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Date Created: 08/21/14
EXAM3 STUDY GUIDE REMEMBER THIS IS JUST A GUIDE TO ASSIST YOU IN YOUR STUDY ALL INFORMATION PRESENTED IN THE BOOK AND LECTURES ARE FAIR GAME ADVICE FOR STUDYING 1 Be able to describe the various topics in your OWN words 2 Apply examples to various topics Lectures 14 Smoking and Tobacco Use Part 1 Deaths related to smoking most preventable cause of death in the world CDC estimates more than 480000 people die each year in the US from tobacco use including second hang smoking Approximately 1315 people die each day in the US from tobaccorelated causes Including secondhand smoke 0 causes nearly 42000 deaths each year among adults in the US 0 7333 annual deaths from lung cancer 0 33951 annual deaths from heart disease Life expectancy and smoking smoking takes off at least 10 years from your life History of smoking and tobacco use readymade cigarettes were massproduced starting in the 1880s it was not popular until the 20th century smoking increased during WW1 and the 19205 How smoking affects the body 2nd most ef cient way of getting drugs in body the first being directly injecting into blood stream Nicotine o Affects both the CNS and PNS 0 Can be found in the brain 7 seconds after smoking 0 Halflife is 3040 minutes 0 Increases metabolic level and decreases appetite Carcinogens agent directly involved in causing cancer 0 Tar is a watersoluble residue 0 Acrolein and formaldehyde cause cell damage 0 Nitric acid and hydrocyanic acid are gases formed from smoking that affect oxygen metabolism Who smokes demographic risk factors Men smoke more often than woman American Indians have highest rates of smoking Asian Americans have the lowest Older adults have low smoking rates low income people as well as those with low education levels have high smoking rates young adults have highest smoking rates among any age group 67 of middle school students smoke 233 of high school students smoke Health Consequences Cancer leading cause of smokingrelated deaths smoking causes about 90 of all lung cancer deaths smoking increases risk of lung cancer 2526 times Cardiovascular disease 2nd largest cause of smokingrelated deaths risk is doubled for smokers even people who smoke fewer than 5 a day can have early signs of cardiovascular disease Chronic Lower Respiratory Disease 0 Chronic bronchitis formation of scar tissues in the bronchi o Emphysema scar tissues and mucus obstruct respiratory pathways and air is trapped in the alveoli 0 Tobacco smoke can trigger asthma attacks and make them worse 0 Smokers are 1213 times more likely to die from COPD chronic obstructive pulmonary disease than nonsmokers 0 810 COPD deaths are due to smoking Passive smoking environmental or secondhand smoke also called environmental tobacco smoke or second hand smoke has been linked to lungbreast cancer heart disease CVD and respiratory problems in children 0 Increase risk of sudden infant death syndrome SIDS o Linked to cognitive and academic de cits in children as well as behavioral problems 0 Affects fetal growth for pregnant women greater respiratory symptoms Smoking during pregnancy fertility problems greater risk of miscarriage can cause problems with the placenta premature and or low birth risk factor for SIDS birth defects such as cleft life or cleft palate Economic costs of smoking Total costs 289 billion Direct medical care 133 billion Lost productivity 156 billion Lectures 15 Smoking and Tobacco Use Part 2 Why d o people start smoking Genetics may increase risk of trying cigarettes at least once maybe due to personality teens at a high genetic risk transitioned quickly from trying cigarettes to becoming regular heavy smokers genetic variations increase peoples vulnerability to become and remain smokers it may also interact with smoking to predict disease 0 Identical twins are more likely to both decide to smoke than fratemal twins Social pressure teens may be encourage to smoke by their peers to fit in with social groups or what they see in moviesmedia they are also more likely to start if they live with a smoker Advertising curiosity 0 Including what factors impact a teens decision I Antismoking ads are not effective they find smoking ads appealing Weight control this appeals to young women with weight related anxieties but is not limited to females only Why do people continue smoking Nicotine is addictive Smoking and Addiction 0 How many cigarettes does it take I 100 0 Role of learning I cues in the environment are conditioned to drug use get conditioned to want to smoke during certain mood states I pathological overlearning o Incentive sensitization liking vs wanting Positive and Negative reinforcement know these concepts 0 Positive pleasure from the smell feelings of relaxation enjoy the aroma manipulation of hands gratifying 0 Negative avoiding withdrawal symptoms to cope with stress and boredom Optimistic Bias smokers believe they personally have a lower risk of disease and death than other smokers and rank their brand of cigarettes as safer than others Fearing weight gain women with weight concerns are more likely to smoke than those without weight concerns when smokers quit they tend to gain weight men moreso than women Quitting smoking How many attempt how many successful 0 44 try to quit each year and 64 of those try so without treatment 0 60 are successful lasting about 7 years Who has the hardest time quitting 0 Young smokers women and lower educated smokers Smoking Interventions and Prevention Strategies to deter smoking 0 Informationeducation alone does not deter people from smoking programs that combine info with building skills on how to refuse to smoke are more successful mass media campaigns are effective in the shorttern 0 Increasing prices Pharmacological approaches nicotine replacement gum inhalers patches 0 Drugs like Chantix varenicline and bupropion which work by reducing withdrawal symptoms and making smoking less reinforcing if one does smoke o Are they effective I Drugs are effective for many but not for teenagers PsychologicalInterventions 0 Cognitive behavioral approaches group therapy motivational interviewing enhancement behavior modification and contracts 0 Most effective are programs including both a counseling component and a pharmacological component Community campaigns such as smokefree workplaces randomdigit dialing smokers has also been shown to reduce smoking rates Relapse and Relapse prevention common and 22 of people who relapse actually smoke at a higher rate after relapse selfquitters have high relapse rates Those who quit without professional aid have higher chance of relapsing Behavioral relapse prevention techniques are most important 13 months after quitting when vulnerability to start smoking again is high Benefits of quitting reduces mortality by 36 quitting smoking by age 35 adds 78 years of life expectancy reduced coronary heart disease risk within 12 years of quitting women who stop smoking during pregnancy also reduce their risk of having a low birth weight baby Lecture 16 Alcohol and Drug Use Part 1 Know the history of alcohol consumption alcohol consumptions has gone down considerably compared to the 1800 s when it was at its peak 1825 students die from alcoholrelated unintentional injuries By age 15 more than 50 of teens have had at least 1 drink More adolescents drink alcohol than smoke cigarettes or use marijuana Alcohol Use Disorder know generally what it is not all the DSM5 criteria Problematic pattem of alcohol use leading to clinically signi cant impairment or distress as manifested by at least two of the following occurring during a 12month period What does tolerance mean Need for markedly increase amounts of the substance in order to achieve desired effect markedly diminished effect with continued use of the same amount of the substance What does withdrawal mean When does it develop Characteristic withdrawal syndrome of the substance the same or similar substance is taken to avoid or relieve withdrawal symptoms Health consequences What are the effects of alcohol on the brain including at what dose 0 At lower levels alcohol stimulates certain brain cells and activates the brains pleasure areas 0 At higher levels alcohol depresses brain functioning o BAC of 08 intoxicated BAC of 35 leads to unconsciousness and potential of death Neurological damage 0 What is Alcohol amnestic disorder Korsakoff s syndrome I Neurological disorder caused by a lack of thiamine vitamin B1 in the brain that leads to amnesia lack of insight apathy minimal content in conversation 0 Alcohol withdrawal delirium can cause hallucinations tremors etc Cardiovascular heavy drinking chronic or binge can interfere with oxidation of fatty acids primary fuel source of heat heart will directly metabolize alcohol impairing functioning increased risk of irregular heartbeats due to reduction in heart contractions related to hypertension and stroke 0 Among heavy drinkers women are more susceptible to alcohol related heart disease than men even though women drink less alcohol over a lifetime than men Cancer 0 Mouth pharynx esophagus colon rectum liver breast Fetal Alcohol Syndrome growth mental and physical problems that may occur in a baby when a mother drinks alcohol during pregnancy Indirect consequences Societal consequences of chronic alcohol use 0 Lost work homelessness health care costs suicide rates DUI costs including deaths crime Benefits of alcohol use Light or moderate drinking may 0 Reduce mortality 0 Lower heart disease deathsrisk of developing type 2 diabetesrisk for ulcers and digestive tract cancersrisk for alzheimer s disease Causal factors in alcohol use disorders as well as other drugs including Biological factors 0 Neurobiology mesocorticolimbic dopamine pathway center of psychoactive drug activation in the brain 0 Genetics and who it affects most I Although strong genetic in uences precise relationships are not well understood I Geneenvironment interaction leaming must play an important role 0 Must be exposed to the substance parental use peer pressure etc 0 Environments that promote initial and continued use I May play a role in developing sensitivity to the addictive power of alcohol or personality traits associated with substance misuse I Having an alcoholic parent increase the risk of alcoholism Psychosocial 0 Parenting I Lack of stable family relationships and parental guidance I Lack of parental monitoring I Chaotic environments I Family involvement and parental monitoring can serve as a protective factor even when other risk factors are present 0 Psychological factors I Comorbidity with antisocial personality disorder depression anxiety and schizophrenia all increase the risk of developing alcohol use disorders I Personality there could be a certain personality type that increases sensitivity to the addictiveness of alcohol 0 What is the tensionreduction hypothesis including who is at greatest risk for alcohol problems Alcohol abusers tend to be unable or unwilling to tolerate tension and stress and many people expect that alcohol use will lower tensionanxiety and increase sexual desire and pleasure in life Adults with less intimate and supportive relationships tend to show greater drinking following sadness or hostility 0 Alcohol Myopia a state of shortsightedness in which superficially understood immediate aspects of experience have a disproportionate in uence on heavier and emotion a state in which we can see the tree albeit more dimly but miss the forest altogether Insightful cognitive processing is compromised which then alters thoughts related to the self stress and social anxiety 0 Social Learning Theory alcohol use is a leamed behavior that can be unleamed with positivenegative reinforcement and modeling Socioculturalconsiderations 0 Social events in westem culture often revolve around alcohol 0 The incidence of alcoholism is minimal among Muslims and Mormons whose religious views prohibit use of alcohol 0 Incidence of alcoholism is high among Europeans 15 in France Lecture 17 Alcohol and Drug Use Part 2 Be familiar with the different classes of drugs including Typical effects for each type of drug we discussed in class 0 Sedatives initially praise for medicinal value I relieves pain anxiety and tension I depress the CNS helps relax muscles I attaches to dopamine receptors which leads to feelings of euphoria I euphoric spasms highpleasant relaxation lethargywithdrawn I Physical effects 0 nauseavomiting tolerancewithdrawal risk of overdose secondary health risks I Social effects 0 Functional impairment legal difficulties affiliation with deviant peers narcotics subculture 0 Drug interactions speed balling using two needles at once I Neurological leaming slowed reaction time cognitive processing impulse control problems 0 Powerful depressant of CNS induce relaxation and sleep psychological amp physical dependency antianxiety med high abuse potential ex Valium Xanax roofies o Stimulants I euphoria confidence alertness excitement 0 Side effects headache dizziness restlessness 0 Health consequences increased BP suppresses appetite result in heart attacks or strokes impaired judgment secondary health risks I helped people stay alert during night shifts helped soldiers battle fatigue prescribed as a last resort for weight loss and narcolepsy 0 Side effects psychologically and physically addictive pushes person to a state of hazardous fatigue psychosis I cts like cocaine but low doses I acts like cocaine one of the most dangerous illegal drugs 0 Hallucinogens distorts sensory images I 2 most potent hallucinogen lasts 89 hours change in sensory perception mood swings feelings of depersonalization and detachment bad trips and ashbacks I has both hallucinogenic and stimulant properties rush feeling of calm energywellbeing intensified feelings colors sounds empathy sensation of understanding and accepting of others 0 Marijuana hallucinogenic effects not as extreme mild euphoria sense of well being pleasant relaxation intensi cation of senses distorted sense of time short term memory deficits and impaired coordination may magnify negative moods Potential consequences of chronic use 0 Cocaine psychosis o Methamphetamine withdrawal can be severe destroys dopamine receptors permanent damage to cognitive ability psychotic behavior extreme weight loss dental problems worsens progression of HIVAIDs o Ecstasy liver kidney and cardiovascular system failure memory impairment and more severe organic brain problems Role of classical conditioning in heroin overdose when a person that is shooting up does it at their usual spot with the same environmental cues their bodies get ready for the rush of heroin and their tolerance goes up however if they do it in a new area their body is not ready for it which leads to an overdose Why is it difficult to estimate prevalence rates for drug use disorders most people with these disorders don t seek treatment What is the role of the MCLP system in drug use ie reward pathway These areas are rich in dopamine receptors and are the ones that are activated when a person takes drugs Changing alcohol and drug use Spontaneous remission disease disappears without treatment Harm reduction approach providing sterile needles for drug users or encourage designated drivers Controlled versus abstinence a problem drinker controlling the amount they drink versus completely giving it up Treatment for substance use disorders Preventing drug use ineffective programs are those who rely on scare tactics moral training factual information about risks effective programs are life skills training resist social pressure Medications antabuse and naltrexone methadone and buprenorphine etc o Antabuse amp Naltrexone block the desire to drink 0 Valium amp diazepam lower the side effects of acute withdrawal AA CBT MI 0 AA selfhelp group that provides emotional support close counseling spiritual development is key addiction is a disease that cannot be cured o CBT coping with cravings managing thoughts about drug use drug refusal skills problemsolving planning for lapses seemingly irrelevant decisions 0 MI motivational interviewing using what the client says to develop discrepancies cognitive dissonance and eliciting selfchange talk What was Project MATCH attempting to match a patients treatment with their particular personality characteristics and their varying degrees of severity results discovered it doesn t make a difference Relapse most relapses occur within 90 days of end of treatment program after 12 months only 35 are still abstinent continued treatment and followups may prevent relapse What is meant by relapse prevention Helping a patient remain off a certain substance Lecture 18 Eating and Weight Part 1 Factors in weight maintenance 3 factors 1 Calories eaten 2 Calories used in basal metabolism resting metabolism 3 Calories expended through physical activity Metabolic rates differ from person to person Neurotransmitters and hormones o Leptin protein that signals when more food is needed 0 Insulin hormone that helps the hypothalamus understand when we have eaten enough food 0 Ghrelin hormone that stimulates appetite and decreases metabolism 0 Serotonin appetite suppressant Experimental studies on Starvation and Overeating Particularly the implications of such research 0 Starvation experiment results showed that too much weight loss leads to irritability and aggression preoccupation with food body slows metabolism down to adjust for caloric restriction I When it came time to regain the weight they all gained it back and some became slightly overweight many still had an obsession with food 0 Overeating experiment prisoners were instructed to gain 2030 pounds at first they gained it easily but required greater caloric intake to keep gaining weight I Showed that too much eating leads people to become uninterested in eating normal weight individuals have trouble increasing their weight substantially and even if they do they have trouble maintaining it What is obesity Regarded as a state of excessive chronic fat storage Including trends 0 O O O 0 Prior to 1920s thinness was unattractive 1980s1990s saw a 50 increase 33 of adults are obese 34 are considered overweight Rates of obesity in children are lowerl0 but still troubling Explanations for recent increases in obesity increased consumption of fast food and sodas growing portion sizes and decrease in physical activity What is BMI body mass index Cutoffs O O Overweight 25299 Obese 30 Problems with such a measure Doesn t differentiate between somebody who is overweight due to muscle mass or fat What is Binge Eating Disorder characterized by excessive eating during a discrete period of time and a feeling of lack of control over eating person has marked distress about binge eating and associated with being overweightobese Obesity and health consequences being slightly overweight is not too much of a health risk but obesity is a mortality risk risk of migraines sleep apnea and colon cancer There is also a chance of developing type 2 diabetes high blood pressure heart disease and stroke Economic costs of obesity estimated annual medical cost of obesity is 147 billion Theories of obesity Setpoint model strengths and limitations 0 Posits that weight is regulated around an internal point a set point and it s hard to deviate from this point Genetic Explanations strengths and limitations 0 O O Obesity runs in families however it might just be due to shared eating habits Studies show that weight BMI and fat distribution are heritable Likely the result of many genes that interact and affect things like one s setpoint system Positive incentive model strengths and limitations 0 Positive reinforcements of eating encourages people to eat more I Personal pleasure social context and biological factors Other causal factors Family in uences O 0 High fatcalorie diets Leamed habits of eating to decrease mood or increase positive mood Stress and comfort food eat to feel better Dieting and weight loss approaches know all 0 Dieting safest way to lose weight is to combine healthful eating and exercising 0 Restricting certain types of food for example carbs fats eating only liquids Diets that don t restrict certain categories of food but focus on increasing fruits and veggies are good choices 0 Behavioral modi cation programs these programs focus on eating and exercising keeping a daily dairy of food and exercise can help individuals lose weight often involve weekly meetings including advice n nutrition 0 Exercise this alone is not an effective way to lose weight pairing this with dieting however is effective 0 Drastic methods drugs surgeries liposuction fasting laxatives Negative side effects to dieting Drugs could have serious side effects psychological consequences crash diets can negatively impact your health Lecture 19 Eating and Weight Part 2 What are eating disorders Characterized by a severe disturbance in eating behavior intense fear of becoming overweight and fat Whats the difference between Anorexia and Bulimia o Anorexic people are usually severely underweight while bulimics are usually at a normal weight or overweight Eating disorders and men 10 of people with eating disorders are men males exhibit similar symptoms to females more likely to have a history or being overweight before their ED develops Health consequences of Anorexia and Bulimia 0 Anorexia death from heart arrhythmias kidney damage renal failure amenorrhealow testosteronedry skin brittle hair and nails yellow skin susceptibility to cold low BP vitamin B1 de ciency osteoporosis 0 Bulimia electrolyte imbalances muscle cramps and weakness anemia low red blood cell count alkalosis high levels of alkaline hypoglycemia when eating large quantities of sweets hypokalemia low potassium damage ot hands throat and teeth from induced vomiting Including mental health cormorbidity 0 very commonly overlap with depression OCD substance abuse disorders personality disorders selfharm behaviors anxiety disorders Course and outcomes of eating disorders 0 after 21 years 0 51 fully recover o 16 are dead 0 10 not recovered o 21 partially recovered 0 Anorexia suicide is 2nd highest cause of death 323 attempt suicide 0 Bulimia 70 tend to recover 2530 attempt suicide Cultural considerations including ethnicity differences eating disorders not limited to westem culture being Caucasian is a risk factor being African American is a protective factor Biological casual factors know all 0 Genetics 0 Risk of AN for relatives with AN is 114 times greater 0 Risk of BN for relatives with BN is 37 times greater 0 Twin studies suggest that both AN and BN are heritable 0 Setpoint 0 Weight that our bodies try to defend patients with BN may experience impulses to binge after attempting to fall below their set point 0 Neurotransmitters serotonin is related to appetite and feeding Sociocultural casual factors know all 0 Peer and media in uences 0 Magazine models diet advertisements Barbie Thin ideal current thin ideal does not characterize all of US history nor all cultures Social contagion of binge eating in one sorority binging was associated with popularity Proana websites encouraging anorexia 0 Family high parental expectations other family members dieting or eating habits Individual Risk factors know all 0 AN and BN more frequent in women than men 0 Intemalizing the thin ideal buying into the notion that being thin is highly desirable 0 Perfectionism relentless pursuit of the perfect body 0 Negative body image perceptions of how fat one is Treatment of eating disorders anorexia and bulimia 0 Why is treating ED very difficult hint How often do the actual patients seek treatment 0 Patients are often very con icted about getting well Approximately 17 with severe eating disorders have to be committed to a hospital for treatment against their will and many that do go in for treatment drop out Hospitalization also often means that they will encounter other people with EDs that are thinner which could lead to competitions There are also websites that actively support anorexic or bulimic behavior 0 What are types of treatment for AN 0 Immediate goals I Restore Weight to a level that is no longer lifethreatening 0 IV feeding feeding tubes 0 Monitoring of caloric intake I Medication 0 Antidepressants and some antipsychotics are supposed to help with distorted thinking however there isn t strong evidence to support this belief o Family Therapy I Treatment of choice among adolescents I 1020 sessions over 612 months I Important aspects include 0 Use family to help build healthier eating habits teach family how to provide appropriate support deal with other family issues Patients that use this form of therapy show 7590 full recovery 0 CognitiveBehavioral Therapy I Change maladaptive behaviors and thoughts I Treatment length recommended for 12 years I Primary focus is on challenging and changing maladaptive cognitions 0 Poptarts ruin diet get fat social consequences 0 Poptarts 320 calories normal Weight attractive I Not as successful as family therapy and perhaps higher relapse rates 0 What are types of treatments for BN 0 Antidepressants or other medications o Cognitivebehavioral therapy main focus is on normalizing eating patterns and restructuring maladaptive patterns of thinking 0 Regular eatingstop purging 0 Alternatives to binge eating 0 Examining food avoidance 0 Challenging dysfunctional thought patterns 0 Preventing relapse I Better outcomes for AN and generally leads to symptom improvement Lecture 20 Exercising and Health Types of exercises 0 Isometric contracting muscle against an immovable object o Bene t can improve muscle strength 0 Example pushing against a solid wall 0 Isotonic contracting of muscles and the movement of joints 0 Bene t can improve muscle strength and endurance 0 Example weight lifting 0 Isokinetic exercise moving muscles and joint against resistance 0 Bene t important in physical rehabilitation 0 Anaerobic short intensive bursts of energy with no increase in oxygen use 0 Bene t can improve speed and endurance 0 Example short distance running 0 Aerobic exercise that involved increased oxygen use 0 Bene t works out both respiratory system and cardiovascular system 0 Example jogging cycling Benefits to exercising Organic versus dynamic fitness 0 Organic determined by inherited characteristics 0 Dynamic determined by the amount and kinds of exercise a person performs Physical Benefits know them all 0 Increased I Muscle strength endurance exibility aerobic fitness Improves cardiovascular health I Reduces CVD risk by 35 I Also reduces risk of diabetes high cholesterol high blood pressure Men and women bene t equally Protects against breast and colorectal cancer Reduces cancer risk by in uencing tumor initiation and growth Helps manage some of the distressing side effects of treatment 0 Protects against osteoporosis Mental health benefits know them all 0 Individuals who exercise are less depressed than those who don t it is also shown to decrease anxiety and stress Improved cognitive functioning 0 Physical activity can improve attention processing speed memory executive functioning o Physically t children show better memory performance and greater volume of the hippocampus Hazards of physical activity 0 Exercise addiction injuries from physical activity death during exercise Recommended guidelines for physical activity avoid extreme temp dogs pollution darkness cars use appropriate equipment and clothing proper warmups and cool downs Including percentage of people meeting recommended guidelines 0 33 of people adhere Strategies to increase adherence 1 Informational interventions a Seek to increase public awareness of the importance of physical activity and its bene ts b People do show increased awareness after these interventions however they may not actually increase peoples physical activity c point of decision prompts may help increase physical activity 2 behavioral and social interventions a teaches people skills so they can adopt and maintain physical activity b social interventions create an environment that makes it easier for people to adopt and maintain physical activity buddy system c individually tailored programs can be effective but are not as successful at maintaining activity levels 3 environmental interventions a seeks to enhance access to places for physical activity simply seeing people exercise can motivate someone O OOOO
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