious, vigilant, on edge, irritable, hostile (due->belief that others are causing probs for them) paranoid can withdraw anxiously bc believe that others cause harm so protect through avoiding paranoid can be time-extensive preoccupation w/the idea of threat that others pose

fun facts about drugs

caffeine cannot lead to use disorder, sexual dysfunction, delirium, dementia cannabis cannot lead to sexual dysfunction/dementia hallucinogens cannot lead to withdrawal, sleep disorders, sexual dysfunction, dementia inhalants cannot lead to withdrawal, sleep disorders, sexual dysfunction opioids/stimulants cannot lead to dementia tobacco cannot lead to intoxication, sexual dysfunction, delirium, dementia

psychoactive substance

chemicals that alter mood, level of perception/consciousness, brain functioning also increase comfort level

Stimulants

cocaine amphetamine nicotine caffeine

CBT for Alcohol Use Disorder

cognitive/behavioral responses that trigger episodes of drug abuse heavy drinking = learned, maladaptive response to cope w/difficult problems/reduce anxiety identify/respond more adaptively->circumstances normally precipitating drug abuse

DSM-5 on ____ Use Disorder

collapse substance dependence/abuse into 1 bc evidence that they're not distinct forms of a disorder each category has 2 total features required for diagnosis severity of Alcohol Use Disorder—2-3 symptoms is mild, 4-5 moderate, severe 6+ first 4 symptoms are impaired control (persistently unsuccessful to quite, cravings), next 3 are social impairment, 8&9 risky use, last 2 are pharmacological criteria (tolerance/withdrawal, which predicted more severe drug problems, greater intensity of exposure->drugs, > comorbidities)

Prevalence of Nicotine/Drugs

combined lifetime prevalence for abuse/dependence of controlled substances (illegal/prescription-only): 10.3% > common in men lifetime prevalence for nicotine: 24% (National Comorbidity Survey), decreased from 1964 where US Surgeon General's Report linked smoking w/cancer; decline greater in men, but increased in 1990s for 18-25 y/os and also in developing countries (less education about health risks)

Conscientiousness

competence order (preoccupied w/rules vs. disorganized) dutifulness (above morality vs. undependable/reliable) achievement striving (workaholic vs. aimless) self-discipline (single-minded pursuit of goals vs. hedonistic/self-indulgent) deliberation (excessive rumination vs. careless in decision-making)

Ch 9 Research Method: Cross-Cultural Comparisons (The Importance of Context)

culture: system of meanings that determines how people think about self & environ ie. bereavement post-close relative death Native Americans expect to hear auditory hallucinations/hearing voices (perceptual experiences in absence of external stimuli) when the dead call to them from afterworld, but not psychotic/dysfunctional—normative and common and no social/occupational impairment Cross-cultural psych: scientific study of ways that behavior/mental processes are influenced by social/cultural vals -ethnic diffs (cultural groups living in same nation @ close proximity) epidemiology—comparing prevalence, etiology main focuses: 1) identify meaning groups: selecting participants representative compare ethnic groups in large multicultural society is difficult—how to know which people share common culture? how to find the boundaries of the "cultural unit"? 2) select equiv measurement procedures: diff dialects/languages so questionnaires/psych tests need cross-validation to ensure that they measure same concepts 3) consider causal explanations: interpreting differences—due->cultural variables or things like poverty, education, age (hold constant and see) 4) avoid culturally biased interps: don't interpret differences as indicative of deficits of minority/non-Western cultures study developmental processes instead of outcomes?

5 Factor Model (FFM) of Personality

each divided into 6 elements/facets description of behavior

Cannabinoids (ie. marijuana)

euphoria altered sense of time maybe hallucinations @ high doses

DSM-5: Gambling Disorder

exhibit 4/9 features 5 symptoms resemble Alcohol Use Disorder's impaired self-control, social impairment, failure to quite despite enormous difficulties gambling w/increasingly larger amounts of $ to experience same level of stimulation (like tolerance), becoming agitated/annoyed when try to stop (similar->withdrawal), repeated failed efforts to quit, preoccupation w/gambling, impaired social/occupational functioning CHASING LOSSES frequent gambling when experiencing emotional distress, lies to cover up extent of gambling, depending on financial help from others to cope from losses from gambling From DSM-IV, ILLEGAL ACTS WAS DROPPED ("person has committed illegal acts, such as forgery, fraud, theft, embezzlement, to finance gambling" bc rarely endorsed except for severe cases, not effective in distinguishing between people who do/don't seek treatment for gambling disorder; NEEDED TO MEET 5 BUT NOW JUST 4 FEATURES (threshold)

Short Term Motivational Therapy

failure to recognize severity of problems=>treatment is not sought out, so gotta increase awareness of the nature of the problem (w/o using diagnostic labels) comprehensive assessment of situation, personalized feedback discuss possible courses of action that encourage the person's belief in his/her own ability to accomplish this positive change motivational interviewing: non confrontational way to resolve ambivalence about using drugs & make a definite commitment to change—in order to change, gotta recognize the inconsistency of current behavior/LT goals -discussion of problems of the addict/others affected; addict will reflect on feedback provided nonthreateningly empathy instead of confrontational argument about the reasons for drinking/demanding action NOW (will only cultivate defensiveness that will interfere w/attempts to change) most helpful for non-severe/non-chronic abuse problems if not ready to abstain, just reduce the freq/intensity of alc consumption

Deviant Children Grown Up by Lee Robins (1966)

follow-up on children treated years earlier @ child guidance clinic boys' conduct disorders were reliable predictors of antisocial behavior as adults concrete observable behaviors documented by legal records (instead of subjectively defined emotional deficits so more reliable), related conflict w/failure to conform->social norms/laws

Causes of BPD

genetic factors/predisposition, personality traits interacting w/environmental events=>emotional dysregulation/attachment relationships parental loss, neglect, mistreatment ie. adolescent girls report pervasive lack of supervision, inappropriate behavior by parents/adults (sexual, verbal, physical abuse), witnessing domestic violence -does childhood abuse=>BPD or does BPD=>biased reporting (likelier to remember being abused)? data from NY State Central Registry for Child Abuse (sexual/physical abuse, neglect)—those w/documented evidence 4x likelier to develop PD symptoms (esp Cluster B) physical abuse & Antisocial, sexual & BPD, neglect & both of above, Narcisstic, Avoidant

Causes of Schizotypal PD

genetically related->schizophrenia? yes! twin studies showed significant genetic contribution when examining schizotypal traits dimensionally who's likeliest to exhibit symptoms of SPD? 1st degree relatives of schizophrenic (just like how paranoid/avoidant PD common among relatives of schizophrenic)

"White Collar Psychopath"

grandiosity deceit/manipulativeness, lack of remorse

Schizotypal PD (SPD)

history closely tied w/schizophrenia bc used to be abbreviation for "schizophrenic phenotype" (maladaptive personality traits seen in those w/genotype w/vulnerability->schizophrenia) symptoms=early manifestations of predisposition to develop schizophrenia symptoms of schizophrenic patients' relatives similar->diagnostic criteria pervasive pattern of social/interpersonal deficits—acute discomfort w/ and reduced capacity for close relationships—and cognitive/perceptual distortions, eccentricities in he suit beginning in early adulthood and present in variety of context, indicated by 5+ of the following: ideas of reference (excluding delusions of reference) odd beliefs/magical thinking that influences behavior and is inconsistent w/subcultural normal (ie. superstitions, belief in clairvoyance, telepathy, 6th sense; in children/adolescents—bizarre fantasies/preoccupations) unusual perceptual experiences including bodily illusions odd thinking & speech (vague, circumstantial, metaphorical, overelaborate, stereotyped) suspiciousness/paranoid ideation inappropriate (emotional responses inconsistent w/social context, ie. giggling uncontrollably & funeral)/constructed (absence of emotional responsiveness, ie. lack of facials) affect odd, eccentric, peculiar behavior lack of close friends/confidants other than 1st degree relatives excessive social anxiety that doesn't diminish w/familiarity & tends to be associated w/paranoid fears and not negative judgments about self ***DOES NOT occur exclusively during course of schizophrenia, BD, depressive disorder w/psychotic features, psychotic disorder, autism spectrum disorder

Substance-Induced Disorders

immediate impact of taking drug (intoxication) or discontinuing use (withdrawal) caffeine doesn't have a "use disorder" but only "intoxication"/"withdrawal"

Personality Disorder Trait Specified (PDTS) Process

impairment in self/interpersonal functioning & 1+ pathological personality traits replace 4 categorical types w/trait ratings advantages: not exhibiting many symptoms (sun threshold in categorical model) can be diagnosed here, multiple diagnoses not necessary ie. paranoid PD rated high in suspiciousness, histrionic—high attention-seeking, dependent—high submissiveness explain overlap/co-morbidity ie. borderline & antisocial PD share maladaptive traits: antagonism/hostility, disinhibition/impulsivity, not just separate diagnoses w/shared symptoms however, distinct bc BPD are high on negative affectivity traits (ie. emotional lability, anxiousness, depressivity)

Problems w/Psychological Explanations for ASPD

implicit assumptions that people conform->social regulations/ethics bc of anxiety/fear of punishment crucial features may not be low anxiety, failure to learn from experience, but lack of shame/pathological egocentricity (choice to behave selfishly and ignore feelings/rights of others)—anxiety is driven by moral judgment

The Mask of Sanity by Hervey Cleckley in 1976 (ASPD)

impulsive, self-centered, pleasure-seeking, no primary emotions like anxiety, shame, guilt psychopath: intelligent, superficially charming but chronically deceitful, unreliable, incapable of learning from experience emotional deficits, personality traits

Treatment of ASPD

ineffective bc unable to establish intimate, trusting relationships (basis of treatment program) behavioral procedures for anger management, deviant sexual behaviors produce temporary changes when closely supervised but may not be generalizable mostly focus on juvenile delinquents, imprisoned adults, criminal justice system outcome: frequency of repeated criminal offenses and not behavioral changes linked->personality traits complicated by: alcohol/substance dependence

Psychological Causes of ASPD

instability/failure in learning from experience, lack of anxiety, impulsivity Laboratory Tasks: learn sequence of responses in order in order to receive reward/avoid aversive consequence (ie. electric shock, losing $$) as accurate as nonpyschopathic but behavior is unaffected by anticipation of the punishment Hypothesis 1: emotionally impoverished, insensitive->effects of punishment physiological responses (ie. involuntary eye blink startle reflex—usually magnitude of response is increased if engaged in ongoing task that elicits fear/- emotional state while started; follow diff pattern of startle responses where no exaggerated startle response indicative of fear in presence of aversive stimuli) Hypothesis 2: difficulty shifting/reallocating attention to consider - consequences of behavior (observation: respond normally->punishment in some but not all situations, esp in mixed incentive situations where reward or punishment) preoccupied w/potential for successful outcome (ie. continue gambling when stakes are high and odds are against them, pursue sex even when other is trying to discourage them) no inhibition of inappropriate behavior bc less able to consider meaning of the signals pointing to their behaviors leading->punishment

Substance Use Disorder

maladaptive pattern of continued use of drugs that causes problems (ie. inability to control drug use, risky use, repeated use, social impairment, pharmacological consequences such as tolerance & withdrawal) involves craving

Sedatives (calm/reduce excitement), Hypnotics, and Anxiolytics, Tranquilizers (decrease agitation), Barbiturates (ie. phenobarbital/Nembutal, amobarbital/Amytal), Benzodiazepines (diazepam/Valium, alprazolam/Xanax; lower overdose potential)

intoxication, impaired judgment, slowed speech, lack of coordination, narrowed attention, disinhibition of sexual/aggressive impulses ("rage reaction", aggressive discontrol) injections=>pleasant, warm, drowsy like opiates stop taking high doses? "discontinuance syndrome" (worsening of anxiety that was supposed to be treated, irritability, paranoia, sleep/perceptual disturbance, agitation, muscle tension, restlessness) avoid withdrawal if gradually discontinue

OCD

intrusive, unwanted thoughts & ritualistic behaviors, DIFF FROM OCPD (high conscientiousness)

Project MATCH (Evaluating Treatments for Alcholism)

large sample size of 1,700+ randomly assigned, outcomes measured for 3 years @ end of treatment tested potential value of matching clients->treatments (would the outcomes from the intervention be different if matched->client's characteristics?)—nah evaluated 3 forms of psychological treatment: 1) CBT (12 sessions, coping skills & relapse prevention) 2) 12-step facilitation theory (12 sessions, engagement in AA) 3) motivational enhancement therapy (4 sessions over 12 weeks, increase commitment to change) all 3 treatments => major improvements in amount of drinking/life functioning (25-> <6 drinking days/month) 12-step was only favored because 24% completely abstinent compared->15% in other 2 groups

Tobacco Regulation

legally avail->adults but curbed in sale/distribution by 1996 FDA efforts to restrict smoking in public places, eliminating ads for cigs, increasing sales tax nicotine = addictive (symptoms of dependence, tolerance/withdrawal, pattern of compulsive use) why not just ban completely? why not eliminate nicotine from tobacco products like cigs? bc impractical, not politically viable—those addicted will create black markets MODERATE APPROACH->REGULATION! regulate medical devices (ie. treat cigs as drug-delivery system) PREVENTION efforts to curb addiction—prohibit sale->under 18, restrict advertising to reduce rate that youngens are recruited to smoke 1997-2004: prevalence rates for smoking among adults from 25-21%

PDs: Community (General Pop.)/Clinical Sample Prevalence

lifetime prevalence for @ least 1 PD: ~10% @ least 50% who meet diagnostic criteria (traditional model) for 1 PD meet for another bc similar symptoms define >1 disorder ie: impulsivity/recklessness for both antisocial & BPD social withdrawal for schizoid, schizotypal, avoidant PDs BPD=most common PD (>30%) among all patients treated @ mental health facilities (for different psychological disorder) highest prevalence rates: OCPD, Antisocial PD, Avoidant PD (3-4%) least common: Narcissistic PD (<<1%) lifetime prevalence rate for Antisocial PD: 3%

Frequency of Gambling Disorder

lifetime prevalence: 2%, may increased w/legality/availability of gambling men more than women

Liz (Borderline PD Case Video)

loneliness, insecurity in relationship & fear of abandonment (bf about to go->Air Force flight school, overprotective and thought he was cheating so they won't be engaged, won't have a husband, won't have fam, etc.)=>attempt to take own life thru overdose=>hospitalized impulsive/compulsive shopping anger management issues

Hallucinogens

low dose hallucinations molecularly similar->neurotransmitters like serotonin (LSD, psilocybin) & norepinephrine (mescaline) MDMA/Ecstasy: synthetic amphetamine derivative, stimulant-esque -clubs/raves w/LSD & meth -within 30 min, enhanced mood/wellbeing that lasts hours -changes perceptual experiences (distort time/space/increased sensory awareness), changes in blood pressure/temperature PCP (phencyclidine): painkiller -small doses=>warmth, relaxation, numbness -high doses=>psychotic behavior, delusions, catatonic motor behavior, manic excitement, sudden mood changes -v toxic—high doses can => coma, convulsions, respiratory arrest, brain hemorrhage vivid visual images (colorful geometry) that can change quickly and result in explosive patterns of movement "Bad trips" are frightening and can => panic attacks and fear of losing one's mind—verbal reminders that this is drug-induced help unique because usually used sporadically and not continuously and also dose is usually not increased across time (if stop using, no problems—no withdrawal) can trigger psychosis in those vulnerable may experience "flashbacks" (visual aftereffects @ unpredictable intervals after the drug has been cleared from the body) if under stress/using other drug like marijuana

Endogenous Opioid NeuroPeptides (Endorphins, enkephalins)

morphine-like (exogenous opioids) in pharmacological properties associated w/pain, emotion, stress, reward systems injections => tolerance/withdrawal in alcoholism, opioid receptor antagonists (block effects of opioid peptides) decrease alcohol self-administration in animals in humans, taking naltrexone=>drinking less, less of a "high" predisposition to increase consumption of alcohol with high levels of opioids

Tobacco (Nicotine=active ingredient, must be diluted or else toxic)

mucous membranes of lungs->heart->brain if tobacco smoke is inhaled (highest []) PNS: increase HR, blood pressure CNS: neurotransmitters (norep for arousal, dopamine/norep into Mesolimbic Dopamine Pathway/reward system for antidepressant-like effects) relax from stress BUT arousal of sympathetic nervous system (maybe only for low doses) one of most harmful/deadly physiological symptoms of withdrawal: drowsiness, lightheaded ness, headache, muscle tremors, nausea sleeping probs, weight gain, concentration difficulties, mood swings (anxiety->anger->depression) psychologically as difficult as heroin risk for heart, lung (bronchitis/emphysema) disease, cancer 80% lung cancer deaths women have fertility problems, birth defects of child

Opiates (pain relievers)

narcotic analgesics heroin

Tolerance

nervous system less sensitive->effects so need more pharmacological mechanisms: metabolic tolerance (repeated exposure=>liver enzymes for metabolism, which is faster so can take larger doses), pharmacodynamic tolerance (neurons decrease receptors/reduce sensitivity adapt to drug) behavioral conditioning mechanism: CS is cue for administration of drug, CR is compensatory (opposite direction as natural effect of drug) and increases in strength so drug effect not felt as strongly heaviest tolerance effects found for opioids (heroin), stimulants (amphetamine), alc, nicotine, but NOT really cannabinoids, hallucinogens

Context & Personality

not all traits are expressed in all circumstances, only ones that require/facilitate a particular response when expressed, social circumstance assigns a positive or negative meaning ie. difficult temperament=adaptive when infant has to be demanding/highly visible ie. lack of fear adaptive in war ie. ability to lie convincingly for espionage agent

CRAVING

not just forceful urge to use drugs take drug to relieve negative mood, avoid withdrawal symptoms (physiological & psychological), prep for public-speaking/writing/sex amount of time planning to take drug, preoccupied w/accessing drugs ("will ___ be avail?" NOT unusual for person who abused to try to stop/abstain ("freedom of choice", voluntary) but self-control usually fails

Borderline PD

one of most perplexing, disabling, frequently treated pervasive pattern of instability of interpersonal relationships, self-image, affects; marked impulsivity beginning by early adulthood and present in a variety of contexts, indicated by 5+ of the following: frantic efforts to avoid real/imagined abandonment (no suicidal/self-mutilating behavior) pattern of unstable, intense interpersonal relationships characterized by alternating between extremes of idealization/devaluation identity disturbance; markedly, persistently unstable self-image/sense of self impulsivity in @ least 2 areas (potentially self-damaging): spending, sex, substance abuse, reckless driving, binge eating, suicidal/self-mutilating behavior recurrent suicidal behavior, gestures, threats, self-mutating behavior affective instability due->marked reactivity of mood (ie. intense episodic dysphoria, irritability, anxiety lasting a few hours and only rarely more than a few days) chronic feelings of emptiness inappropriate, intense anger/difficulty controlling anger (frequent displays of temper, constant anger, recurrent physical fights) transient, stress-related paranoid ideation/severe dissociative symptoms

Opiates (pain-relievers)

opium active ingredients: morphine, codeine opioids (ie. heroin, oxycodone/OxyContin, hydrocodone/Vicodin) = synthetic prescribed morphine is oral so slow absorption in digestive system or else injected in high [] in brain tissue dreamlike euphoria/brief rush/pleasure (positive emotional effects do not last past 30-60 min), sensitivity in hearing/vision nausea/vomiting, constrict pupils, disrupt coordination of digestive system, decreased sex hormone levels (less sex drive/fertility) speedball=cocaine + opiates low doses: can remain healthy and productive high doses=>comatose state, chronically lethargic, depressed breathing, convulsions, decreased motivation/productivity misused as painkillers, unintentional overdose deaths high—double cocaine and 5x heroin in 2007 tolerance developed quickly, severe health consequences sometimes not due to the drug but to the lifestyle of the addict (expensive and hard to obtain=>neglecting housing, nutrition, health care) LIKELIEST TO DIE FROM AIDS, violence, suicide

PDs: Gender Diffs

overall prevalence = in men/women antisocial: 5% men, 2% women BPD/dependent may be > prevalent in women but weak evidence speculation that paranoid & OCPD > common in men

Symptoms of Addiction

patterns of pathological consumption (impaired control & continued use despite mounting problems) consequences following prolonged pattern of abuse (social/occupational impairments, interpersonal disruptions, deteriorating medical conditions) quantity of drug consumed is irrelevant (impacted by age, gender, activity level, physical health) drug use disorders lie on continuum of severity

Antisocial Personality Disorder

pervasive, persistent disregard for/violation of rights of others callous indifference, shallow emotional experience low anxiety & concern about danger

Social Causes of ASPD (Familial Conflict)

physical abuse, childhood neglect temperament/characteristic response styles influencing parental behavior ie. difficult (high levels of - emotion, excessive activity) can be irritating clumsy, overactive, inattentive, irritable, impulsive, resistant->discipline is discouraging parents from being persistent, maladaptive reactions from parents poorly equipped to deal (=>harsh punishments/no discipline) sustaining antisocial behavior... 1) limited range of behavioral skills: no social skill learning for appropriate responses (instead of lying, cheating, stealing) 2) results of antisocial behavior in childhood/adolescence: progressively ensnared by drug addiction, teenage pregnancy, dropping out, criminal record narrows opportunities

DSM-5 Criteria for Alcohol Use Disorder

problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least 2 of the following, occurring within a 12-month period... - (1) Alcohol is often taken in larger amounts or over a longer period than was intended - (2) There is a persistent desire or unsuccessful efforts to cut down or control alcohol use - (3) A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects - (4) Craving, or a strong desire or urge to use alcohol - (5) Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home - (6) Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol - (7) Important social, occupational, or recreational activities are given up or reduced because of alcohol use - (8) Recurrent alcohol use in situations in which it is physically hazardous - (9) Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol - (10) Tolerance, as defined by the following: (a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect + (b) a markedly diminished effect with continued use of the same amount of alcohol - (11) Withdrawal, as manifested by either of the following: (a) the characteristic withdrawal syndrome for alcohol + (b) Alcohol (or closely related benzodiazepine) is taken to relieve or avoid withdrawal symptoms

Treatment for BPD

psychodynamic therapy transference relationship (how patient behaves toward therapist, reflects early primary relationships) allows for realistic experiencing of self/others maintaining close personal relationships is key (rage toward therapist due->alternating between devaluation/idealization=>discontinue treatment prematurely) DBT psychotropic/active meds (ie. antipsychotics/depressants/lithium/anticonvulsants) but no disorder-specific drug, just treatment of symptoms (ie. impulsive aggression, emotional instability, transient paranoid thinking)

Relapse Prevention (Cognitive-Behavioral Approach->Treatment)

quitting is ez but maintaining is hard (usually return->excessive/uncontrolled use of the drug) emphasis on events after detoxification, helping addict deal w/challenges w/o drugs adaptive coping responses (ie. applied relaxation, social skills) when in situation that triggers urges ABSTINENCE VIOLATION EFFECT: guilt, perceived loss of control when slip up after period of abstinence -self-blame for failing their promise to quit -see this as signal that further efforts to control their drinking = futile/useless -interpret these slips as "lapses" and not total "relapse"

Cognitive Perspectives Regarding Self/Others

realistic/stable self-image allows planning, negotiating, evaluating your relationships perception of self: having confidence in values/opinions is needed for independent, unassisted, unreassured decisions and stable mood evaluating own importance (hopefully not seeings self as grandiose/inept or inferior) perception of others: mia perceive intentions/motives/abilities as threatening/incompetent/uncaring (ie. paranoia & the idea that others are deceiving/exploiting you, fears of being abandoned/criticized/rejected) cooperate by appreciating competence of others problems in social distance—(in)appropriate intimacy deficit in empathy: anticipate/decipher/understand others' emotional reactions

Mesolimbic Dopamine (Catecholamines like Norep & Serotonin)/Reward Pathways

reinforcement! primary circuit: medial forebrain bundle (ventral tegmental->nucleus accumbens) connections->(pre)frontal areas (planning/judgment) & amygdala (limbic system) deficiency in serotonin activity in limbic system=> drinking to increase serotonin activity BUT tolerance worsens stimulants inhibit reuptake of dopamine in nerve terminals, increasing dopamine concentrations in limbic system & medical prefrontal cortex exposure->cues signaling drug use cause medial prefrontal activation (drug craving) opioids, nic, alc decreasing activity of inhibitory GABA that normally results in reduced dopamine release so VTA has heightened dopamine activity genes affecting GABA reception are affected by alcohol dependence

Detoxification

removal of drug for 3-6 weeks to MAINTAIN REMISSION (best outcomes w/stable, long-term abstinence) symptoms of withdrawal as gradually adjust->drug's absence (esp gradual for CNS depressants like alc, hypnotics, sedatives; abruptly for stimulants) minimized by benzodiazepines & anticonvulsants usually in hospital or close outpatient supervision other medications: 1. disulfiram/Antabuse: block chemical breakdown of alc so violent illness (nausea, vomiting, profuse sweating, increased heart/respiration rate) that leads to avoidance of unpleasant reaction by NOT drinking; compliance is poor (some just wanna continue drinking or believe they can manage w/o the drug) 2. naltrexone/Revia: antagonist of endogenous opioids that dampens cravings bc alc can't stimulate the opioid system to induce feelings of reward; w/psychotherapy, less likely to relapse 3. acamprosate/Campral: reduce avg # drinking days by 30-50%, increases proportion of completely abstinent (22% vs. 12% for placebo after 12 months of treatment); used w/psychotherapy so dropout rates high 4. SSRIs like fluoxetine: small, inconsistent effects to reduce drinking even in patients w/dual diagnosis of major depression

PDs ("deviates markedly from cultural expectations") & Culture

restrained/subtle emotional displays vs. visible, public displays individualism (pursuits of personal goals) vs. collectivism (sharing, self-sacrifice for good of group) ie. collectivist society may view as egotistical/self-centered what are the personality traits => marked interpersonal difficulties or social/occupational impairment? are our diagnostic criteria meaningful cross-culturally? methodological problems: for paranoid PD, minority groups (immigrants from diff culture) are likelier than dominant groups to hold realistic concerns about victimization/exploitation so understanding experiences of oppression under which these concerns formed prevents diagnosing the undiagnosable

Ch 11 Research Method: Studies of People @ Risk for Disorders

risk: P(outcome will occur), but maybe won't suffer harm risk factor: variables associated w/higher P(developing disorder) *****JUST CORRELATIONAL, NO CAUSATION IMPLIED demographics (race, gender), bio psycho, family history?, expectancies about effects risk for alcoholism: 14/100 combined risk for illegal/controlled substances: 8/100 -longitudinal studies to see whether certain risk factors play a causal role in the disorder collect data b4 onset (is the risk factor present b4?) high-risk research design: subjects selected from general pop. w/well-documented risk factor; can identify factors => increased or decreased probability that someone vulnerable will active develop active symptoms

Alcoholism as Central Activity?

set of interests/patterns of behavior that motivate identity, behavior, life choices heavy drinkers are people who have made long, complex decisions/judgments/choices of commission & omission that can coalesced into this central activity drinking becomes meaningful but destructive part of their struggle to live their lives, they are not victims->disease

Alcohol Intoxication

slurred speech, lack of coordination/unsteady gait, nystagmus (involuntary eye movements up/sideways), impaired attention/memory, stupor/coma

Self-Help Groups (Alcoholics Anonymous, from 1935)

sobriety "first line of attack against alcoholism", 12-step program principle assumption: people cannot recover on their own, so group therapy gives a space for people to acknowledge/confront the severity of their problems not associated w/mental health professional treatment but often get Narcotics (opioids) & Cocaine Anonymous too 1st step: acknowledge that they're powerless over alcohol and are unable to manage their drinking spiritual/interpersonal matters like accepting a "Power greater than ourselves"=>sense of direction, recognizing/accepting personal weaknesses, amending previous errors due->drinking regular attendance (ie. everyday of first 90 days after stopping drinking) helps w/urges to drink variability in the format/membership of local AA meetings long-term follow up difficult, traditional methods of outcome research inapplicable (ie. random assignment, placebo controls), early dropout rates (~1/2 leave in <3 months) survival (sobriety) rates high for continued members, 80% of AA members who have remained sober for 2-5 years will remain sober for the next

Coping Skills Training (CBT)

social skills like resisting pressures to drink socially how to reduce the factors that initiate/maintain the drinking problem-solving procedures to identify situations that can lead to heavy drinking and alternative courses of action -ie. anger management if drink out of frustration can be remedied w/learning how to express negative emotions constructively cognitive expectations about the effects of alc = challenged, adaptive thoughts are rehearsed negative thoughts about self/events in environ are addressed (trigger unpleasant emotions => problem drinking)

Synthetic Amphetamine (ie. Dexedrine, Meth)/Naturally Occurring Cocaine (Psychomotor Stimulants that activate sympathetic nervous system)

stimulate neurotransmitters like (no)epinephrine, dopamine, serotonin constant blood level easiest if oral, absorbed slowly in digestive system, less potent effects can "freebase"—heat combustible chemicals and inhale smoke increase HR, blood pressure, dilate blood vessels/airways in lungs overdoses=>irregular heartbeat, convulsions, coma, death (esp when immune->euphoria effects so have to consume LOTS to try to feel the rush) suppress appetite/sleep large doses=>dizziness, confusion, panic positive mood/exhilaration for short while until lethargy/mild depression or irritability; low doses=>feel more confident, friendly, energized; higher doses have brief, intense euphoria (=>tolerance)/sexual arousal (but actually leads to sexual dysfunction psychosis is intensified or developed for the first time (auditory/visual hallucinations, delusions of persecution/grandeur) social/occupational roles disrupted—physical exhaustion, financial ruin (costly)=>criminal activities either drug (paranoia, hostility) or associated activities =>violence withdrawal symptoms not severe, but depression/suicidal ideation is in the long-term

Withdrawal

symptoms upon stopping use of drug ie. hand tremors, sweating, nausea, anxiety, insomnia convulsions, visual/tactile/auditory hallucinations, delirium (sudden disturbance of consciousness and changes in cognitive processes=>not aware of environ, unable to sustain attention) for alcohol most severe for alcohol, opioids, sedatives, hypnotics, anxiolytics (ie. Valium/Xanax) amphetamines, cocaine, nicotine are less NOT really for hallucinogens, PCP (phencyclidine)

Antisocial PD (ASPD)

yo like psychopathy and this are not interchangeable all criminals are not psychopaths and vice versa (ie. callous, egocentric, manipulative businessman) problem w/DSM-5 is that it seems to suggest that all psychopaths are criminals bc the category diagnoses so many criminals REQUIRED PRESENCE OF SYNPTOMS B4 AGE 15, PRESENCE OF @ LEAST 3/7 SIGNS OF IRRESPONSIBLE/ANTISOCIAL BEHAVIOR AFTER 15 (ie. lack of remorse, which Cleckley also wrote)