psych exam 3

video on bullimia

"thought if she lost a few pounds maybe she will look better in a bikini". Lived on apples for a week and then gained back the weight after Hawaii, and felt the weight of clothes on her skin. She saw her friend eating and throwing up and thought she would try it. Manipulation and lying involved. Would eat much in front of people bc they would discover her secret, and think why could she east so much. Would go home and binge eat In her room then would make herself throw after feeling guilty about what she ate. ( food controlling her) Father thinks she was doing it bc it was the one thing in life she could control but really food was controlling her. - most ppl w bulimia have more than. one binge episode per week. (2000- 3000 cals)

Biological views: Genetic factors on schizophrenia

( most research) Diathesis-stress perspective: People with a biological predisposition will develop a disorder only if certain kinds of events or stressors are present Evidence for the role of genetic factors in schizophrenia comes from: Family pedigree studies of relatives of people with schizophrenia Adoption studies of adults with schizophrenia: there biological relative more likely tp have schizophrenia than adoptive relatives. Direct genetic linkage research and molecular biology: tried to identify specific genes but not a single gene linked there is more than 100 gene sites. Polygenetic- combination of genes.

The Minnesota Semi-Starvation Experiment (1944-1945)

- 36 White male participants, ages 22-33 - All in good mental and physical health Goal: To learn the effects of semi-starvation and potential post-war relief efforts Three phases: baseline, semi-starvation, rehabilitation During the semi-starvation period, participants experienced: Odd behaviors involving food Body image disturbance Complaints of "fat" and "flab" around thighs, waists, butts Emotional problems Emotion dysregulation Depression Social withdrawal and isolation Cognitive problems Difficulty concentrating and comprehending Loss of sexual interest Discovered people exhibited odd behaviors and ritualistic behaviors around foods. ( eating things they didn't like, scooping and licking plates) start exhibiting emotional problems. Started exhibiting symptoms of eating disorders.

More about cannabis

1 18-25 year-olds - most common Regularly get high from smoking or ingesting; develop symptoms of tolerance and withdrawal; and experience social, occupational, and/or academic impairment The current varieties of marijuana are 7x more powerful than those found in the 1970s Other potential dangers Panic reactions (irritability and anxiety), automobile accidents, and poor concentration and impaired memory while high Long-term health use: Potential respiratory problems, effects on reproduction: men lowers sperm count and women it can lead to abnormal ovulation.

Aftermath of bulimia nervosa

Average lifetime duration is 6 years; untreated bulimia nervosa can last for years Treatment provides immediate, significant improvement in about 40% of cases; another 40% show moderate response- good response rates. Ten years after treatment, about 3/4 of patients are fully or partially recovered Relapses are not uncommon and are often triggered by stress- or those who have a longer history of the disease or lingering inter personal problems

Treating eating disorders

Broad treatment goals Correct dangerous eating patterns as quickly as possible- stabilization (nutritionally and physically)- Address broader psychological and situational factors that have led to and maintain the eating problem

how many ppl w schizophrenia recieve care?

1/3

Typical age of onset for anorexia nervosa

14-20 years old

typical age of onset for bulimia nervosa

15-20 years old

typical age of onset for binge eating disorder

22-30 years

Video from impatient eating disorder unit

in morning nurse takes vitals and weight. Afternoon they have one therapy a day like (music or dance). Also have group therapy session with family. Can have dinner with family. Focus is to get them eating again. They get to walk outside if they are physically cleared, some people very impaired if its physically unsafe for them to go on a walk. Trying to make a sense of normalcy in abnormal way.

binge eating disorder added to dsm in

last decade

Substance use disorder: Symptom checklist (8-11)

8-9 (risky use) 10-11 (pharmacological) 8. Recurrent use in situations in which it is physically hazardous: risky use doing it in place that puts their health or safety at risk. 9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance: person keeps using despite having this problem. (Lung cancer diagnosis and continues smoke) 10. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of the substance to achieve the desired effect b. A markedly diminished effect with continued use of the same amount of the substance 11. Withdrawal reactions- many take substance to then alleviate the withdrawal.

Biological views: Dysfunctional brain structures and circuitry ( schizophrenia)

A dysfunctional brain circuit may contribute to schizophrenia Includes the prefrontal cortex, hippocampus, amygdala, thalamus, striatum, and substantia nigra, among other structures Brain circuit structures function and interconnect in problematic and abnormal ways ( some are overactive but some are underactivie) and problems w connecitivity between structures as well. Newer research suggests there may be two distinct subcircuits whose various structures sometimes overlap - One responsible for positive symptoms, other responsible for negative symptoms Abnormal dopamine activity is now seen as part of broader circuit dysfunction that can propel people toward schizophrenia- dopamine is problematic within thus more dysfunctional brains circuit

Alcohol

All alcoholic beverages contain ethyl alcohol Absorbed into the blood through the stomach lining, carried in the bloodstream to the CNS, depressing our functioning Helps GABA ( inhibitory nuerotransmitter) to shut down neurons and relax the drinker- inhibitory As more alcohol is absorbed, different effects emerge The first affected brain area controls judgment and inhibition: looser, more talkative, relaxed, and confident When more alcohol is absorbed, additional areas in the CNS are affected, leaving the drinker even less able to make sound judgments, speak clearly, and remember well: highly emotional, loud, or agressive. As drinking continues, motor difficulties increase and reaction times slow: unsteady, clumsy, blurred Vision, driving wld be sig impaired. Effects determined by concentration in the blood: by body size and gender, women at the same level get more intoxicated than men. Also the concentration of the alcohol. Effects subside only when alcohol concentration declines as it is metabolized by the liver ( time and metabolism) - avg rate of metabolism 25% of an ounce per hour

bulimia nervosa and anorexia similarities

Begin after a period of dieting Fear of becoming obese Drive to become thin Preoccupation with food, weight, and appearance Distorted body perception Disturbed eating attitudes Feelings of anxiety, depression, obsessiveness, and perfectionism Heightened risk of suicide attempts and fatalities Substance use (including diet pills)

Prescribing first-generation antipsychotics

Clinicians are now more careful in their prescription practices of these drugs Prescribe the lowest effective dose ( stop at lowest effective dose) Gradually reduce or stop the medication weeks or months after the patient begins functioning normally If a medication is ineffective, they will add another drug to achieve a synergistic effect (polypharmacy)

Alcohol use among adolescents and young adults

College students: 38% engage in monthly binge drinking Alcohol-related arrests ( account for majority) Sexual assaults Academic problems Fatal injuries

Anorexia Nervosa criterion

Criterion A: Restriction of energy intake relative to requirements leading to a significantly low body weight Must take age, sex, developmental trajectory, physical health into account Significantly low weight = "less than minimally normal" Criterion B: Intense fear of gaining weight or becoming fat and/or Persistent behavior that interferes with weight gain Criterion C: Disturbance in the way in which one's body weight or shape is experienced- ask ppl to draw body shape ppl w anorexia draw a larger body shape, could be a delusion. Undue influence of weight or shape on self-evaluation, and/or Persistent lack of recognition of seriousness of current low weight- can not acknowledge t=how serious it is that they are this low weight. One of these need to be met.

Comorbid psychopathology

Depression can often precede eating disorder symptoms. Many more people with eating disorder are diagnosed with major depressive disorder than in the normal population. Antidepressant drugs sometimes help persons with eating disorders.

Personal and social impacts of alcohol use disorder

Destroys families, social relationships, and careers Alcohol plays a role in 1/3 of all suicides, homicides, assaults, sexual assaults, and fatal automobile accidents - accounts for more than 10,000 deaths each year Long-term excessive drinking can seriously damage physical health (e.g., cirrhosis) and lead to major nutritional problems (e.g., Korsakoff's syndrome)- memory disorder by the loss of brain tissue- ppl who drink a lot think there full but not acc getting the nutrition they need. Spillover effects on children Drinking during pregnancy creates risk for fetal alcohol syndrome (FAS): heart defects, birth defects. >10% of children live with a parent with alcohol problems; affects their mental health: kids who grow up w parent of alcohol use disorder worse social outcomes, low self esteem.

Biological views: Biochemical abnormalities of schizophrenia

Dopamine hypothesis Certain neurons using dopamine fire too easily or too often, producing symptoms of schizophrenia- This theory is based on the effectiveness of antipsychotic drugs/ medications, which are dopamine antagonists (particularly for the D-2 receptors) Challenge to the dopamine hypothesis Discovery of a new generation of antipsychotic drugs which bind to D-2 dopamine receptors, D-1 receptors, and other neurotransmitters (serotonin, glutamate, and GABA)- more effective than first class of antipsychotics. Shows not only dopamine but other neurotransmitters play a role as well. Dopamine not sole factor contributing to the disorder. But its the primary one that we think about. Suggests that schizophrenia may be related to abnormal activity or interactions of dopamine and other neurotransmitters, rather than to abnormal dopamine activity alone

Substance use basics

Drug: Any substance other than food that affects our bodies or minds Substance intoxication: Temporary changes in behavior, emotion, or thought caused by substances Substance use disorders: Patterns of maladaptive behaviors and reactions brought about by repeated substance use In any given year, 7.4% of all teens and adults in the U.S., more than 20 million people, have a substance use disorder Only 18.4% of this group receives treatment from a mental health professional ( very low rate) ( lowest rate) 1 in 5 people. Overall cost of substance misuse is $740 billion in the U.S. alone (crime, loss work productivity, and healthcare activity)

The promise of community treatment

Effective community programs that properly provide a combination of services result in more improvements than other kinds of programs National interest groups have formed to push for better community treatment (NAMI) Well-coordinated community treatment is seen as a crucial solution to the problem of severe mental dysfunction- giving peple medication is not enough.

Physical Consequences of Anorexia

General weakness and fatigue Inability to stand at times Fainting Sensitivity to cold Delayed gastric emptying - often feel bloated and uncomfortably full after small meals Osteoporosis- bone density gets more porous Cerebral atrophy --> increased risk of seizures Irregular heart beat (very dangerous; can lead to death)- deadliest parts- high rates w anorexia mortality rates w people w this disorder. Lowered reproductive hormones --> amenorrhea and risks of infertility- loss of menstrual cycle- removed from dsm bc of men Lanugo (fine hair on body - grows to help keep body warm)

Racial and ethnic differences in substance use disorders

Highest in Native Americans/ American Indians- due to poverty and discrimination

Cognitive, social, and emotional symptoms & consequences of anorexia

Illness and/or treatment often require dropping out of school, losing one's job- functional impairments, and difficulty concentrating when in this starving state. Difficulty concentrating (interferes with work/school) Increased anxiety Symptoms of depression and low self-esteem Emotional problems Increased irritability Mood lability, poor emotion regulation Paranoid thoughts: "Everyone's trying to make me fat" Extreme strain in social relationships May become more withdrawn May lash out at those around them

First-generation antipsychotic drugs

In 1954, chlorpromazine (Thorazine) was approved for sale in the US as an antipsychotic drug ( based on research of antihistamine drugs) found one group of antihistamines can help people be calm due to surgery then relaized can be used to treat people with psychosis as well. Found to result in significant reduction in symptoms and a calming effect among patients with psychosis ( sig advance) Called neuroleptic drugs because they often produce undesired movement effects similar to the symptoms of neurological diseases- Reduce psychotic symptoms by blocking excessive activity of dopamine very effective- Reduce symptoms in 70% of people with schizophrenia.

Amphetamines

Laboratory-manufactured stimulant drugs Examples: Amphetamine, dextroamphetamine, Adderall, methamphetamine- ADHD Most often taken in pill or capsule form, but sometimes injected or smoked- quicker and more powerful effect Stimulate the CNS- by inc dopamine, norepinephrine and serotonin. Small dose: inc alertness and energy and suppress appetite High doses- rush, intoxication or even psychosis Can get letdown when leaves from the body. Effects vary depending on dose Misuse common among college students: academic performance, get high, or reduce apettite. More about methamphetamine Recent surge in its popularity Serious negative effects on physical, mental, and social life: meth month, body sores, and decreasing in cognitive functioning

Psychological theories ( schizophrenia)

Little research support for either psychodynamic ("schizophrenogenic mothers") or cognitive-behavioral theorized causes of schizophrenia ( mother self sacrificing to meet Childs needs.. recording) no evidence for this.

Consequences of inadequate community treatment

Many people with schizophrenia are discharged prematurely ( not enough in patient beds, cant stay in hospital as much as they need to stabilize bc other people need to be admitted) and then receive inadequate follow-up treatment Some return to their families with medication and some other supports, but they often receive little other treatment A significant number have become homeless In the US, approximately 1/4 who are homeless have a severe mental disorder, commonly schizophrenia Many have been released from hospitals or were never hospitalized in the first place Others with severe mental disorders are in prisons and jails In the US, because people with severe mental disorders are in prisons or jails, often because their disorders have led them to break the law

Schizoaffective disorder

Marked symptoms of both schizophrenia and a major depressive episode or a manic episode for 6 months or more.

Sociocultural Theories: Gender Differences ( eating disorders)

Men are as likely as women to eat in unhealthy ways but account for only 25 percent of all people with reported anorexia nervosa and bulimia nervosa. Different standards of attractiveness Different methods of weight loss: men = exercise; women = dieting Causes for men Link to requirements and pressures of job or sport Body image- thin women ideal and muscular man ideal. Different patterns of dysfunctional eating (muscularity-oriented disordered eating behaviors: muscle dysmorphia- wants to gain muscle and look a certain way not about eating more about exercise. Most research focuses on cisgender populations, but some research shows transgender and non-binary individuals experience elevated rates of eating disorders

Cocaine

Most powerful known natural stimulant Can be snorted, injected, or smoked Tried by 40 million people; currently used by 2 million people Produces a euphoric rush of well-being and confidence, followed by letdown (crashing) Increases the supply of dopamine at key neurons throughout brain as well as norepinephrine and serotonin levels: then effects wear off and people have crash. High doses can produce cocaine intoxication and/or cocaine-induced psychosis: intoxication: poor muscle coordination, grandiosity, anxiety confusion. Psychosis: hallucinations and delusions. Harmful effects on behavior, cognition, and emotion; risk of overdose Can lead to brain seizures and can suppress respiratory breathing from brain.

Cognitive-behavioral perspective of substance use disorders

Operant conditioning: Tension-reduction, rewarding effects of drugs- behaviors depend on what consequences of them are. More things that feel good less that feel bad. Take substance and temporarily feel better and bc of that someone wants to take it again or try higher doses or more powerful methods bc of this. May also develop an expectancy that substances will be rewarding, which motivates users to increase their drug use during times of tension: have expectation that will feel good leads you to feel that way when you are taking the drug. Self-medication hypothesis: 20% w a substance use disorder also have a psychological disorder. doing these things to help us feel better. Influenced by classical conditioning when cues or objects are present during drug use: pavlovs salivating dogs: around a certain friend or sight of a needle or smtg can help you feel good.

Key features of effective community care, continued

Partial hospitalization: Provide daily supervised activities and programs to improve social skills Semihospital (residential crisis center): Houses or other structures in the community provide 24-hour nursing care for patients with severe mental disorders- Daily supervised activities and programs to improve social skills. Supervised residences: Provide shelter and supervision for those patients who are unable to live alone or with their families, but who do not require hospitalization. Indicates by research that the help people. Occupational training and support: Training in a sheltered workshop or through vocational agencies. Work brings people structure and a sense of purpose, and give them occupational training. helps network and helps with social relationships. Ex: shelter or workshop ( where all employees have a disorder but not many of them)

Incidence and onset of anorexia

Peak onset age between 14 and 20 years- can happen at any age when see major change in body.

Cognitive-Behavioral Theories on eating disorders

Positive reinforcement When people begin to lose weight, other people reinforce the weight loss- like you look great. Compliments keep it going even though to the point when its suppose to be a compliment but ppl w anorexia will see it as a compliment when the other person sees it as a concern. The idea of control can be highly reinforcing Negative reinforcement: Food and weight gain are feared or shame around weight gain Avoidance of food/weight gain lead to: Short-term reductions in anxiety: feel of temporary belief to over time to believe they need to avoid food which keeps the cycle going. Long-term maintenance or worsening of the fear the disorder is maintained Behaviors that resemble OCD compulsions ("safety behaviors") Constant weight checks (often multiple times per day) and catastrophizing normal fluctuations in weight- relief if anxious checking the weight again but then can motivate them to losing more weight. Body checks (e.g., counting ribs, checking to see if thighs touch)

More info about binge-eating disorder

Repeated eating binges during which people feel no control over their eating but (unlike in bulimia nervosa) they do not engage in inappropriate compensatory behavior Frequency of binges can vary from 1-3/week (mild) to 14+/week (extreme) Often occurs in secret and causes shame- attempt to conceal their symptoms and are ashamed of what's happening but without compensatory behavior. Many shared features with bulimia nervosa or anorexia nervosa, but not the same drive to thinness and unlikely to begin after a diet. - mostly focus on appearance... Demographics of note At least 64% are female- Later age of onset (most often in their 20s) other ones ( 15-20) like anorexia and bulimia Many develop health problems as a result of their frequent binges ( GI problems)

Schizophrenia and the psychotic disorders

Schizophrenia is one of a spectrum of disorders characterized by psychosis: a state in which a person loses contact with reality- can either be substance induced or due to brain injury but most common in form of schizophrenia. (Comes from greek meaning split mind) The psychotic disorders are defined by abnormalities in one or more of the following five domains: Delusions Hallucinations Disorganized thinking and speech (first 3 are positive symptoms bc addition to persons behavior) Grossly disorganized or abnormal motor behavior Negative symptoms (take away from a persons behavior)

Sociocultural approaches for substance use disorder

Self-help and residential treatment programs Most common is Alcoholics Anonymous (AA)- over 2 million members, offers peer support with guidelines to get over addiction. Do one day at a time, once a alcoholic always alcoholic remind ppl of that. Absitence- better approach for this ewho have chronic long problems w alcohol. Culture- and gender- sensitive programs- recognizing ppl that who are poor or homeless or miniroty groups need special needs to be met for treatment- like woman aswell. Prevention programs Can focus on the individual, the family, the peer group, the school, or the community- provide education to individuals ab effects and teach parenting skills to prevent substance misuse. Most effective programs - compose a constant message ab drug use in all aspects of your life.

Opiod use disorder video and treatments

Several medications can help. All medications target receptors. Naloxone works in minutes to prevent opiod overdose and kicks of opiod from the receptors. Buprenophrine- connects to opiod receptors but only does partially, helps w withdrawal symptoms and cravings. Methadone- doesn't produce a high in ppl w opiod use disorder. Naltrexone used for all substance abuse disorder and opiod use disorder.

Depressants

Slow the activity of the central nervous system (CNS) Reduce tension and inhibitions May interfere with judgment, motor activity, and concentration Most widely used depressants Alcohol- more than 2 billion ppl consume worldwide and US half of adults drink alcoholic bevs. Sedative-hypnotic drugs Opioids

Stimulant use disorder

Stimulant dominates the individual's life Leads to poor functioning in social relationships and at work Tolerance and withdrawal reactions develop Annual rates among people older than age 11

Stimulants

Stimulants increase the activity of the central nervous system (CNS) Increases in blood pressure, heart rate, and alertness Rapid behavior and thinking Most common stimulants Cocaine Amphetamines Caffeine Nicotine

Effectiveness of the first generation antipsychotics

Symptoms reduce in majority (70%) of patients with schizophrenia More effective than any other approach used alone Generally see improvement within weeks, with maximum level of improvement within the first 6 months of treatment High rates of relapse when ppl stop taking the drug prematurely. Positive symptoms of schizophrenia are reduced more completely (delusions and hallucinations) , or at least more quickly, than negative symptoms Patients often dislike powerful effects - side effects, some patients refuse to take them. Some symptoms of schizophrenia may give people reason to restrict meds. (Delusions that someone is poisoning u)

multifinality model of schziophrenia

same past/ childhood but leads to different final outcome

Biological views: Viral problems ( schizophrenia)

Theory: Exposure to viruses before birth triggers an immune response in the mother, is passed on to the developing fetus, enters the developing brain, and interrupts brain development Evidence Animal model investigations Links involving late winter births ( increased viruses in winter increases fetal exposure to viruses during that time of year) Mother influenza exposure ( during pregnancy than those who do not) Antibodies to suspicious viruses in people with schizophrenia- that we do not see in people w out schizophrenia.

Treating binge-eating disorder

Treatments are often similar to those for bulimia nervosa (e.g., CBT, other forms of psychotherapy, antidepressant medications) Aimed at reducing/eliminating binge-eating patterns and changing disturbed thinking such as being overly concerned with weight and shape Psychotherapy generally more effective than medication Short-term effectiveness; high relapse risk

Aftermath of anorexia nervosa

Use of combined treatment has greatly improved the outlook for patients Average lifetime duration is six years- recovery is difficult Positives Weight is quickly restored and continued improvement is evident for the majority of clients- menstrual cycle usually returns w normal weight. Medical improvements mean fewer deaths Negatives At least 20% experience continued difficulties Recovery is not always permanent- see in 1/3 of recovered patients usually triggered by stressors Psychological problems such as depression, obsessiveness, and social anxiety may persist- as well as continued concerns about their weight and appearance. Course and outcome of disorder vary from person to person- variability - longer they had disorder and lost more weight the prognosis is worse, also worse in people w other existing disorders ( like family or interpersonal relationships)

Family therapy as part of treatment for anorexia nervosa

Valuable part of treatment, especially for children and adolescents Involvement of entire family- therapist meets w family members patterns and help them make changes. Separation of feelings and needs from those of other family members- anenishment- feeling to close together.

Brief psychotic disorder

Various psychotic symptoms, such as delusions, hallucinations, disorganized speech, restricted or inappropriate affect, and catatonia- present for at least one day but less than one month.

Findings from the Minnesota Study

We typically think about eating disorders as a psychological state causing physical changes. But sometimes physical changes may contribute to a psychological state

anorexia restricting type

Weight loss attained primarily through dieting, fasting, and/or excessive exercise Individual does not regularly engage in binge-eating or purging behavior-

Caffeine

World's most widely used stimulant (90% consume some each day) 99% of ingested caffeine is absorbed by body; reaches peak concentration within an hour Serves as a CNS stimulant- produces release of dopamine, norepinephrine and serotonin. Reduces fatigue increases motor activity. Caffeine use disorder is not listed in DSM-5-TR (though there is an "Unspecified Caffeine-Related Disorder") More than 250 mg of caffeine can produce caffeine intoxication- restless, nervousness, anxiety, and stomach problems. Sudden stop or cutback of usual caffeine intake can cause caffeine withdrawal symptoms, including headaches, depression, anxiety, and fatigue

positive symptoms of schizophrenia

delusions and hallucinations, and disorganized speech

Equifinality of substance use disorder

different past/ childhood leads to same final outcome

binge eating article

ny times - half gallon of iceream only the beginning Could eat 3,000 calories in one sitting - one night in binge she became sucidial- lost control of eating and cldnt go on that way. - was still physically active - bing eating aspects of bulimia with out the compensatory behaviors

media messages

there is a gigantic industry ($9.5 billion/year in U.S.) devoted to: "Helping people lose weight"- marketed it as a problem Contributing to body dissatisfaction such that people will purchase products and services to fix their "flaws" Individuals (especially girls) tend to become acutely aware of media pressures at the transition to adolescence We are bombarded with messages about the importance of achieving bodily "perfection"- also with snapchat filters Losing weight is portrayed as a goal everyone should aspire toward Body positivity movement attempting to change narrative away from body shaming More accessibility to how we can change our bodies and then like it more keep using it. Problematic when people are looked up to in society.

Jorges case : ( can I get a refund if I dont need to be here )

- dangerous alcohol consumption and particpating in binge drinking - first bonding experience w dad was with alcohol ( positive association) - got very drunk and his his head on coffee table - has drug dependence because he feels rewarded when the desire is reduced= CBT model - symptoms: desire, interpersonal problems, has ben told about drinking problem, important social activities given up, drinking more than intended, need more for same effect. - Diagnosis: alcohol use disorder - Treatment: rehab program. Pill helpful getting heavy alcohol users off their dependence before serious health problems occur ( could help and make him feel negative effects)

Jenny's Case: ("They are just jealous")

- has a fear of gaining weight - Only ate 500 cal per day - Struggles w/ Restricterm-54ting-type Anorexia Nervosa - Could use family therapy - had to have "right kind of body" to be a figure skater - has an emeshed family pattern (over involved) - Gets target weight and feels disgusting and horrible, will want to lose more weight - Symptoms: low weight, unaware of risks of low wieght, restriction of energy intake, behavior that interferes with weight gain all these make her think about death - Unable to induce vomiting, limits herself to 500 cals/day, works out for 2 hours each day= restricting-type anorexia nervosa subtype - liked the reinfocring compliments about her weight loss - Diagnosis: anorexia nervosa - Treatment: family therapy ( would be best) Part 2 People at the gym could clearly tell a girl was anorexic Said "her body was deteriorating, eyes were gray" Had been anorexic since she was 10, had been in and out of treatment Lauren's heart almost stopped, almost needed a pacemaker Went through treatment, 36 pounds heavier, now graduating with OT degree to help others with eating disorders

Sbrit video

- have universal screening to see risk level then go on to brief intervention which contains the motivational interview to motivate the indivdaul to cut back on their substances so they dont develop a substance use disorder. drinks a lot, says its fun and tastes great, reduces her stress, says no bad signs of drinking. She was very collaborative. doesnt have to be perfect but needs to be better. getting her to motivate change Uses vacation days to recover from drinking. Blackout at 30. Knows she's drinking too much. If she has to for health reasons she will be more motivated. Replaces her stress reliever of pays activity bc works more and doesn't hv time.

summary of eating disorders

- more likely in females - less than half in all receive treatment - majorty who do recieve treatment show a long successful recovery

Randy's Case: ("They stole my brain and I want it back")

- odd disruptive behavior led to his arrest - claims his brain is missing - making up words (neolgisms) - has delusion that TV stole his brain - symptoms: delusions, hallucinations, disorganized speech, impairment in self care/ interpersonal functioning - Diagnosis: schizophrenia - has auditory hallucinations - where he hears voices in his head that aren' t actually present. - Treatment: medication CNN anchor Anderson Cooper trying to complete series of tasks while undergoing a schizophrenia simulation where he hears recordings of voices by wearing ear buds Hard to concentrate, focus, and understand when something is talking in your head Words he is hearing in his head he describes as unpleasant, disturbing, isolating, depressing, negative, creepy, and sometimes supportive Says he wants to talk back to voices

Biological Theories on eating disorders

- strong genetic component Relatives of people with eating disorders are six times more likely to develop eating disorders themselves. - There may be irregularities in bodily systems responsible for detecting and regulating hunger (lateral ( inc) and ventromedial (reduce) hypothalamus). In brain. -Losing weight rapidly can contribute to some symptoms. - can co tribute to the psychological symptoms of the disorder.

Nicotine

3/4 of smokers keep smoking because they are addicted to nicotine, the active substance in tobacco People addicted to nicotine have tobacco use disorder Nicotine is a stimulant of the CNS As addictive as cocaine and amphetamines Tobacco use is the leading preventable cause of mortality in the US Life expectancy for smokers is 13 years shorter than for nonsmokers Electronic cigarettes (e-cigarettes): Handheld battery-powered vaporizers that allow users to inhale aerosol (vapor) rather than cigarette smoke Concerns about vaping Exposes lungs to a variety of chemicals- known carcinogens and metal nano particles. Nicotine is addictive in any form Continued nicotine vaping can make other drugs such as cocaine and methamphetamine more pleasurable to a teen's developing brain

Diagnostic criteria for bulimia nervosa

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances- limited period of time, doesn't necessarily have to be a single setting, someone can stat their binge at a restaurant and then continue to eat when they go home. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)- inability to refrain from eating or to stop eating when you start. Can abandon efforts to control their eating at all would also meet criteria. B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise( when significantly interferes with other activities or occurring at inappropriate times or setting or continuing to exercise with in jury or other medical problems. - binge eating paired with compensating for binge eating, most common is self induced vomiting. When people vomit they feel relief from the discomfort of binge eating physically and physically and psychologically, the vomiting makes them feel better because they feel like they're not gonna gain weight. ( reinforcing cycle) C. The binge eating and inappropriate compensatory behaviors ( most common is self induced vomiting) both occur, on average, at least once a week for 3 months. D. Self-evaluation is unduly influenced by body shape and weight- place an excessive emphasis on body shape or weight in determining their self esteem.

Diagnostic criteria for binge-eating disorder

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating) NO compensatory behaviors B. The binge-eating episodes are associated with three (or more) of the following: 1. Eating much more rapidly than normal 2. Eating until feeling uncomfortably full 3. Eating large amounts of food when not feeling physically hungry 4. Eating alone because of feeling embarrassed by how much one is eating 5. Feeling disgusted with oneself, depressed, or very guilty afterward

Diagnostic criteria for schizophrenia

A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3): Delusions Hallucinations Disorganized speech (e.g., frequent derailment or incoherence) Grossly disorganized or catatonic behavior Negative symptoms (i.e., diminished emotional expression or avolition)

Sociocultural interventions: Family therapy

Addresses family-related issues, creates more realistic expectations, provides psychoeducation about the disorder, and builds emotional support and empathy Can be helpful for all members of the family and esp one w schizophrenia they can help them cope better w fam issues and to develop better interactions with family. When combined with drug therapy, helps reduce family tensions and lowers the risk of relapse and hospital readmission

Sociocultural interventions: Coordinated specialty care (CSC)

Addresses social and personal difficulties in clients' lives Can include practical advice, problem solving, decision making, social skills training, medication management, employment counseling, financial assistance, and housing ( combination) addressing all difficulties many different sorts of services usally offered by a team or a group of professionals rather tghan an individual therapist - helps with early intervention for schizophrenia. Research shows that this approach reduces rehospitalization when paired with medication

Key features of effective community care

Assertive community treatment: Team provides medication, psychotherapy, help in handling daily pressures and responsibilities, guidance in making decisions, social skills training, residential supervision, and vocational counseling- (when there is effective community care patients do much better) many communities do not have these resources and those patients in these communities do much worse. Coordinated services: Community mental health centers expected to provide medications, psychotherapy, and inpatient emergency care, and coordinate services as needed. like in patient care,- when these exists patients do better. Short-term hospitalization: If treatment on an outpatient basis is unsuccessful. Then released to aftercare. There should be available short term hopistals then release them to aftercare.

Cognitive-behavioral interventions for substance use disorders

Aversion therapy: Individuals are repeatedly presented with an unpleasant stimulus at the very moment they are taking a drug: principles of classical conditioning.. use substance and becomes associated w smtg u don't like. (Drink all and then use drug that makes ur be nauseas and vomiting) effective but has limited success when only form of treatment bc ppl find it unpleasant- requires multiple sessions so limited success. Contingency management: Receive incentives for passing drug tests and staying substance-free: voucher for prizes or cash if they have pos toxicology screens over time. Better successful when combined w other approaches. Relapse-prevention training: Clients are taught to identify and plan ahead for high-risk situations and to learn from mistakes and lapses_ have someone track when they use the substance too much, and focus on coping strategies and plan ahead so ur less likely to abuse the substances mostly used for alcohol, best for those that are young and yet to develop withdrawal symptoms. Acceptance and commitment therapy: Mindfulness-based approach, trained to observe their cravings, worries , and depressive thoughts learning u don't need to act on those things just acknowledge them and accept and let them pass. Particularly effective when combined w other treatment.

Diagnostic criteria for schizophrenia, continued

B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning. ( different before onset of disorder)

Second-generation antipsychotic drugs ("atypical" antipsychotics)

Biological mechanism of action differs from first-generation antipsychotics Received at fewer dopamine (D-2) receptors; more D-1, D-4, and serotonin receptors than the others- diff dopamine receptors than first gen antipshyoctic drugs. At least as effective, often more effective, than first-generation antipsychotics Reduce positive and some negative symptoms Cause fewer extrapyramidal symptoms ( side effects) and less tardive dyskinesia Now considered first line of treatment for schizophrenia ( second gen) Concerns : There are some downsides to these medications as well- risk of disorder w decrease in white blood cells, can also cause weight gain, sexual dysfunction, changes in blood sugar. only produce modest improvement in life satisfaction. Called atypical because different course than first generation antipsychotics and challenges dopamine and serotonin.

Treatment of substance use disorders

Biological treatments Cognitive-behavioral interventions Sociocultural approaches Often paired with motivational interviewing: collaborative and goal oriented style of communication: strengthens someone own motivation for a commitment to a certain goal, goal oriented, using these collaborations to lead to positive changes (recording add) Treatments sometimes very helpful, but are often only moderately helpful, hard to treat and relapse is common. Helps some tho. Can be inpatient, outpatient, or a combination most common form of treatment is outpatient rehabilitatation

Diagnostic criteria for binge-eating disorder, continued

C. Marked distress regarding binge eating is present D. The binge eating occurs, on average, at least once a week for 3 months E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa

Opioid use disorder

Can develop after just a few weeks Opioid use interferes significantly with social and occupational functioning Tolerance for the drug quickly builds and withdrawal occurs when drug ingestion stops Early withdrawal symptoms include anxiety and restlessness Later symptoms include twitching, aches, fever, vomiting, diarrhea, and weight loss from dehydration Increased doses are required to avoid withdrawal; so result to criminal activity. Prevalance - display opioid use disorder within a given year Misusing prescription drugs 3/4- to heroin illegal 1/4 400% increase in the number of deaths caused by opioid overdoses in the past two decades (opioid epidemic)- 2/3 of all drug overdoses are based on opioids And untreated opioid use disorder- Mortality rate is 63x that of the original population

Grossly disorganized or abnormal motor behavior

Can manifest in a variety of ways, ranging from childlike "silliness" to unpredictable agitation Problems can be noted in any form of goal-directed behavior, leading to difficulties in performing activities of daily living- level of disorganization can't do these basic activities that we would expect a normal person to do. Catatonia: Decrease in reactivity to the environment Ranges from resistance to instructions (negativism- movements being wooden); to maintaining a rigid, inappropriate, or bizarre posture; to a complete lack of verbal and motor responses (mutism and stupor) Stupor (a state of reduced responsiveness) mutism- unwillingness or refusal to speak. Can also include purposeless and excessive motor activity without obvious cause (catatonic excitement)- wildly waving arms and legs ( pos symptom) Other features include repeated stereotyped movements, staring, grimacing, and the echoing of speech

Alcohol use disorder

Clinical picture Patterns can vary, but people with this disorder generally drink large amounts regularly, affecting cognition, social life, and work Damage in various structures of the brain as well as impairments in memory, speed of thinking, attention skills, and balance ( impairments in brain) Tolerance increases consumption levels; repeated use so then increase consumption Negative withdrawal symptoms [e.g., delirium tremens (DTs)]: nausea, vomitting, severe- DTs- can be fatal: hallucinations, seizures, stroke, loss of consciousness, shivering, sweating. Prevalence U.S. population older than 11 years: 5.4% Men versus women: 2:1- men able to metabolize alcohol faster than women. more men than women. Ethnic differences: Highest among Native Americans / American Indians , and lowest among Asian Americans (3.8%)

Diagnostic criteria for schizophrenia, continued ( exclusionary)

D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated) ( not autism spectrum disorder)

Diagnostic criteria for bulimia nervosa, continued

D. Self-evaluation is unduly influenced by body shape and weight- place an excessive emphasis on body shape or weight in deterring self esteem. E. The disturbance does not occur exclusively during episodes of anorexia nervosa

bulimia nervosa (symptoms) and anorexia differences

Differences: Bulimia( symptoms) More concern about pleasing others Tend to be more sexually experienced Mood swings, frustration and boredom, poor coping, and impulsivity more likely Comorbid personality disorder more likely Different medical complications ( bc of purging) - Dental problems more likely Amenorrhea less likely in bulimia - irregular menstrual periods, mostly all w anorexia have amenhorrhea

Biological view of substance disorders (brain circuits)

Drugs activate the reward circuit (reward center) directly or indirectly: pleasure pathway- ampethamines cocoaine and cafiiene stimulate directly stimulate structures in reward circuit. Alcohol, opioids and marijuanna indirectly stimulates it. Dopamine is the key neurotransmitter Incentive-sensitization theory: When substances repeatedly stimulate the reward center, the center develops a hypersensitivity to the substances: neurons in the brain circuit more readily when substances are taken so makes them want to take it again bc it feels good. Reward-deficiency syndrome: The reward center is not readily activated by "normal" life events, so the person turns to drugs to stimulate this pleasure pathway, particularly in times of stress: activities like exercise and being w friends won't activate those pathways so they turn to drugs or substances particularly in times of stress. Defects in D-2 receptors are a possible cause

Family environment on eating disorders

Families may impact and maintain eating disorders. History of emphasis on thinness, appearances, or dieting Dieting and perfectionistic parents- Family could effect and focus on dieting or enforce dieting. Or parents want you to look a certain way. Enmeshed family patterns (overinvolvement; overconcern) (Minuchin)

Effective programs remain out of reach for many people who need them

Fewer than half of all people who need them receive appropriate community mental health services In any given year, at least 35% of all people with schizophrenia and other severe mental disorders receive no treatment at all African Americans with schizophrenia are particularly unlikely to receive proper services like behavioral or community care ( racism, poverty, discrimination). more likely to be attended to in emergency room or receive no care.

Delusions

Fixed beliefs that are not amenable to change in light of conflicting evidence Can be bizarre (clearly implausible, do not derive from ordinary life experiences) or nonbizarre Bizarre ex: someones belief that an outside force has removed their internal organs and replaced them w someones else but w out any visible scar. Non ordinary life experience ( not likely to happen to anyone from an ordinary life experience) Non bizzarre ex: someone believing that the police is telling them or there under police survallience. ( it happens for some ppl) ordinary life experience Common delusions Persecution: One is going to be harmed, harassed, etc. by an individual, organization, or other group- ex: believing that Walmart is maintaining a file on ur shopping actictivites and using that file to destroy ur life. ( family dog was planning to kill her) Reference: Certain gestures, comments, environmental cues, etc. are directed at oneself- ex: believing that a tv show was taken from your life. Believe ur the frame of reference. Grandeur: Exceptional abilities, wealth, or fame- can be specific or general- someone believing they were madonna or someone believing they have great musical talent and are destined to be a great star. Thought insertion: Outside thoughts have been put into one's mind- thought inserted into mind by someone else. Ex he thinks his thoughts have been planted into his mind by his neighbors dog.

Cognitive-behavioral therapies: Cognitive remediation: (schizophrenia)

Focuses on difficulties in attention, planning, and memory- computer tasks, begin w simpler tasks to move on to harder tasks like planning and memory. Provides increasingly more complex computer tasks ranging from attention to short-term memory to planning and social awareness Produces moderate improvement in attention, planning, memory, and problem-solving that surpass those from other interventions These benefits extend to everyday client life and social relationships Paired w meds could lead to more positive life satisfaction

Developmental psychopathology perspective of substance use disorders

Genetically-inherited predisposition Dysfunctional brain reward circuits Problematic temperaments Disinhibited (externalizing): more impulsive, aggressive, overactive, low frustration tolerance and low attention. Inhibition and negative affectivity (internalizing): lots of fears, depression, neg thinking, dependence on others. Experiences: dev psychopathology view argues Numerous stressors throughout childhood Inadequate parenting Rewarding substance use experiences Relationships with peers who use drugs Significant stressors

Opioid disorder video:

Got oxy after pregnant w her daughter. Took 2 pills from her coworker. Then kept on increasing then took them orally to injecting them. First time someone uses one they seek for that euphoria. Needle users Clint get the high taking the pills after a bit. Put heroin before her family and thought she can do nothing w out it. Pill addict vs heroin addict same thing. Started w pills then move onto heroin to get the desired effect bc tolerance went up after repeated use. depress CNS . One person was snorting pills before driving a daycare bus.

Video on drinking on college campuses:

Hazing deaths, feeling like need to belong, more you can drink cooler you are, binge drinking has become normalized. Used to be men more likely to binge drink more than women but now the gap is closed. 1 in 4 women sexually assaulted in America and in half cases drinking is present. Parents pass down wrong idea of drinking as it being fun. Hispanic parties more normalized not as much as Americans do parties and bars. binge drinking becoming normalized.

Cognitive-behavioral therapies: Hallucination reinterpretation & acceptance

Help change how clients view and react to their hallucinations ( but schizophrenia is not caused by CBT deficits but can be a useful way of teaching indiviuals to cope with schizophrenia. Combination of behavioral and cognitive techniques Education and evidence about biological causes of hallucinations (psychoeducation) Identification of events and triggers of hallucinations Challenge inaccurate ideas about the power of hallucinations ( cognitive intervention) - tell them a delusion is a thought that you have and have them experiment try not responding to thje hallucination and see what happens. Reattribution and more accurate interpretation of hallucinations Learn techniques for coping with hallucinations ( deep breathing, relation, distraction) ( hallucinations have biological cause so cant eliminate them this helps people get more control over their hallucinations) New-wave cognitive-behavioral therapies Help clients become detached and comfortable observers of their hallucinations and develop more adaptive behaviors while moving forward with their lives More mindfulness based approaches- and that they can accept and learn to live with them rather than respond to them help people gain more control and control hallucinations and reduce delusions. Helps reduce re hospitalization as well Biological treatments can be combined w these CBT treatments These types of approaches often produce helpful results

Treating anorexia nervosa

Immediate goals Regain lost weight Recover from malnourishment Eat normally again Methods: Nutritional rehabilitation- usally offered in day treatment programs Intravenous feedings- eating through a tube only used in extreme cases and can sometimes breed mistrust- placing tube against patients will (but need it to survive). Behavioral weight-restoration approaches- patient get award when behave properly and gain weight but no reward for bad behaviors and losing weight. Combination of supportive nursing care, nutritional counseling, & high-calorie diet- gradually increasing a patient's diet over the course of several weeks. Nursed would monitor patients and try to educate them that the weight gain won't lead to obesity. Motivational interviewing- broad category of intervention- combining empathy and asking people questions to make changes relating to positive behavior. Offered in day treatment programs. Can be offered in out patient setting. Typically gain weight 8-12 weeks (2-3 months) for these treatments to work.

The community approach

In 1963, Congress passed the Community Mental Health Act Passed in response to conditions in mental hospitals as well as the emergence and promise of antipsychotic drugs Ordered that patients with a variety of psychological disorders should be released and treated in the community rather treated institutionally ( horrible facilities) Part of deinstitutionalization process Antipsychotic drugs been around for decade. Said need assertive community treatment- team provides meds, psychotherapy, etc.. Services should be coordinated- like in patient care, hospitals,.... Inadequate quality of community care has created a "revolving door" pattern for many patients- released and then cant fucntion and community and then re admitted to an institution not getting complete care they need... and cycle continues

Institutional care in the early 20th century

In the first half of the 20th century, many patients with schizophrenia were institutionalized in public mental hospitals Primary goals were restraint and providing food, shelter, and clothing Patients rarely saw therapists and were generally neglected (some were abused) By the mid 1950s: Significant overcrowding and understaffing Many developed more symptoms as a result of Institutionalization caused patients to feel ( loss of interest, anger, and irritability, aggressivness) Which caused them to withdraw. Institutions began adopting other approaches Milieu therapy: Based on humanistic principles; milieu must promote productive activity, self-respect, and individual responsibility. (Started calling the residents rather than patients), gives them more power and capability. Tried to apply openers and resents could finally participate in daily activities as well , and set up daily routine that's similar to life outside the hospital. Token economy: Based on behavioral (operant conditioning) principles; patients receive rewards when they behave acceptably. What happens after behavior increases likelihood to do it. Ex: care for oneself and ones possessions, following the rules and speaking normally. Tokens they can use for food, cigarettes, or outdoor time. Concern: Some patients could lie and realized they can say certain things to get a reward. In real world people don't get rewards for doing this behavior, so its questions how well the residents are prepared when they enter the real world.

More info about binge episodes

Incidence 1% develop bulimia nervosa in their lifetime females- 3/4 Generally begins in adolescence or young adulthood (15-20 years old) 5% of adolescent girls develop full syndrome High rate among college students Progression Typically begins during or after a period of intense dieting that earned praise from family members and friends- then start these patterns. Lasts for years with periodic letups Weight fluctuates but typically within normal or overweight - some can be significantly be underweight then meet criteria for anorexia nervosa

Opioids

Include natural (opium, heroin, morphine, codeine) and synthetic (methadone) blended drugs, known collectively as narcotics ( each have diff tolerance and diff effect, spped of tolerance and tolerance level) Morphine, codeine, and oxycodone are medical opioids 86 million people over age 11 have taken medical opioids in past year ( to relieve pain) illicit: problematic use. Injection most common of problematic use. Can be smoked, inhaled, snorted, injected, or swallowed Opioids depress the CNS by attaching to endorphin-related brain receptors: followed by a high can experience a rush like an orgasm and several hours of pleasurable high. mimic endorphins ( bodys natural high)

Substance use disorder: Symptom checklist

Individual displays a problematic pattern of substance use leading to significant impairment or distress ( usually phsyciological symptoms) , as manifested by at least 2 of the following symptoms ( 2 out of 11) within a 1-year period: 1-4 (impaired control category) 5-7 ( social impairment) 1. Substance often taken in larger amounts or over a longer period than was intended 2. Persistent desire or unsuccessful efforts to cut down or control substance use: want to cut down but tried and not able to 3. A great deal of time is spent in activities necessary to obtain, use, or recover from the effects of substance use: out of control 4. Craving, or a strong desire or urge to use the substance: daily activities on how they can use or obtain the substance 5. Recurrent use results in a failure to fulfill major role obligations at work, school, or home: bc of use cant fulfill major expectations 6. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance use:continuing to use substance despite having a lot of interpersonal problems due to the substance. 7. Important social, occupational, or recreational activities are given up or reduced because of substance use : time or money or combo

Psychodynamic Theory (Bruch) on eating disorders

Ineffective parents fail to attend to child's needs: They feed when the child is anxious, comfort when the child is tired, etc. Children of ineffective parents become confused adults who are unaware of their internal needs. People with eating disorders inaccurately perceive internal cues (alexithymia)- unable top label internal experiences- and are more likely to worry about how they are viewed by others.

Sociocultural views ( schziophrenia)

Multicultural factors Racial and ethnic group differences: African Americans are more likely than non-Hispanic White Americans to be diagnosed with schizophrenia; overrepresented in mental hospitals as well More prone to disorder; biased diagnoses ( clinicians more likely to make diagnosis to these minorities) ; misread cultural differences ( interpret cultural differences in ways that are more in proportion with the disorder) ; economic hardship effects ( more economics than have to do w race) Immigrant and native-born population differences Higher prevalence, extending into second-generations Overdiagnoses; stressors unique to immigration; discrimination 4x higher in immigrants than it is in native people. Social labeling: Features of schizophrenia are influenced by the diagnosis- society labels people that don't conform to normal behavior- dangers of having these labels- stigma asspciated w label impairing effect on initial and course of disorder. Family dysfunction: Linked to family stress High expressed emotion: Criticism, disapproval, hostility, and intrusiveness: parents more involved with their kids than other parents. More likely to relapse if their family members demonstrates this period of high expressed emotion. Outcome could be due to reaction of family member w schizophrenia.

Biological view of substance disorders ( nuerotransmitters)

Neurotransmitter-focused explanation of drug tolerance and withdrawal symptoms- take a substance inc activity of neurotransmitters in Brain (calming ones, or inc mood or alertness) for example the brain will stop making these substances brain slows down production of their own neurotransmitter person has to inc substance use to feel the same way (tolerance) bc not relying on own natural biological processes Withdrawal: lower supply of this neurotransmitter and body not producing enough neurotransmitter as it should be. The brain has caught back up so experience withdrawal. Taking a substance increases activity of certain neurotransmitters Drug tolerance and withdrawal symptoms are caused by cutbacks in the brain's production of particular neurotransmitters during excessive and chronic drug use: Lower GABA production: Alcohol or benzodiazepines Lower endorphin production: Opioids Lower dopamine production: Cocaine or amphetamines Reduced anandamide production: Marijuana

Treating bulimia nervosa

Nutritional rehabilitation to eliminate binge-purge patterns and establish good eating habits Cognitive-behavioral therapy tailored to unique features of bulimia nervosa- often tried first because it is so effective Behavioral techniques Diaries- keep track of eating behavior and feelings related to it, helps them identify their triggers and emotions which trigger them to binge. Exposure and response prevention (ERP)- expose people to situations that raise anxiety and typically trigger there binge eating behaviors but restrict them from binge eating and those behaviors. ( used in OCD as well) Cognitive techniques Help clients recognize and change maladaptive attitudes toward food, eating, weight, and shape Teach them to identify and challenge negative thoughts that precede the urge to binge- helps them recognize their perfectionistic standards and low self esteem.

Eating disorder prevention: The Body Project

Originally designed to help high school and college-age women identify Western society's ultra-thin ideal and engage in activities aimed at body acceptance Four weekly group sessions that include verbal, written, role-playing, and behavioral exercises Based on cognitive dissonance theory- idea that we can't have two opposing views at once, so have to resolve it one way or the other. By speaking out against the belief should help them to accept the more adaptive belief. Has been delivered to more than 1 million young women around the world and shown to be effective in many studies

Other treatments for bulimia nervosa

Other forms of psychotherapy in individual or group formats Interpersonal psychotherapy- treatment for depression in other notes Psychodynamic therapy- sometimes used no researc showing its effective. Family therapy- used to supplement the individual treatments. Can be used in a group format. Antidepressant medications Particularly effective when used in combination with CBT Helps patients reduce their frequency of binging and purging- somewhat effective for bulimia. not used for anorexia. Not as effective as psychotherapy but as effective when combined w CBT.

Extrapyramidal effects of the first-generation antipsychotics (motor activity)

Parkinsonian and related symptoms: ( at least half of ppl experience) Muscle tremors and rigidity, among other symptoms. Result of medication-induced reductions of dopamine activity ( in area of brain that controls posture) . Restlessness, agitation, and discomfort. Some times symptoms can be reversed if they take an anti parkinsonian drug. Little facial expression, Parkinson's symptoms. Neuroleptic malignant syndrome: Severe, potentially fatal reaction. Particularly common in the elderly. ( very rare ) muscle rigidity, fever, improper functioning, altered consciousness of ANS. Sometimes give dopamine enhancing drugs to counteract these severe reactions. Tardive dyskinesia: Symptoms emerge later. Includes involuntary writhing or tic-like movements. Can be difficult to eliminate. Ex: mouth, lips, tongue or body. ( seen in 15% of ppl who take the drug). If discovered early than symptoms can be reduced but can be hard to diagnose bc symptoms overlap and ppl think its a consequence of schizophrenia rather than the meds.

Achieving lasting changes in the treatment of anorexia nervosa

Patients must overcome underlying psychological problems for lasting change, typically through a combination of education, psychotherapy, and family therapy Cognitive-behavioral therapy Understand and change the behaviors and thought processes that keep their restrictive eating going Behaviorally: Monitor ties between feelings, hunger levels, and food intake Cognitively: Identify core pathology- deep seeded belief that they should be judged by their shape and weight and they can control that. Teach alternative stress and problem-solving strategies Help recognize their need for independence and control, recognize and trust their internal feelings, change attitudes about eating and weight Often effective; most successful when continued for at least a year beyond recovery and supplemented by other approaches- help many patients restore their weight, correct self esteem, adapt ore adoptive eating attitudes, correct body distortions. psychotherapy, cognitive therapy, and family therapy

Sociocultural perspective of substance use disorders

People are most likely to develop substance use disorders when they are: Living in stressful socioeconomic conditions- also correlates w higher rates of unemployment. In families or social environments that value or tolerate substance use- problematic drinking more common in families w alcohol use or w bad social situations. higher in eastern europe Are confronted regularly by other kinds of stress such as discrimination- have higher rates of substance use. Higher among black, lgbtq and hispanic Americans when working in stressful environments

Hallucinations

Perception-like experiences that occur without an external stimulus: believing u feeling something even though there is nothing there that would trigger that feeling. Most common are auditory- seeing someone on street who is responding to something that is not there. Visual, olfactory- smells , gustatory- food or drink that tastes strange, somatic- feeling smtg happening inside ur body ( like snake crawling inside stomach) , and tactile hallucinations can also occur- touch, feeling things like tinging burning or electric shock like hallucinations.

Combinations of substances

Polysubstance use: When people take more than one drug at a time Synergistic effects: Drugs multiply each other's effects( combined impact) Similar actions (e.g., alcohol with opioids)- both depressants and severly depress CNS which could lead to death. Opposite (antagonistic) actions (e.g., stimulants with alcohol)- concerning bc you may build up lethal amount of drugs in body and liver won't process things efficiently. Each year thousands are hospitalized and die because of polysubstance use

More info on schizophrenia

Prevalence ~1 in 100 people experience schizophrenia during their lifetime Equally distributed between men and women (but age at onset is younger for men) age onset younger for men than it is for women. More frequently found in lower-SES groups- stress of poverty can contribute to disorder, or maybe disorder causes people experiencing it in low socioeconomic status. (Theories) Has significant financial and emotional costs, including increased risk of suicide and physical illness Average lifespan is 10-20 years younger than general population ( life expectancy) Symptoms, triggers, and course of schizophrenia vary greatly; some ppl believe its a group of diff disorders . Commonly co-occurs with substance use disorder- may take substances as a way of self medication or impaired judgement and develop a substance use disorder. Substance use can lead to or exasterbate their schizophrenia.

Sociocultural Theories: Racial and Ethnic Differences ( on eating disorders)

Prior to this century Eating behaviors, values, and goals of women of color in the U.S. were considerably healthier than those of non-Hispanic White American women.- ethnic differences. Ideal white is like s supermodel and blacks not held to those high standards. Research over past two decades Young women of color in the U. S. express body dissatisfaction to the same degree as young non-Hispanic White American women- now increased equal throughout ethnicities

Sedative-hypnotic (anxiolytic drugs)

Produce feelings of relaxation and drowsiness to reduce anxiety and help people sleep Low doses = calming or sedative effect High doses = sleep inducers or hypnotics Barbiturates Widely prescribed for first half of twentieth century; largely replaced bc very addictive. Benzodiazepines Most common antianxiety drugs (e.g., Xanax, Ativan, Valium) Increase GABA activity- bind to gaba receptors, reducing some anxiety that you would feel. Safer and less likely to lead to intoxication, tolerance effects, and withdrawal reactions In high doses, can cause intoxication and lead to sedative-hypnotic use disorder Long term use by elderly can cause severe cognitive impairment: intellectual decline, confusion, and memory loss.

Hallucinogens (psychedelic drugs)

Produce powerful changes primarily in sensory perception ("trips") LSD (lysergic acid diethylamide) lab produced Brings on a state of hallucinogen intoxication (hallucinosis): Increased and altered sensory perception (typically visual perceptions) like blades of grass, psychological changes (hallucinations- see people objects that are not acc present) , and physical symptoms ( tremors) (within two hours of being swallowed).. effects typically wear off after 6 hours Produces these symptoms by binding to serotonin receptors- so produces different emotional symptoms. Tolerance and withdrawal are rare, but the drugs do pose dangers: like a bad trip, experiencing a lot or not very good perceptional, behavioral or emotional reactions and can experience flashbacks, even days or weeks after taking the substance. MDMA (ecstasy, Molly) lab produced Stimulant that produces hallucinogenic effects; provides an energy boost and strong feelings of attachment and connectedness (party drug) Can be dangerous psychologically ( produce immediate feelings of depression, anxiety or memory impairment) and physically( liver problem/ damage .) when taken repeatedly 2.5 million ppl used this year. Inc levels of serotonin and some dopamine then quickly depleted and MDMA repeatedly body's starts to make less serotonin.

Cannabis

Produced from varieties of hemp plants Hashish: Solidified resin of the cannabis plant Marijuana: Mixture of buds, crushed leaves, and flowering tops Major active ingredient: tetrahydrocannabinol (THC) (greater content more powerful the drug) Recreational in 21 states+ guam and DC Medical use 37 states and DC 10% of adolescents and adults smoke at least monthly When smoked or eaten, cannabis produces a mixture of hallucinogenic, depressant, and stimulant effects, known as cannabis intoxication - absorbed faster when smoked than when eaten but bc absorbed faster high doesn't last as long. Low doses: Joy and relaxation; but can become anxious, suspicious, or irritated High doses: Odd visual experiences, changes in body image, and hallucinations, may become confused or impulsive Most of the effects last 2 to 6 hours when inhaled; 12 when eaten

Psychotherapy for schizophrenia

Psychotherapy was rare before antipsychotic drugs emerged- bc level of impairment so great that ppl wouldn't be able to engage that much in therapy. but now bc of antipshyoctic durgs people are more stabilized Today, psychotherapy is more successful in schizophrenia treatment Cognitive-behavioral therapies- cognitive remediation ( focuses on patients, planning and memory, and attention with increasingly more complex tasks. Sociocultural interventions

anorexia Binge-Eating/Purging Type

Recurrent episodes of binge eating and/or purging- gets to low weight through episodes of binge eating and or purging. The amount their binging and purging is still much less sometimes its a normal size meal but bc there so afraid of food it feels like a really big meal.

Course of schizophrenia

Schizophrenia usually first appears between the late teens and mid-thirties Three phases Prodromal: Beginning of deterioration; mild symptoms- person may start withdrawing socially or speaking in odd or weird ways, displaying little emotion, strange ideas. Active: Symptoms become apparent- often triggered by stress, more actively psychotic. Residual: Return to prodromal-like levels- negative symptoms in particular may have Lessing of positive symptoms from active phase Can last from days to years. 1/4 recover fully ( had better pre functioning before onset) (later and abrupt onset treated successfully as well as... ; 3/4 continue to have residual problems Relapses are often more likely during periods of stress

SBRIT

Screening, Brief Intervention, and Referral to Treatment middle of pop risky or harmful use not at stage w substance use disorder but using more than recommended and seeing neg effects bc of that. Screen based os cores then brief intervention ( motovational interview principles) and then referral to treatment if neccessary.

Factors contributing to the failures of the community treatment approach

Shortage of services Inadequate number of community programs are available to people with schizophrenia ( more ppl need services than the services can help) Inadequate services are provided by many programs that do exist Economic factors contributing: Less funding for people with severe disorders Program funding often falls to state and local governments rather than federal gov't that has much more money Poor coordination of services Lack of communication across agencies and settings Community therapists as case managers can help facilitate this- in addition to proving therapy or other kinds of support. many may not have training though to serve in this role and tend to be over loaded with clients.

Developmental psychopathology view of schizophrenia

Similar to diathesis-stress model: Genetic predisposition for the disorder (expressed as a dysfunctional brain circuit) may eventually lead to schizophrenia if the person experiences significant life stressors, difficult family interactions, and/or other negative environmental factors over the course of development Some refinements Schizophrenia typically begins to unfold long before the actual onset of the disorder in young adulthood One key way that the dysfunctional brain circuit may adversely affect functioning is through the circuit's impact on the operation of the HPA stress pathway- leads to overactivity in HPA axis which makes ppl highly sensitive to stress. Also effects on immune functioning. Possibility of prevention (e.g., coping strategies, improved family dynamics)

Biological view of substance disorders (genetic)

Similarity of alcohol preferences among alcohol-preferring animals and their offspring: animal models, some prefer alc more than the others and have those ones mates over other and their offspring prefer alc as well. Alcoholism concordance rate in identical twins (50%) versus fraternal twins (30%)- both rates high but suggests other factors Biological parent-adoptee child alcohol abuse rate higher: adoption studies- sep effects of nature vs nurture- look at biological parent and child who is adopted, adoptees that biological parents abuse all have higher rates of abusing alcohol or substances related to alcohol in adulthood. Abnormal form of dopamine-2 (D-2) receptor gene in people with substance use disorders: majority of ppl have w the disorder.

Sociocultural Theories on eating disorders

Western standards for attractiveness- standards of beauty and body shape, value thin bodies and still a lot of pressure to be thin. Socially accepted prejudice against anyone who does not fit those attractiveness standards- very common, still fat jokes in media, and poor representation of characters that aren't very very thin, a lot of thin privilege in our world. Fiji experiment- didnt have alot of western influence. observing this remote islands really valued feasting and food and having a larger body was seen as valued and attractive. after televsion introudced and observed women saying they wanna look like that, alot of girls binging and purging. Social comparisons: Constantly comparing one's body to others' More than 600 pro-anorexia (or "Pro-Ana") websites "Thinspiration" messages Sharing "tips"

CBT treatment schizophrenia ( cognitive remediation)

biggest fear for those w schizophrenia is that things will get worse and worse. Meds help but don't leave patients free of symptoms. Has a hard time keeping track of his daily routine and goals and where he's going or what he's doing. Proposed brain plasticity to repair the weaker areas of the brain.- by having the braind o exercises to help some of the cognitive symptoms of schizophrenia and the social deficits of this. Exercise where distinguishing between 2 tones. Also how the brain processes emotions and faces. Impairments in brain functioning and need to build up brain functioning capacity. make brain faster and more efficent in making those distinctions. they hope if can intervene early people and get back to work and get back to school and get back to their everyday lives.

Video on residential treatment programs

his friends believed they would catch his mental illness. Says his room made him feel at home. Don't have to worry about being afraid to step outside. Many ppl w schizophrenia can't live in a safe place. When living there he felt safe and less worried. safe space to come home to. help people become a part of a community. Access services that they need is very valuable

Biological treatments for substance use disorders

limited success over long term but better when paired w psychological approach as well. Detoxification: Systematic and medically supervised withdrawal from a drug Withdrawal can be gradual (tapering doses) or induced (give additional medication to block symptoms of withdrawal) Relapse rates high if one does not go on to get another treatment afterwards Antagonist drugs: Block or change the effects of the addictive substance Examples: Disulfiram (Antabuse) for alcohol- if you take when drink its awful make you nauseous and dizzy. So don't want to drink anymore bc of bad reactions( only effective for those motivated enough to keep taking) ; naloxone for opioids- blocks the endorphin receptors in the brain, so if you take an endorphin like an opioid it doesn't make you feel good anymore so then less inclined to keep taking. Also helps w helping stop a fatal overdose. ▪Drug maintenance therapy: Designed to provide a safe, legal, and medically supervised substitute ( often to the illegal drug)- drugs have problematic effects on body but also heroin has dirty needles. Examples: Methadone (safe substitute of heroin) ppl become depended on methadone but then maintained under medical supervision has to be prescribed by methadone clinics . , buprenorphine ( safe alt to heroin and pain killers) - less potent than methadone. Can be prescribes in primary physicians office.

Disorganized thinking and speech (formal thought disorder)

loose associations or derailment: Switch from one topic to another- each sentence picks up one one before it ( joint memos then says I have joints in my body) ( song in my heart, heart attacks part of death ill die at some point) Neologisms: Made-up words that typically have meaning only to the person using them- continue using the word and continually same thing to them and approximated a real world. (retchidism or fim) Perseveration: Repeat words and statements again and again- must stop writing, but I have to finish it, but I need to stop writing. Clang or rhymes: The sounds of words, rather than their meaning, determine the content of one's speech- ex: someone if asked how are you may respond like I'm fine, following a line, its all mine. Incoherence or "word salad": Speech that is severely disorganized and nearly incomprehensible - ex: sheep furiously color cows speaking. Sheep on roof 12 New Jersey . No meaning In it.

Schizophrenia video

managed to stay clear of hospitals for almost 3 decades. Week or more barely eaten, face looked and felt like a mask, made dark in her apartment. .Feels gravity is pulling her down and scared. Diagnosed as chronic schizophrenia and "grave" be in care and do low grade jobs but she didn't follow that, got married as well and is a lawyer. Often have delusion she killed hundreds and thousands of people with her thoughts, sometimes has hallucinations and she describes as a nightmare while your awake. Jumbled words- word salad. One professor helped her and hated she was mechanically retsrained to hospital beds. Doesn't make psychiatric patients feel safe. Head explosions and people trying to kill her asked doc to help them or tell them not to kill her. Works at USC law school. She said in her psychosis that her devils are so terrifying that all her angels have already fled. Had a delusion she was god (grandeur)- shows how terrifying it is.

diathesis-stress model

suggests that a person may be predisposed for a mental disorder that remains unexpressed until triggered by stress

Negative symptoms (schizophrenia)

take away from personality. Alogia: Diminished speech output Diminished emotional expression / restricted affect- blunted affect- less anger, less joy, in situations where u expect someone to experience those emotions. Flat affect- showing no emotion at all, no eye contact. No change in tone. Avolition: Decrease in motivated, self-initiated, purposeful activities- going drained of energy and interest of normal goals, may sit still for periods of time. Asociality: Apparent lack of interest in social interactions- can sometimes be associated w avolition. May be shined from social interactions as well or other ppl pushing them away.

most people with schizophrenia live in

unsupervised living