EXAM 2 (Ch. 6, 7, 9, and 12)

1 in __ women is raped at some time during her life.

6

It has been estimated that the cost of substance misuse is ____ each year in the United States alone

$740 billion

gender and depression

-women are at least twice as likely as men to receive a diagnosis of unipolar depression

"People who experience a large number of stressful events are particularly vulnerable to...

... the onset of anxiety disorders."

bipolar I disorder

"a type of bipolar disorder marked by full manic and major depressive episodes" -people have full manic and major depressive episodes -most people experience an alternation of the episodes; for example, weeks of mania followed by a period of wellness, followed in turn by an episode of depression -some however, have mixed features, in which they display both manic and depressive symptoms within the same episode (ex. having racing thoughts amidst feelings of extreme sadness) -without treatment, the mood episodes tend fo recur for people with bipolar I

bipolar II disorder

"a type of bipolar disorder marked by mild manic (hypomanic) and major depressive episodes" -people have mildly manic episodes that alternate with major depressive episodes over the course of time -some people with this pattern accomplish huge amounts of work during their mild manic periods -without treatment, the mood episodes tend to recur for people with bipolar II

the "four-letter word" in suicide

"only" -as in "suicide was the only thing I could do"

the most common mood changes preceding suicide attempts

#1. an increase in sadness -also increases in feelings of anxiety, tension, frustration, anger, or shame

MDMA

(known as: Ecstasy, X, Adam, hug, beans, or love drug) -MDMA is a laboratory-produced stimulant (similar to amphetamines) but also produces hallucinogenic effects -MDMA was developed as far back as 1910, but only in the past 25 years has it gained life as a club drug -in the United States alone, consumers collectively take hundreds of thousands of doses of MDMA weekly -18 million Americans over the age of 11 have now tried MDMA at least once in their lifetime, 1.5 million in the past year -around 3.6 percent of all high school seniors have used it within the past year -as a stimulant and hallucinogen, it helps to raise the mood of many partygoers and provides them with an energy boost that enables them to keep dancing and partying -it may also produce strong feelings of attachment and connectedness in users -although it is no longer used as much as it was in the early 2000s, MDMA seems to have regained considerable popularity in recent years—particularly in the form of "Molly," marketed as pure MDMA—finding its way back to raves, dance clubs, and various college settings

LSD

(lysergic acid diethyl amide) a hallucinogenic drug derived from ergot alkaloids -one of the most powerful hallucinogens derived by a Swiss chemist named Albert Hoffman in 1983 -within 2 hours of being swallowed, LSD brings on a state of hallucinogen intoxication, sometimes called hallucinosis, marked by a general strengthening of perceptions, particularly visual perceptions, along with psychological changes and physical symptoms -people may focus on small details—the pores of the skin, for example, or individual blades of grass -colors may seem enhanced or take on a shade of purple -people may have illusions in which objects seem distorted and appear to move, breathe, or change shape -a person under the influence of LSD may also hallucinate—seeing people, objects, or forms that are not actually present -hallucinosis may also cause one to hear sounds more clearly, feel tingling or numbness in the limbs, or confuse the sensations of hot and cold -some people have been badly burned after touching flames that felt cool to them under the influence of LSD -the drug may also cause different senses to cross, an effect called synesthesia -colors, for example, may be "heard" or "felt" -LSD can also induce strong emotions, from joy to anxiety or depression -the perception of time may slow dramatically -long-forgotten thoughts and feelings may resurface -physical symptoms can include sweating, palpitations, blurred vision, tremors, and poor coordination -all of these effects take place while the user is fully awake and alert, and they wear off in about 6 hours -LSD produces these symptoms primarily by binding to some of the neurons that normally receive the neurotransmitter serotonin, changing the neurotransmitter's activity at those sites -these neurons ordinarily help the brain send visual information and control emotions; thus LSD's activity there produces various visual and emotional symptoms -more than 15% of all people in the United States have used LSD or another hallucinogen at some point in their lives -around 0.5%, or 1.2 million people, are currently using them -although people do not usually develop tolerance to LSD or have withdrawal symptoms when they stop taking it, the drug poses dangers for both one-time and long-term users -it is so powerful that any dose, no matter how small, is likely to produce enormous perceptual, emotional, and behavioral reactions -sometimes the reactions are extremely unpleasant—a so-called bad trip (when LSD users injure themselves or others, for instance, they are usually in the midst of a bad trip) -another danger is the long-term effect that LSD may have -some users eventually develop psychosis or a mood or anxiety disorder -a number have flashbacks—a recurrence of the sensory and emotional changes after the LSD has left the body -flashbacks may occur days or even months after the last LSD experience

dissociative identity disorder

(once known as multiple personality disorder) have two or more separate identities that may not always be aware of each other's memories, thoughts, feelings, and behavior -average number of subpersonalities for women is 15 and 8 for men

long-term stressors

(related to suicide) -social isolation -serious illness -an abusive environment -occupational stress

common forms of immediate stress

(related to suicide) loss of a loved one through death, divorce, or rejection; loss of a job; significant financial loss; and stress caused by hurricanes, earthquakes, or other natural disasters, even among very young children

object relations theorists on unipolar depression

(the psychodynamic theorists who emphasize relationships) propose that depression results when people's relationships, especially their early relationships, leave them feeling unsafe, insecure, and dependent on others

caffeine

--Caffeine is the world's most widely used stimulant. Around 90 percent of the world's population consumes it daily -Most of this caffeine is taken in the form of coffee (from the coffee bean); the rest is consumed in tea (from the tea leaf), cola (from the kola nut), so-called energy drinks, chocolate (from the cocoa bean), and numerous prescription and over-the-counter medications, such as Excedrin. -Around 99 percent of ingested caffeine is absorbed by the body and reaches its peak concentration within an hour. -It acts as a stimulant of the central nervous system, again producing a release of the neurotransmitters dopamine, serotonin, and norepinephrine in the brain. -Thus it raises a person's arousal and motor activity, enhances physical stamina, and reduces fatigue. -It can also disrupt mood, fine motor movement, and reaction time and may interfere with sleep -More than 250 milligrams of caffeine (that is, two to three cups of brewed coffee, six cans of cola, or three cans of Red Bull or a comparable energy drink) can produce caffeine intoxication, which may include such symptoms as restlessness, nervousness, anxiety, stomach disturbances, twitching, and a faster heart rate -Doses larger than 10 grams of caffeine (about 100 cups of coffee) can cause grand mal seizures and fatal respiratory failure -Many people who suddenly stop or cut back on their usual intake of caffeine—even those whose regular consumption is low (two and a half cups of coffee daily or seven cans of cola)—have withdrawal symptoms -A breakthrough study on this subject had adult participants consume their usual caffeine-filled drinks and foods for 2 days, then abstain from all caffeine-containing foods for 2 days while taking placebo pills that they thought contained caffeine, and then abstain from such foods for 2 days while taking actual caffeine pills (Silverman et al., 1992). More participants had headaches (52 percent), depression (11 percent), anxiety (8 percent), and fatigue (8 percent) during the 2-day placebo period than during the caffeine periods. In addition, people used more unauthorized medications (13 percent) and performed experimental tasks more slowly during the placebo period than during the caffeine periods. -Although DSM-5 acknowledges that many people go through caffeine intoxication and caffeine withdrawal, it does not go so far as to list caffeine use disorder as an official category -If added to the DSM, the key criteria for this disorder would be a 1-year pattern of problematic caffeine use, unsuccessful efforts to reduce caffeine use, awareness that one's continued caffeine use is causing a repeated physical or psychological problem, withdrawal symptoms if one stops caffeine use, and significant impairment or distress

alcohol

-2 billion people worldwide consume alcohol -in the United States more than half of all residents at least from time to time drink beverages that contain alcohol -All alcoholic beverages contain ethyl alcohol

acceptance and commitment therapy for substance use disorder

-ACT therapists use a mindfulness-based approach to help clients become aware of their streams of thoughts as they are occurring and to accept such thoughts as mere events of the mind -for people with substance use disorders, that means increasing their awareness and acceptance of their drug cravings, worries, and depressive thoughts -by accepting such thoughts rather than trying to eliminate them, the clients are expected to be less upset by them and less likely to act on them by seeking out drugs -research indicates that ACT is more effective than placebo treatments and at least as effective as other cognitive-behavioral treatments for substance use disorders, and sometimes more effective -in many cases, ACT has been combined with relapse-prevention training or other cognitive-behavioral approaches, a combination that typically yields more success than either approach alone

opioid use disorder

-After taking heroin repeatedly for just a few weeks, users may develop opioid use disorder -Their heroin use interferes significantly with their social and occupational functioning, and their lives center around the drug -They may also build a tolerance for heroin and experience a withdrawal reaction when they stop taking it -At first the withdrawal symptoms are anxiety, restlessness, sweating, and rapid breathing; later they include severe twitching, aches, fever, vomiting, diarrhea, loss of appetite, high blood pressure, and weight loss of up to 15 pounds (due to loss of bodily fluids) -These symptoms usually peak by the third day, gradually subside, and disappear by the eighth day -A person in heroin withdrawal can either wait out the symptoms or end withdrawal by taking the drug again -The temporary high becomes less intense and less important -Heroin users may spend much of their time planning their next dose, in many cases turning to criminal activities, such as theft and prostitution, to support the expensive "habit" -Surveys suggest that more than 1 percent of adults in the United States, a total of 2.6 million people, display an opioid use disorder within a given year (even higher in teens) -Most of these persons (80 percent) are addicted to pain-reliever opioids, prescription drugs such as oxycodone -Around 20 percent of those with opioid use disorder are addicted to heroin -According to some studies, the mortality rate of untreated persons with opioid use disorder is 63 times the rate of other persons

lack-of-control theory

-draws on the learned helplessness research and proposed that women may be more prone to depression because they feel less control than men over their lives -victimization of any kind, from discrimination to burglary to rape, often produces a sense of helplessness and increases the symptoms of depression--and women are more Miley than men to be victims across various domains

tolerance and withdrawal in alcohol use disorder

-As their bodies build up a tolerance for alcohol, they need to drink ever larger amounts to feel its effects. In addition, they have withdrawal symptoms when they stop drinking -Within hours their hands, tongue, and eyelids begin to shake; they feel weak and nauseated; they sweat and vomit; their heart beats rapidly; and their blood pressure rises -They may also become anxious, depressed, unable to sleep, or irritable -A small percentage of people with alcohol use disorder go through a particularly dramatic withdrawal reaction called delirium tremens ("the DTs") -It consists of terrifying visual hallucinations that begin within three days after they stop or reduce their drinking -Some people see small, frightening animals chasing or crawling on them or objects dancing about in front of their eyes -Like most other alcohol withdrawal symptoms, the DTs usually run their course in 2 to 3 days -However, people who have severe withdrawal reactions such as this may also have seizures, lose consciousness, suffer a stroke, or even die -Today certain medical procedures can help prevent or reduce such extreme reactions

dangers of cocaine

-Aside from cocaine's harmful effects on behavior, cognition, and emotion, the drug poses serious physical dangers -The growth in the use of the powerful forms of cocaine has caused the annual number of cocaine-related emergency room incidents in the United States to multiply more than 125 times since 1982, from around 4,000 cases to 505,000 -Cocaine use has also been linked to many suicides -The greatest danger of cocaine use is an overdose -Excessive doses have a strong effect on the respiratory center of the brain, at first stimulating it and then depressing it to the point where breathing may stop -Cocaine can also create major, even fatal, heart irregularities or brain seizures that bring breathing or heart functioning to a sudden stop -In addition, pregnant women who use cocaine run the risk of having a miscarriage and of having children with predispositions to later drug use and with abnormalities in immune functioning, attention and learning, thyroid size, and dopamine and serotonin activity in the brain

herion

-In 1898, morphine was converted into yet another new pain reliever, heroin -For several years heroin was viewed as a wonder drug and was used as a cough medicine and for other medical purposes -Eventually, however, physicians learned that heroin is even more addictive than the other opioids -By 1917, the U.S. Congress had concluded that all drugs derived from opium were addictive, and it passed a law making opioids illegal except for medical purposes

percentages of individuals with substance use disorder

-In any given year, 7.8 percent of all teens and adults in the United States, around 21 million people, have a substance use disorder -American Indians have the highest rate of substance use disorders in the United States (11.6 percent) -Asian Americans have the lowest (3.8 percent) -Non-Hispanic white Americans, Hispanic Americans, and African Americans have rates between 7 and 8.2 percent -Only 18 percent of all those with substance use disorders receive treatment from a mental health professional

MDMA in the brain

-MDMA works by causing the neurotransmitters serotonin and (to a lesser extent) dopamine to be released all at once throughout the brain, at first increasing and then depleting a person's overall supply of the neurotransmitters -MDMA also interferes with the body's ability to produce new supplies of serotonin -with repeated use, the brain eventually produces less and less serotonin -Ecstasy's impact on these neurotransmitters accounts for its various psychological effects and associated problems

clinical picture of alcohol use disorder

-MRI scans of chronic heavy drinkers have revealed damage in various structures of their brains and, correspondingly, impairments in their memory, speed of thinking, attention skills, and balance -Eventually the drinking interferes with their social behavior and ability to think and work. They may have frequent arguments with family members or friends, miss work repeatedly, and even lose their jobs -Individually, people's patterns of alcoholism vary -Some drink large amounts of alcohol every day and keep drinking until intoxicated -Others go on periodic binges of heavy drinking that can last weeks or months; they may remain intoxicated for days and later be unable to remember anything about the period -Still others may limit their excessive drinking to weekends, evenings, or both

personal and social impacts of alcoholism

-Medical treatment, lost productivity, and losses due to deaths from alcoholism cost society many billions of dollars annually -The disorder also plays a role in more than one-third of all suicides, homicides, assaults, rapes, and accidental deaths, including 29 percent of all fatal automobile accidents in the United States -Altogether, intoxicated drivers are responsible for more than 10,000 deaths each year -Around 10 percent of all adults have driven while intoxicated at least once in the past year -Although this is a frightening number, it represents a significant drop since 2002 when 14 percent of adults had driven in an intoxicated state -Alcoholism has serious effects on the 30 million children of people with this disorder -Home life for these children is likely to include much conflict and perhaps sexual or other forms of abuse -In turn, the children themselves have higher rates of psychological problems -Many have low self-esteem, poor communication skills, poor sociability, and marital problems -Long-term excessive drinking can also seriously damage a person's physical health; it so overworks the liver that people may develop an irreversible condition called cirrhosis, in which the liver becomes scarred and dysfunctional. Cirrhosis accounts for more than 38,000 deaths each year -Alcohol use disorder may also damage the heart and lower the immune system's ability to fight off cancer, bacterial infections, and AIDS -Long-term excessive drinking also causes major nutritional problems -Alcohol makes people feel full and lowers their desire for food, yet it has no nutritional value; as a result, chronic drinkers become malnourished, weak, and prone to disease; their vitamin and mineral deficiencies may also cause problems -An alcohol-related deficiency of vitamin B (thiamine), for example, may lead to Korsakoff's syndrome, a disease marked by extreme confusion, memory loss, and other neurological symptoms -People with Korsakoff's syndrome cannot remember the past or learn new information and may make up for their memory losses by confabulating—reciting made-up events to fill in the gaps -Women who drink during pregnancy place their fetuses at risk -Excessive alcohol use during pregnancy may cause a baby to be born with fetal alcohol syndrome, a pattern of abnormalities that can include intellectual disability disorder, hyperactivity, head and face deformities, heart defects, and slow growth -It has been estimated that in the overall population, around 1 of every 1,000 babies is born with this syndrome; the rate may increase to as many as 67 of every 1,000 babies of women who are problem drinkers -If all alcohol-related birth defects (known as fetal alcohol spectrum disorder) are counted, the rate becomes 80 to 200 such births per 1,000 heavy-drinking women -In addition, heavy drinking early in pregnancy often leads to a miscarriage -9.3 percent of pregnant American women have drunk alcohol during the past month and 4.6 percent of pregnant women have had binge drinking episodes

virtual reality therapy

-PTSD clients use wraparound goggles and joysticks to navigate their way through a computer-generated military convoy, battle, or bomb attack in a landscape that looks like Iraq, Afghanistan, or other war zones -the therapists controls the intensity of the horrifying sights, terrifying sounds, and awful smells of combat, triggering very real feelings of fear or panic in the client -exposure therapy proceed with the therapy proceeds with the therapist applying the exposures to these stimuli in either gradual steps or abruptly

stimulant use disorder

-Regular use of either cocaine or amphetamines may lead to stimulant use disorder -The stimulant comes to dominate the person's life, and the person may remain under the drug's effects much of each day and function poorly in social relationships and at work -In a given year, 0.1 percent of all people over the age of 11 years display stimulant use disorder that is centered on cocaine, and 0.3 percent display stimulant use disorder centered on amphetamines

hallucinogen intoxication

-drugs such as LSD may produce this -which consists largely of perceptual distortions and hallucinations

complex PTSD

-encounters with multiple or recurring traumas can lead to this -persons experience virtually all of the symptoms along with profound disturbances in their emotional control, self-concept, and relationships

the psychodynamic view of unipolar depression

-Sigmund Freud and Karl Abraham developed the first psychodynamic explanation of depression -it started with the observation of being grieving loved ones and displaying behaviors of constant weeping, loss of appetite, difficulty sleeping, loss of pleasure in life, and general withdrawal -according to theorists, unconscious processes where a person is unable to accept the loss causes them to regress to the oral stage of development (the period of total dependency when infants cannot distinguish themselves from their parents); by regressing to this stage, the mourning person merges their own identity with that of the person they have lost, so symbolically they regain that lost person; this process is called introjection -for most mourners, introjection is temporary however, for some whose dependency needs were improperly met during infancy and early childhood, grief worsens over time and they develop clinical depression -to explain why people became depressed without losing a loved one, Freud proposed the concepts of symbolic or imagined loss -studies have shown that major losses, especially ones suffered early in life, may set the stage for later depression (ex. based on a survey, those whose fathers had died during their childhood scored higher on depression) -in some studies, depressed patients filled out a scale called the Parental Bonding Instrument and many identified their parents' child-rearing style as "affectionless control," consisting of a mixture of low care and high protection -research does not indicate that loss or problematic early relationships are always at the core of depression; it is estimated that less than 10% of all people who have major losses in life actually become depressed

suicide rates country to country

-Sir Lanka, Guyana, South Korea, Lithuania, and Angola have very high rates--more than 20 suicides annually per 100,000 persons -conversely, Egypt, Mexico, Greece, and Indonesia have relatively low rates, fewer than 5 per 100,000 -falling in between are England (7.4), China (8.5), Germany (9.1), Canada (10.4), the U.S. (12.6), and Russia (17.9)

danger of opioid use

-The most immediate danger of opioid use is an overdose, which closes down the respiratory center in the brain, almost paralyzing breathing and in many cases causing death -Death is particularly likely during sleep, when a person is unable to fight this effect by consciously working to breathe -People who resume heroin or pain reliever use after having avoided it for some time often make the fatal mistake of taking the same dose they had built up to before -Because their bodies have been without such opioids for some time, however, they can no longer tolerate this high level -There has been a 400 percent increase in the number of deaths caused by opioid overdoses in the past decade -Currently, approximately 20,000 people in the United States die from pain reliever overdoses each year and 13,000 die from heroin overdoses - These numbers represent two-thirds of all drug overdose deaths -Heroin users run other risks as well -Drug dealers often mix heroin with a cheaper drug or even a deadly substance such as cyanide or battery acid -In addition, dirty needles and other unsterilized equipment spread infections such as AIDS, hepatitis C, and skin abscesses -In some areas of the United States, the HIV infection rate among active heroin users is reported to be as high as 60 percent

substance

-The term "substance" is now frequently used in place of "drug," in part because many people fail to see that such substances as alcohol, tobacco, and caffeine are drugs, too. -When a person ingests a substance—whether it be alcohol, cocaine, marijuana, or some form of medication—trillions of powerful molecules surge through the bloodstream and into the brain. -Once there, the molecules set off a series of biochemical events that disturb the normal operation of the brain and body. -Not surprisingly, then, substance misuse may lead to various kinds of abnormal functioning. -Substances may cause temporary changes in behavior, emotion, or thought; this cluster of changes is called substance intoxication

binge drinking episode

-When people consume five or more drinks on a single occasion -Twenty-five percent of people in the United States over the age of 11, most of them male, binge drink each month -Around 6.5 percent of people over 11 years of age binge drink at least five times each month; they are considered heavy drinkers -Among heavy drinkers, males outnumber females by at least 2 to 1

gender and alcohol concentration

-Women have less of the stomach enzyme alcohol dehydrogenase, which breaks down alcohol in the stomach before it enters the blood -So women become more intoxicated than men on equal doses of alcohol, and women may be at greater risk for physical and psychological damage from alcohol than men who drink similar quantities of alcohol

ethyl alcohol

-a chemical that is quickly absorbed into the blood through the lining of the stomach and the intestine. -immediately begins to take effect as it is carried in the bloodstream to the central nervous system (the brain and spinal cord), where it acts to depress, or slow, functioning by binding to various neurons -one important group of neurons to which ethyl alcohol binds are those that normally receive the neurotransmitter GABA which carries an inhibitory message—a message to stop firing—when it is received at certain neurons -When alcohol binds to receptors on those neurons, it apparently helps GABA to shut down the neurons, thus helping to relax the drinker -At first ethyl alcohol depresses the areas of the brain that control judgment and inhibition; people become looser, more talkative, and often more friendly -As their inner control breaks down, they may feel relaxed, confident, and happy -When more alcohol is absorbed, it slows down additional areas in the central nervous system, leaving the drinkers less able to make sound judgments, their speech less careful and less coherent, and their memory weaker -Many people become highly emotional and perhaps loud and aggressive -Motor difficulties increase as a person continues drinking, and reaction times slow -People may be unsteady when they stand or walk and clumsy in performing even simple activities; they may drop things, bump into doors and furniture, and misjudge distances; their vision becomes blurred, particularly their peripheral, or side, vision, and they have trouble hearing -As a result, people who have drunk too much alcohol may have great difficulty driving or solving simple problems -The extent of the effect of ethyl alcohol is determined by its concentration, or proportion, in the blood -Thus a given amount of alcohol has less effect on a large person than on a small one -When the alcohol concentration reaches 0.06 percent of the blood volume, a person usually feels relaxed and comfortable -By the time it reaches 0.09 percent, however, the drinker crosses the line into intoxication -If the level goes as high as 0.55 percent, the drinker will likely die -Most people lose consciousness before they can drink enough to reach this level; nevertheless, more than 1,000 people in the United States die each year from too high a blood alcohol level -Most of the alcohol is broken down, or metabolized, by the liver into carbon dioxide and water, which can be exhaled and excreted -The average rate of this metabolism is 25 percent of an ounce per hour, but different people's livers work at different speeds; thus rates of "sobering up" vary -Despite popular belief, only time and metabolism can make a person sober -Drinking black coffee, splashing cold water on one's face, or "pulling oneself together" cannot hurry the process

psychache (Schneidman)

-a feeling of psychological pain that seems intolerable to the person -believed by Schneidman to be the key to suicide

antagonist drugs for substance use disorder

-as an aid to resisting temptation, some people with substance use disorders are given antagonist drugs, which block or change the effects of the addictive drug -Disulfiram (Antabuse), for example, is often given to people who are trying to stay away from alcohol -by itself, a low dose of disulfiram seems to have few negative effects, but a person who drinks alcohol while taking it will have intense nausea, vomiting, blushing, a faster heart rate, dizziness, and perhaps fainting -people taking disulfiram are less likely to drink alcohol because they know the terrible reaction that awaits them should they have even one drink -Disulfiram has proved helpful, but again only with people who are motivated to take it as prescribed -for substance use disorders centered on opioids, several opioid antagonist drugs,such as naloxone, are used -these antagonists attach to endorphin receptor sites throughout the brain and make it impossible for the opioids to have their usual effect -without the rush or high, continued drug use becomes pointless; in addition, by blocking endorphin receptors during an opioid overdose, opioid antagonists can actually reverse the deadly effect of respiratory depression, thus saving the user's life -so-called partial antagonists, opioid antagonists that produce less severe withdrawal symptoms, have also been developed -many clinicians now prefer partial antagonists over full antagonists to help people withdraw from opioid use -the use of antagonists to help people withdraw is often called rapid detoxification because the antagonists speed things along -the full antagonists remain the treatment of choice in emergency cases of overdose -research indicates that opioid antagonists may also be useful in the treatment of substance use disorders involving alcohol or cocaine -in some studies, for example, the opioid antagonist naltrexone has helped reduce cravings for alcohol -the answer may lie in the reward circuit of the brain -if various drugs eventually stimulate the same pleasure pathway, it seems reasonable that antagonists for one drug may, in a roundabout way, affect the impact of other drugs as well

cultural background and depression

-a great majority of depressed people in these very different countries reported symptoms of sadness, joylessness, tension, lack of energy, loss of interest, loss of ability to concentrate, ideas of insufficiency, and thoughts of suicide -however, research suggests that the precise picture of depression varies from country to country -depressed people in non-Western countries (China and Nigeria) are more likely to be troubled by physical symptoms such as fatigue, weakness, sleep disturbances, and weight loss -depression in those countries is less often marked by cognitive symptoms such as self-blame, low self-esteem, and guilt -researchers have found few differences in the symptoms of depression among members of different ethnic or racial groups; nor have they found significant differences in the overall rates of depression between such minority groups -research does reveal there are often striking differences between ethnic/racial groups in the recurrence of depression -Hispanic Americans and African Americans are 50% more likely than non-Hispanic white Americans to have recurrent episodes of depression; likely because around 54% of depressed non-Hispanic white Americans receive treatment for their disorders (medication and/or psychotherapy), compared with 34% of depressed Hispanic Americans and 40% of depressed African Americans -it may be that minority groups in the U.S. are more vulnerable to repeated experiences of depression partly because many of their members have more limited treatment opportunities when they are depressed -depression is more common among Hispanic and African Americans born in the U.S. than among Hispanic and African American immigrants -within Hispanic American populations, Puerto Ricans have a higher rate of depression than do Mexican Americans or Cuban Americans

culture- and gender-sensitive programs for substance use disorder

-a growing number of today's treatment programs try to be sensitive to the special sociocultural pressures and problems faced by drug abusers who are poor, homeless, or members of minority groups -therapists who are sensitive to their clients' life challenges can do more to address the stresses that often lead to relapse -similarly, therapists have become more aware that women often require treatment methods different from those designed for men -women and men often have different physical and psychological reactions to drugs, for example -in addition, treatment of women with substance use disorders may be complicated by the impact of sexual abuse, the possibility that they may be or may become pregnant while taking drugs, the stresses of raising children, and the fear of criminal prosecution for abusing drugs during pregnancy -thus many women with such disorders feel more comfortable seeking help at gender-sensitive clinics or residential programs; some such programs also allow children to live with their recovering mothers

developmental psychopathology view of substance use disorder

-a number of substance use theorists have tried to integrate the variables identified by each of the models; once again, developmental psychopathology theorists have been active in this endeavor -according to this perspective, the road to substance use disorders begins with genetically inherited predispositions—predispositions characterized by a less-than-optimal reward circuit in the brain and by a problematic temperament featuring some of the negative traits discussed earlier in this chapter -developmental psychopathologists contend that such predispositions will eventually result in a substance use disorder if the individual further experiences numerous stressors throughout childhood, inadequate parenting (for example, substance misuse modeling), rewarding substance use experiences, relationships with peers who use drugs, and/or significant adult stressors -at the same time, individuals who experience manageable adversities throughout childhood and adolescence can develop a level of resilience that may help them counter such unfavorable predispositions, adversities, and negative family and peer influences -the theorists propose that either of two very different temperaments may set the stage for later substance abuse -on the one hand, some individuals may begin with a disinhibited temperament, also called an externalizing temperament—featuring impulsivity, aggressiveness, overactivity, limited persistence, low frustration tolerance, and inattention -these individuals have great difficulty controlling their behaviors, thus increasing their risk of having early family conflicts, behavioral problems, and school difficulties—variables that may, in turn, lead to social problems, relationships with undesirable peers, access to alcohol and drugs from those peers, rewards from those peers for repeated drug use, and, ultimately, the onset of substance use disorders -a large number of developmental studies have confirmed that this cluster and sequence of variables does indeed unfold in many cases of substance use disorder -on the other hand, according to the developmental psychopathology perspective, other individuals may begin with a temperament of inhibition and negative affectivity, sometimes called an internalizing temperament—characterized by multiple fears, depression, negative thinking, and dependence -this temperament may contribute to worrying and sadness throughout the individuals' development, low self-concept, a sense of helplessness, and interpersonal rejections -these individuals may eventually turn to alcohol and drugs largely because the substances reduce their emotional pain, quiet their troublesome thoughts, and help them through interpersonal difficulties -a number of developmental studies have indicated that this cluster and sequence of variables may also lead to substance use disorders -as you may recall, this notion that different temperaments may trigger and interact with different developmental factors to bring about substance use disorders is consistent with one of the key principles of the developmental psychopathology perspective, equifinality—the principle that different developmental pathways can lead to the same psychological disorder -in short, identifying key factors in substance use disorders is only part of a comprehensive explanation -it is also necessary to identify when and how those factors interact

major depressive episode

-a period of two or more weeks marked by at least five symptoms of depressions, including sad mood and/or loss of pleasure -in extreme cases, the episode may include psychotic symptoms marked by a loss of contact with reality such as delusions or hallucinations -sometimes an apparent case of major depressive disorder is a depressive episode occurring within a larger pattern of bipolar disorder (and if the person has a manic episode at a later time, the diagnosis is changed to bipolar disorder)

emotional symptoms of mania

-a person has active, powerful emotions in search of an outlet -the mood of euphoric joy and well-being is out of al proportion to the actual happenings in the person's life -not every state of mania is happy though, some instead become very irritable and angry, especially when others get in the way of their exaggerated ambitions

family members and friends modeling suicide

-a recent suicide by a family member or friend increases the likelihood that a person will attempt suicide -the death of a family member or friend, especially when self-inflicted, is a life-changing event, and suicidal thoughts or attempts may be tied largely to that trauma or sense of loss -however, even when researchers factor out these issues, they find increases in the risk of suicide among the relatives and friends of people who recently committed suicide -the additional risk factor is often called the social contagion effect

negative thinking of CBT on unipolar depression

-according to Aaron Beck, negative thinking, rather than underlying conflicts or a reduction in positive rewards, lies at the heart of depression -"maladaptive attitudes, a cognitive triad, errors in thinking, and automatic thoughts combine to produce unipolar depression" -Beck believes that some people develop maladaptive attitudes as children which result from their own experiences and the judgments of the people around them -many failures are inevitable so such attitudes set the stage for all kinds of negative thoughts and reactions -Beck suggests that later in these people's lives, upsetting situations may trigger an extended round of negative thinking -thinking typically takes three forms, which he calls the cognitive triad -depressed people make errors in their thinking -in one common error of logic, they draw arbitrary inferences--negative conclusions based on little evidence -depressed people often minimize the significance of positive experiences or magnify that of negative ones -depressed people have automatic thoughts; in the course of only a few hours, depressed people may be visited by hundreds of such thoughts -several studies have confirmed that depressed people hold maladaptive attitudes and the more maladaptive attitudes they hold, the more depressed they tend to be -studies have found the cognitive triad in depressed people -studies have shown that depressed people seem to recall unpleasant experiences more readily than positive ones, rate their performance on laboratory tasks lower than non depressed people do, and select pessimistic statements in storytelling tests -people who generally make ruminative responses during their depressed moods--that is, repeatedly dwell mentally on their mood without acting to change it--feel dejection longer and are more likely to develop clinical depression later in life than people who avoid such ruminations -research shows that negative thinking is linked to depression but fails to show that such patterns of thoughts are the cause and core of unipolar depression

"baby blues"

-as many as 80% of women experience them -most researchers say it's normal -as mothers try to cope with the wakeful nights, rattled emotions, and other stresses that accompany the arrival of a new baby, they may have crying spells, fatigue, anxiety, insomnia, and sadness -symptoms usually disappear within days or weeks

suicide prevention

-many of today's mental health centers, hospital emergency rooms, pastoral counseling centers, and poison control centers include suicide prevention programs among their services -there are also hundreds of suicide hotlines, 24-hour-a-day phone services -callers reach a counselor, typically a paraprofessional, a person trained in counseling but without a formal degree who provides services under the supervision of a mental health professions -suicide prevention programs and hotlines respond to suicidal people as individuals in crisis--that is, under great stress, unable to cope, feeling threatened or hurt, and interpreting their situations as unchangeable; thus, these programs offer crisis intervention -because crises can occur at any time, the centers advertise their hotlines and also welcome people who walk in without appointments -another way to prevent suicide is to reduce the public's access to particularly lethal and common means of suicide through measures such as gun control, safer medications, better bridge barriers, and car emission controls

cognitive-behavioral view of substance use disorder

-according to cognitive-behavioral theorists, operant conditioning may play a key role in substance use disorders -they argue that the temporary reduction of tension or raising of spirits produced by a drug has a rewarding effect, thus increasing the likelihood that the user will seek this reaction again -similarly, the rewarding effects may eventually lead users to try higher dosages or more powerful methods of ingestion -beyond these conditioning explanations, cognitive-behavioral theorists further argue that such rewards eventually produce an expectancy that substances will be rewarding, and this expectation helps motivate people to increase drug use at times of tension -studies have found that many people do drink more alcohol or seek heroin when they feel tense -one study, as participants worked on a difficult anagram task, a confederate planted by the researchers unfairly criticized and belittled them; the participants were then asked to participate in an "alcohol taste task," supposedly to compare and rate alcoholic beverages; those who had been harassed drank more alcohol during the taste task than did the control participants who had not been criticized -the cognitive-behavioral theorists are arguing that many people take drugs to "medicate" themselves when they feel tense; if so, one would expect higher rates of substance use disorders among people who suffer from anxiety, depression, and other such problems -and, in fact, at least 20 percent of all adults who suffer from psychological disorders also display substance use disorders -a number of cognitive-behavioral theorists have proposed that classical conditioning may also play a role in these disorders -just the sight of a hypodermic needle, drug buddy, or regular supplier, for example, has been known to comfort people who are addicted to heroin or amphetamines and to relieve their withdrawal symptoms. In a similar manner, cues or objects that are present during withdrawal distress may produce withdrawal-like symptoms -one man who had formerly been dependent on heroin became nauseated and had other withdrawal symptoms when he returned to the neighborhood where he had gone through withdrawal in the past—a reaction that led him to start taking heroin again -although classical conditioning certainly appears to be at work in particular cases of substance use disorder, it has not received widespread research support as the key factor in such disorders

learned helplessness: a cognitive-behavioral interplay of CBT on unipolar depression

-according to psychologist Martin Seligman, feelings of helplessness are at the center of depression, aka learned helplessness theory -Seligman noted that the effects of learned helplessness greatly resemble the symptoms of human depression, and he proposed that people in fact become depressed after developing a general belief that they have no control over reinforcements in their lives -participants who undergo helplessness training have displayed reactions similar to depressive symptoms -human participants when exposed to uncontrollable negative events, later score higher than other individuals on depressive mood scales -much of the learned helplessness research relies on animal subjects (dogs being shocked) and it's impossible to know whether animals' symptoms do in fact reflect the clinical depression found in humans

depressants

-alcohol -sedative-hypnotic drugs (barbiturates, benzodiazepines) -opioids

most common treatments for PTSD

-antidepressant drug therapy -cognitive-behavioral therapy -couple or family therapy -group therapy

do suicidal people contact prevention centers?

-apparently only a small percentage -the typical caller to an urban prevention center appears to be young, African American, and female -whereas the greatest number of suicides are carried out by older, non-Hispanic white men

alcohol use disorder

-around 23 percent of middle school students admit to some alcohol use, while 33 percent of high school seniors drink alcohol each month (most to the point of intoxication) and 1.3 percent report drinking every day -Surveys indicate that over a one-year period, 5.9 percent of all people over 11 years of age in the United States display alcohol use disorder, known in popular terms as alcoholism -For teenagers specifically, the rate is 2.5 percent -Men with this disorder outnumber women by 2 to 1 -The current prevalence of alcoholism is around 6.1 percent for non-Hispanic white Americans, 6.4 percent for Hispanic Americans, and 4.9 percent for African Americans -American Indians, particularly men, tend to display a higher rate of alcohol use disorder than any of these groups; overall, 9.7 percent of them experience the disorder, although specific prevalence rates differ widely across the various American Indian reservation communities -Generally, Asians in the United States and elsewhere have a lower rate of alcoholism (3.2 percent) than do people from other cultures -As many as half of these individuals have a deficiency of alcohol dehydrogenase, the chemical responsible for breaking down alcohol, so they react quite negatively to even a modest intake of alcohol. Such reactions in turn help prevent extended use

teen suicides: multicultural issues

-around 9 of every 100,000 non-Hispanic white American teens die by suicide each years, compared with 5 of every 100,000 African American teens, and 5 of every 100,000 Hispanic American teens -the rates of the three groups are in fact becoming closer -this closing trend may reflect increasingly similar pressures on young African, Hispanic, and non-Hispanic white Americans--competition for grades and college opportunities, is now intense for all three groups -the growing suicide for young African and Hispanic Americans may be linked to their risking unemployment, the many anxieties and economic pressures of inner-city life, and the indignation many feel over racial inequities and discrimination in our society -studies indicate that 5.7 of every 100,000 Asian American teens now end their lives each year -the highest teen suicide rate of all is displayed by American Indians -18 of every 100,000 American Indian teens die by suicide each year, double the rate of non-Hispanic white American teens and triple that of other minority teens -clinical theorists attribute this extraordinarily high rate to factors such as the extreme poverty faced by most American Indian teens, their limited educational and employment opportunities, their particularly high rate of alcohol abuse, and the geographical isolation of those who live on reservations -also it appears that certain American Indian reservations have extreme suicide rates called cluster suicides and that teens who live in such communities are unusually likely to be exposed to suicide, to have their lives disrupted, to observe suicidal models, and to be at risk for suicide contagion

different categories of substances

-depressants -stimulants -hallucinogens -cannabis

biological treatments for substance use disorder

-detoxification -antagonist drugs -drug maintenance therapy -biological treatments may be used to help people withdraw from substances, abstain from them, or simply maintain their level of use without increasing it further -as with the other forms of treatment, biological approaches alone rarely bring long-term improvement, but they can be helpful when combined with other approaches

internet disorders

-as people increasingly turn to the Internet for activities that used to take place in the "real world"—communicating, networking, shopping, playing games, and participating in a community—a new psychological problem has emerged: an uncontrollable need to be online -this pattern has been called Internet use disorder, Internet addiction, and problematic Internet use, among other names -for people who have this pattern—at least 1 percent of all people—the Internet has become a black hole -they spend all or most of their waking hours texting, tweeting, networking, gaming, Internet browsing, e-mailing, blogging, visiting virtual worlds, shopping online, or viewing online pornography -specific symptoms of this pattern parallel those found in substance use disorders and gambling disorder, extending from the loss of outside interests to possible withdrawal reactions when Internet use is not possible -although clinicians, the media, and the public have shown enormous interest in this problem, it is not included as a disorder in DSM-5 -rather, the DSM workgroup has recommended that one version of the pattern, which it calls Internet gaming disorder, receive further study for possible inclusion in future editions

behavioral symptoms of mania

-behavior is usually very active -people move quickly, as though there were not enough time to do everything they want to do -they may talk rapidly and loudly, their conversations filled with jokes and efforts to be clever or, conversely, with complaints and verbal outbursts -flamboyance is not uncommon: dressing in flashy clothes, giving large sums of money to strangers, or even getting involved in dangerous activities

psychodynamic view of suicide

-believe that suicide results from depression and from anger at others that is redirected toward oneself -"no one kills himself who has not wanted to kill another or at least wished the death of another" Wilhelm Stekel -Freud and Karl Menninger echoed this belief (murder in the 180th degree) -when people experience the real or symbolic loss of a loved one, they come to "introject" the lost person and unconsciously incorporate the person into their own identity and feel toward the lost loved one are experienced as self-hatred -suicide is thought to be an extreme expression of this self-hatred and self-punishment -researchers have often found a relationship between childhood losses--real or symbolic-- and later suicidal behaviors -a study found that early parental loss was much more common among suicide attempters (48%) than among nonsuicidal individuals (24%) -common forms of loss were death of the father and divorce or separation of the parents -a study of 343 depressed individuals found that those who had felt rejected or neglected as children by their parents were more likely than other people to attempt suicide as adults -according to Freud, while most people learn to redirect their "death instinct" by aiming it toward others, suicidal people, caught in a web of self-anger, direct it squarely toward themselves -national suicide rates have been found to drop in times of war, when people are encouraged to direct their self-destructive energy against "the enemy" -societies with high rebates of homicide tend to have low rates of suicide, and vice versa -research has failed to establish that suicidal people are in fact dominated by intense feelings of anger; although hostility is an important element in some suicides, studies find that other emotional studies are even more prevalent

several factors have been tied closely to unipolar depression

-biological abnormalities -a reduction in positive reinforcements -negative ways of thinking -a perception of helplessness -life stress and other sociocultural influences -more contributing factors have been associated with unipolar depression than with most other psychological disorders -however, it is still not clear how all of these factors relate to unipolar depression

factors that contribute to the development of PTSD

-biological factors -childhood experience -personal styles -social support systems -severity and nature of the trauma

biological factors in developing PTSD

-brain-body stress pathways -brain's stress circuit -inherited predispositions

brain structure and bipolar disorder

-braining imaging and postmodern studies have identified a number of abnormal brain structures in people with bipolar disorders -ex. the hippocampus, basal ganglia, and cerebellum of these people tend to be smaller than those of other people; they have lower amounts of gray matter in the brain; and their raphe nuclei, striatum, amygdala, and prefrontal cortex have some structural abnormalities -is is not clear what role such abnormalities play in bipolar disorders -some researchers believe that they collectively reflect dysfunction throughout a bipolar-related brain circuit -it may also be that they are related to the brain's depression-related circuit

depressive disorders

-bring severe and long-lasting psychological pain that may intensify as time goes by -those who suffer from such disorders may lose their will to carry out the simplest of life's activities and some even lose their will to live

cognitive-behavioral therapy for PTSD

-bringing significant overall improve to 50% or more of those who receive such treatment -on cognitive side, therapists guide the veterans to examine and change the dysfunction attitudes and styles of interpretation they have developed as a result of their traumatic experiences -during cognitive processing therapy, the veterans learn to deal with difficult memories and feelings, come to accept what they have done and experienced, become less judgmental of themselves, and begin to trust other people once again -on behavioral side, typically apply exposure therapy techniques when treating veterans with PTSD -some studies indicate that exposure is the single most helpful intervention for people with PTSD -during exposure therapy, veterans with PTSD are guided to confront trauma-related (usually combat-related) objects, events, and situations that continue to cause them extreme upset and anxiety and the experiences may be imagined or in vivo

self-injury implicit association test

-developed by Matthew Nock -rather than asking people if they plan to attempt suicide, this cognitive test simply instructs them to pair various suicide-related words (ex. "dead", "lifeless", "suicide") with words that are personal relevant ("I", "myself", "mine") and with words that are not personally relevant ("they", "them", "other") -it turns out that individual who are inclined to attempt suicide pair suicide-related words with personal relevant words much more quickly than with non personally relevant words -this test has detected and predicted past and future suicide behavior more accurately than traditional self-report assessment scales

cognitive responses to fear

-disturbing our ability to concentrate and remember -distorting our view of the world -ex. remembering things incorrectly or exaggerating the harm that actually threatens us

the brain's reward circuit and substance use disorder

-but why are drugs so rewarding, and why do certain people turn to them in the first place? -brain-imaging studies conducted in recent years answer these questions by pointing to the operation of a particular brain circuit—the circuit within which the neurotransmitters under discussion do their work -as you've read earlier, a brain circuit is a network of brain structures that work together, triggering each other into action to produce a distinct behavioral, cognitive, or emotional reaction -the circuit that has been tied to substance misuse is the reward circuit, also called the reward center and the pleasure pathway -apparently, whenever a person ingests a substance (from foods to drugs), the substance eventually activates the brain's reward circuit -this reward circuit features the brain structure called the ventral tegmental area (in the midbrain), a structure known as the nucleus accumbens, and the prefrontal cortex -in addition, the circuit includes the striatum, hippocampus, and several other important structures; the key neurotransmitter in this circuit is dopamine -when dopamine is activated throughout this circuit, a person feels pleasure -music may activate dopamine in the reward circuit; so may a hug or a word of praise; and so do drugs -although other neurotransmitters also play roles in the reward circuit, dopamine is the primary one -remember that cocaine and amphetamines directly increase dopamine activity -other drugs seem to stimulate it in roundabout ways -the biochemical reactions triggered by alcohol, opioids, and marijuana set in motion a series of chemical events that eventually lead to increased dopamine activity in the reward circuit and, in turn, excessive communications (that is, heightened interconnectivity) between the structures in the reward circuit -a number of theorists further believe that as substances repeatedly stimulate this reward circuit, the circuit develops a hypersensitivity to the substances -neurons in the circuit fire more readily when stimulated by the substances, contributing to future desires for them -this theory, called the incentive-sensitization theory of addiction, has received considerable support in both animal and human studies -still other theorists suspect that people who chronically use drugs may suffer from a reward deficiency syndrome: their reward circuit is not readily activated by the usual events in their lives, so they turn to drugs to stimulate this pleasure pathway, particularly in times of stress -abnormal genes, such as the abnormal D2 receptor gene, have been cited as possible contributors to this syndrome -in short, the chronic intake of certain substances helps to produce a dysfunctional reward circuit in the brain and, along with that, the symptoms of a substance use disorder

egoistic suicide

-carried out by people over whom society has little or no control -these people are not concerned with the norms or rules of society nor are they integrated into the social fabric -this kind of suicide is more likely in people who are isolated, alienated, and nonreligious -the larger the number of such people living in a society, the higher that society's suicide rate

psychodynamic view of dissociative disorders

-caused by repression, the most basic ego defense mechanism -people fight off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness -people with DID thought to repress their memories excessively -dissociative amnesia is a single episode of massive repression: a person unconsciously blocks the memory of an extremely upsetting event to avoid the pain of facing it (repressing may be his/her only protection from overwhelming anxiety -DID is thought to result from a lifetime of excessive repression motivated by traumatic childhood events, particularly abusive parenting

the behavioral dimension of CBT in unipolar depression

-clinical researchers Peter Lewinsohn was one of the first theorists to link depression to significant changes in the number of rewards and punishments people receiving in their lives -he suggested that the positive rewards in life dwindle for some people, leading them to perform fewer and fewer constructive behaviors therefore, they spiral toward depression -researchers have found that the number of rewards people receive in life is related to the presence or absence of depression -not only do depressed participants typically report fewer positive rewards than non depressed participants, but when their rewards begin to increase, their mood improved as well -investigations have found a strong relationships between positive life events and feelings of life satisfaction and happiness -Lewinsohn and other theorists have further proposed that social rewards are particularly important in the downward spiral of depression -research has shown that depressed persons receive fewer social rewards than non depressed persons and that as their mood improves, their social rewards increase -although depressed people are sometimes the victims of social circumstances, it may also be that their dark mood and flat behaviors help produce a decline in social rewards

the family-social perspective of sociocultural views on unipolar depression

-consistent with CBT, the belief is shared that a decline in social rewards is particularly important in the development of depression -researchers have found that depressed people often display weak social skills and communicate poorly; they typically speak more slowly and quietly and in more of a monotone than non depressed people, pause longer between words and sentences, and take longer to respond to others; they also seek repeated reassurances from others and such social deficits make other people uncomfortable and may cause them to avoid the depressed individuals; as a result, the social contacts and rewards of depressed people decrease, and, as they participate in fewer social interactions, their social skills deteriorate still further -depression has been tied repeatedly to the unavailability of social support such as that found in a happy marriage -research indicates that people in troubled marriages are 25 times more likely to have a depressive disorder than people in untroubled marriages -in some cases, the spouse's depression may contribute to marital discord or divorce, but often the interpersonal conflicts and low social support found in troubled relationships seem to lead to depression -researchers have found that people whose lives are characterized by weak social supports, isolation, and lack of intimacy are particularly likely to become depressed and remain depressed longer than other people

contingency management for substance use disorder

-contingency management programs offer clients incentives (such as vouchers, prizes, cash, or privileges) that are contingent on the submission of drug-free urine specimens -in essence, this procedure, usually lasting 8 to 16 week, is rewarding clients for abstaining from the use of the substances upon which they are dependent -studies indicate that clients in contingency management programs maintain a higher attendance record than those in other kinds of programs -however, unless the programs are part of a larger treatment approach, they are at best moderately effective at helping clients abstain from substances for an extended period -a major limitation is that the approach can be effective only when people are motivated to continue despite its unpleasantness or demands -contingency management programs are most useful in the treatment of stimulant use disorder and opioid use disorder -true to the principles of operant conditioning, research has found that the larger the rewards offered in a contingency management program, the greater a client's improvement, at least temporarily -for example, a study of two cocaine-focused contingency management programs—one offering a total incentive of $2,000 and the other offering a $500 incentive—found that twice as many clients in the former program were abstinent at the end 24 weeks

teen suicides: attempts vs completions

-far more teens attempt suicide than actually kill themselves--most experts believe the ratio is 100 to 1 or possibly as high as 200 to 1 -in contrast, the ratio is thought to be 4 to 1 among the elderly -the unusually large number of unsuccessful teen suicides may mean that adolescents are less certain than middle-aged and elderly people who make such attempts -some may simply want to make others understand how desperate they are, or they may want to get help or teach others a lesson -up to half of teens who make a suicide attempt try again in the future, and as many as 14% eventually die by suicide -as the number and proportion of teenagers and young adults in the general population have risen, the competition for jobs, college positions, and academic and athletic honors has intensified for them, leading increasingly to shattered dreams and ambitions -other explanations point to weakening ties in the family (which may product feelings of alienation and rejection in many of today's young people) and to the easy availability of alcohol and other drugs and the pressure to use them among teenagers and young adults -mass media coverage of suicides by teenagers and young adults may also contribute to the high rate of suicide attempts among the young -the detailed descriptions of teenage suicide that the media and the arts often offer may serve as models for young people who are contemplating suicide

stress and the hypothalamus

-features of arousal are set in motion by the hypothalamus -when our brain interprets a situation as dangerous, neurotransmitters in the hypothalamus are released, triggering the firing of neurons throughout the brain and the release of chemicals throughout the body -the hypothalamus activates two important systems: the autonomic nervous system and the endocrine system

emotional symptoms of depression

-feeling sad and dejected -feeling miserable, empty, and humiliated -tend to lose sense of humor, report getting little pleasure from anything -may experience anxiety, anger, or agitation

cannabis and society

-for centuries, cannabis played a respected role in medicine -it was recommended as a surgical anesthetic by Chinese physicians 2,000 years ago and was used in other lands to treat cholera, malaria, coughs, insomnia, and rheumatism -when cannabis entered the United States in the early twentieth century, mainly in the form of marijuana, it was likewise used for various medical purposes -soon, however, more effective medicines replaced it, and the favorable view of cannabis began to change -marijuana began to be used as a recreational drug, and its illegal distribution became a law enforcement problem -authorities assumed it was highly dangerous and outlawed the "killer weed" -in the 1980s, researchers developed precise techniques for measuring THC and for extracting pure THC from cannabis; they also developed laboratory forms of THC -these inventions opened the door to new medical applications for cannabis, such as its use in treating glaucoma, a severe eye disease -cannabis was also found to help patients with chronic pain or asthma, to reduce the nausea and vomiting of cancer patients in chemotherapy, and to improve the appetites of people with AIDS and so help them combat weight loss -in light of these findings, several interest groups campaigned during the late 1980s for the medical legalization of marijuana, which operates on the brain and body more quickly than the THC capsules developed in the laboratory -government agencies resisted this movement, saying prescriptions for pure THC served all needed medical functions -however, medical marijuana advocates pressed on, and in 2009 the U.S. Attorney General directed federal prosecutors to not pursue cases against medical marijuana users or their caregivers who are complying with state laws. Currently, 29 states (plus Washington, D.C., Guam, and Puerto Rico) have laws allowing marijuana to be used for medical purposes, and several more have such laws pending -medical marijuana is now legal in about a dozen countries -in fact, since 2012 residents in eight states have voted to legalize marijuana for use of any kind—although such state measures still can be blocked by the federal government -moreover, according to recent polls, 57% believe that marijuana should be made legal, up from 12% in 1969 and 41% in 2010 -in such polls, more than half of all respondents acknowledge they have tried marijuana and most say that the federal government should not enforce federal antimarijuana laws in states where marijuana is legal -several other countries have moved faster than the United States with regard to the recreational use of marijuana -in 2017, for example, Canada's prime minister introduced legislation to completely legalize marijuana as a consumer product, for any purpose—legislation that is expected to allow legal sales throughout the country by the middle of 2018

inherited predisposition in developing PTSD

-genetic studies have located several genes that might be involved in this inherited susceptibility -family pedigree research supports the notion of an inherited susceptibility -researchers have found that people suffering from PTSD are more likely to transmit relevant biological abnormalities to their children

hormone explanation

-holds that hormone changes trigger depression in many women, particularly during puberty, pregnancy, and menopause -research suggests however, that the social and life events that accompany these developmental milestones are also profound and may account for experiences of depression as well as or better than, hormone shifts -hormone explanations have been criticized as sexist, since they imply that a woman's normal biology is flawed

artifact theory

-holds that women and men are equally prone to depression but that clinicians often fail to detect depression in men -depressed women display more emotional symptoms, such as sadness and crying, which are easily diagnosed, while depressed men mask their depression behind traditionally "masculine" symptoms such as anger -however, research indicates that women are actually no more willing or able than men to identify their depressive symptoms and to seek treatment

emotional responses to fear

-horror -dread -panic

genetic predisposition and substance use disorder

-in several studies investigators have first identified animals that prefer alcohol to other beverages and then mated them to one another; generally, the offspring of these animals have been found also to display an unusual preference for alcohol -numerous studies have found an alcoholism concordance rate of around 50 percent in identical twins; that is, if one identical twin displays alcoholism, the other twin also does in 50 percent of the cases -in contrast, in these same studies, fraternal twins have a concordance rate of only 30 percent -as you have read, however, such findings do not rule out other interpretations; for one thing, the parenting received by two identical twins may be more similar than that received by two fraternal twins -a clearer indication that genetics may play a role in substance use disorders comes from studies of alcoholism rates in people adopted shortly after birth -these studies have compared adoptees whose biological parents abuse alcohol with adoptees whose biological parents do not; by adulthood, the individuals whose biological parents abuse alcohol typically show higher rates of alcoholism than those with nonalcoholic biological parents -genetic linkage strategies and molecular biology techniques provide more direct evidence in support of a genetic explanation -one line of investigation has found an abnormal form of the so-called dopamine-2 (D2) receptor gene in a majority of research participants with substance use disorders but in less than 20 percent of participants who do not have such disorders; other studies have tied still other genes to substance use disorders

neurotransmitters and bipolar disorder

-in the 1960s, clinicians found a relationships between low norepinephrine activity and unipolar depression -because serotonin activity often parallels norepinephrine activity in unipolar depression, theorists at first expected that mania would also be related to high serotonin activity, but no such relationship has been found -research suggests that mania, like depression, may be linked to low serotonin activity -low serotonin activity accompanied by low norepinephrine activity may lead to depression but low serotonin activity accompanied by high norepinephrine activity may lead to mania -in recent years, researchers have found ties between bipolar disorder and abnormal activity of other neurotransmitters, such as GABA, the brain chemical

ion activity and bipolar disorder

-ions seem to play a critical role in relaying messages within a neuron; ions help transmit messages down the neuron's axon to the nerve endings -some studies suggest that, among bipolar individuals, irregularities in the transport of these ions may cause neurons to fire too easily (resulting in mania) or to stubbornly resist firing (resulting in depression)

abilities and preferences of subpersonalities

-it is not uncommon for the different subpersonalities to have different abilities -one may be able to drive, speak a foreign language, or play a musical instrument while others cannot -subpersonalities may have different tastes in food, friends, music, and literature

self-help and residential treatment programs for substance use disorder

-many people with substance use disorders have organized among themselves to help one another recover without professional assistance -the drug self-help movement dates back to 1935, when two Ohio men suffering from alcoholism met and wound up discussing alternative treatment possibilities -the first discussion led to others and to the eventual formation of a self-help group whose members discussed alcohol-related problems, traded ideas, and provided support. The organization became known as Alcoholics Anonymous (AA) -today AA has approximately 2 million members in 110,000 groups across the world; it offers peer support along with moral and spiritual guidelines to help people overcome alcoholism -different members apparently find different aspects of AA helpful -for some it is the peer support; for others it is the spiritual dimension -meetings take place regularly, and members are available to help each other 24 hours a day -by offering guidelines for living, the organization helps members abstain "one day at a time," urging them to accept as "fact" the idea that they are powerless over alcohol and that they must stop drinking entirely and permanently if they are to live normal lives -AA views alcoholism as a disease and takes the position that "Once an alcoholic, always an alcoholic" -related self-help organizations, Al-Anon and Alateen, offer support for people who live with and care about people with alcoholism -self-help programs such as Narcotics Anonymous and Cocaine Anonymous have been developed for other substance use disorders -it is worth noting that the abstinence goal of AA is in direct opposition to the controlled-drinking goal of relapse-prevention training and several other interventions for substance misuse -in fact, this issue—abstinence versus controlled drinking—has been debated for years -feelings about it have run so strongly that in the 1980s the people on one side challenged the motives and honesty of those on the other -research indicates, however, that both controlled drinking and abstinence may be useful treatment goals, depending on the nature of the particular drinking problem -studies suggest that abstinence may be a more appropriate goal for people who have a long-standing alcohol use disorder, whereas controlled drinking can be helpful to younger drinkers whose pattern does not include tolerance and withdrawal reactions -those in the latter group may indeed need to be taught a nonabusive form of drinking -studies also suggest that abstinence is appropriate for people who believe that it is the only answer for them, as they are more likely to relapse after having just one drink -many self-help programs have expanded into residential treatment centers, or therapeutic communities—such as Daytop Village and Phoenix House—where people formerly addicted to drugs live, work, and socialize in a drug-free environment while undergoing individual, group, and family therapies and making a transition back to community life -the evidence that keeps self-help and residential treatment programs going comes largely in the form of individual testimonials -many tens of thousands of people have revealed that they are members of these programs and credit them with turning their lives around -studies of the programs have also had favorable findings, but the number of such studies has been limited

is marijuana dangerous?

-it occasionally causes panic reactions similar to the ones caused by hallucinogens, and some smokers may fear they are losing their minds -typically such reactions end in 2 to 6 hours, along with marijuana's other effects -because marijuana can interfere with the performance of complex sensorimotor tasks and with cognitive functioning, it has caused many automobile accidents -4% of adults have driven while under the influence of marijuana at least once during the past year -people on a marijuana high often fail to remember information, especially anything that has been recently learned, no matter how hard they try to concentrate; thus heavy marijuana smokers are at a serious disadvantage at school or work -one study compared blood flow in the brain arteries of chronic marijuana users and nonusers; after one month of abstinence from smoking marijuana, chronic users continued to have higher blood flow than nonusers; though still higher than normal, the blood flow of light marijuana users (fewer than 16 smokes per week) and of moderate users (fewer than 70 smokes per week) did improve somewhat over the course of the abstinence month -the blood flow of heavy users, however, showed no improvement -this lingering effect may help explain the memory and thinking problems of chronic heavy users of marijuana -it may contribute to lung disease, although there is considerable debate on this issue -some studies suggest that marijuana smoking reduces the ability to expel air from the lungs, perhaps even more than tobacco smoking does -another concern is the effect of regular marijuana smoking on human reproduction -studies since the late 1970s have discovered lower sperm counts in men who are chronic smokers and abnormal ovulation in women who are chronic smokers -efforts to educate the public about the dangers of repeated marijuana use appeared to have paid off throughout the 1980s -the percentage of high school seniors who smoked marijuana on a daily basis decreased from 11 percent in 1978 to 2 percent in 1992 -today, however, 6 percent of high school seniors smoke it daily, and 69 percent of seniors do not believe that regular use poses a great risk

accurate figures on suicide

-it's difficult to obtain -many investigators believe that estimates are often low -suicide can be difficult to distinguish from unintentional drug overdoses, automobile crashes, drownings, and other accidents -many apparent "accidents" are probably intentional -also, since suicide is frowned on in our society, relatives and friends often refuse to acknowledge that loved ones have taken their own lives

state-dependent learning: a cognitive-behavioral view of dissociative disorders

-learning that becomes associated with the conditions under which it occurred, so that it is best remembered under the same conditions -a particularly level of arousal will have a set of remembered events, thoughts, and skills attached to it (when a situation produces that particularly level of arousal, the person is more likely to recall the memories linked to it) -people who develop dissociative disorders have state-to-memory links that are unusually rigid and narrow -each of their thoughts, memories, and skills may be tied exclusively to a particular state of arousal so they recall a given event only when they experience an arousal state almost identical to the state in which the memory was first acquired

biochemical factors

-low activity of two neurotransmitter chemicals, norepinephrine and serotonin, has been strongly linked to unipolar depression -medical researchers discovered that certain medications for high blood pressure often caused depression because some of those medications lowered norepinephrine activity and others lowered serotonin -in the discovery of truly effective antidepressant drugs, researchers soon learned that while the drugs were relieving depression, they also were bringing about increases in norepinephrine and/or serotonin activity -for years it was thought that low activity of either norepinephrine or serotonin directly produced depression but current research indicates that interactions between serotonin and norepinephrine activity or between these and other kinds of neurotransmitters the brain, are more influential than the operation of any one neurotransmitter alone -studies suggest that the activity of these neurotransmitters may either reflect or help produce dysfunction of a depression-related circuit in the brain, dysfunction that may itself be a key to the development of depression -researchers have also learned that another group of chemicals--the body's hormones--are linked to depression -research indicates that the hypothalamic-pituitary-adrenal (HPA) pathway of people with depression (particularly those whose depression includes feelings of anxiety) is also overly reactive in the face of stress, causing excessive and enduring releases of cortisol and related hormones at times of stress

drug maintenance for substance use disorder

-maintenance treatment with methadone has again sparked interest among clinicians in recent years, partly because of new research support and partly because of the rapid spread of the HIV and hepatitis C viruses among intravenous drug abusers and their sex partners and children -not only is methadone treatment safer than street opioid use, but many methadone programs now include AIDS education and other health instructions in their services -research suggests that methadone maintenance programs are most effective when they are combined with education, psychotherapy, family therapy, and employment counseling -today thousands of clinics provide methadone treatment across the United States -another opioid substitute drug, buprenorphine, has been gaining momentum as a form of maintenance therapy during the past decade -like methadone, this drug is itself an opioid that is administered to patients as a safer alternative to heroin, painkillers, and the like -however, according to research, buprenorphine is a less potent substitute drug than methadone and produces less tolerance and fewer withdrawal reactions -for these reasons, buprenorphine is permitted by law to be prescribed by physicians in their offices rather than as part of a highly structured clinic program—offering a level of accessibility that is not possible with methadone treatment

treatment for substance use disorders

-many approaches have been used to treat substance use disorders, including psychodynamic, cognitive-behavioral, and biological approaches, along with several sociocultural therapies -these various approaches are often combined with motivational interviewing in which therapists help motivate the clients to make constructive choices and behavioral changes -although treatment sometimes meets with great success, more often it is only moderately helpful -today the various treatments are typically used on either an outpatient or inpatient basis or a combination of the two -the effectiveness of treatment for substance use disorders can be difficult to determine -first, different substance use disorders pose different problems -second, many people with such disorders drop out of treatment very early -third, some people recover without any intervention at all while many others recover and then relapse -fourth, different criteria are used by different clinical researchers

"Increases in stress have been linked to...

... the onset of depression, schizophrenia, sexual dysfunctions, and other psychological problems."

"We feel some degree of stress whenever we are faced with...

...demands or opportunities that require us to change in some manner."

genetic factors and bipolar disorders

-many theorists believe that people inherit a biological predisposition to develop bipolar disorders -identical twins of those with bipolar disorder have a 40 to 70% likelihood of developing the same disorder, and fraternal twins, siblings, and other close relatives of such persons have a 5 to 10% likelihood, compared with the 1 to 2.6% prevalence rate in the general population -research has linked bipolar disorders to genes on chromosomes 1, 4, 6, 10, 11, 12, 13, 15, 18, 20, 21, and 22 -such wide-ranging findings suggest that a number of genetic abnormalities probably combine to help bring about bipolar disorders

identifying features of subpersonalities

-may differ in features as basic as age, gender, race, and family history

treatments used after suicide attempts

-medical care due to the resulting injuries from their efforts to harm themselves -once the physical damage is treated, psychotherapy or drug therapy may begin on an inpatient or outpatient basis -unfortunately, even after trying to kill themselves, many suicidal people daily to receive systematic follow-up care -sad because individuals who survive a suicide attempt are 6 times as likely as other people to make future suicide attempts -the likelihood is especially high among individual who used guns or other violent techniques in their first attempt -around 50% of all people who die from suicide have made a previous attempt -the average number of therapy sessions attend by teens who receive follow-up care is 8; around 18% of such teens terminate treatment against their therapists' advice -goals of therapy are to keep the individuals alive, reduce their psychological pain, help them achieve a nonsuicidal state of mind, provide them with hope, and guide them to develop better ways of handling stress -studies indicate that people who receive therapy after their suicide attempts have a lower risk of future suicide attempts and deaths than do attempters who do not receive such therapy -various therapies have been employed including, drug, psychodynamic, CBT, group, and family therapies -research indicates that CBT may be particularly helpful -using elements of CBT, the therapists may help their suicidal clients to assess, challenge, and change many of their negative attitudes and illogical thinking processes -applying mindfulness-based CBT, the therapists may also guide the clients to become keenly aware of the various painful thoughts and feelings rather than trying to eliminate them -acceptance is expected to increase the clients' tolerance of psychological distress -employing a number of therapy exercises, homework assignments, and other CB tools, the therapists may try to teach clients better coping and problem-solving skills -all these treatment features are particularly prominent in a new-wave CB approach called dialectical behavior therapy (DBT) which is being used increasingly in cases of suicidal thinking and attempts

explanation for gender differences in suicides

-men tend to use more violent methods, such as shooting, stabbing, or hanging themselves, whereas women use less violent methods, such as drug overdose -guns are used in 62% of the male suicides in the U.S., compared with 37% of the female suicides

methadone maintenance programs

-methadone maintenance programs: an approach to treating opioid-centered substance use in which clients are given legally and medically supervised doses of a substitute drug, methadone -in these programs, people with an addiction are given the laboratory opioid methadone as a substitute, or agonist, for heroin -although they then become dependent on methadone, their new addiction is maintained under safe medical supervision -unlike heroin, methadone produces a moderate high, can be taken by mouth (thus eliminating the dangers of needles), and needs to be taken only once a day -at first, methadone programs seemed very effective, and many of them were set up throughout the United States, Canada, and England -these programs became less popular during the 1980s, however, because of the dangers of methadone itself -many clinicians came to believe that substituting one addiction for another is not an acceptable "solution" for a substance use disorder, and many people with an addiction complained that methadone addiction was creating an additional drug problem that simply complicated their original one

the elderly and suicide

-more than 16 of every 100,000 people between the ages of 65 and 74 years in the U.S. kill themselves, a rate that rises to 21.4 per 100,000 among people over the age of 74 years -elderly people account for over 18% of all suicides in the U.S., yet they comprise only 15% of the total population -as people grow older, all too often they become ill, lose close friends and relatives, lose control over their lives, and lose status in our society -such experiences may result in feelings of hopelessness, loneliness, depression, burdensomeness, or inevitability among aged persons and so increase the likelihood that they will attempt suicide -one study found that 2/3 of particularly elderly individuals (those over 80) who died by suicide had been hospitalized for medical reasons within 2 years preceding the suicide, and another found a heightened rate of vascular or respiratory illnesses among elderly people who attempted suicide -other research has shown that the suicide rate of elderly people who have recently lost a spouse is particularly high; the risk is greatest during the first weeks of bereavement, but it remains high in later months and years -elderly people are typically more determined than younger people in their decision to die and give fewer warnings, so their success rate is much higher -1 in every 4 elderly persons who attempts suicide succeeds -some people argue that older persons who want to die are clear in their thinking and should be allowed to carry out their wishes -however, clinical depression appears to play an important role in as many as 60% of suicides by the elderly, suggesting that more elderly people who are suicidal should be receiving treatment for their depressive disorders -in fact, research suggests that treating depression in over persons helps reduce their risk of suicide markedly -suicide rate among the elderly in the U.S. is lower in some minority groups -although American Indians have the highest overall suicide rates, the rate among elderly is relatively low -this is in sharp contrast to the loss of status often experienced by elderly non-Hispanic white Americans -the suicide rate is only 1/4 as high among elderly African Americans as among elderly non-Hispanic white Americans -one reason for this low suicide rate may be the pressures faced by African Americans, of who it is sometimes said: only the strongest survive; so those who reach an advanced age often have overcome significant adversity and many feel proud of what they have accomplished -for non-Hispanic white Americans, reaching old age is not in itself a form of success -another explanation is that African Americans have managed to overcome or reduce the feelings or indignation that prompt many suicides in younger African Americans

the physical use and symptoms of opioids

-most opioids are smoked, inhaled, snorted, injected, or, as in the case of many pain relievers, swallowed in pill or liquid form -in injections, the opioid may be deposited just beneath the skin ("skin-popping"), deep into a muscle, or directly into a vein ("mainlining") -an injection quickly brings on a rush—a spasm of warmth and ecstasy that is sometimes compared with orgasm -the brief spasm is followed by several hours of a pleasant feeling called a high or nod -during a high, the drug user feels relaxed, happy, and unconcerned about food, sex, or other bodily needs -Opioids create these effects by depressing the central nervous system, particularly the centers that help control emotion -The drugs attach to brain receptor sites that ordinarily receive endorphins—neurotransmitters that help relieve pain and reduce emotional tension -When neurons at these receptor sites receive opioids, they produce pleasurable and calming feelings just as they would do if they were receiving endorphins -In addition to reducing pain and tension, opioids cause nausea, narrowing of the pupils ("pinpoint pupils"), and constipation—bodily reactions that can also be brought about by releases of endorphins in the brain

biological causes of bipolar disorder

-neurotransmitter activity -ion activity -brain structure -genetic factors

mental disorders and suicide

-not all people who attempt suicide necessarily have a psychological disorder -the vast majority of all suicide attempters do have such a disorder -25% of people with severe depression, chronic alcoholism, or schizophrenia try to kill themselves -people who are both depressed and substance-dependent seem particularly prone to suicidal impulses -certain anxiety disorders, including PTSD and panic disorder, have also been linked to suicide, but in most cases of suicide these disorders occur in conjunctions with a depressive disorder, a substance use disorder, or schizophrenia -many people with borderline personality disorder try to harm themselves or make suicidal gestures as part of their disorder -people with major depressive disorder often have suicidal thoughts -among those who are severely depressed, the risk of suicide may actually increase as their mood improves and they have more energy to act on their suicidal wishes

behavioral symptoms of depression

-people are usually less active and less productive -may spend more time alone and may stay in bed for long periods -people may also move and even speak more slowly

physical symptoms of depression

-people frequently have physical ailments of headaches, indigestion, constipation, dizzy spells, and general pain -many depressions are misdiagnosed as medical problems at first -disturbances in sleep are particularly common -most depressed people eat less, sleep less, and feel more fatigued than they did prior to the disorder -some individuals sleep and eat excessively

cognitive symptoms

-people hold extremely negative views of themselves -they consider themselves inadequate, undesirable, inferior, perhaps even evil -they blame themselves for nearly every unfortunate event, even things that have nothing to do with them -they rarely credit themselves for positive achievements -experience pessimism: usually convinced that nothing will ever improve, and they feel helpless to change any aspect of their lives -because they expect the worst, they are likely to procrastinate -their sense of hopelessness and helplessness makes them especially vulnerable to suicidal thinking -people frequently complain that their intellectual ability is very poor -they feel confused, unable to remember things, easily distracted, and unable to solve even the smallest of problems -in lab studies, depressed people perform slightly more poorly than non depressed people but that may be due to lack of motivation rather than cognitive differences

shifts in patterns of thinking

-people may become preoccupied with their problems, lose perspective, and see suicide as the only effective solution to their difficulties

increased arousal, negative emotions, and guilt

-people may feel excessively alert (hyperalertness), be easily startled, having trouble concentrating, and develop sleep problems -people may display anxiety, anger, or depression in a pattern called emotional dysregulation or labile mood -many may feel extreme guilt because they survived the traumatic event while others did not or guilt for what they had to do to survive

reexperiencing the traumatic event

-people may have recurring thoughts, memories, dreams, or nightmares connected to the event -few relive the event so vividly in their mind (flashbacks) that they think it is actually happening again

polysubstance use

-people taking more than one drug at a time

the state of mania

-people typically experience dramatic and inappropriate rises in mood -these symptoms of mania span the same areas of functioning as those of depression (emotional, motivational, behavioral, cognitive, and physical) but mania affects those areas in an opposite way

motivational symptoms of depression

-people typically lose the desire to pursue their usual activities -a lack of drive, initiative, and spontaneity -may force themselves to have to go to work, talk with friends, eat meals, or have sex -many depressed people become uninterested in life or wish to die -they may wish they could kill themselves and some actually do

serious illness and suicide

-people whose illnesses cause them great pain or severe disability may attempt suicide, believing that death is unavoidable and imminent -they may also believe that the suffering and problems caused by their illnesses are more than they can endure -as many as 1/3 of those who die by suicide have been in poor physical health during the months prior to their suicidal acts -the illnesses linked to higher suicide rates include cancer, heart disease, chronic lung disease, stroke, and diabetes mellitus

social support systems in developing PTSD

-people whose social and family support systems are weak are more likely to develop PTSD after a traumatic event -rape victims who feel loved, cared for, valued, and accepted and people treated with dignity and respect by the criminal justice system recover from their ordeal more successfully -poor social support contributes to the development of PTSD in some combat veterans

personal styles in developing PTSD

-people with certain personalities, attitudes, and coping styles are particularly likely to develop PTSD -research has found that people who generally view life's negative events are beyond their control tend to develop more severe stress symptoms after sexual abuse or other kinds of traumatic events than people who feels they have more control over their lives -people who generally find it difficult to derive anything positive from unpleasant situations adjust more poorly after traumatic events than other people -people with a resilient style of personality are less kiley than other individuals to develop PTSD

depressive vs. bipolar disorders

-people with depressive disorders grapple with depression only, called unipolar depression -those with bipolar disorders contend with both depression and mania

physical symptoms of mania

-people with mania feel remarkably energetic -the typical get little sleep yet feel and act wide awake -even if they miss a night or two of sleep, their energy level may remain high

motivational symptoms of mania

-people with mania seems to want constant excitement, involvement, and companionship -they enthusiastically seek out new friends and old, new interests and old, and have little awareness that their social style is overwhelming, domineering, and excessive

one-way amnesic relationships

-the most common relationship patterns, some subpersonalities are aware of others, but the awareness is not mutual

cognitive symptoms of mania

-people with mania usually show poor judgment and planning, as if they feel too good or move too fast to consider possible pitfalls -filled with optimism, they rarely listen when others try to slow them down, interrupt their buy-in sprees, or prevent them from investing money unwisely -they may also hold an inflated opinion of themselves, and sometimes their self-esteem approaches grandiosity -some have trouble remaining coherent or in touch with reality

reduced responsiveness and dissociation

-people with these disorders may feel detached from other people, be unresponsive to external stimuli, and lose interest in activities that once brought enjoyment -many endure symptoms of dissociation, depersonalization, or have a sense of derealization

modeling and suicide

-perhaps people (teenagers) have been struggling with a major problem and the other person's suicide seems to reveal a possible solution, or perhaps they have been thinking about suicide and the other person's suicide seems to give them permission or finally persuades them to act -one suicidal act apparently serves as a model for another -suicides by family members or friends, those by celebrities, other high publicized suicides, and those by coworkers or colleagues are particularly common triggers

community prevention programs

-perhaps the most effective approach to substance use disorders is to prevent them -the first drug-prevention programs were conducted in schools -today such programs are also offered in workplaces, activity centers, and other community settings and even through the media -around 12 percent of adolescents report that they have participated in drug prevention programs outside school within the past year -around 75 percent have seen or heard a substance use-prevention message -and almost 60 percent have talked to their parents in the past year about the dangers of alcohol and other drugs -some prevention programs are based on a total abstinence model, while others teach responsible use -some seek to interrupt drug use; others try to delay the age at which people first experiment with drugs -programs may also differ in whether they offer drug education, teach alternatives to drug use, try to change the psychological state of the potential user, help people change their peer relationships, or combine these techniques -prevention programs may focus on the individual (for example, by providing education about unpleasant drug effects), the family (by teaching parenting skills), the peer group (by teaching resistance to peer pressure), the school (by setting up firm enforcement of drug policies), or the community at large -the most effective prevention efforts focus on several of these areas in order to provide a consistent message about drug misuse in all areas of people's lives -some prevention programs have even been developed for preschool children -after a 5-year study, the Government Accountability Office concluded in 2006 that the highly regarded My Anti-Drug campaign of the late 1990s and early 2000s had been largely ineffective -thus, it is encouraging that a number of studies are now being conducted to assess the actual impact of the various community-based prevention programs -one nationwide survey of 3,000 students, for example, suggested that watching Above the Influence ads helped reduce marijuana use by teenagers -the survey found that 8 percent of eighth-graders familiar with the campaign have taken up marijuana use, in contrast to 12 percent of students who have never seen the ads

physical responses to fear

-perspiration -breathing quickens -muscle tense -heart beats faster -turning pale -developing goose bumps -feeling nauseous

the developmental psychopathology perspective of unipolar depression

-proponents of this perspective believe that early negative factors generally set the stage for later negative factors and ultimately for depression, but later positive factors sometimes are able to offset the lingering impact of early negative factors -developmental psychopathologists believe that the road to unipolar depression often begins with a genetically inherited predisposition (characterized by low activity of key neurotransmitters serotonin and norepinephrine in key brain structures, an overly reactive HPA stress pathway, and a dysfunctional depression-related brain circuit) -researchers have found that biological predispositions will most likely result in later depression if the individual is also subjected to significant traumas early in life (particularly interpersonal losses) and/or inadequate parenting (such as a disrupted, depressive style, inconsistent, or rejecting) -individuals who travel through this unfavorable developmental sequence are particularly likely to become depressed when they experience stress in adult life, especially interpersonal stress -studies have found that individuals who experience moderate and manageable adversities throughout their childhood often develop resilience and become better able to withstand the depressive effects of life stress in adulthood

leading theories on the underlying causes of suicide

-psychodynamic model -sociocultural model -biological model -some of these hypothesis have, however, received limited research support and fail to address the full range of suicidal acts -thus, the clinical field currently lacks a satisfactory understanding of suicide

psychodynamic view of substance use disorder

-psychodynamic theorists believe that people with substance use disorders have powerful dependency needs that can be traced to their early years -they suggest that when parents fail to satisfy a young child's need for nurturance, the child is likely to grow up depending excessively on others for help and comfort, trying to find the nurturance that was lacking during the early years -if this search for outside support includes experimentation with a drug, the person may well develop a dependent relationship with the substance -some psychodynamic theorists also believe that certain people respond to their early deprivations by developing a substance abuse personality that leaves them particularly prone to drug abuse -personality inventories, patient interviews, and even animal studies have in fact indicated that individuals who abuse drugs tend to be more dependent, antisocial, impulsive, novelty-seeking, risk-taking, and depressive than other individuals -however, these findings are correlational (at least, the findings from human studies are), and do not clarify whether such traits lead to chronic drug use or whether repeated drug use causes people to be dependent, impulsive, and the like -one pioneering longitudinal study measured the personality traits of a large group of nonalcoholic young men and then kept track of each man's development -years later, the traits of the men who developed alcohol problems in middle age were compared with the traits of those who did not; the men who developed alcohol problems had been more impulsive as teenagers and continued to be so in middle age, a finding suggesting that impulsive men are indeed more prone to develop alcohol problems -similarly, in various laboratory investigations, "impulsive" rats—those that generally have trouble delaying their rewards—have been found to drink more alcohol when offered it than other rats -a major weakness of this line of argument is the wide range of personality traits that have been tied to substance use disorders -different studies point to different "key" traits -while some people with these disorders appear to be dependent, others impulsive, and still others antisocial, researchers cannot presently conclude that any one personality trait or group of traits stands out in the development of the disorders

psychodynamic treatment of substance use disorder

-psychodynamic therapists first guide clients to uncover and work through the underlying needs and conflicts that they believe have led to the substance use disorder -the therapists then try to help the clients change their substance-related styles of living -although this approach is often used, it has not been found to be particularly effective -it may be that substance use disorders, regardless of their causes, eventually become stubborn independent problems that must be the direct target of treatment if people are to become drug-free -psychodynamic therapy tends to be of more help when it is combined with other approaches in a multidimensional treatment program

localized amnesia

-the most common type of dissociative amnesia -a person loses all memory of events that took place within a limited period of time, almost always beginning with some very disturbing occurrence

treatments for dissociative amnesia

-psychodynamic therapy: guide patients to search their unconscious in the hope of bringing forgotten experiences back to consciousness, suited well for uncovering unconscious memories -hypnotic therapy: therapists hypnotize patients then guide them to recall their forgotten events, suited well since dissociative amnesia may be a form for self-hypnosis -drug therapy: "truth serums" can calm people, free their inhibitions, thus helping them to recall anxiety-producing events (injects of barbiturates such as sodium amobarbital or sodium pentobarbital)

elderly people and severe depression

-rate is twice as high among adults UNDER age 65 compared to those over 65 -this may be because people who are depressed have a higher mortality rate than other people and are less likely to live to an old age -therefore, reducing the prevalence of depression among the elderly (ie: many won't make it to old age, so the people who do make it to old age are much less likely to be depressed) -nevertheless, among elderly people with significant or chronic medical problems have a higher rate of depression than those in relatively good health

the biological view of suicide

-research has found higher rates of suicide among the parents and close relatives of suicidal people than among those of nonsuicidal people; so such findings may suggest that genetic or biological factors are at work -twin studies also supported the biological view of suicide (in a study, in 4 of the identical pairs, the other twin also died by suicide, while none of the other twins among the fraternal pairs had done so) -research on serotonin levels also provides or direct support for the biological view of suicide -the activity level of this neurotransmitter has often been found to be low in people who complete suicide -they studied 68 depressed patients and found that 20 of the patients had particularly low levels of serotonin activity; it turned out that 40% of the research participants with such serotonin levels attempted suicide, compared with 15% of those with higher serotonin levels -researchers interpreted this to mean that low serotonin activity may be a "predictor of suicidal acts" -later studies found that suicide attempters with low serotonin activity are 10 times more likely to make a repeat attempt and succeed than are suicide attempters with relatively high serotonin activity -brain scan studies revealed that low serotonin activity of suicidal persons corresponds to dysfunction throughout their depression-related brain circuit (ie: activity in their prefrontal cortex, hippocampus, amygdala, and subgenus cingulate is abnormal and the interconnectivity between these structures is atypical) -at first glance, these studies may seem to tell us only that depressed people often attempt suicide, but there is evidence of low serotonin activity and brain-circuit dysfunction even among suicidal people who have no history of depression -one possibility for this is that serotonin and circuit abnormalities contribute to aggressive and impulsive behaviors -it has been found that aggressive and impulsive men display lower serotonin activity and poorer brain-circuit functioning than do other men -moreover, studies have found that depressed patients with particularly low serotonin activity and poor brain-circuit functioning attempt suicide more often, use more lethal methods, and score higher in hostility and impulsivity on personality inventories than do depressed patients with relatively higher serotonin activity and better functioning circuits

genetic factors

-research on family pedigree, twin, and gene studies suggest that some people inherit a predisposition to unipolar depression -family pedigree studies select people with unipolar depression as pro bands, examine their relatives, and see whether depression also afflicts other members of the family -researchers have found that as many as 30% of those relatives are depressed, compared with fewer than 10% of the general population -twin studies supported this and when an identical twin has unipolar depression, there i a 38% chance that the other twin has already has or will eventually have the same disorder -in contrast, when a fraternal twin has unipolar depression, the other twin has only a 20% chance of having the disorder -researchers have found evidence that unipolar depression may be tied to genes on chromosomes 1, 3, 4, 6, 9, 10, 11, 12, 13, 14, 17, 18, 20, 21, 22 and X -a number of researchers have found that people who are depressed often have an abnormality of their 5-HTT gene, a gene located on chromosome 17 that is responsible for the activity of the neurotransmitter serotonin

rumination theory

-research reveals that women are more likely than men to ruminate when their mood darkens, perhaps making them more vulnerable to the onset of clinical depression -rumination is related to depression

the interpersonal view of suicide

-research shows that without the further presence of perceived burdensomeness, thwarted belongingness, and acquired capability, other factors are not likely to result in self-inflicted death -people with perceived burdensomeness believe that their existence places a heavy and permanent burden on their family, friends, and even society -this belief is typically inaccurate, but held dearly, and often leads to self-hatred -it may produce the notion that "my death would be worth more than my life to my family and friends" -people with thwarted belongingness feel isolated and alienated from others--not an integral part of a family or social network -their sense of social disconnect may be overstated or it may be accurate, but either way, it feels enduring, unchangeable, and confining -a large body of research indicates that people who experience both of these interpersonal perceptions are inclined to develop a desire for suicide -however, studies also show that such individuals are unlikely to attempt suicide unless they further possess the third variable--the psychological capability to inflict lethal harm on themselves -according to Joiner, we all have a basic motive to live and preserve ourselves--a motive that weakens for certain people as a result of their repeated exposure to painful life experiences like abuse, trauma, severe illness, etc. -given such recurrent experiences, these individuals may develop a heightened tolerance for pain and a fearlessness about death which would allow them to acquire a psychological capability for suicidal acts -Military ex. due to the nature and impact of military training and combat, they eventually develop feelings that they are a hardship on their families (perceived burdensomeness), have difficulty integrating into civilian life (thwarted belongingness), and grow accustomed to violence (acquired suicide capability) -this perspective uncovered key variables in acts of suicide, like the importance of looking at those variable collectively rather than individually

brain-body stress pathways in developing PTSD

-research suggests that people who develop PTSD react with especially heightened arousal -evidence suggests that even prior to confronting a severe trauma, such individual's pathways are overly reactive to modest stressors, thus setting up a predisposition to develop PTSD -evidence suggests that after confrontation with severe trauma, those brain-body pathways become even more overly reactive

celebrities modeling suicide

-research suggests that suicides by entertainers, political figures, and other well-known people are regularly followed by unusual increases in the number of suicides across the nation -a classic study on the issues found, for example, that the national suicide rate rose 12% during the week after the suicide of actress Marilyn Monroe in 1963

the brain's stress circuit in developing PTSD

-researchers believe that chronic overreactivity of the two stress pathways may help bring about dysfunction in a distinct brain circuit, sometimes called the brain's stress circuit -researchers have found that dysfunctions within and between three structures in this circuit (amygdala, prefrontal cortex, and hippocampus) play a particularly key role in PTSD -researchers have found that in people with PTSD, the interconnection between the amygdala and prefrontal cortex is flawed (activity by the former is too high and activity by the latter is too low) making people experience persistent symptoms of arousal -research suggests that dysfunctions in the hippocampus and in its connection to the amygdala may result in the unchecked emotional memories and persistent arousal symptoms that characterize PTSD as well as the dissociations found in many cases

childhood experience in developing PTSD

-researchers believe that predispositions to PTSD may be acquired during childhood rather than inherited at birth -ex. young children who are chronically neglected or abused or otherwise traumatized develop overly reactive stress pathways and a dysfunction brain stress circuit that carry into later life -their unfortunate childhood experiences increase a person's risk for later PTSD -people whose childhoods were marked by poverty; an assault, abuse, or a catastrophe; multiple traumas; parental separation or divorce; or living with family members suffering from psychological disorders appear more likely to develop the disorder in the face of later trauma

sociocultural view of substance use disorder

-sociocultural theorists propose that people are most likely to develop substance use disorders when they live under stressful socioeconomic conditions -studies have found that regions with higher unemployment levels have higher rates of alcohol or opioid use disorder -similarly, people in lower socioeconomic classes have rates of substance use disorder that are higher than those of the other classes -in a related vein, 18 percent of unemployed adults currently use an illegal drug, compared with 11 percent of full-time employed workers and 13 percent of part-time employees -sociocultural theorists hold that people confronted regularly by other kinds of stress also have a heightened risk of developing substance use disorders -studies conducted with Hispanic and African American people, for example, find higher rates of substance use disorders among those participants who live or work in environments of particularly intense discrimination -still other sociocultural theorists propose that people are more likely to develop substance use disorders if they are part of a family or social environment in which substance use is valued or at least accepted -researchers have learned that problem drinking is more common among teenagers whose parents and peers drink, as well as among teenagers whose family environments are stressful and unsupportive -moreover, lower rates of alcoholism are found among Jews and Protestants, groups in which drinking is typically acceptable only as long as it remains within clear limits, whereas alcoholism rates are higher among the Irish and Eastern Europeans, who do not, in general, draw as clear a line

the severity and nature of the trauma in developing PTSD

-some events may override a favorable biological foundation, nurturing childhood, positive attitudes, and/or social support -the more severe or prolonged the trauma and the more direct one's exposure to it, the grater the likelihood of developing a stress disorder -mutilation, severe physical injury, or sexual assault in particular seem to increase the risk of stress disorders, as does witnessing the injury or death of other people -people who experience intentionally inflicted traumas are more likely to develop a stress disorder than persons who encounter unintentional traumas

occupational stress and suicide

-some jobs create feelings of tension or dissatisfaction that may trigger suicide attempts -studies have revealed higher suicide rates among people working in unskilled occupations -for persons in skilled occupations, research has found relatively high rates for psychiatrists and psychologists, physicians, nurses, dentists, lawyers, police officers, fire fighters, emergency workers, and farmers

body dissatisfaction explanation

-states that females in Western society are tough, almost from birth, but particularly during adolescence, to seek a low body weight and slender body shape--goals that are unreasonable, unhealthy, and often unattainable -research finds that as adolescence unfolds, girls do become more and more dissatisfied with their weight and body and, on average, display an increased rate of depression -however, it is not clear that eating and weight concerns actually cause depression, they may instead be the result of depression

common triggering events of suicide

-stressful events -mood and thought changes -alcohol and other drug use -mental disorders -modeling

biological views of substance use disorder

-studies on genetic predisposition, neurotransmitters, and brain circuits have all pointed in this direction

explanation of social environments and suicides

-studies suggest that at least half of individuals who carry out suicide are socially isolated and have few or no close personal friends, although they may be active on social media -research has revealed that never-married and divorced persons have a higher suicide rate than married or cohabitating individuals

physiological responses of subpersonalities

-subpersonalities may have differences in blood pressure levels and allergies

stimulants

-substance that increase the activity of the central nervous system, resulting in increased blood pressure and heart rate, more alertness, and sped-up behavior and thinking -the most troublesome stimulants are cocaine and amphetamines, whose effects on people are very similar -two other widely used and legal stimulants are caffeine and nicotine

life stress theory

-suggests that women in our society are subject to more stress than men -on average, they face more poverty, more menial jobs, less adequate housing, and more discrimination than men--all factors linked to depression--and in many homes, woman bear a disproportionate share of responsibility for child care and housework

explanation of race/ethnicity differences in suicides

-the overall suicide rate of non-Hispanic white Americans is more than twice as high as that of African Americans, Hispanic Americans, and Asian Americans -a major exception to this pattern is the suicide rate of American Indians, which is higher than that of non-Hispanic white Americans -extreme poverty of many American Indians may partly explain their high suicide rate; along with factors such as alcohol use, modeling, and the availability of guns -among Hispanic Americans, for example, Puerto Ricans are significantly more likely to attempt suicide than any other Hispanic American group -studies suggest that the actual rate of suicide may be 15% higher for African Americans and 6% higher for women than usually reported -people in these groups are more likely than others to use methods of suicide that can be mistaken for causes of accidental death, such as poisoning, drug overdose, single-car crashes, and pedestrian accidents

adolescents and suicide

-suicidal actions become much more common after the age of 13 than at any earlier age -8 out of every 100,000 teens (age 14-18) end their lives in the U.S. each year -at least 12% of teens have persistent suicidal thoughts and 4-8% make suicide attempts -because fatal illness are uncommon among the young, suicidal has become the second leading cause of death in this age group, after accidents -around 19% of all adolescent deaths are the result of suicide -about 50% of teen suicides have been tied to clinical depression, low self-esteem, and feelings of hopelessness, but many teens who try to kill themselves also struggle with anger and impulsiveness or have serious alcohol or drug problems; some also have deficiencies in their ability to sort out and solve problems -teens who consider or attempt suicide are often under great stress; they may be dealing with long-term pressures such as poor (or missing) relationships with parents, family conflict, inadequate peer relationships, social isolation, or repeated bullying -suicide attempts are at least twice as common among teenage victims of bullying as among other teenagers -alternatively, their actions may be triggered by more immediate stress, such as a parent's unemployment or medical illness, financial setbacks for the email, or a social loss such as a breakup with a partner -stress at school seems to be a particularly common problem for teenagers who attempt suicide (some have trouble keeping up at school, while others may be high achievers who feel pressured to be perfect and stay at the top of the class) -LGBTQ teens are under particular stress because in addition to possible sexual or gender doubts and concerns, they often experience abuse, prejudice, stigmatization, and victimization by peers -studies indicate that LGBTQ teens are 3 times more likely than other teenagers to have suicidal thoughts and to attempt suicide -adolescence is a period of rapid growth that is often marked by conflicts, depressed feelings, tensions, and difficulties at home and school -adolescents tend to react to events more sensitively, angrily, dramatically, and impulsively than individuals in other age groups, thus the likelihood of engaging in suicidal acts during times of stress is higher -the suggestibility of adolescents and their eagerness to imitate others, including others who attempt suicide, may set the stage for suicidal action -one study found that adolescents exposed to suicide by an acquaintance or relative within the past year were more likely to attempt suicide than adolescents without a personal exposure of this kind -it is believed that recent suicides by individuals on social networking sites may also raise the likelihood of attempted suicide by many young users

chidden and suicide

-suicide is infrequent among children, although it has been increasing over the past several decades -for children under 11 years of age, 1 out of every million kill themselves -the rate rises to 2 per 100,000 among children aged 11-14 years, and 8 per 100,000 among teens aged 15-19 years -1 of every 100 children tries to harm themself, and many thousands of children are hospitalized each year for deliberately self-destructive acts such as stabbing, cutting, burning, or shooting themselves; overdosing; or jumping from high places -researchers have found that suicide attempts by the very young are commonly preceded by such behavioral patterns as running away from home; accident-proneness; aggressive acting out; temper tantrums; self-criticism; social withdrawal and loneliness; extreme sensitivity to criticism by others; low tolerance of frustration; sleep problems; dark fantasies, day dreams, or hallucinations; marked personality change; and overwhelming interest in death and suicide -studies have further linked child suicides to the recent or anticipated loss of a loved one, family stress and a parent's unemployments, abuse by parents, victimization by peers (ex. bullying), and a clinical level of depression -many child suicides appear to be based on a clear understanding of death and on a clear wish to die -suicidal thinking among even normal children is apparently more common than most people once believed -between 6 and 33% of schoolchildren have thought about suicide -many of today's elementary schools have tried to develop tools and procedures for better identifying and assessing suicide risk among their students

other highly publicized cases modeling suicide

-suicides with bizarre or unusual aspects often receive intense coverage by the news media -such highly publicized accounts may lead to similar suicides -during the year after a widely publicized, politically motivated suicide by self-burnin in England, for example, 82 other people set themselves on fire, with equally fatal results -reports revealed that most of those people had histories of emotional problems and that none of the suicides had the political motivation of the publicized suicide -the imitators seemed to be responding to their own problems a manner triggered by the suicide they had observed or read about -clinicians are that more responsible reporting could reduce this frightening impact of highly publicized suicides

couple and family therapy for PTSD

-symptoms of PTSD are particularly apparent to spouses and other family members, who may be directly affected by the client's anxieties, depressed mood, or angry outbursts -with the help and support of their family members, they may come to examine their impact on others, learn to communicate better, improve their problem solving skills, and reestablish feeling of closeness

the immune system

-the body's network of activities and body cells that fight off bacteria, viruses, and other foreign invaders -when people are under intense stress for a while, their immune system may become dysregulated, leading to slower functioning of important white blood cells called lymphocytes and to increased production of C-reactive protein (CRP), a protein that spreads throughout the body and causes inflammation and various illnesses -some researchers belief that immune system dysregulation of this kind helps produce depression -studies have found that people with depression display lower lymphocyte activity, higher CRP production, and greater body inflammation than do other people -depressed people have a higher incidence of migraines, irritable bowel syndrome, chronic fatigue syndrome, rheumatoid arthritis, and other illnesses caused by CRP production and body inflammation -the reverse could be true though and the depression could act as a severe stressors that leads to immune system problems instead

recent age-related suicide trends

-the exceptional rate of suicide among those who are middle-aged is a relatively recent phenomenon and is not fully understood -up until 2006, that rate had been considerably lower than the current rate and always lower than that of elderly people

dangers of ecstasy (MDMA)

-the mood and energy lift produced by MDMA comes at a high price -it can cause the following problems: -immediate psychological problems such as confusion, depression, sleep difficulties, severe anxiety, and paranoid thinking; these symptoms may also continue for weeks after ingestion of MDMA -significant impairment of memory and other cognitive skills -physical symptoms such as muscle tension, nausea, blurred vision, faintness, and chills or sweating -increases in heart rate and blood pressure, which place people with heart disease at special risk -reduced sweat production; at a hot, crowded dance party, taking Ecstasy can even cause heat stroke, or hyperthermia; users generally try to remedy this problem by drinking lots of water, but since the body cannot sweat under the drug's influence, the excess fluid intake can result in an equally perilous condition known as hyponatremia, or "water intoxication" -potential liver damage

alcohol and drug use and suicide

-the more intoxicated suicide attempters are, the more lethal their chosen suicide methods -it may be that the use of alcohol lowers a person's inhibitions, reduces his or her fears of suicide, releases underlying aggressive feelings, or impairs judgments and problem-solving ability -research shows that the use of other kinds of drugs may have a similar tie to suicide, particularly in teenagers and young adults

schizophrenia and suicide

-the population notion is that when schizophrenic people kill themselves, they must be responding to an imagined voice commanding them to do so or to a delusion that suicide is a grand and noble gesture -however, research indicates that suicides by people with schizophrenia and other disorders featuring psychosis more often reflect feelings of demoralization, a sense of being entrapped by their disorder, and fears of further mental deterioration -suicide is the leading cause of premature death among people with schizophrenia

self-hypnosis and dissociative disorders

-the process of hypnotizing oneself, sometimes for the purpose of forgetting unpleasant events -some theorists conclude that people hypnotize themselves to forgot unpleasant events

selective amnesia

-the second most common form of dissociative amnesia -people remembers some, but not all, events that took place during a period of time

depersonalization disorder

-the sense that one's own mental functioning or body are unreal or detached -people feel as though they have become separated from their body and are observing themselves from outside; their body parts feel foreign to them, their hands and feet smaller or bigger than usual; many describe their emotional state as mechanical, dreamlike, or dizzy -they are aware that their perceptions are distorted and in that sense remain in contact with reality

derealization disorder

-the sense that one's surroundings are unreal or detached -people feel as though the external world is unreal and strange; objects may seem to change shape or size, other people may seem removed, mechanical or even dead

coworkers and colleagues modeling suicide

-the word-of-mouth publicity that attends suicides in a school, workplace, or small community may trigger suicide attempts -the suicide of a recruit at a U.S. Navy training school, for example, was followed within 2 weeks by another and also by an attempted suicide at the school -today, a number of schools, for individuals of all ages, put into action programs of this kind (staff education and group therapy sessions) after a student dies by suicide -such postsuicide programs are often referred to by clinicians as postvention

suicide education programs

-these programs take place in schools and concentrate on students and their teachers

pro-suicide websites

-these sites vary in their specific messages, but many of them celebrate former users who have died by suicide, others help set up appointments for joint or partner suicides, and several offer specific instructions about suicide methods, prospective suicide locations, and the writing of suicide notes -clinicians are greatly concerned that they seem to be growing in number and negative influence, especially among teenagers and young adults -these sits may have tripled over the past 7 years -one study found that 7.5% of teenagers seek out information about suicide on the internet; more than a third of those further access sites that provide information on how to hurt or kill oneself

neurotransmitters and substance use disorder

-these theorists contend that when a particular drug is ingested, it increases the activity of certain neurotransmitters whose normal purpose is to calm, reduce pain, lift mood, or increase alertness -when a person keeps on taking the drug, the brain apparently makes an adjustment and reduces its own production of the neurotransmitters -because the drug is increasing neurotransmitter activity or efficiency, the brain's release of the neurotransmitter is less necessary -as drug intake increases, the body's production of the neurotransmitters continues to decrease, leaving the person in need of progressively more of the drug to achieve its effects -in this way, drug takers build tolerance for a drug, becoming more and more reliant on it rather than on their own biological processes to feel comfortable, happy, or alert -if they suddenly stop taking the drug, their natural supply of neurotransmitters will be low for a time, producing the symptoms of withdrawal -withdrawal continues until the brain resumes its normal production of the neurotransmitters -to some extent, the abused substance dictates which neurotransmitters will be affected -repeated and excessive use of alcohol or benzodiazepines may lower the brain's production of the neurotransmitter GABA, regular use of opioids may reduce the brain's production of endorphins, and regular use of cocaine or amphetamines may lower the brain's production of dopamine -in addition, researchers have identified a neurotransmitter called anandamidethat operates much like THC; excessive use of marijuana may reduce the production of anandamide

the developmental psychopathological perspective in developing PTSD

-they suggest that certain people have a biological predispositions (inherited or acquired) for overreactivity in their brain-body stress pathways and for dysfunction in the brain's stress circuit -this predisposition sets the stage for, but does not guarantee, the later development of PTSD -if these individual encounter extreme stressors throughout their childhood, their stress pathways may become still more overreactive and their brain's stress circuit may become more dysfunction and their risk of later developing PTSD may continue to grow -their risk may increase further if, over the course of their lives, the individuals acquire poor coping mechanisms, develop problematic personal styles, and/or have weak social supports -the relationship between the contributing factors is often a two-way street -the timing of stressors and traumas over the course of development has a profound influence on whether an individual will develop PTSD

the cognitive-behavioral view on unipolar depression

-this theory contents that unipolar depression results from a combination of problematic behaviors and dysfunctional ways of thinking -these theories fall into three groups: (1) explanations that focus mostly on the behavioral realm, (2) those that give primary attention to negative thinking, and (3) ones that feature a complex interplay between cognitive and behavioral factors

abusive or repressive environments and suicide

-victims of an abusive or repressive environment from which they have little or no hope of escape sometimes pursue suicide -ex. prisoners of war, inmates of concentration camps, abused spouses, abused children, and prison inmates try to end their lives -these people may feel that they can endure no more suffering and believe that there is no hope for improvement in their condition

full manic episode

-when for at least one week they display an abnormally high or irritable mood, increased activity or energy, and at least three other symptoms of mania -the episode may even include psychotic features such as delusions or hallucinations -when the symptoms of mania are less severe (causing little impairment), the person is said to be having a hypomanic episode

anomic suicide

-those pursued by people whose social environment fails to provide stable structures, such as family and religion, to support and give meaning to life -such a society condition, called anomie (literally, "without law"), leaves people without a sense of belonging -unlike egoistic suicide, which is the act of a person who rejects the structures of a society, anomic suicide is the act of a person who has been let down by a disorganized, inadequate, often decaying society -when societies go through periods of anomie, their suicide rates increase (historical trends support this) -a major change in a person's immediate surroundings, rather than general societal problems, can also lead to anomic suicide -ex. people who suddenly inherit a great deal of money may go through a period of anomie as their relationships with social, economic, and occupational structures are changed -Durkheim predicted that societies with more opportunities for change in individual wealth or status would have higher suicide rates (support by research) -people who are removed form society and sent to a prison environment may experience anomie as well

coconscious subpersonalities

-those who are not aware -"quiet observers" who watch the actions and thoughts of the other subpersonalities but do not interact with them -coconscious personality makes itself known through indirect means such as auditory hallucinations (a voice giving commands) or automatic writing (the current personality finding itself writing down words over which it has no control)

social isolation and suicide

-those without social supports are particularly vulnerable to suicidal thinking and actions -researchers have found a heightened risk for suicidal behavior among those who feel little sense of "belongingness," believe that they have limited or no social support, live alone, and have ongoing conflicts with other people

sociocultural view of suicide

-today this theory continues to be influential and is often supported by research -the probability of suicide is determined by how attached a person is to such social groups as the family, religious institutions, and community -the more thoroughly a person belongs, the lower the risk of suicide; conversely, people who have poor relationships with their society are at higher risk of killing themselves -several categories of suicide: egoistic, altruistic, and anomic -Durkheim himself concluded that the final explanation of suicide probably lies in the interaction between society and individual factors -most agree that interpersonal, social structure, and cultural stress often play major roles in suicide

treatment of suicidal people

-two categories: treatment after suicide has been attempted and suicide prevention -treatment may also be beneficial to relatives and friends of those who complete or attempt suicide

peripartum depression (postpartum depression)

-typically begins within 4 weeks after the birth of a child -many cases actually begin during pregnancy -different from "baby blues" -depressive symptoms continue and may last up to a year or more -symptoms include extreme sadness, despair, tearfulness, insomnia, anxiety, intrusive thoughts, compulsions, panic attacks, feelings of inability to cope, and suicidal thoughts -women who have an episode of postpartum depression have a 25 to 50% chance of developing it again with a subsequent birth -many clinicians believe that the hormonal changes accompanying childbirth trigger postpartum depression because all women go through some time of hormone "withdrawal" after delivery -estrogen and progesterone levels, which rise as much as 50 times above normal during pregnancy, now drop sharply to levels far below normal -a woman with a family history of mood disorders appears to be at high risk, even if she herself has not previously had a mood disorder -self-help support groups have proved extremely helpful for many women who have or who are at risk for postpartum depression -many individuals respond well to antidepressant medication, CBT, interpersonal psychotherapy, or a combination of these approaches

antidepressant drug therapy for PTSD

-typically most useful for PTSD symptoms of increased arousal or negative emotions and less useful for the PTSD recurrent negative memories, dissociations, and avoidance behaviors -around 50% of PTSD patients who take antidepressant drugs experience some symptom reductions -psychotropic drugs do not fare well in PTSD research and are prescribed less often

altruistic suicide

-undertaken by people who are so well integrated into the social structure that they intentionally sacrifice their lives for its well-being -soldiers who threw themselves on top of a live grenade to save others, Japanese kamikaze pilots who crashed their planes into enemy ships during WWII, and Buddhist monks and nuns who protested the Vietnam War by setting themselves on fire may have been undertaking altruistic suicide -societies that encourage people to sacrifice themselves for others and to preserve their own honor (as East Asian societies do) are likely to have higher suicide rates

sociocultural views on unipolar depression

-unipolar depression is strongly influenced by the social context that surrounds people -their belief is support by the finding that depression is often triggered by outside stressors -two kinds of sociocultural views: the family-social perspective and the multicultural perspective

cannabis use disorder

-until the early 1970s, the use of marijuana, the weak form of cannabis, rarely led to a pattern of cannabis use disorder -today, however, many people, including large numbers of high school students, are developing the disorder, getting high on marijuana regularly and finding their social and occupational or academic lives very much affected -many regular users also develop a tolerance for marijuana and may feel restless and irritable and have flulike symptoms when they stop smoking -around 4 million people, 1.5 percent of all teenagers and adults in the United States, have displayed cannabis use disorder within the past year -Why have more and more marijuana users developed cannabis use disorder over the past three decades? -mainly because marijuana has changed; the marijuana widely available in the United States today is at least four times more powerful than that used in the early 1970s -the average THC content of today's marijuana is 8 percent, compared with 2 percent in the late 1960s -marijuana is now grown in places with a hot, dry climate, which increases the THC content

group therapy for PTSD

-veterans meet with others like themselves to share experiences and feelings (particularly with guilt and rage), develop insights, and give mutual support

adrenal medulla

-when stimulated, the chemicals epinephrine (adrenaline) and norepinephrine (noradrenaline) are released -these chemicals act as hormones and travel through the bloodstream to various organs and muscles, further producing arousal

It has been estimated that ____ people die by suicide each year, more than 42,000 in the U.S. alone.

1 million

countries most burdened by major depressive disorder

1. India 2. China 3. U.S. 4. Indonesia 5. Brazil 6. Russia 7. Pakistan 8. Bangladesh 9. Nigeria 10. Iran

gambling disorder dx checklist

1. Individual displays a maladaptive pattern of gambling, featuring at least four of the following symptoms over the course of a full year: -Can achieve desired excitement only by gambling more and more money -Feels restless or irritable when tries to reduce gambling -Repeatedly tries and fails at efforts to control, reduce, or cease gambling -Consumed with gambling thoughts or plans -Gambling is often triggered by upset feelings -Frequently returns to gambling to try and recoup previous losses -Covers up amount of gambling by lying -Gambling has put important relationships, job, or educational/career opportunities at risk -Seeks money from others to address gambling-induced financial problems 2. Individual experiences significant distress or impairment.

substance use disorder dx checklist

1. Individual displays a maladaptive pattern of substance use leading to significant impairment or distress 2. Presence of at least 2 of the following symptoms within a 1-year period a. Substance is often taken in larger amounts or over a longer period than intended b. Unsuccessful efforts or persistent desire to reduce or control substance use c. Much time spent trying to obtain, use, or recover from the effects of substance use d. Failure to fulfill major role obligations at work, school, or home as a result of repeated substance use e. Continued use of substance despite persistent social or interpersonal problems caused by it f. Cessation or reduction of important social, occupational, or recreational activities because of substance use g. Continuing to use substance in situations in which use poses physical risks h. Continuing to use substance despite awareness that it is causing or worsening a physical or psychological problem i. Craving for substance j. Tolerance effects k. Withdrawal reactions

___ % of the individuals with stress disorders seek treatment, but relatively few do so when they first develop disorders

50

dissociative amnesia Dx checklist

1. Person cannot recall important life-related information, typically traumatic or stressful information. The memory problem is more than simple forgetting. 2. Significant distress or impairment. 3. The symptoms are not caused by a substance or medical condition.

dissociative identity disorder Dx checklist

1. Person experiences a disruption to his or her identity, as reflected by at least two separate personality states or experiences of possession. 2. Person repeatedly experiences memory gaps regarding daily events, key personal information, or traumatic events, beyond ordinary forgetting. 3. Significant distress or impairment. 4. The symptoms are not caused by a substance or medical condition.

Shneidman's four kinds of suicide seekers

1. death seeker 2. death initiator 3. death ignorer 4. death darer

common predictors of suicide

1. depressive disorder and certain other mental disorders 2. alcoholism and other forms of substance abuse 3. suicidal ideation, talk, preparation; certain religious ideas 4. prior suicide attempts 5. availability of lethal weapons 6. social withdrawal, isolation, living alone, loss of support 7. hopelessness, feeling trapped, cognition rigidity 8. impulsivity and risk-taking behavior 9. being an older, white American male 10. modeling, suicide in the family, genetics 11. economic or work problems; certain occupations 12. marital problems, family pathology 13. dramatic changes in mood 14. anxiety 15. stress and stressful events 16. anger, aggression, irritability 17. psychosis 18. physical illness 19. sleep problems

dx full manic episode

1. for 1 week or more, person displays a continually abnormal, inflated, unrestrained, or irritable mood as well as continually heightened energy or activity, for most of every day 2. person also experiences at least three of the following symptoms: -grandiosity or overblown self-esteem -reduced sleep need -increased talkativeness, or drive to continue talking -rapidly shifting ideas or the sense that one's thoughts are moving very fast -attention pulled in many directions -heightened activity or agitated movements -excessive pursuit of risky and potentially problematic activities 3. significant distress or impairment

major depressive episode Dx checklist

1. for a 2-week period, person displays an increase in depressed mood for the majority of each day and/or a decrease in enjoyment or interest across most activities for the majority of each day 2. for the same 2 weeks, person also experiences at least 3 or 4 of the following symptoms: -considerable weight change or appetite change -daily insomnia or hypersomnia -daily agitation of decrease in motor activity -daily fatigue or lethargy -daily feelings of worthlessness or excessive guilt -daily reduction in concentration or decisiveness -repeated focus on death or suicide, a suicide plan, or a suicide attempt 3. significant distress or impairment

most common causes of death in the U.S.

1. heart disease (614,348) 2. cancer (591,699) 3. chronic respiratory diseases (147,101) 4. accidents (136,053) 5. stroke (133,103) 6. alzheimer's (93,541) 7. diabetes (76,488) 8. pneumonia and influenza (55,227) 9. kidney disease (48,146) 10. suicide (42,773)

dx bipolar I disorder

1. occurrence of a manic episode 2. hypomanic or major depressive episodes may precede or follow the manic episode

persistent depressive disorder Dx checklist

1. person experiences the symptoms of major or mild depression for the last 2 years

___ % of those who recover from severe depression have at least one other episode later in their lives.

50

PTSD dx checklist

1. person is exposed to a traumatic event--death or threatened death, severe injury, or sexual violation 2. person experiences at least one of the following intrusive symptoms: -repeated, uncontrolled, and distressing memories -repeated and upsetting trauma-linked dreams -dissociative experiences such as flashbacks -significant upset when exposed to trauma-linked cues -pronounced physical reactions when reminded of the event(s) 3. person continually avoids trauma-linked stimuli 4. person experiences negative changes in trauma-linked cognitions and modes, such as being unable to remember key features of the event(s) or experiencing repeated negative emotions 5. person displays conspicuous changes in arousal or reactivity, such as excessive alertness, extreme startle responses, or sleep disturbances 6. person experiences significant distress or impairment, with symptoms lasting more than a month

major depressive disorder Dx checklist

1. presence of a major depressive episode 2. no pattern of mania or hypomania

dx bipolar II disorder

1. presence of history or major depressive episode(s) 2. presence of history of hypomanic episode(s) 3. no history of a manic episode

treatments for dissociative identity disorder

1. recognize fully the nature of their disorder: therapists try to bond with the primary personality and each of the subpersonalities then educate patients and help them recognize fully the nature of their disorder (possibly introducing the subpersonalities to one another, by hypnosis, or by having patients look at videos of their other personalities); group and family therapy can help with this 2. recover gaps in their memory: may use psychodynamic therapy, hypnotherapy, and drug treatment to recover missing pieces of their past however, subpersonalities may keep denying experiences and one may even assume a "protector" role to prevent the primary personality from suffering the pain of recollecting traumatic experiences 3. integrate their subpersonalities into one functional personality: a continuous process that occurs throughout treatment until patients "own" all of their behaviors, emotions, sensations, and knowledge; fusion is the final merging of two or more subpersonalities; many patients and their subpersonalities may see integration as a form of death

2 components to a state of stress

1. stressor 2. stress response

2 brain-body pathways that produce arousal

1. sympathetic nervous system 2. hypothalamic-pituitary-adrenal pathway

Research suggests that over ___ of all victims of physical or sexual assault develop PTSD.

1/3

Autopsies reveal that about ___ of the people who attempt suicide are legally intoxicated.

1/4 or 25%

At least ___ % of new mothers, experience clinical depression for the weeks and months after childbirth

10

In fact, because they occur more often, civilian traumas have been the trigger of stress disorders at least ___ times as often as combat traumas.

10

It is estimated that for every completed teen suicide, there are as many as _____attempts.

100

Approximately ___ to ___ % of people with bipolar disorder eventually end their own lives, usually out of a sense of hopelessness.

10; 15

One study found that people who generally expressed feelings of hopelessness were __ times more likely to die by suicide over a 13-year follow-up period than people who did not feel hopeless.

11

Onset usually occurs between the ages of __ and __ years.

15; 44

At least __% of teenagers and young adults purposely injure themselves, particularly by skin cutting.

17

Exception: Poland, a largely Roman Catholic country, has a suicide rate of ___ suicides per 100,000 persons, one of the higher suicide rates in the world.

18.5

The average age of onset of severe depression is ___ years, with the peak age being late adolescence or early adulthood.

19

Surveys from around the world indicate that between __ and __% of all adults are suffering from a bipolar disorder at any given time.

1; 2.6

In 1962, only ___ million people in the United States had ever used marijuana, cocaine, heroin, or another illegal substance; today the number has climbed to ___ million (SAMHSA, 2017; NSDUH, 2016). In fact, ___ million people have used illegal substances within the past month. A ___ of all teenagers have used an illegal substance.

4; 131; 27; 1/4 (quarter)

Currently __ of every 100,000 people under 15 years of age in the U.S. kills themself each year Compared with __ of every 100,000 people between 15 and 24 years old __ of every 100,000 people between 25 and 44 years old __ of every 100,000 people between 45 and 64 years old __ of every 100,000 people between 65 and 74 and __ of every 100,000 people over age 75.

2 11 16 20 16 21

According to one study cited in the text, when a dizygotic twin had unipolar depression, there was about a _____ percent chance that his or her fraternal twin had unipolar depression too.

20

Around ___ % of all adults experience an episode of severe unipolar depression at some point in their lives.

20

___ % attempt with stress disorders attempt suicide

20

Around __ million other people throughout the world, and 65, 000 in the U.S., make unsuccessful attempts to kill themselves.

25

____% of people with PTSD do not develop a full clinical syndrome until 6 months or more after their trauma.

25

As many as ___ % of women have an episode of severe unipolar depression at some time in their lives, compared with ___ % of men.

26; 12

one famous study identified 8000 high-risk individuals who contacted the LA suicide prevention center and approximately __% of these callers later killed themselves, compared with the __% suicide rate usually founding similar high-risk groups.

2; 6

sociocultural treatment for substance use disorder

3 sociocultural approaches have been used to help people overcome substance use disorders: (1) self-help programs, (2) culture- and gender-sensitive programs, and (3) community prevention programs

___ to ___ % of people in North America have one of the stress disorders in any given year

3.5; 6

Between ___ to ___ % of torture victims develop PTSD

30; 50

According to one study cited in the text, when a monozygotic twin had unipolar depression, there was about a _____ percent chance that his or her identical twin had unipolar depression too.

38

___ times as many women attempt suicide as men, yet men die from their attempts at more than ___ times the rate of women.

3; 3

As many as __% experience one of the bipolar disorders at some time in their life.

4

___ % of all adults in the U.S. and ___ % of all New York adults report high terrorism fears.

42; 70

Between ___ and ___ % of people who suffer from severe depression die by suicide.

6; 15

Studies indicate that as many as __ % of the people who attempt suicide drink alcohol just before they do so.

70

Research suggests that as many as ___% of all suicide attempters had been experiencing severe depression (unipolar or bipolar), ___% chronic alcoholism, and ___% schizophrenia.

70; 20: 10

Approximately ___ % of the victims are raped by acquaintances, intimates, or relatives.

71

___ to ___ % suffer from one of the stress disorders during their lifetimes

7; 12

___ % of all severe episodes occur within a month or two of a significant negative event.

80

Approximately ___ % of people with unipolar depression, including severe depression, recover within 6 months, some without treatment.

85

___ % of adults in the U.S. suffer from a severe unipolar pattern of depression in any given year, while as many as ___ % suffer from mild forms.

8; 5

Approximately ____ cases of rape or attempted rape are reported to the police each year.

91,000

___ % of rape victims fully qualified for a clinical diagnosis of acute stress disorder when they were obsess around 12 days after the assault.

94

drug

A drug is defined as any substance other than food that affects our bodies or minds. It need not be a medicine or be illegal.

opium

a highly addictive substance made from the sap of the opium poppy seed -has been in use for thousands of years -in the past it was used widely in the treatment of medical disorders because of its ability to reduce both physical and emotional pain -eventually, however, physicians discovered that the drug was addictive

DSM-5's treatment of bereavement-related symptoms

A person who is newly bereaved can qualify for a diagnosis of major depressive disorder if the depressive symptoms are severe enough.

identity

a sense of who we are and where we fit in our environment

dissociation

a split between memory and personality

automatic thoughts

a steady train fo numerous unpleasant thoughts that help to cause or maintain depression, anxiety, or other forms of psychological dysfunction

studying people who survive their suicide attempts

a strategy researchers employ to attempt to understand suicide -it is estimated that there are 12 nonfatal suicide attempts for every fatal suicide -however, it may be that people who survive attempts differ in important ways from those who do not -many of them may not really have wanted to die, for example

bipolar disorders appears to be best explained by a focus on one kind of variable:

biological factors -the evidence suggests that biological abnormalities, perhaps inherited and perhaps triggered by life stress, cause bipolar disorders

delusions

bizarre ideas or beliefs without foundation

involuntary activities of the organs

breathing, heartbeat, blood pressure, perspiration, etc.

Which is not part of Aaron Beck's cognitive triad?

Individuals repeatedly interpret their behaviors in negative ways.

cyclothymic disorder

characterized by numerous periods of hypomania and mild depressive symptoms

Which of these is the LEAST powerful cannabis drug?

Marijuana

According to _____, feelings of helplessness are at the center of depression

Martin Seligman

Brodmann Area 25, located just under the _____ cortex, tends to be smaller in depressed people than nondepressed people.

cingulate

one stressor that has been consistently linked to suicide is ___ ___.

combat stress

between 6 and 15% of people with severe depression

commit suicide

Some time after snorting cocaine, Frederico begins to feel dizzy and feels a headache coming on. Suddenly, he faints. Frederico is likely:

crashing

Hallucinogens can strengthen normal sensory perceptions as well as induce other sensory perceptions such as _____ and hallucinations.

illusions

Malaika's mother thinks she may be using heroin. Which physical indicator might help confirm her suspicions?

narrowing of the pupils

_____ are more likely than ___ to develop one of these disorders; around ___ % of women who are exposed to a severe trauma may develop one, compared with ___ % of men.

Women; men; 20; 8

psychological debriefing (critical incident stress debriefing)

a form of crisis intervention in which victims are helped to talk about their feelings and reactions to traumatic incidents within days of the critical incident -clinicians then clarify to the victims that their reactions are normal responses to a terrible event, offer stress management tips, and in some cases, refer the victims to professionals for long-term counseling

dissociative fugue

a form of dissociative amnesia in which a person travels to a new location an may assume a new identity, simultaneously forgetting his or her past -the fugue may be brief, a matter of hours or days, and end suddenly -fugues tend to end abruptly -a majority of people who go through a dissociative fugue regain most or all of their memories and never have a recurrence

substance intoxication

a cluster of temporary undesirable behavioral or psychological changes, such as slurred speech or mood changes, that may develop during or shortly after the ingestion of a substance

dissociative disorders

a group of disorders in which some parts of one's memory or identity seem to be dissociated, or separated, from other parts of one's memory or identity -triggered by traumatic events -may feel dazed, have trouble remembering things, or have a sense of depersonalization or derealization -people with this typically do not have the significant arousal, negative emotions, sleep difficulties, and other problems that characterize acute and post traumatic stress disorders

corticosteroids

a group of hormones, including cortisol, released by the adrenal glands at times of stress; traveling to various body organs where they further produce arousal reactions

morphine

a highly addictive substance derived from opium that is particularly effective in relieving pain -in 1804 a new substance, morphine, was derived from opium -named after Morpheus, the Greek god of sleep, this drug relieved pain even better than opium did and initially was considered safe -however, wide use of the drug eventually revealed that it, too, could lead to addiction -so many wounded soldiers in the United States received morphine injections during the Civil War that morphine addiction became known as "soldiers' disease"

relapse-prevention training for substance use disorder

a cognitive-behavioral approach to treating alcohol use disorder (and applied to certain other disorders) in which clients are taught to keep track of their drinking behavior, apply coping strategies in situations that typically trigger excessive drinking, and plan ahead for risky situations and reactions -the overall goal of this approach is for clients to gain control over their substance-related behaviors -several strategies typically are included in relapse-prevention training for alcohol use disorder: (1) Therapists have clients keep track of their drinking. By writing down the times, locations, emotions, bodily changes, and other circumstances of their drinking, people become more aware of the situations that place them at risk for excessive drinking. (2) Therapists teach clients coping strategies to use when such situations arise. Clients learn, for example, to recognize when they are approaching their drinking limits; to control their rate of drinking (perhaps by spacing their drinks or by sipping them rather than gulping); and to practice relaxation techniques, assertiveness skills, and other coping behaviors in situations in which they would otherwise be drinking. (3) Therapists teach clients to plan ahead of time. Clients may, for example, determine beforehand how many drinks are appropriate, what to drink, and under which circumstances to drink -relapse-prevention training has been found to lower some people's frequency of intoxication and of binge drinking, although such gains are often made only after repeated relapse-prevention treatments -people who are young and do not have the tolerance and withdrawal features of chronic alcohol use seem to do best with this approach -relapse-prevention training has also been used in cases of marijuana and cocaine abuse as well as with other kinds of disorders, such as sexual paraphilic disorders

catatonic

a depressive disorder marked by either immobility or excessive activity

seasonal disorders

a depressive disorder that changes with the seasons (for example, if the depression recurs each winter)

melancholic

a depressive disorder where the person is almost totally unaffected by pleasurable events

premenstrual dysphoric disorder

a diagnosis given to certain women who repeatedly experience clinically significant depressive and related symptoms during the week before menstruation

acute stress disorder

a disorder in which fear and related symptoms are experienced soon after a traumatic event and last less than a month -at least half of all acute stress disorders develop into post traumatic stress disorder

post traumatic stress disorder

a disorder in which fear and related symptoms continue to be experienced long after a traumatic event; symptoms may begin either shortly after the traumatic event or months to years afterwards

cyclothymic disorder

a disorder marked by numerous periods of hypomanic symptoms and mild depressive symptoms -the symptoms of this milder form of bipolar disorder continue for two or more years, interrupted occasionally by normal moods that may last for only days or weeks -this disorder, like bipolar I and II, usually begins in adolescence or early adulthood and is equally common among women and men -at least -.4% of the population develops cyclothymic disorder -in some cases, the milder symptoms eventually blossom into a bipolar I or II disorder

gambling disorder

a disorder marked by persistent and recurrent behavior, leading to a range of life problems -also an addictive disorder alongside the substance use disorders -it is estimated that as many as 4 percent of adults and 3 to 10 percent of teenagers and college students suffer from gambling disorder -clinicians are careful to distinguish between this disorder and social gambling -gambling disorder is defined less by the amount of time or money spent gambling than by the addictive nature of the behavior -people with gambling disorder are preoccupied with gambling and typically cannot walk away from a bet -when they lose money repeatedly, they often gamble more in an effort to win the money back, and continue gambling even in the face of financial, social, occupational, educational, and health problems -they usually gamble more when feeling distressed, and often lie to cover up the extent of their gambling -many people with gambling disorder need to gamble with ever-larger amounts of money to reach the desired excitement, and they feel restless or irritable when they try to reduce or stop gambling—symptoms that are similar to the tolerance and withdrawal reactions often associated with substance use disorder -some studies suggest, for example, that people with gambling disorder may: (1) inherit a genetic predisposition to develop the disorder (2) experience heightened dopamine activity and dysfunction of the brain's reward circuit when they gamble (3) have impulsive, novelty-seeking, and other personality styles that leave them prone to gambling disorder (4) make repeated and cognitive mistakes such as inaccurate expectations and misinterpretations of their emotions and bodily states -however, the research on these theories has been limited thus far, leaving such explanations tentative for now -treatments include cognitive-behavioral approaches like relapse-prevention training, and biological approaches such as opioid antagonists. In addition, the self-help group program Gamblers Anonymous, a network modeled after Alcoholics Anonymous, is available to the many thousands of people with gambling disorder -people who attend such groups seem to have a better recovery rate

premenstrual dysphoric disorder

a disorder marked by repeated experiences of significant depression and related symptoms during the week before menstruation -including this in the DSM-5 is controversial

dissociative amnesia

a dissociative disorder marked by an inability to recall important personal events and information -not caused by physical factors such as a blow to the head -typically directly triggered by a traumatic or upsetting event -may be localized, selective, generalized, or continuous -2% of all adults experience dissociative amnesia -many cases seem to begin during serious threats to health and safety (wartime or natural disasters) or childhood abuse (particularly childhood sexual abuse) can trigger dissociative amnesia -it also could occur under more ordinary circumstances such as sudden loss of a loved on through rejection or death, or extreme guilt over certain actions

depersonalization-derealization disorder

a dissociative disorder marked by the presence of present and recurrent episodes of depersonalization, derealization, or both -not characterized by the memory difficulties found in the other dissociative disorders -symptoms cause considerable distress and may impair social relationships and job performance -usually comes on suddenly and may be triggered by extreme fatigue, physical pain, intense stress, or recovery from substance abuse -survivors of traumatic experiences or people caught in life-threatening situations such as hostages or kidnap victims seems to be particularly vulnerable to this disorder -disorder tends to be long-lasting, symptoms may improve or disappear for a time but return or intensify during times of severe stress

attribution-helplessness theory

a modified version of learned helplessness theory where, when people view events as beyond their control, they ask themselves why this is so; if they attribute their present lack of control to some internal cause that is both global and stable ("I am inadequate at everything"), they may feel helpless to prevent future negative outcomes and they may experience depression; if they make other kinds of attributions, they are unlikely to have this reaction -ex. "It's my fault [internal], I ruin everything I touch [global], and I always will [stable]." -a refinement of this theory suggests that attributions are likely to cause depression only when they further produce a sense of hopelessness in a person

Researchers have found that 80 percent of all severe episodes of unipolar depression occur within _____ of a significant negative event.

a month or two

serotonin

a neurotransmitter whose abnormal activity is linked to depression, obsessive-compulsive disorder, and eating disorders

norepinephrine

a neurotransmitter whose abnormal activity is linked to panic disorder and depression

substance use disorder

a patterns of long-term maladaptive behaviors and reactions brought about by repeated use of a substance, sometimes also including tolerance for the substance and withdrawal reactions -People with a substance use disorder may come to crave a particular substance and rely on it excessively, resulting in damage to their family and social relationships, poor functioning at work, and/or danger to themselves or others -In many cases, people with such a disorder also become physically dependent on the substance, developing a tolerance for it and experiencing withdrawal reactions

symbolic or imagined loss

a person equates other kinds of events with the loss of a loved one -part of psychodynamic theory

a traumatic event

a person is exposed to actual or threatened death, serious injury, or sexual violation

death initiators

a person who attempts suicide believing that the process of death is already under way and that he or she is simply quickening the process -they also clearly intend to end their lives, but they act out of a belief that the process of death is already under way -some expect that they will die in a matter of days or weeks -many suicides among the elderly and very sick fall into this category

death ignorers

a person who attempts suicide without recognizing the finality of death -do not believe that their self-inflicted death will mean the end of their existence -they believe they are trading their present lives for a better or happier existence -many child suicides fall into this category, as do those of adult believers in a hereafter who kill themselves to reach another form of life

death seekers

a person who clearly intends to end his or her life at the time of a suicide attempt -this singleness of purpose may last only a short time; it can change to confusion the very next hour or day, and then return again in short order

death darers

a person who is ambivalent about the wish to die even as he or she attempts suicide -they experience mixed feelings about their intent to die even at the moment of their attempt -although to some degree they wish to die, and they often do die, their risk-taking behavior does not guarantee death -ex. Russian roulette

hopelessness

a pessimistic belief that one's present circumstances, problems, or mood will not change

methamphetamine (nicknamed crank)

a powerful amphetamine drug that has experienced a surge in popularity in recent years, posing major health and law enforcement problems -almost 6 percent of all people over the age of 11 in the United States have used methamphetamine at least once -around 0.3 currently have methamphetamine use disorder -the drug is available in the form of crystals (also known by the street names ice and crystal meth), which users smoke -most of the nonmedical methamphetamine in the United States is made in small "stovetop laboratories," which typically operate for a few days in a remote area and then move on to a new—safer—location -such laboratories have been around since the 1960s, but they have increased eightfold—in number, production, and in being confiscated by authorities—this century -a major health concern is that the secret laboratories expel dangerous fumes and residue -methamphetamine is about as likely to be used by women as men. Around 40 percent of current users are women -the drug is popular today among a wide range of people, from biker gangs to rural Americans to urban gay communities, and it has gained wide use as a "club drug," the term for those drugs that regularly find their way to all-night dance parties, or "raves" -like other kinds of amphetamines, methamphetamine increases activity of the neurotransmitters dopamine, serotonin, and norepinephrine, producing increased arousal, attention, and related effects -it can have serious negative effects on a user's physical, mental, and social life -of particular concern is that it damages nerve endings, a problem called neurotoxicity -but users focus more on methamphetamine's immediate positive impact, including perceptions by many that it makes them feel hypersexual and uninhibited

crack

a powerful, read-to-smoke freebase cocaine -millions more people use crack -it makes a crackling sound when inhaled, hence the name -in the 1980s, its affordability led to an epidemic of use among people who previously could not have afforded cocaine, primarily those in poor, urban areas -although the prevalence of crack use has declined over the past two decades, around .3 percent of all people over the age of 11 (almost 1 million individuals) have used it within the past year

suicide prevention program

a program that tries to identify people who are at risk of killing themselves and to offer them crisis intervention

retrospective analysis

a psychological autopsy in which clinicians and researchers piece together information about a person's suicide from the person's past -relatives, friends, therapists, or physicians may remember past statements, conversation, and behaviors that shed light on a suicide -retrospective information may also be provided by the suicide notes some victims leave behind -such sources are not always reliable though, because of this many researchers use a second strategy--studying people who survive their suicide attempts

suicide

a self-inflicted death in which the person acted intentionally, directly, and consciously to end one's life

natural reaction to a threatening stressor

a sense of fear

hallucinogens

a substance that causes powerful changes primarily in sensory perception, including strengthening perceptions and producing illusions and hallucinations (also called a psychedelic drug) -they produce sensations so out of the ordinary that they are sometimes called "trips" -the trips may be exciting or frightening, depending on how a person's mind interacts with the drugs -the hallucinogens include LSD, mescaline, psilocybin, and MDMA (Ecstasy, X, Adam, hug, beans, or love drug) -many of these substances come from plants or animals; others are produced in laboratories

parasuicides

a suicide attempt that does not result in death

subintentional death

a suicide-like category classified by a death in which the victim plays as indirect, hidden, partial, or unconscious role -ex. drug, alcohol, or tobacco use; recurrent physical fighting; medication mismanagement are behaviors that may contribute to subintentional deaths -researchers have found a correlation between regularly engaging in such behaviors and later attempts at suicide

freebasing

a technique for ingesting cocaine in which the pure cocaine basic alkaloid is chemically separated from processed cocaine, vaporized by heat from a flame, and inhaled through a pipe -crack is a powerful form of freebase cocaine produced by boiling cocaine down into crystalline balls and smoked with a crack pipe

alcohol intoxication

a temporary state of poor judgment, mood changes, irritability, slurred speech, and poor coordination

interpersonal theory of suicide

a theory asserting that people with perceived burdensomeness, thwarted belongingness, and a psychological capability to carry out suicide are the most likely to attempt suicide (also called interpersonal-psychological theory)

crisis intervention

a treatment approach that tries to help people in a psychological crisis view their situation more accurately, make better decisions, act more constructively, and overcome the crisis

aversion therapy for substance use disorder

a treatment in which clients are repeatedly presented with unpleasant stimuli (ex. an electric shock) while performing undesirable behaviors such as taking a drug -after repeated pairings, they are expected to react negatively to the substance itself and to lose their craving for it -aversion therapy has been used to treat alcoholism more often than it has to treat other substance use disorders -in one version of this therapy, drinking is paired with drug-induced nausea and vomiting; the pairing of nausea with alcohol is expected to produce negative responses to alcohol itself -another version of aversion therapy requires people with alcoholism to imagine extremely upsetting, repulsive, or frightening scenes while they are drinking; the pairing of the imagined scenes with alcohol is expected to produce negative responses to alcohol itself -aversion therapy for substance use disorders has had only limited success when it is the sole form of treatment -a major problem is that the approach can be effective only if people are motivated to subject themselves to multiple sessions of this unpleasant procedure, and many people are not

Regardless of whether suicidal acts themselves represent a distinct disorder, ____ ____, a breakdown of coping skills, emotional turmoil, a distorted view of life, usually plays a role in such acts.

psychological dysfunction

A third factor-- ______or _____-- may cause both substance abuse and suicidal thinking.

psychological pain; desperation -such people may be caught in a downward spiral -they are driven toward substance use by psychological pain or less, only to find themselves caught in a pattern of substance abuse that aggravates rather than solves their problems

dissociation

psychological separation; feeling dazed, having trouble remembering things

cocaine

an addictive stimulant obtained from the coca plant; it is the most powerful natural stimulant known -Processed cocaine (hydrochloride powder) is an odorless, white, fluffy powder -For recreational use, it is most often snorted so that it is absorbed through the mucous membrane of the nose -Some users prefer the more powerful effects of injecting cocaine intravenously or smoking it in a pipe or cigarette -Cocaine brings on a euphoric rush of well-being and confidence -Given a high enough dose, this rush can be almost orgasmic, like the one produced by heroin -At first cocaine stimulates the higher centers of the central nervous system, making users feel excited, energetic, talkative, and even euphoric -As more is taken, it stimulates other centers of the central nervous system, producing a faster pulse, higher blood pressure, faster and deeper breathing, and further arousal and wakefulness -Cocaine apparently produces these effects largely by increasing supplies of the neurotransmitter dopamine at key neurons throughout the brain -Excessive amounts of dopamine travel to receiving neurons throughout the central nervous system and overstimulate them. Cocaine appears to also increase the activity of the neurotransmitters norepinephrine and serotonin in some areas of the brain -High doses of the drug produce cocaine intoxication, whose symptoms are poor muscle coordination, grandiosity, bad judgment, anger, aggression, compulsive behavior, anxiety, and confusion -Some people have hallucinations, delusions, or both, a condition called cocaine-induced psychosis -As the stimulant effects of cocaine subside, the user goes through a depression-like letdown, popularly called crashing, a pattern that may also include headaches, dizziness, and fainting -For occasional users, the aftereffects usually disappear within 24 hours, but they may last longer for people who have taken a particularly high dose -These people may sink into a stupor, deep sleep, or, in some cases, coma

prolonged exposure

an exposure treatment in which client confront not only trauma-related objects and situations, but also their painful memories of traumatic experiences -the most widely applied exposure technique in cases of PTSD -therapists direct clients to confront not only trauma-related objects and situations, but also their painful memories of traumatic experiences, memories they've been actively avoiding -clients repeatedly recall and describe the memories in great detail for extended periods of time, holding on to them until becoming less aroused, anxious, and upset by them

eye movement desensitization and reprocessing (EMDR) therapy

an exposure treatment in which clients move their eyes in a rhythmic manner from side to side while flooding their minds with images of objects and situations they ordinarily avoid

anhedonia

an inability to experience any pleasure at all

special process (hypnosis)

an out-of-the-ordinary kind of functioning -people with dissociative amnesia and DID place themselves in internal trances during which their brain and conscious functioning is significantly altered

Sadie's continued use of marijuana will lead to a reduction of the neurotransmitter _____ in her brain, requiring more marijuana to achieve the same effects.

anandamide

self-injury or self-mutilation

another behavioral pattern of curing or burning oneself or banging one's head which is not officially classified as a mental disorder -the framer's of DSM-5 have proposed that a category called nonsuicidal self-injury to be studied for possible inclusion in future revisions of DSM-5 -is more common than previously recognized, particularly among teenagers and young adults, and it may be on the increase -it appears the behavior becomes addictive in nature -the pain brought on by self-injury seems to offer some relief from tension other kinds of emotional suffering, the behavior serves as a temporary distraction from problems, and the scares the result may document the person's distress -self-injury may help a person deal with chronic feelings emptiness, boredom, and identity confusion -although self-injury and the other risky behaviors mentioned earlier may indeed represent an indirect attempt at suicide, the true intent behind them is unclear

disruptive mood dysregulation disorder

another kind of depressive disorder characterized by a combination of persistent depressive symptoms and recurrent outbursts of severe temper -this disorder emerges during mid-childhood or adolescence

anxiety disorders vs acute stress disorder/posttraumatic stress disorder

anxiety disorders: typically triggered by situations that most people would not find threatening acute stress disorder/post traumatic stress disorders: the situations (ie: combat, rape, an earthquake, an airplane crash) would be traumatic for almost anyone

physical torture

beatings, waterboarding, electrocution

specific suicide hotlines

crisis text line: -started in 2013, in the first 6 months exchanged nearly a million texts with 19,000 teens -by 2017 it had proceeded 28 million texts the trevor lifeline: -a nationwide, around-the-clock hotline available for LGBTQ teens who are thinking about suicide -the trevor project as a whole organization is decimated to providing support, guidance, and information and promoting acceptance of LGBTQ teens online chat rooms/forums: -most of them do not seek out suicidal people or try to prevent suicide -typically these sites are not prepared to deal with suicidal people, do not offer face-to-face support, do not involve professional or paraprofessionals, and do not have ways of keeping out malicious users therapy offices: -suicide experts encourage all therapists to look for and address signs of suicidal thinking in their clients, regardless of the broad reasons that the clients are seeking treatment -a number of guidelines have been developed to hep therapists effectively uncover, assess, prevent, and treat suicidal thinking and behavior in their daily work

delusions vs hallucinations

delusions are bizarre ideas without foundation, whereas hallucinations are perceptions of things that are not actually present

low serotonin activity accompanied by low norepinephrine activity may lead to ___

depression

In most cases, the initial mood episode is ____, the ____ episodes occur three times as often as ____ ones, and the ____ last longer.

depression; depressive; manic; depressive

Regardless of their particular pattern, people with bipolar disorder tend to experience _____ more than ____ over the years.

depression; mania

anxiolytic drugs

drugs that reduce anxiety and produce feelings of relaxation and drowsiness

sedative-hypnotic drugs

drugs used in low doses to calm people and in higher doses to help people sleep -also called anxiolytic drugs -at low dosages, the drugs have a calming or sedative effect -at higher dosages, they are sleep inducers, or hypnotics

mutually cognizant patterns

each subpersonality is aware of the rest; they may hear one another's voices and even talk among themselves, some are on good terms while others do not get along

counselor tasks during crisis intervention

establish a positive relationship: -they convey that they are listening, understanding, interested, nonjudgmental, and available understand and clarify the problem: -first trying to understand the full scope of the caller's crisis and help the person see the crisis in clear and constructive terms assess suicide potential: -fill out a questionnaire called lethality scale, to estimate the caller's potential for suicide which helps counselors determine the degree of stress the caller is under, the caller's relevant personality characteristics, how detailed the suicide plan is, the severity of symptoms, and the coping resources available to the caller assess and mobilize the caller's resources: -it's the counselor's job to recognize, point out, and activate the client's strengths and resources, including relatives and friends formulate a plan: -they are agreeing on a way out of the crisis, an alternative to suicidal action -typically setting up follow-up counseling sessions over the next few days or weeks -each plan requires the caller to take certain actions and make certain changes in his or her personal ife -usually a "no-suicide contract" a promise not to attempt suicide, or at least a promise to reestablish contact if the caller again considers suicide -the effectiveness of these contrast has been called into question in recent years

suicide rates among the elderly:

fall during ages 65-74, rise during ages 75-84, and rise again for those over 85.

derealization

feeling that the environment is unreal or strange

depersonalization

feeling that their conscious state or body is unreal

According to the DSM-5, a major depressive episode is marked by at LEAST _____ symptoms of depression and lasts for _____ weeks or more

five; two

the developmental psychopathology perspective

focuses on the intersection and context of important variables at key points of time throughout an individual's lifespan

rape

forced sexual intercourse or another sexual act committed against a non consenting person or intercourse with an underage person

continuous amnesia

forgetting continues into the present

adrenal glands

glands located on top of the kidneys

Fredo wanted to buy the MOST powerful cannabis drug he could, so he sought to find some _____ to purchase.

hashish

learned helplessness theory

holds that people become depressed when they think (1) that they no longer have control over the reinforcements (the rewards and punishments) in their lives, (2) that they themselves are responsible for this helpless state

common social and cognitive processes

hypnotic behaviors and hypnotic amnesia are produced by high motivation, focused attention, role enactment, and self-fulfilling expectations -people are performing tasks that are asked of them while believing all long the hypnotic state is doing the work for them -common process theorists hold that people with dissociative amnesia and dissociative identity disorder provide themselves (or are provided by others) with powerful suggestions to forget and that social an cognitive mechanisms then put the suggestions into practice

hypothalamic-pituitary-adrenal pathway map

hypothalamus --> pituitary gland --> secretion of ACTH -->adrenal cortex --> corticosteroids

sympathetic nervous system map

hypothalamus --> sympathetic ANS fibers --> adrenal glands --> adrenal medulla --> epinephrine and norepinephrine --> parasympathetic ANS fibers --> back to normal

rapid cycling

if a person has four or more episodes within a one-year period

synergistic effect

in pharmacology, an increase of effects that occurs when more than one substance is acting on the body at the same time -when different drugs are in the body at the same time, they may multiply, or potentiate, each other's effects -the combined impact is often greater than the sum of the effects of each drug taken alone: a small dose of one drug mixed with a small dose of another can produce an enormous change in body chemistry -one kind of synergistic effect occurs when two or more drugs have similar actions; for instance, alcohol, benzodiazepines, barbiturates, and opioids—all depressants—may severely depress the central nervous system when mixed -combining them, even in small doses, can lead to extreme intoxication, coma, and even death -a young man may have just a few alcoholic drinks at a party, for example, and shortly afterward takes a moderate dose of barbiturates to help him fall asleep; he believes he has acted with restraint and good judgment—yet he may never wake up -a different kind of synergistic effect results when drugs have opposite, or antagonistic, actions -stimulant drugs, for example, interfere with the liver's usual disposal of barbiturates and alcohol; thus people who combine barbiturates or alcohol with cocaine or amphetamines may build up toxic, even lethal, levels of the depressant drugs in their systems -students who take amphetamines to help them study late into the night and then take barbiturates to help them fall asleep are unknowingly placing themselves in serious danger -each year tens of thousands of people are admitted to hospitals with a multiple-drug emergency, and several thousand of them die -sometimes the cause is carelessness or ignorance; often, however, people use multiple drugs precisely because they enjoy the synergistic effects -in fact, as many as 90 percent of those who use one illegal drug are also using another to some extent

The likelihood of dying by suicide steadily ____ with age up through middle age, then ____ during the early stages of old age, and then ____ again beginning at age 75.

increases; decreases; increases

There is a growing belief among some researchers that immune system dysregulation, resulting in _____, helps produce depression.

inflammation

disruptive mood dysregulation

is characterized by a combination of persistent depressive symptoms and recurrent outbursts of severe temper

Countries that are largely Catholic, Jewish, or Muslim tend to have ___ suicide rates. Perhaps in these countries, strict prohibitions against suicide or a strong religious tradition deter many people from attempting suicide.

low

People with ___ incomes are twice as likely as people with higher incomes to experience stress disorders.

low

mania and depression may both be linked to __ levels of serotonin

low

The bipolar disorders are equally common in women and men, but they are more common among people with ___ _____ than those with ___ ___.

low incomes; higher incomes

People with a bipolar disorder experience both the _____ and the ____.

lows of depression; highs of mania

low serotonin activity accompanied by high norepinephrine activity may lead to ___

mania

Hastily written texts often lend themselves to _______ between senders and receives--ones that can quickly spin out of control. Murdock also noted that many participants in her study felt the need to constantly keep up with ongoing text conversations, interrupting their in-person conversations--thus inviting _____ into those relationships as well.

misunderstandings; damage

Many suicide attempts are preceded by a change in ____.

mood

Researchers have counted ____ stressful events in the recent lives of suicide attempters than in the lives of non attempters.

more

introjection

mourning individuals direct all their feelings for the loved one, including sadness and anger, toward themselves

brain circuits

networks of brain structures that work together, triggering each other into action and producing a particular kind of emotional or behavioral reaction -an array of brain-imaging studies point to several brain structures that are likely members of the circuit (whose dysfunction contributes to unipolar depression), including the prefrontal cortex, hippocampus, amygdala, and subgenus cingulate (also called Brodmann Area 25) -some theorists believe that the subgenus cingulate, a subregion of the brain's anterior cingulate cortex, is distinctly part of the depression-related circuit and may be the single most important contributor to depression -research suggests that among depressed people, activity and blood flow are unusually low in certain parts and unusually high in other parts of the prefrontal cortex; the hippocampus is undersized and its production of new neurons is low; activity and blood flow are elevated in the amygdala; the subgenus cingulate is particularly small and active; and communication between these various structures, called interconnectivity, is often problematic -the abnormal activity of these neurotransmitters in this brain circuit might be the result of dysfunction within or between the circuit's various structures, or, alternatively, the cause of such circuit dysfunction

_____ theorists emphasize relationships and propose that depression results when people's relationships leave them feeling unsafe and insecure.

object-relations

barbiturates

one group of sedative-hypnotic drugs that reduce anxiety and helps produce sleep -For the first half of the twentieth century, a group of drugs called barbiturates were the most widely prescribed sedative-hypnotic drugs -Although still prescribed by some physicians, these drugs have been largely replaced by benzodiazepines

traumatic event

one in which a person is exposed to actual or threatened death, serious injury, or sexual violation

hypothalamic-pituitary-adrenal (HPA) pathway (brain-body pathway)

one of the two major roles by which the brain and body produce arousal and fear

A study of 44 patients with terminal illnesses revealed that fewer than ______ of them had thoughts of suicide or wished for an early death and that those who did were all suffering from major depressive disorder.

one-quarter

opioids

opium, drugs derived from opium (ie: heroin, orphan, and codeine), and similar synthetic drugs -also known collectively as narcotics -each drug has a different strength, speed of action, and tolerance level -morphine, codeine, and oxycodone (the key ingredient in OxyContin and Percocet) are medical opioids usually prescribed to relieve pain -in contrast to these opioids, heroin is illegal in the United States in all circumstances

avoidance (traumatic reaction)

people usually avoid activities that remind them of the traumatic event and try to avoid related thoughts, feelings, or conversations

resilience

people who adapt well and cope effectively in the face of life adversity -studies find that young children who are regularly exposed to manageable stress often develop heightened resilience (which may continue throughout adulthood)

hallucinations

perceptions of things that are not actually present

sexual torture

rape, violence to the genitals, sexual humiliation

glands

release hormones into the bloodstream and on to the various body organs

pituitary gland

secretes the adrenocorticotropic hormone (ACTH)

According to Edwin Shneidman, death _____clearly intend to end their lives at the time they attempt suicide. This singleness of purpose may last only a short time. It can change to confusion the very next hour or day and then return again in short order.

seekers

Not every ___-___ ___is a suicide.

self-inflicted death -ex. a man who crashes his car into a tree after falling asleep at the steering wheel is not trying to kill himself

Research suggests that mania may be linked to low _____ activity

serotonin

torture through deprivation

sleep, sensory, social, nutritional, medical, or hygiene deprivation

what causes substance use disorders?

sociocultural, psychological, and biological explanations -no single explanation, however, has gained broad support -it is viewed as a combination of all three factors

amphetamines

stimulant drugs that are manufactured in the laboratory -some common examples are amphetamine (Benzedrine), dextroamphetamine (Dexedrine), and methamphetamine (Methedrine) -first produced in the 1930s to help treat asthma, amphetamines soon became popular among people trying to lose weight; athletes seeking an extra burst of energy; soldiers, truck drivers, and pilots trying to stay awake; and students studying for exams through the night -amphetamines are most often taken in pill or capsule form, although some people inject the drugs intravenously or smoke them for a quicker, more powerful effect -like cocaine, amphetamines increase energy and alertness and reduce appetite when taken in small doses; produce a rush, intoxication, and psychosis in high doses; and cause an emotional letdown as they leave the body -also like cocaine, amphetamines stimulate the central nervous system by increasing the release of the neurotransmitters dopamine, norepinephrine, and serotonin throughout the brain, although the actions of amphetamines differ somewhat from those of cocaine

the biological explanation of unipolar depression

studies suggest that genetic factors, biochemical factors, brain circuits, and the immune system could be the biological contributors to unipolar depression

cannabis

substance produced from the varieties of the hemp plant, Cannabis sativa; it causes a mixture of hallucinogenic, depressant, and stimulant effects -produces sensory changes, but also has depressant and stimulant effects, so it is considered apart fro hallucinogens in DSM-5 -the most powerful of them is Hashish; the weaker ones include the best-known form of cannabis, marijuana, a mixture derived from the buds, crushed leaves, and flowering tops of hemp plants -more than 22 million people over the age of 11 (8.3 percent of the population) currently smoke marijuana at least monthly -each of the cannabis drugs is found in various strengths because the potency of a cannabis drug is greatly affected by the climate in which the plant is grown, the way it was prepared, and the manner and duration of its storage -of the several hundred active chemicals in cannabis, tetrahydrocannabinol (THC) appears to be the one most responsible for its effects -the higher the THC content, the more powerful the cannabis; hashish contains a large portion, while marijuana's is small -when smoked, cannabis produces a mixture of hallucinogenic, depressant, and stimulant effects -at low doses, the smoker typically has feelings of joy and relaxation and may become either quiet or talkative -some smokers, however, become anxious, suspicious, or irritated, especially if they have been in a bad mood or are smoking in an upsetting environment -many smokers report sharpened perceptions and fascination with the intensified sounds and sights around them -time seems to slow down, and distances and sizes seem greater than they actually are. This overall "high" is technically called cannabis intoxication -physical changes include reddening of the eyes, fast heartbeat, increases in blood pressure and appetite, dryness in the mouth, and dizziness -some people become drowsy and may fall asleep -in high doses, cannabis produces odd visual experiences, changes in body image, and hallucinations -smokers may become confused or impulsive -some worry that other people are trying to hurt them -most of the effects of cannabis last 2 to 6 hours -the changes in mood, however, may continue longer

Suicide is not officially classified as a mental disorder, although DSM-5's framers have proposed that a category called ___ ___ ___ be studied for possible inclusion in future revisions of DSM-5.

suicidal behavior disorder

detoxification for substance use disorder

systematic and medically supervised withdrawal from a drug -some detoxification programs are offered on an outpatient basis -others are located in hospitals and clinics and may also include individual and group therapy, a "full-service" institutional approach that has become popular -one detoxification approach is to have clients withdraw gradually from the substance, taking smaller and smaller doses until they are off the drug completely -a second—often medically preferred—detoxification strategy is to give clients other drugs that reduce the symptoms of withdrawal -antianxiety drugs, for example, are sometimes used to reduce severe alcohol withdrawal reactions such as delirium tremens and seizures -detoxification programs seem to help motivated people withdraw from drugs -however, relapse rates tend to be high for those who do not receive a follow-up form of treatment—psychological, biological, or sociocultural—after successfully detoxifying

It is not unusual for people, particularly ____, to attempt suicide after observing or reading about someone else who has done so.

teenagers

adrenocorticotropic hormone (ACTH)

the body's "major stress hormone"; stimulates that outer layer of the adrenal glands triggering the release of a group of stress hormones called corticosteroids

tolerance

the brain and body's need for ever-larger doses of a drug to produce earlier effects

central nervous system

the brain and spinal cord

stressor

the event that creates the demands may include: -everyday hassles (ie: rush-hour traffic) -turning-point events (college graduation or marriage) -long-term problems (ie: poverty or poor health) -traumatic events (ie: major accidents, assaults, tornadoes, military combat)

memory

the faculty for recalling past events and past learning -a key to this sense of identity, the link between our past, present, and future -without a memory we would always be starting over

amnestic episode

the forgotten period where people may appear confused

cognitive-behavioral treatment of substance use disorder

the leading cognitive-behavioral interventions for these disorders are aversion therapy, contingency management, relapse prevention training, and acceptance and commitment therapy (ACT)

generalized amnesia

the loss of memory extends back to times long before the upsetting period -in extreme cases, persons might not even recognize relative and friends

the psychological view of unipolar depression

the models that have been most widely applied to unipolar depression are the psychodynamic and cognitive-behavioral models -psychodynamic has not been strongly supported by research -cognitive-behavioral has received considerable support and gained a large following

benzodiazepines

the most common group of antianxiety drugs, which includes Valium and Xanax -which are generally safer and less likely to lead to intoxication, tolerance effects, and withdrawal reactions compared to barbiturates -Like alcohol and barbiturates, they calm people by binding to receptors on the neurons that receive GABA and by increasing GABA's activity at those neurons -Benzodiazepines relieve anxiety without making people as drowsy as other kinds of sedative-hypnotics -They are also less likely to slow a person's breathing, so they are less likely to cause death in the event of an overdose -When benzodiazepines were first discovered, they seemed so safe and effective that physicians prescribed them generously, and their use spread -Eventually it became clear that in high enough doses the drugs can cause intoxication and lead to sedative-hypnotic use disorder, a pattern marked by craving for the drugs, tolerance effects, and withdrawal reactions -Over a one-year period, 0.4 percent of all adults in the United States display this disorder

parasympathetic nervous system

the nerve fibers of the autonomic nervous system that help return bodily processes to normal

sympathetic nervous system (brain-body pathway)

the nerve fibers of the autonomic nervous system that quicken the heartbeat and produce other changes experienced as arousal and fear -one of the two major routes by which the brain and body produce arousal and fear

autonomic nervous system

the network of nerve fibers that connect the central nervous system (brain and spinal cord) to all the other organs of the body

probands

the person who is the focus of such a study

stress response

the person's reactions to the demands; influenced by the way we judge both the event and our capacity to react to them in an effective way -people who sense that they have the ability and the resources to cope are more likely to take stressors in stride and respond well

mutually amnesic relationships

the subpersonalities have no awareness of one another

endocrine system

the system of glands located throughout the body that help control important activities such as growth and sexual activity

the cognitive triad

the three forms of negative thinking that Aaron Beck theorizes lead people to feel depressed -the individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways that lead them to feel depressed

switching

the transition from one subpersonality to another, usually sudden and may be dramatic -usually triggered by a stressful event, although clinicians can also bring about the change with hypnotic suggestion

subpersonalities or alternate personalities

the two or more distinct personalities found in individuals suffering with dissociative identity disorder -each with a unique set of memories, behaviors, thoughts, and emotions -at any point in time, one of the subpersonalities takes center stage and dominates the person's functioning -usually one subpersonality, called the primary or host personality, appears more often than the others

torture

the use of brutal, degrading, and disorienting strategies to reduce victims to a state of utter helplessness -often done on the orders of a government or another authority to force persons to yield information or make a confession

Suicide attempts may also be preceded by shifts in patterns of ____.

thinking

psychological torture

threats of death, rock executions, verbal abuse, degradation

cross-tolerance

tolerance that a person develops for a substance as a result of regularly using another substance similar to it -sometimes two or more drugs are so similar in their actions on the brain and the body that as people build a tolerance for one drug, they are simultaneously developing a tolerance for the other, even if they have never taken the latter -cross-tolerance can reduce the symptoms of withdrawal from one drug by taking the other -alcohol and antianxiety drugs are cross-tolerant, for example, so it is sometimes possible to reduce the alcohol withdrawal reaction of delirium tremens by administering benzodiazepines, along with vitamins and electrolytes

research indicates that combat veterans from various wars are more than ___ as likely to die by suicide as nonveterans

twice

the multicultural perspective of sociocultural views on unipolar depression

two kinds of relationships have captured the interest of multicultural theorists 1. links between gender and depression (a strong relationship has been found, but a clear explanation for that relationship has yet to emerge) 2. ties between cultural and ethnic background and depression

withdrawal

unpleasant, sometimes dangerous reactions that may occur when people who use a drug regularly stop taking or reduce their dosage of the drug -cramps, anxiety attacks, sweating, nausea

dichotomous thinking

viewing problems and solutions in rigid "either/or" terms

reactive (exogenous) depression

which follows clear-cut stressful events

endogenous depression

which seems to be a response to internal factors