PSY 358 Exam III Notes
Popular in Abnormal Psychology
Popular in Psychlogy
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Date Created: 02/22/15
Suicide 101 320 14 The facts about suicide 0 Components of depression Tenth leading cause of death in the US US 177 per 100000 males 45 per 100000 females Underreported due to misclassi cation of singlevehicle car accidents 0 WHO estimates that one million people die from suicide every year 16 per 100000 Suicidal ldeation Suicide Attempts and Completed Suicide 0 Range from thoughts to detailed plans Suicidal ideation Sl thoughts of suicide 0 Passive wish to be dead without plan 0 Active thoughts and includes detailed plan Parasuicide super cial cutting and OD on nonlethal medications Previous attempts at suicide increase the risk of suicide 3040 times Who is at risk andor commits Suicide Males vs Females o Males are more likely to actually take action females are more likely to ideate Males are more likely to choose lethal methods hanging guns 0 Risk factors for youth 0 relationships break ups money problems 0 Risk for elderly 0 chronic illness Highest rate among whites and American IndianNative Indians 0 poverty substance use access to health care unemployment Risk factors for Suicide Family history family members across generations have committed suicide Psychiatric illness 90 of attempted or completed suicides are committed by people with mental illness 0 Anorexia is one of the highest mental illnesses that lead to suicide 0 Depression substance abuse Biological factors very low levels of serotonin impulsivity and pathological aggression Understanding Suicide The Aftermath Only 15 to 13 leave behind suicide notes Psychological autopsy interviews with family friends coworkers and health care providers in an attempt to identify psychological causes of suicide Coroner identi es the physical cause of death Impact on those left behind Severity of suicidal ideation Prevention of Suicide Crisis intervention suicide hotlines Focus on highrisk groups children of parents with mood disorders who have attempted suicide themselves Societal level prevention using teacher and peer support Preventing suicidal contagion copycat suicides Use of critical incident debrie ng CID Treatment after Suicide Attempts Deliberate selfharm factor for suicide Psychological intervention Psychosocial intervention Followup psychiatric care Anorexia Nervosa AN A serious condition marked by an inability to maintain a normal healthy body weight 0 Measured by body mass index BMI Based on a person s height and weight Study chart in book Two SubTypes o Restricting vs binge eatingpurging type A person is restricting their energy intake A very visible disorder Symptoms o Intense fear of gaining weight for quotfeeling fatquot Use weight and shape as a measure of selfevaluation Perception of body and size and weight is distorted Restricting or binge eatingpurging subtypes Denial of illness 0 Stop getting menstrual cycle used to be a symptom Most important is extreme perfectionism OOOO Anorexia Nervosa and the facts Affects 1 of the general population 1 out of 100 Females are 3x more likely to develop the disorder Low BMls amp Osteoporosis Begins in adolescence usually after puberty Highest mortality rate of any psychiatric disorder 105x more likely Who s Considered at Risk Segments of the population where emphasis is placed on body shape and weight 0 Actors dancers models athletes etc 0 Personality traits o Perfectionism Obsession Neuroticism Low selfesteem Developmental tasks leaving home for college 0 Worries Comorbidity and AN 0 80 will suffer from major depression 0 Up to 75 will suffer from anxiety disorders 0 Anxiety as a risk factor in the development of AN Bulimia Nervosa BN OOOO o A disorder characterized by recurrent episodes of binge eating in combination with some form of compensatory behavior aimed at undoing the effects of the binge or preventing weight gain Compensatory behaviors o Purging subtype vs nonpurging subtype What one needs to be diagnosed with BN Recurrent episodes of binge eating 0 Experience a lack of control over eating Engage in recurrent compensatory behaviors o Selfinduced vomiting 0 Misuse of laxatives diuretics enemas or other medications Fasting or excessive exercise Some causes of BN Westernized societal emphasis on the quotthin idealsquot culturebound syndrome 0 Environmental exposure 0 Social learning 0 Information sharing ie hearing about it from friends or reading material on the disorder 0 Personality ie lowself esteem perfectionism more impulsive and have higher rates of novelty seeking behaviors Comorbidity and BN 0 80 of people with BN have another psychiatric disorder 0 Most common disorder seen in conjunction with BN anxiety disorders major depression substance use and personality disorders 0 Examples Elton John and Princess Diana Binge Eating Disorder BED o A disorder characterized by regular binge eating behaviors but without the compensatory behaviors that are part of bulimia nervosa 0 Still under investigation 0 Common in people who are overweight and obese found that 5 to 8 of the general population meet criteria What one needs to be diagnosed with BED Recurrent episodes of binge eating 0 Report of distress over binge eating 0 Associated with three or more of the following O 0000 0 Eating rapidly Eating past the point of quotfeeling fullquot Eating large amounts of food when not physically hungry Eating alone due to embarrassment Feeling disgusted with oneself depressed or guilty Often considered a chronic disorder Impact of Gender and Ethnicity Gender 0 0 More common in females than males Reasons quotThin idealquot Objecti cation of the female body In uence of female hormones Males athletes Ethnicity Stereotypes 0 Lack of clear data 0 Need for research with more diverse populations 0 Factors to consider ie SES education level familial in uence 0 Developmental issues to consider Weight problems Prevalence rates in childhood vs adolescence Social 0 leads to social isolation from peers and family Emotional 0 associated with symptoms of depression and anxiety Physical o onset of menstruation percentage of body fat and more mature womanly gures And the brain says Biological factors to consider in the development of eating disorders 0 Role of the hypothalamus Activitybased anorexia Neuroendocrine and neurohormonal factors Brain structure and brain functioning Family genetics OOOO But my thoughts tell me Psychological factors to consider in the development of eating disorders 0 Patterns of family dysfunction Enmeshment o Distorted cognitions Related to body shape weight eating and personal control 0 Society and Culture Western quotthin idealsquot Culture value on beauty The Treatment of Eating Disorders Basic Treatment Goals Anorexia Nervosa o Normalization of eating behavior and weight 0 Increase caloric intake and weight gain Bulimia Nervosa o Normalization of eating 0 Elimination of binge eating and purging Binge eating disorder 0 Normalization of eating 0 Elimination of binge eating 0 Weight stabilization or weight loss 0 Improve psychological factors ie depression selfesteem and self ef cacy Once hospitalized then what 0 lnpatient treatment 0 Multidisciplinary teach approach 0 Maintenance of healthy weight 0 Consideration of other factors ie social support other medical conditions work school suicidal ideation etc o Psychotherapy ie individual group and family 0 Privilege given as result of compliance with treatment 0 Treatment comprehensive plan including quotfoodquot Medication Quick x or longterm results 0 Biological treatment 0 Commonly prescribed 0 Need for medication speci c to symptoms of Anorexia Nervosa o Fluoxetine Prozac Nutritional Counseling 0 Nutritional rehabilitation o Dieticians and Nutritionists specializing in the treatment of eating disorders 0 Nutritional needs for someone with anorexia nervosa o Nutritional needs after assessment of someone with bulimia nervosa o Nutritional needs upon evaluation of someone with binge eating disorder 0 Best utilized in conjunction with other treatments Changing faulty beliefs one step at a time o Cognitivebehavioraltherapy o Focuses on changing one s perception about body shape weight eating and sense of control 0 Addresses both automatic thoughts and core beliefs 0 Replaces negative thoughts and problematic behaviors 0 Use of selfmonitoring Review Behavioral Chain Interpersonal Psychotherapy IPT o IPT o A brief timelimited therapy approach that focuses on decreasing eating disorder symptoms by enhancing social skills in relationships 0 Addresses four problem areas ie interpersonal disputes role transitions abnormal grief and interpersonal de cits Eating Disorders and the Family Unit Familybased interventions o Minuchin s and Palazzoli s views of dysfunctional family system 0 Modern approaches to family therapy 0 The Maudsley Method 0 Effective with adolescents with eating disorders Let s talk about sex Considered a taboo subject and people nd it difficult to discuss because of the intimacy factors Alfred Kinsey Drs William Masters and Virginia Johnson Sexual Functioning Human sexual response cycle Four phases of sexual response 1 Desire phases response to external and internal cues 2 Arousal phase physical and psychology signs of sexual arousal 3 Orgasm phase 4 Resolution phase Men vs Women when it comes to sexual response Sex drive physical andor psychological craving for sexual activity and pleasure Exists equally for men and women Men engage in more frequent sexual activity and tend to think about sex more often than women Women equate sexual desire with a need for emotional intimacy Understanding Sexual Behavior Men are more likely to be exclusively attracted to the same sex Women are more likely to describe themselves as attracted to both sexes The development of sexual orientation is biologically based genetic and prenatal hormone in uences There seems to be a greater erotic plasticity among women more women are identi ed as bisexual than males Gender Dysphoria Sexbiology GenderHow you identify with either male or female Gender Dysphoria when sex and gender don t match Transgender behavior Transsexualism Sex Reassignment Surgery SRS or Gender Reassignment Surgery GRS Take steps to assign there sex to there gender Functional Impairment of Gender Dysphoria Peer rejection Social isolation Negative moods Distress in parents Distress in children for being prevented from engaging in the desired behaviors Sex race and ethnicity factors related to gender Dysphoria Detected between ages 2 to 4 Early signs persistent cross dressing and play Verbal wishes to be of the opposite sex may not happen until 67 Prevalence rates prepubescent vs adolescence Cultural considerations Etiology of gender Dysphoria Biological o Brains of transsexual males similar to heterosexual females has not been replicated o Prenatal hormone imbalances 0 Hormonal condition congenital adrenal hyperplasia CAH complicated condition that can occur in either males or females Too much production of androgen male hormone in both male and female fetuses Male will be hypermasculine and females will have more male characteristics 0 Androgen production Psychosocial 0 Parental rejection parentchild relationship 0 A number of theories exist for the origin of gender dyphoria but no empirical data has supported any of these Treatment options for gender Dysphoria Three phases of treatment 0 Living as desired gender for at least two years 0 Hormone therapy 0 Sex reassignment surgery SRS also known as gender reassignment surgery GRS Surgery Male to Female Female to Male and surgical outcomes 0 Some women may get their breasts removed orjust bind them and leave the bottom half the same Psychological 0 Attention and reinforcement of samesex activities 0 Behavioral approach with rewards and punishment Seen in individuals who do not believe they should be thinking these thoughts or parents with their children Sexual Dysfunctions Absence or impairment of some aspect of sexual response also includes ability to enjoy pleasure that causes distress or impairment 0 Happens consistently Factors that contribute to sexual performance age sex culture life circumstances illness or separation from sexual partner 0 Older adult experiencing sexual dysfunction is different than a 25 year old experiencing sexual dysfunction To desire or not sexual interestdesire disorders 0 Sexual desire interest in sexual activity or objects or wishes to engage in sexual activity 0 Diminished or absent interest in sexual activity 0 Factors associated with decreased sexual desire 0 Low sexual satisfaction 0 Another sexual dysfunction can have one disorder that can lead to another one Ex Pain associated with sex will have a decreased desire for sex 0 Negative thoughts about sex and sexuality trauma history related to sex or grew up in a conservative house where sex is not talked about or is referred to negatively 0 Depression or anxiety 0 Relationship discord in a bad place in your relationship so you have a decrease in sexual desire Sexual arousal disorders 0 Female sexual interestarousal disorder 0 Psychological reasons vs physiological reasons or both 0 75 of women report sexual arousal disorder to their gynecologist Male erectile disorder 0 Persistent and recurrent inability to maintain an adequate erection until completion of sexual activity Every once in a while because a male is tired stressed or drunk is not the disorder 0 Signi cant distress andor interpersonal difficulty Hypersexual disorderread in book Orgasmic Disorders 0 Female orgasmic disorder 0 Persistent and recurrent delay or absence of orgasm following the normal excitement phase 0 Important to consider age adequacy of sexual stimulation and sexual experience 0 More common in younger women than older women 0 Male orgasmic disorder 0 Delayed ejaculation or the delay of or inability to achieve orgasm not as common as premature ejaculation Premature ejaculation o Consistent ejaculation with minimal sexual stimulation 30 of men also known as rapid ejaculation Less than 1 minute More common than male orgasmic disorder Sexual pain disorders 0 GenitoPelvic painpenetration disorder men involved in anal intercourse o Consistent genital pain associated with sexual intercourse o 35 of men report this 0 14 of gay men report this Vaginismus o Unwanted involuntary spasms of the vaginal muscles that interfere with intercourse or any attempt at vaginal insertion o 72 of women report pain with sex How do sexual disorders impact individuals 0 Both individuals sexual wellbeing is affected 0 Sexual functioning vs overall functioning Sexual difficulties are common Impacts selfesteem sexual relationship but not always quotoverall relationshipquot 0 Only less than 19 of people seek treatment 0 People don t know that what they have is considered a dysfunction Etiology of sexual disorders 0 Biological O O O O O O 0 Hormonal imbalances hypothyroidism or hypogonadism Menopause decrease levels of estrogen Decrease in testosterone levels beginning in the 305 to 405 Physical disorders cardiovascular disease hypertension diabetes kidney failure and cancer Androgens Alcohol and drugs Antidepressants SSRls Psychosocial O 0000 CO Depression Anxiety Stress quotPerformance anxietyquot Classical conditioning repeated experiences involving the need to ejaculate quickly Couple distress and negative life events Environmental factors Aging Treatment of sexual disorders 0 Biological o Testosterone replacement therapy injection patch or gel 0 SSRls increase sexual desire but impair sexual performace 0 Media and advertisements Viagra Levitra and Cialis o Penile implants 0 Vacuum Devices Psychosocial 0 Sex therapy 4 steps 0 quotStopSqueeze technique 0 Directed masturbation 0 Systematic desensitization with the use of differentsized vaginal dilators CBT to challenge irrational beliefs 0 Sensate focus 1 couple engage in pleasant touching that is not sexual back rub 2 3 intercourse both partners in tuned with what feels good Paraphilic Disorders lntense persistent and frequently occurring sexual urges fantasies or behaviors that involve unusual situations objects or activities 0 Association with criminal activity Considered unusual or quotout of the normquot Sexual Arousal toward Nonhuman Objects Fetishistic disorder 0 Fantasies urges or behaviors that involve nonliving objects not limited to female clothing used in crossdressing O 0 Person is not sexually attracted to the person in the clothes but the clothes itself 0 Most common 0 Female underwear stocking footwear or other apparel Transvestic disorder 0 Sexual arousal in men that results from wearing women s clothing and is accompanied by distress and impairment Occurs only among heterosexual men Sexual Arousal toward children and noncesenting Individuals Exhibitionistic Disorder exposure of one s genitals to unsuspecting viewers Voyeuristic Disorder seeing an unsuspecting person naked undressing or engaging in sexual activity Frotteuristic Disorder rubbing against a nonconsenting person Pedophilic Disorder sexual urges fantasies or actual behavior directed toward a prepubescent child Sexual Arousal lnvolving Suffering or Humiliation of Oneself or Others 0 Sexual masochism disordersexual arousal as a result of being humiliated beaten bound or otherwise made to suffer pain 0 Examples whipped spanked oxygen depravation Sexual sadism disorder in iction of pain or humiliation but in this case the physical or psychological suffering is in icted on another person 0 Found primarily in males 20 males to 1 female Paraphilia Disorders and the Facts 0 People usually have more than one 0 There is no cookiecutter pro le 0 They are described as welladjusted successful and above the norm The Facts about Sex Ethnicity and Development 0 Most people with paraphilic disorders are male 0 Sexual masochism disorder is found in women but males attribute to 20 to 1 ratio 0 Women prefer less pain during sexually masochistic activities Onset begins from age 7 to 38 with 16 being the average age for paraphilic disorders 0 Cultural implications The Causes of Paraphilic Disorders 0 Unknown 0 Behavioral component with conditioning one engages in a paraphilic disorder and achieves sexual release therefore the behavior is likely to be reinforced due to experience of pleasure Lack of data to support biological or psychological reasons Biological Treatment options to consider 0 Past treatment of surgical castration although is no longer used Medications SSRls and antiandrogens 0 Examples of testosteronelowing medications 0 Just How Severe is the Problem 0 Substance uselow to moderate use of a substance that doesn t involve impairment of functioning Substance intoxication acute effects of substance use 0 The person can quotcome downquot and it is reversible quotLicitquot Drugs Legal Drugs Caffeine A CNS stimulant that boosts energy mood awareness concentration and wakefulness 0 Can be consumed safely in moderation Most frequently used drug 0 Impact on neurotransmitters Long half life can feel the effect 6 hours after the dose But it s only caffeinefunctional impairment 0 Consumption is socially accepted 0 Health effects headaches mental disorders reproductive problems cancer and psychiatric disturbances Caffeine intoxication Caffeine withdrawal Epidemiology of Caffeine Most widely used drug universally accepted 0 80 of the world s population consumes it daily 0 87 of the US population 0 Sodas 2 to 5 mg to 60 mg of caffeine per ounce Coke vs Mt Dew o Lattes over 20 mg per ounce o Espresso 50 mg per ounce 0 Energy drinks 10 mg to over 100 mg per ounce quotLicitquot Drugs Legal DrugsNicotine A highly addictive component of tobacco that is considered to be both a stimulant and a sedative Methods of delivery cigars pipes smokeless tobacco Rapid effects 0 Relief from tension 0 Social implications 0 Physical effects 0 Impact on neurotransmitters It s So Difficult to StopNicotine and Functional Impairment Use leads to addiction Withdrawalcravings Largest preventable cause of death in the world 0 Impact on health Complications related to pregnancy Epidemiology of Nicotine Trends in declines in the number of people who smoke 0 Currently 453 million adults and 3 million teens smoke 215 of adult men smoke Impacts all SES levels quotLicitquot DrugsAlcohol 0 Also termed ethyl alcohol Depressant Absorbed by the stomach and intestines into the bloodstream Just One More DrinkAlcohol and Functional Impairment Withdrawal symptoms and cravings o Delirium tremens 0 Alcohol cirrhosis WernickeKorsakoff syndrome 0 Fetal alcohol syndrome FAS Epidemiology Sex Race and Ethnicity of Alcohol 0 Most common psychoactive substance 0 More common among males 693 vs females 255 0 Heavy drinking de ned as more than 5 drinks a day 0 Men are more at risk but women are much more susceptible to the risks from drinking 0 Alcohol abuse is higher among whites 0 Alcohol dependence is higher in whites Native Americans and Hispanics than Asians Illicit DrugsMarijuana Derived from Cannabis Sativa THC active ingredient in Marijuana Leaves can be used in food drink or smoked Activation of the brain s reward system Marijuana and Functional Impairment 0 Persistent memory loss impairment of attention learning skills and motor movement Addiction 0 Physical health problems Medicinal purposes Withdrawal symptoms Epidemiology of Marijuana 0 Most frequently used 148 million users 0 More common among males 83 vs females 43 0 Average age of rst use 18 years of age quotIllicit DrugsquotCNS Stimulants Amphetamines o stimulant drugs that prolong wakefulness and suppress appetite o Ecstasy 0 Crystal Methamphetamine Form of meth that produces longer physiological reactions 0 Common effects Euphoria Increased energy Alertness Rapid speech 0 Three preparations of amphetamine Inject it or take a pill Functional Impairment and Epidemiology of CNS stimulants Currently 12 million Americans age 12 and up are users 0 Prevalence equal among both males and females 0 Causes increased heart rate and blood pressure Damage blood vessels in brain causing stroke 0 Development of psychotic symptoms Tolerance develops rapidly Greater use among whites Over time users become violent and aggressive Illicit DrugsCocaine Derived from leaves of coca plant 0 18005 a legal additive to cigars cigarettes and Coca Cola Used as a painkiller Powder form vs rock form Functional Impairment and Epidemiology of Cocaine Currently 14 million Americans age 12 and up users 0 Highly addictive 0 Used more by males 189 0 Impact on the neurotransmitters Dopamine Anesthetic and convulsant effects 0 Prevalence rates 0 American Indians 20 0 African Americans 16 o Whites 08 o Hispanics Native Hawaiian or other Paci c Islanders 02 o Asians 02 Illicit DrugsSedative Drugs 0 Two classes 0 Barbiturates sedatives that act on the GABA system in a manner similar to alcohol 0 Benzodiazepines sedatives that can be responsibly and effectively used for the short term but still have addictive properties Routes of administration 0 Effects of sedative drug use 0 Common barbiturates o Amobarbital Pentobarbital and Secobarbital Common benzodiazepines o Valium Xanax and Halcion Functional Impairment and Epidemiology of Sedative Drugs 0 Can result in oversedation 0 Problems in thinking and interacting with others Tolerance 0 High potential for overdose 0 Death 0 Withdrawal symptoms similar to alcohol withdrawal symptoms 0 Most common users 0 59 women o Anglo 0 Higher levels of education Illicit DrugsOpioids Derived from opium poppy such as heroin morphine and codeine Used to treat physical pain Synthetic methadone Routes of administration Effects of opioid use Impact on neurotransmitter endorphins Functional Impairment and Epidemiology of Opioids Tolerance develops very rapidly 2 to 3 days Ways of administration Withdrawal symptoms 18 of substance abuse treatment account for opioids use 843 involved heroin use Dangers associated with opioid use Illicit DrugsLSD and Natural Hallucinogens Hallucinogens drugs that produce altered states of bodily perception and sensations intense emotions detachment from self and environment and for some users feeling of insight with mystical or religious significance Dlysergic acid diethylamide LSD a synthetic hallucinogen rst synthesized in 1938 Psilocybin magic mushroom Mescaline a product of the peyote cactus Functional Impairment and Epidemiology of LSD and Natural Hallucinogens Psychological symptoms emotional swings panic and paranoia Hallucinogen persisting perception disorder 0 More common among males 0 Not considered addictive 0 Do not produce withdrawal symptoms Illicit Drugsnhalants o Inhalants vapors from a variety of chemicals that yield an immediate effect of euphoria or sedation Can cause permanent damage to all organ systems and the brain 0 Include the following Functional Impairment and Epidemiology of Inhalants Chronic exposure can cause damage to all vital organs Nerve damage and neurological problems 0 Muscle spasms and tremors Changes in brain structure by MRI
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