Abnormal Psychology

What is psychogenesis?

EXAM 1 – Study Guide

Psychology 

. ABNORMAL= when condition causes DISTRESS/IMPAIRMENT in life

1) Statistical infrequency (good/bad): height/IQ

2) Violation of social norms: criminal/immoral behavior, considering culture and context 3) Distress, disability, functional impairment (health, work, family)

. Normal-Abnormal: dichotomy or continuum?

- Most phenomena are on a CONTINUUM (eg: temperature, blood pressure)

Mental Health Practitioners 

. DOCTORAL LEVEL

1) Psychiatrists (MD, DO)

2) Psychologists= administer/score psychometric tests, get involved in forensics - PhD Don't forget about the age old question of mat 265 asu

- PsyD: nurses can provide psychological medicines with this

How does psychotherapy change the brain?

We also discuss several other topics like Post 1969’s structure: covertly racist (no longer a structural need for Jim Crow ideology; problems: if no racism, how do we explain racial inequality?
If you want to learn more check out cs1200 utd

- EdD: doctor of educational psychology (can also do therapy)

. MASTERS LEVEL= can work independently

1) Licensed clinical social worker (LCSW)

2) Licensed mental health counselor (LMHC)

3) Licensed marriage and family therapist (LMFT)

. OTHER TERMINOLOGIES

1) Psychotherapist (not an actual thing)

2) Psychoanalyst: psychotherapists that use this technique

3) Professor of psychology: do research in teaching

Theories of Human Behavior 

. HISTORICAL: humans interpreted their own behavior in terms of their understanding of the  world around them

1) DEMONOLOGY= believe in demonic possessions (still millions who do) 2) ASTROLOGY= heavenly bodies which influence behavior

What is dementia?

3) SOMATOGENESIS: things that occur in body, affect the mind (discovery of electricity  affecting animal tissue)

4) PSYCHOGENESIS= mental forces can affect mental outcomes and affect behavior . AGE OF SCIENCE: conceptions of human behavior followed technological paradigms of time  period

1) Hydraulic model= brain/mind is steam engine (get rid of nervous energy) 2) Electric model= brain/mind is a circuit

3) Telephonic model= brain/mind is a switchboard

4) Cybernetic model= brain/mind is a computer Don't forget about the age old question of jaleesa has been diagnosed with irritable bowel syndrome (ibs). all of the following are correct about ibs except that

5) Holographic model= brain/mind is an analog computer

6) Newer models= “chaos theory”, etc.

neurotransmitters= enzymes/chem.

reactions

Biological Models of Human Behavior 

. BEHAVIOR GENETICS= genesproteins (biostructures)brainsbehaviors - Genes and phenotypes: can be affected by many factors since conception - Polygenetic inheritance: behaviors are determined by many genes

- Twin adoption studies: identical twins reared apart are more similar to each other than to  adoptive families

 - Stress-diathesis (inborn dispositions) model

- Passive/active gene-environment correlations: environment affects predispositions and  predisposed  

individuals create own environment

1) PASSIVE a diathesis can be enhanced by environment

  talented people may not develop a talent in certain environments

2) ACTIVE people actually create their own environments

- Epigenetics: certain factors can release/depress certain traits (released traits that may  have not appeared until  

 your generation will now be passed on)

- Example: low MAOA gene combined with childhood abuse can create mood disorders BUT 1) Low MAOA and being well treated doesn’t have much effect on mood disorders 2) High MAOA and being mistreated doesn’t have much effect on mood disorders Don't forget about the age old question of college math notes

Neurophysiology 

. 84/85 billion neurons in brain (around same amount of glial cells) 100,000 connections each . Cell body/dendrites (branching out to increase surface area)= receive info - Coming in dendrites: excites neuron If you want to learn more check out fele subtest 2 study guide

- Coming in cell body: inhibits neuron

. Axon/myelin sheath= where impulse travels down

. Axon terminals= contain neurotransmitters (inside neurotransmitter vesicles) . ACTION POTENTIAL= impulse when a certain threshold is reached

- Graded potentials: inhibitory/excitatory

. Presynaptic membrane  

. Synaptic cleft

. Postsynaptic membrane

. Receptor molecules

. Neurotransmitter break down/uptake

Neurochemistry 

NEUROTRANSMITTERS

1) Glutamate (L-glu)= main excitatory transmitter (too muchbrain dysfunction) 2) Acetylcholine (Ach)= voluntary muscle movements and cognitive functions in cerebral  cortex  

(dysfunctiondementia)

3) Dopamine (Da)= involved in any kind of motivated behavior (makes you feel good) - Stimulating substances (drugs, caffeine, etc.) boost levels of dopamine

4) Norepinephrine= breakdown of dopamine and balances the “go for it” of dopamine with  “wait a minute” (anxious/jittery feeling after pump of dopamine)

5) Serotonin (5-Ht)= balances/regulates other levels of neurotransmitters 6) Gamma aminobutyric acid (GABA)= sedative neurotransmitter

. Surplus- deficit model

. Complex interactions between all transmitters

HORMONES  

. Feedback relationship: hypothalamuspituitary glandendocrine organshormones 1) Thyroid hormone= hypo (sluggish, unmotivated)/hyper (agitated, anxiety) 2) Cortisol= secreted with high stress (little memory for event)

3) Testosterone= affect physiological development and behavior in men and women - High levels combined with low serotonin problems with bad behavior . Behavior affected by

- Health and nutrition

- Infection and microbiology

- Environmental toxins

- Gene-environment correlations (eg: DRD2-MAOA)

PSYCHOPHARMACOLOGY

. Evolution of psychopathologies coevolved with treatment

1) Antipsychotic medication= lower amount of circulating dopamine

2) Antidepressants= target serotonin receptors

3) Anxiolytics= stimulate GABA system

4) Mood Stabilizers (eg: SSRIs)

5) Antiparoxysmals= target too much static in brain (like in bipolar disorder) 6) Others (eg: beta-blockers)

Neuropsychology 

. LIMBIC SYSTEM= emotion, motivation, memory (anything that is truly meaningful to you for  survival)

. CEREBRAL CORTEX= informs and is informed by limbic system and almost all rest of brain  (reciprocal sharing of info)

. FRONTAL LOBES= allow to control oneself and perform executive functions . CEREBRAL HEMISPHERES= united by corpus callosum

- Left: verbal, analytic

- Right: spatial, emotional, analyze things as a whole

. BRAIN DAMAGE= from outside/disease

. BRAIN SYNDROME= from within brain (eg: ADHD)

. NEUROPSYCHOLOGICAL ASSESSMENT= evaluating patients cognitive strengths/weaknesses

Psychodynamic Models of Human Behavior 

PSYCHODYNAMIC APPROACH= roots of personality are deep within and people normally  disguise it (goal: reveal it)

Psychoanalysis 

. FREUD (1865-1939)= developed theory of mind

- Theory individuals will present symptoms that have no organic explanation when  unconscious  

 animalistic/instinctive nature is repressed

- Dreams/what we say: reveal hidden motivations (road to unconscious) - Freudian slips: words/actions that pop out without noticing (parapraxis)

success in  

all

stages: MATUR E

- Psychosexual stages of development:

1) ORAL STAGE= emotional/nutritional deficiency can cause dependency 2) ANAL STAGE (2 years)= conflict over elimination may develop anal  retentive personality  

 (obsessive, clean) or anal expulsive personality  

(aggressive, impulsive)

3) PHALLIC STAGE= Oedipus complex may lead to castration personality (trouble with  authority)

4) LATENCY STAGE= show repulsiveness to sexuality

- Scheme of mind:

1) ID= unconscious forces that you’re unaware of and that pressure into  

consciousness

2) EGO= rational part of brain that enables us to express thoughts/urges in  socially acceptable way by

 repressing ID (may be conscious or preconscious)

3) SUPEREGO= conscious which regulates EGO and tells them what to do based on  knowledge of rules

. If weak unconstrained

. If too strong overly constrained

- Defense mechanisms (Ana Freud): based on repression (unconscious)  

suppression (voluntary)

1) DENIAL= refuse to believe something you see

2) PROJECTION= repudiate something you don’t want to acknowledge for yourself  (onto someone else)

3) DISPLACEMENT= displacing emotions onto a safe person (eg: anger towards your boss onto your son)

4) RATIONALIZATION (not rational though)= look for reasonable explanations for  your actions

5) REACTION FORMATION= behaving, speaking, thinking in way completely opposite of how you feel

6) SUBLIMATION= take instinct of urge and put it into something positive/acceptable . NEOFREUDIANS

1) CARL JUNG (1875-1961)

- Analytical Psychology= quasi mystical, less scientific approach

- Collective unconscious= in our mind are not only our individual experiences but  those of all the world

- Animas/Anima= dichotomies in nature are to some degree/overlap (eg: boys have  some feminism)

- Introversion/Extroversion= most individuals have a balance of both

2) Alfred Adler

- Individual Psychology= people’s motives/behavior are individual man's striving for  superiority and  

 power, partly in compensation for his feeling of inferiority

- Inferiority complex= those who fail in the strive for high status do not reach a  healthy mind

. EGO-PSCYHOLOGISTS (early American transplants/born in US)

- Focus on conscious cognitive functions of EGO (traditional psychoanalysis focused most  on ID instead)

- More emphasis on individual choice/self-determination (not mere robots controlled by  unconscious)

- Introduced experimentation into psychodynamic research/theory (empirical studies) - Cognitive style= combined with early upbringing, determines personality (ways EGO  deals with issues in life)

- Brief psychodynamic= targeted to specific problems that didn’t need months/years to  treat

Psychoanalytic psychotherapy 

. Therapy on couch: people would release unconscious material better when relaxed - FREE ASSOCIATION= sit on couch and say whatever comes to mind (devise patterns with  Freudian slips or  

 others and associate anything that happens now to the past)

- DREAM INTERPRETATION= reveal unconscious

- TRANSFERENCE= people react towards therapist as they respond to authority in their  lives

- COUNTERTRANSFERENCE= therapist may find himself responding to patients in ways  reminiscent to the past

- INTERPRETATION and WORKING-THROUGH= person develops an insight that makes them more likely to  

 master their own faith from an authentic/self

directed reason

Legacy of Psychodynamic Paradigm 

. Hidden unconscious dimensions to people’s personalities

. Childhood influences on adult behavior

. Symptoms as metaphors for conflicts between instinctual drives/conscious decisions . Emphasis on relational aspects of therapy (intense relationship between analyst and patient  due to transference)  

. Therapy as freedom to choose (“Where ID was, EGO shall be”)

. TODAY not very popular, expensive therapy (long-term)

BEHAVIORAL MODELS OF HUMAN BEHAVIOR= based on what we can observe to figure out  HOW before why

. Psychology as empirical science, not “mentalism”

- PAVLOV= classical conditioning

- THORNDIKE= studied cats and their ability to learn (Law of Effect)

- WATSON= father of the behaviorism school of thought  

- SKINNER= operant conditioning

Classical Conditioning

- Unconditioned stimulus= any event that can elicit response w/o being paired to an event  (eg: meat powder)

- Unconditioned response= drooling at meat powder (spontaneous)

- Conditioned stimulus= has effect as the nervous system associated unconditioned  stimulus with it (eg: bell)

- Conditioned response= drooling at sound of bell

- Extinction= response extinguishes to conditioned stimulus if not paired for long - Generalization= respond to other conditioned stimuli even if not paired w/unconditioned  (eg: other noises)

- Human examples craving for alcohol at parties even though you haven’t even smelled  it; phobias

Operant Conditioning

- Reinforcement= mechanisms used to adapt

1) Positive: something presented after a behavior that INCREASES it

2) Negative: something withdrawn after a behavior that DECREASES it (eg: stop  electric shock)

- Punishment= least effective form to control behavior

- Shaping by successive approximations= after many trials, make associations - Schedules of reinforcement= if you give a reinforce after every response, quick extension as soon as you stop it

1) Interval: get reinforce after certain amount of time 2) Ratio: reinforcing by number of responses (eg: after every 5 presses)

Highest rates of  response

- Clinical and social applications all behavior can be controlled with conditioning (radical  behaviorism) but  

 there are differences in people to learn  

(genetics/environment)

Behavior Therapies 

. COUNTERCONDITIONING

. SYSTEMATIC DESENSITIZATION= start out by the smallest fear and reassociate  (countercondition) stimulus to relaxation

. BIOFEEDBACK (Behavioral Medicine)= amplifying biological signal

. DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIOR= ignore unwanted behavior and reinforce opposite one

. TOKEN ECONOMIES= give people access to reinforcers (eg: money after every hour they  behaved well)

. MODELING, ROLE-PLAYING, REHEARSAL

. TIME-OUT FROM REINFORCEMENT

. AVERSIVE CONDITIONING= occasional use of punishment

- Used on mental ill people who harm themselves (eg: electric shock when they do generally last resource)

- Everyday application: rubber band on wrist to punish yourself when you’re about to break your diet

Psychodynamics:  

COGNITIVE MODELS OF HUMAN BEHAVIOR  

. Study how people think consciously and state not everything is stimulus response

unconscious  

Behaviorists: stimulus response

- People don’t just feel and react, they also think/ conceptualize/interpret their experiences before responding

- Empirical orientation but emphasis on clinical application

- Cognitive Therapy: began as treatment for depression but now applied to wide range of  disorders/problems

- Legacies: ego psychologists, learning theorists, neuropsychologists  

- BECK Cognitive-Behavioral Therapy

- ELLIS Rational-Emotive Therapy  

Cognitive Therapy 

. Reciprocal relationship between thoughts, feelings, actions and environment . When people are in distress erroneous perceptions of themselves

- COGNITIVE DISTORTIONS:

1) Dichotomous thinking (all or nothing)

2) Overgeneralization  

3) Exceptionalizing (discounting positives)

4) Catastrophing

5) Magnification (of bad)/Minimization (of good)

6) Personalization (attribute to yourself a general problem)

7) Mind reading (over assumptions)

. Therapy techniques:

- Direct disputation= argue distortions, requiring proof of them

- Hypothesis testing= request evidence for belief of themselves

- Thought stopping= distraction activities

- Cognitive restructuring

- Imagery= use it to imagine yourself being successful

- Affirmations= reminding yourself of your positives

- Self-talk= talking yourself through rough situations

- Task-relevant self-instructional training

- Combining/integrating techniques

- Ultimate transition to self-management

EVOLUTIONARY MODELS OF HUMAN BEHAVIOR

. Humans are social organisms:

- Cooperation/Competition (flow of both in all human interactions

- Reproductive strategies: male (spread DNA)/female (find best adaptive mate) - Sex and aggression (individual/species survival)

- Reciprocal altruism (sacrifice themselves so other relatives can pass on traits ) - Human diversity and fitness (more chance that group as a whole will adapt to many  environments)

- Assortative mating= individuals with similar phenotypes mate with one another more  frequently

- Persistence of psychopathology there are still people with extreme forms of traits  reproducing

. Adaptive traits:  

- Aggression / Conciliation

- Promiscuity / Chasity

- Greed / Generosity

- Deception / Honesty

Everyone has these  

- Open-mindedness / Dogmatism

- Dreamer / Realist

- Optimist / Pessimist

- Happiness / Gloominess - Openness / Suspiciousness

combinations of traits that  have enabled humans to  survive

Diagnosis and Classification of Mental Disorders 

. Scientific steps: observation, classification, correlation, causation (hypothesis), explanation  (theory), control (goal)

. DIAGNOSIS (in realm of correlation, causation, explanation)

- Categoricaleither or diagnosis (you have it or not)

- Dimensional degrees of disorders

- Reliability= several observers using same technique get same diagnosis - Validity= validate diagnosis over time

- Main classification system= DSM (to check syndromes, while ICD used to diagnose) . CLASSIFICATION

- Sign= objective, observable feature/lab finding/behavior eg: limping, groaning - Symptom= subjective experience reported by patient eg: pain in knee - Syndrome= set of regularly occurring signs and symptoms with a common etiology and  predictable course

- Disorder= syndrome that causes significant distress to the patient/others

Signs and Symptoms of Abnormal Behavior 

. General inappropriateness of behavior

. Disorientation for time, place, person (in order of deterioration) normally in organic brain  syndromes

. Impaired cognition: perception, memory, thinking (confusion)

. Speech (reveals thinking)

- TANGENTIALITY= difficulty staying on a subject

- CIRCUMSTANTIALITY= difficulty getting off subject (can’t deviate from immediate  preoccupation)

- PERSEVERATION= doing/saying the same thing over and over even when circumstances  change

- PRESSURE= words don’t seem to come fast enough (can happen in normal exciting  events) mania-like

- SLOWNESS= slow rate or long latency (time to answer) of speech depression-like . Aphasias (due to brain damage: organic impairment of language)  

- EXPRESSIVE= know what you want to say but can’t think of words to say it - RECEPTIVE= difficulty understanding what others say

- APROSODIA= ability to understand content of language but not the TONALITY in  individuals with damage to  

 right hemisphere (opposite for those with damage to left hemisphere) . Thinking

- FIGHT OF IDEAS= jumping from one thing to the next (often revealed by tangentiality) - PARANOIA= attribution of malevolence w/o any real evidence of it (hard for others to  prove them wrong)

- GRANDIOSITY= inflated sense of own importance to the point that it becomes delusional - IDEAS OF REFERENCE= over interpreting coincidences (connecting things to oneself) - DELUSION= false belief/thought/conception

- HALLUCINATON= false perception (sensory)  

. Mood  

- AFFECT= outward expression of current mood

elevated/depressed/irritable/flat/constricted/labile

Clinical Psychological Assessment 

. Presenting problem (reason of referral): get sense of why person is here . History of the presenting problem: how long, when did it start

. Background history: medical, educational, vocational, family, etc.

. Prior examinations/ tests (eg: report cards) and prior treatment history

. Appearance and behavior: dress and grooming

. Mental status: orientation, cognition

. Psychological testing: not always but in some cases administration of psychometric tests . Results and diagnostic conclusions

. Recommendations: provide understandable feedback

Psychotherapy (changes way brain functions) 

. Models:

1) TRANSFORMATIVE= make fundamental changes in the person’s psyche -Eg: psychodynamic (psychoanalysis) and existential therapies

2) CORRECTIVE= patients learns more productive ways of thinking, reacting, behaving -Eg: cognitive-behavioral therapies

3) ADAPTATIONAL= patient is helped to cope with minimally changeable circumstances -Eg: supportive-expressive therapies

. Applications:

1) INDIVIDUAL= patient/therapist interacting with each other

2) COUPLES= couple/therapist

3) CHILD= may come in as individual or in context of family therapy

4) FAMILY= try to find IP (identifiable patient where problem revolves around), and modify  behaviors of family  

 as a whole to help all/individual

5) GROUPS= group interacts in way members reveal how they interact in the real world  (famous by Irvin Yalom)

6) COMBINATIONS= any combination of the above

7) SPECIAL POPULATIONS AND APPLICATIONS= specialized in certain disorders - Validity and Flexibility: evidence based treatment seeks validity but may turn into  robotic/cookbook diagnosing

- Nowadays: computers are fats to diagnose (but lack of judgment won’t allow them to  replace psychotherapy)

. Common factors in success:

1) WORKING ALLEGIANCE= therapist and patient feel comfortable to work together 2) AGREEMENT ON THERAPEUTIC GOALS= patient/therapist agree on why they’re there 3) PERCEIVED POSITIVE QUALITIES OF THERAPIST= patient perceives them 4) THERAPIST’S KNOWLEDGE AND FLEXIBILITY= confidence

- Diagnosis and assessment

- Psychotherapeutic techniques (bestlook like natural interactions)

- Interpersonal skills and maturity

5) RATIONALE FOR THE CHANGE PROCESS= patient feels therapist understand and can  explain

6) REALISTIC GOALS

7) PATIENT’S POSITIVE EXPECTATIONS

8) PATIENT’S ABILITY/WILLINGNESS TO CHANGE

9) PATIENT’S OPPORTUNITY FOR CATHARSIS AND EXPRESSION

10) OPPORTUNITY TO LEARN/PRACTICE NEW ATTITUDES AND BEHAVIORS 11) INSIGHT, UNDERSTANDING AND CREATION OF A MEANINGFUL NARRATIVE

Forensic psychology and psychotherapy 

. Law deals with human behavior in its two law systems:

1) CIVIL (you sue someone)

- Contracts/wills (do they have mental capacity to do so)

- Estates/inheritance

- Family law: marriage, divorce, custody

- Civil competencies/capacities

- Torts: worker’s compensations, personal injury, etc. (most common due to  psych/cognitive injuries)

2) CRIMINAL (justice system presses charges on you)

- Criminal competencies to proceed in process/stand trial

- NGRI: insanity defense (mental state at time of crime)

- Diminished capacity and mitigation

- Prediction of dangerousness and future offending

. Civil competencies:

- Presumption of competency

- Individual vs. Plenary (incompetent for just about everything)  

- Guardianship (family) or ward of court if incompetent: responsible for acts and decisions - Mental skills relevant to competency:

1) General abilities= memory, attention, self- knowledge

2) Specific cognitive abilities= mathematical ability, etc.

- Clinical syndromes relevant to competency:

1) Stable/Permanent= not going to get better (eg: mental retardation)

2) Progressive= competency gets worse (eg= dementia)

3) Potentially recoverable= may become competent with treatment or  

spontaneously

. Criminal competency to proceed:

- Three essential elements

1) Understand the nature of the charges

2) Understand the range of possible penalties

3) Be able to assit one’s attorney in one’s own defense (right to an attorney in  criminal system)

- Requires documentation of mental impairment, but no specific diagnosis required in  insanity defense

. Insanity Defense (1 out of 400):

- To be found guilty

1) ACTUS REA= you need to prove that a crime was committed and that the suspect did it

2) MENS REA= prove that it was you with intent to commit crime

- Presumption of competency (unless the defendant pleas insanity)

- Insanity Defense standards (requires diagnosis of mental disease/defect) 1) COGNITIVE= not guilty if at time of crime, person was suffering from a mental  disease that impaired  

 him to understand the nature of act or to know it was wrong

2) VOLITIONAL= didn’t know what you were doing or you couldn’t control it  (irresistible impulse)

- Diminished capacity: level of impairment insufficient for insanity defense (considered in  trial to lessen penalty)

- Immediate evaluation for dangerousness to others after declared not guilty - Set conditions: comply to treatment to be released, no alcohol, etc.

The Brain and Behavior 

. CENTRAL NERVOUS SYSTEM= brain and spinal cord

. PERIPHERAL NERVOUS SYSTEM

- Somatic: voluntary control of body movements

- Autonomic: parasympathetic (homeostasis, rest/digest functions), sympathetic  (responses to threats)

CNS 

. SPINAL CORD 

- Conveys info from the brain to the body and vice versa

- Reflexes

. BRAIN STEM

- Medulla= controls life giving functions (eg: respiration), crossing over of motor fibers  (contra lateral control)

- Pons= bridging structures (fibers from cerebrum to cerebellum), controls complex  movement

- Midbrain= controls eye movement, hearing, motor control, sleep/wake, arousal,  temperature regulation

- Reticular formation= responsible for attention, alertness, normal sleep/wake patterns . CEREBELLUM

- Voluntary movement modulator (coordinates all movements)

. BASAL GANGLIA  

- Allows to maintain background postural movement behind all voluntary movement - Currency: dopamine point of coordination between motor/motivational system  (determines why you move)

- Impairment:

1) Huntington’s disease= reduces coordinating movements (twitching)

2) Schizophrenia= involves mesolymbic dopamine system

3) Parkinson’s= stiffening of movement

. LIMBIC SYSTEM

- Emotion, motivation, memory (for what’s important)

- Amygdala= determine how important something is

- Hippocampus= transcription and encoding of what’s important (PTSD, mood disorders  may interfere with this)

. THALAMUS  

- Great processing station between sub cortical structures and cortical representations . HYPOTHALAMUS

- Controls most of visceral/bodily functions that keep you alive (thirst, sex drive, maternal  instinct, wake/sleep  

 cycles, salt, insulin)

- Controls pituitary gland (controls all endocrine glands in body which secrete hormones) feedback system

. CEREBRAL CORTEX

- Elaborates/expands functions provided by sub cortical structures

- Four lobes:

1) Frontal= knowledge translated to beh.  programs movements (anterior)/moves  muscles (posterior)

2) Parietal= bodily sense  simple functions (hot, cold)/complex functions (quarter  vs. dime)

3) Occipital= processing visual material (mostly elementary)  

4) Temporal= hearing, emotion/motivation (limbic system), receptive speech

Cerebral Hemispheres 

. 7 bridges of white matter connecting 2 hemispheres (biggest: corpus callosum) . Contraletral representation: sensation and movement

1) LEFT= controls right side of body

- Breaking down/ analysis (math, scientific skills, written/spoken language,  objectivity, logic, reason)  

- Process things over time (eg: sounds)

2) RIGHT= controls left side of body

- Synthesis/intuition (face recognition, art, creativity, imagination, subjectivity,  emotion, 3D shapes)

. Damages and personality disorders:  

- Left: depression (right part takes over more conservative)

- Right: apathy (left part takes over more impulsive)

Organic Brain Syndrome 

. ACQUIRED= had a normal brain and something affected it (infection/accident)  - Injury= result of external force

- Disease= result of pathological process

. DEVELOPMENTAL= came into world with it (eg: autism)

. Affect 4 primary dimensions:

1) C= cognition

2) O= orientation

3) M= memory

4) P= perception  

Cortical signs (neurological disorders, not psychopathological ones)

. APHASIA= difficulty articulating speech (receptive/expressive)

. ALEXIA= difficulty reading

. AGRAPHIA= difficulty writing

. AGNOSIA= complex perception

. AMNESIA= memory inability to learn new info

. ACALCULIA= math

. SPATIAL DISORIENTATION= intro/extra personal space

Neurodevelopmental disorders 

. Brain dysfunctions

- MINIMAL BRAIN DYSFUNCTION= cognitive, emotional, behavioral abnormalities with  development analogues  

 to organic brain syndromes caused by acquired cerebral  

damage in adults

. All theories emphasize role of early development on later behavior

. Separate syndromes vs. On a continuum syndromes (with normal behavior) . Internalizing vs. Externalizing disorders

- INTERNALIZING= “pepper” (make you feel terrible inside but seem fine to those around eg: anxiety)

- EXTERNALIZING= “garlic” (main affect is on those around you eg: bipolar, anti social  personality)

Assessment 

. INTELECTUAL DEFICIENCY 

- IQ can predict many characteristics (average: 90-110) 

- Deficiency= below 70 

1) MILD: can generally learn reading/writing/math, can hold jobs 

2) MODERATE: can learn some reading/writing/safety, may need some oversight 3) SEVERE: likely not able to read/write, but may learn self-help skills/routines, require  supervision in daily life

4) PROFOUND: may be able to communicate, require intensive support, may have medical  conditions that  

 require nursing/therapy 

ATTENTION DEFICIT HYPERACTIVITY DISORDER  

. ADD vs. ADHD (hyperactivity component) 

- ADD= internalize everything in future (anxiety, depression) 

- ADHD= primarily a disorder of self-control and self-regulation of attention, emotion,  motivation, speech, and

 behavior. Externalize everything (conduct problems, mood disorders) 

. ADHD signs and symptoms

- Dysregulation of attention - Impaired socialization (immaturity): overly  influenced by peers

- Distractibility - Impaired executive functions - Impulsivity in speech/behavior - More common in boys

- Emotional lability (‘dramatic’) - Comorbid with: LD, ODD, CD, ASP, etc. . Genetics:

- Greater chance when close relatives have it

- More common in boys

. ADHD brain

- Lack of dopamine in frontal lobe= don’t get energized for action nor feel reward after job  well done

. Treatment

- MEDICATIONS: alleviate symptoms but don’t teach lessons

1) Stimulants= dexamphetamine, methylphenidate (Ritalin)

2) Non-stimulants= atomoxetine (Strattera) mood stabilizers for mood disorders - PSYCHOTHERAPY: Behavior therapy, EEG feedback

- DIETARY CONSIDERATIONS: food restrictions, supplements (not much evidence though) - LEARNING AIDES

- ENVIRONMENT: sometimes just switching schools helps

LEARNING DISORDERS

. ACADEMIC= reading, spelling, math, writing (composition/mechanical coordination) . NON-ACADEMIC= visual-motor, phonological processing, perceptual problems, language,  memory (visual/auditory

. Learning disorders problem typically in LEFT hemisphere (verbal, less impulsive) 1) DYSLEXIA= reading disorder

2) DYSCALCULIA= mathematics disorder

3) DYSGRAPHIA= disorder of written expression

4) NONVERBAL LEARNING DISORDER (right hemisphere learning disorder) - Motoric incoordination, especially axial muscles (“Klutz syndrome”)

- Sensory hypersensitivity (problem with some clothes, water, temperature, etc.) - Impaired visuospatial, perceptual, organizational, executive functions (bad at art,  music)

- Difficulties in 4 areas: tactile/visual, psychomotor/spatial, social/emotional,  cognitive (can succeed in  

 bio classes but not in literature)

- Causes: Dr. Byron P. Rourke believes it’s caused by damage to white matter in  right hemisphere

COMMUNICATION DISORDERS

1) Expression Language Disorder= putting thoughts into words

2) Speech Sound Disorder= difficulty forming sounds (phonological disorder) 3) Childhood-Onset Fluency Disorder= stuttering (repetition of speech sound)/stammering  (extension of speech sound)

4) Social (Pragmatic) Communication Disorder= take thing literally, don’t understand emotions - Can occur with other disorders (Nonverbal Learning Disorder, etc.)

BEHAVIOR DISORDERS

1) OPPOSITIONAL DEFIANT DISORDERS (ODD)

- Persistent refusal to comply with instructions or rules

- Stubbornness to compromise with adults or peers

- Failing to accept responsibility

- Easily annoyed, angered, irritated

- Being deliberately annoying, aggravating others

- Verbal hostility to others

- Deliberate testing of limits

2) CONDUCT DISORDERS (mini psychopaths: mostly predicts antisocial disorders in adults) - Aggression to people/animals

- Destruction of property

- Deceitfulness/theft

- Serious violations of rules

. Antisocial brain= plan/premeditate their controlling actions (turned on with control over others) Neurodevelopment (why do this disorders occur)

Geschwind Theory 

. Over secretion of testosterone in utero that blocks synaptic organization of some part the brain  while freeing up organization of other part inhibits cell migration from left to right hemisphere  (good at spatial, art, fixing, athletics)

- Left-handedness

- Verbal deficits

- Cerebral lateralization: more right hemisphere lateralized

- Planum temporale

- Frontal lobes

AUTISM SPECTRUM DISORDER (coined by Leo Kanner)

. Symptoms= 2 main classifications (preoccupations/idiosyncratic behavior and pragmatic/social  communication)

- Sustained odd play

- Uneven gross and fine motor skills

- Little/no eye contact

- Insistence on sameness, resist change in routine

- Noticeable physical over activity or extreme underactivity

- Tantrums, extreme distress for no apparent reason

- Speech/Language absence or delays

- Inappropriate laughing/giggling

- Echolalia (repeating words/phrases in place of normal language)

- Abnormal ways of relating to people/object/events (too much/nothing)

- Spin objects

. Diagnosis= bell curve (mild-severe)

. DSM-5 Criteria

A) Persistent deficits in social communication/interaction across contexts not accounted for  general dev. delays

- Deficits in social-emotional reciprocity

- Deficits in non-verbal communicative behavior used for social interaction - Deficits in developing/maintaining relationships

B) Restricted/repetitive patterns of behavior, interests, activities

- Stereotyped/repetitive speech, motor movements, use of objects

- Excessive adherence to routines, ritualized patterns, resistance to change - Highly restricted interests, abnormal in intensity

- Hyper/hypo reactivity to sensory input, unusual interest in sensory aspects C) Symptoms must be present in early childhood

D) Symptoms must limit/impair everyday functioning

. ASD Brain= larger (lack of normal synaptic pruning: too many connections) - Positive: savant syndrome (excel in one area and deficits in other Geshwind theory) - Negative: obstruct other functions

ASPERGER SYNDROME (now under ASD on high functioning edge: can be taught to live in  human world)

. Key characteristics (more common in males)

- Lack of skills - Repetitive routines/rituals

- Difficulty in social relationships- Speech/language peculiarities

- Poor concentration - Non-verbal communication problems - Restricted interests - Tend to be “in their own world”

- Sensitive to loud noise - Difficulty planning and coping with change TOURETTE SYNDROME (subclass of TIC disorders)

. Progressive development of multiple motor tics

. Genetic transmission and comorbidities

. 90% diagnose before age 10

. More common in males

. Lifelong progressive illness, with insidious onset, fluctuating course and transit remissions . Exacerbated by anxiety, may disappear during sleep/sex, can be temporarily suppressed  voluntarily

. Syndromic overlap: may be misdiagnosed as ADHD, OCD, behavior disorders (pharmacological  challenge for treatment)

. Diagnosis criteria:

- Onset before age 21

- Recurrent, involuntary, rapid, purposeless motor movements of multiple muscle groups - One or more vocal tics (phonic tics)

- Variations in intensity of symptoms over weeks to months (waxing/waning) - A duration of more than a year

. Symptoms:

- Multiple motor tics: individually/together, may change over time

- Vocal tics: simple noises/monosyllabic phonemes

- COPROLALIA: progress from syllables to word sentences

- ECHOLALIA (repeat what you said), PALILALIA (continue repeating), and other vocal  symptoms

- ECHOPRAXIA= repeat action

- Very high activity level

- Lack of inhibition: brain unable to do its job (inhibiting)

1) Touching (objects, other people)

2) Use of curse words/strong punching words (consonant words)

- Stuttering

- Sticking out tongue

- Smelling objects

- Pounding chest/body

- Grabbing one’s genitals

- Bruxism

. Brain= basal ganglia (involuntary postural/motivational aspects of movement) is hyperactive

. Treatment:

- Behavioral Therapy paired with medication (dopamine antagonists)

- Lesions in hyperactive parts of brain (in extremely severe symptoms only)

Neurocognitive Disorders 

DELRIUM

. Acute (rapid action: mins/hours) or sub-acute (days) disturbance of cognitive, emotional,  behavioral functioning caused by and encephalopathic process, which may be partially/wholly  reversible

. Clinical features:

- Clouding of consciousness

- Restlessness, agitation, fear (predominant emotion)

- Lethargy (unresponsiveness)

- Non-systematized delusions (no story behind delusion paranoia)

- Hallucination (especially visual): organic or drug induced (not like in psychotic disorders) - Thought processes and speech: slow and disorganized

. Etiologies:

- Cerebral trauma: concussion

- Cerebral infections

- Systemic infections: fever

- Cerebral anoxia: primary and cardiac

- Post-surgical: confusion after waking up

- Toxic: endogenous (liver/kidney failures), exogenous

- Metabolic: liver, kidney, endocrine (not able to detoxify)

- Drug effects: interactions, overdose, withdrawal

DEMENTIA

. A slowly progressive degenerative disorder of brain

- Many types with diverse etiologies

1) ALZHEIMER’S DEMENTIA

. Most common form of dementia in later life

. Usually presents age >40, most commonly >60

. Average age from diagnosis to death= 7 years (but can be from 1-2 years to 15 years later) . The older you get, the more likely to show Alzheimer’s disease

. Continuum with normal brain aging, or separate disease?

- Earlier onset usually more severe and rapidly progressive

- Number of genetic variations

. Other syndromes show Alzheimer-like neuropathological changes (eg: Down Syndrome, Chronic  Traumatic Encephalopathy)

. Symptoms:

- Episodic memory (memory for events) starts to go

- New learning impaired

- Attention and working memory impaired: lose focus  

- Cortical signs:

1) Language processing= receptive/expressive aphasias (1st sign: anomia) 2) Visuospatial abilities= agnosias (inability to recognize objects)

3) Complex movement= apraxias (inability to program movements even for over  learnt tasks)

- Executive functions: reasoning, planning, task completion, emotional and behavioral self regulation

- Mirror sign: walk up to mirror and stare at oneself (maybe difficulty recognizing oneself) - Corphologia: imaginary picking

- Impaired insight: impulsive behavior

- Loss of interest and initiative

- Irritability, agitation, restlessness

- Concreteness and loss of humor

- Sundowning: person becomes more active/agitated/confused at night (lack of  people/light)

- Late symptoms: incontinency, walking at night (require custodial care)

. Neuropathology:

- AMYLOID NPLAQUES= deposits of a protein (beta amyloid) that form around dead brain  cells. As they do, they  

stick together in clumps (plaques) which accumulate between neurons  

and progressively impair neurotransmission

- NEUROFIBRILLARY TANGLES= formed when abnormal accumulation of tau protein causes neuronal  

microtubules to deform, coagulate, and disintegrate, impairing  

transmission and eventually causing death of the neuron

2) FRONTOTEMPORAL DEMENTIA

. Primary progressive agnosia

. Differences with Alzheimer’s  

- 1/10 as common as Alzheimer’s

- Affects frontal/temporal (verbal) brain earlier than Alzheimer’s  

- Behavioral variant: impaired emotional control and social functioning

3) LEWY BODY DEMENTIA  

. Build up of lewy bodies (very tiny abnormal protein structures)

- Build up in some of temporal/subcortical structures affect basal ganglia and limbic  system

. Symptoms:

- Motor stiffness/rigidity - REM sleep behavior disorder (muscles not inhibited): act  out dreams

- Attention impairment - Less severe memory impairment

- Visuospatial impairment - More pronounced executive function impairment - Visual hallucinations - May be mistaken for mood/psychotic disorders - Mood swings and changes

4) VASCULAR/MULTI-INFARCT DEMENTIA

. Typically associated w/cardiovascular and cerebrovascular risk factors (hypertension/diabetes) . Consists of multiple small infarcts throughout brain

. Often shows step-wise progression (declines after each small infarct)

. Often affects white matter (connections between neurons) more than gray matter (neurons  themselves)

. May or not be associated with actual stroke

. Executive functions affected more severely than language and memory

. Can occur with other dementias (eg: Alzheimer’s)

5) SUBCORTICAL DEMENTIAS

. Involve subcortical structures, such as the thalamus and basal ganglia (spare cortex/limbic  system until late in disease)

- HUNTINGTON’S CHOREA

- PARKINSON’S DISEASE

- PROGRESSIVE SUPRANUCLEAR PALSY

. Typically show pattern of frontal lobe symptoms but w/o cortical signs until later . May resemble psychiatric syndromes

. Signs/symptoms:

- Apathy

- Bradyphrenia: slow thinking

- Emotional lability (changes)

- Behavioral inertia: spontaneity/perseveration

- Impulsivity/impaired self-control

- Memory: difficulty with new learning due to inattention/distractibility (sinking pyramid  w/o temporal gradient)

- Impaired organization and planning

- Functional impairment diminished by increased interest/motivation

6) PSEUDODEMENTIA OF DEPRESSION

. Associated with prior history of major depressive disorder: bio changes of depression cause  dementia effects

. May occur with or w/o classic depressive symptoms: “masked depression” . Cognitive symptoms fluctuate with the course of depressive episode

. Usually affects attention, concentration, motivation, executive functions, while sparing  language

. Depression can be harbinger or accompanying symptom of other dementias Traumatic Brain Injury 

. Head injury:

- OPEN (penetrating)= exposes tissue to outside environment (eg: bullet/skull fracture) - CLOSED= skull doesn’t get penetrated but brain is being impacted inside (most of  injuries)

1) Coup Lesion: impact against surface of skull in point of impact

2) Contre-coup lesion: lesion that occurs at opposite pole of impact (from  pulling away of brain)

3) Intermediary coup lesion: contusion in deeper brain structure located along the line of impact

. Concussion: impairment in functioning in part of brain (may or not be associated with detected  physiological change)

. Contusion: rupture of blood vessels in brain

- Gliding contusion: displacement of the gray matter of the cerebral cortex . Diffuse Axonal Injury (DAI): tearing of the brain's axons  usually causes coma (but many times  medical induced coma  

 is used in TBI to slow down brain and reduce  

swelling)

Factors associated with TBI 

. Neuronal death . Glial scarring

. Axonal disruption . Hormonal disturbances

. Blood vessel damage/clot (hematoma) . Brain surgery

. Bruising (contusion) . Diuretic drugs, medication/substance abuse  effects

. Brain swelling (edema) . Barbiturate coma

Effects

. Pathological changes may produce:

-Ischemia: inadequate blood supply to an organ or part of the body (especially the heart  muscles)

- Pressure effects

- Cardiorespiratory failure

- Posttraumatic seizures

- Diffuse axonal injury

- Cognitive and behavioral impairment: “post concussion syndrome”  

POST-CONCUSSION SYNDROMES

. Somatic impairment: (mostly temporary and may recover from them) - Blurred/double vision - Headache: vascular/muscular contraction - Dizziness: syncope, vertigo - Sexual dysfunction

- Fatigue - Seizures

- Nausea, vomiting - Sensory hypersensitivity: photophobia, phonophobia - Sleep disorders - Autonomic dysregulation (eg: temperature) . Cognitive impairment:

- Attention - Abstraction  

- Concentration - Spatial orientation

- Mental processing speed - Speech, reading, spelling

- Memory - Organization

- Judgement - Motor coordination

. Behavioral/Emotional impairment:

- Anxiety - Substance abuse

- Depression - Social withdrawal

- Egocentricity - Interpersonal conflict

- Impulsivity - PTSD (comorbidity)

- Irritability/rage - Brain injury in children: the earlier, more likely to have  general

- Hypochondriacally concern impairment of function (not completely  lateralized)

Seizure Disorders 

. Seizures represent an abnormal excitation of neural tissue

- Symptomatic (secondary): caused by something else, like brain tumor/metabolic  disorder/stroke adults

- Idiopathic (primary): 1st seen/diagnoses in childhood

. ICTUS= phenomena during seizures (onset of seizures)

- Most have preictal, octal, postictal, inerictal phases

. Frequency: can occur while awake/asleep and ranges from sporadic to status epilepticus  - EPILEPSY= a disorder characterized by multiple seizures

. Major types:

1) GRAND MAL (general complex): few seconds

- Tonic phase: body stiffens, lose consciousness

- Clonic phase: contractions

. What to do:

- Help person to a soft surface and place them on the side and protect their head - Don’t attempt to restrain them/put anything in their mouth

- As consciousness returns, reassure person and make them feel comfortable - If they injured themselves/full recovery doesn’t occur within 5 mins: call for  medical help

2) PETIT MAL (generalized elementary): absence

- Brief loss of consciousness w/o ant major disruptions of muscle tone

. Characteristics:

- Absence of seizures: most common type in pre-school, primary, elementary age  students

- Brief stare, glazed look on face, may appear to be day dreaming, unaware of  surroundings

- Lasts just matter of seconds (but may occur hundreds of times a day if untreated) - Students unable to process any info during seizure academic difficulty

3) FACIAL (partial elementary): Jacksonian, Infantile spasms, Akinetic seizures  . Don’t produce loss of consciousness

. Jacksonian

- Typically involve seizures that stick to one part of the brain (location)

- Can be sensory, motor, emotional, cognitive, etc.

- Jacksonian march: distal-proximal (seizure occurs in one side of body)

- May spread to become generalized (eg: grand mal) rare

4) PSYCHOMOTOR (partial complex)

TEMPORAL LOBE SEIZURES

. Also called: temporal lobe epilepsy (TLE), psychomotor seizures, partial complex seizures (PCS), complex partial s. (CPS)

. Difference with other seizures disorders: person experiences symptoms as alien to itself  (EGODISONIC: in OBS only)

- For earlier part retains consciousness and can describe what they were experiencing . Onset: childhood/adolescence

. Etiology: typically giiosis of the temporal lobe (infantile febrile seizures or birth anoxia with glial  scarring)

. Origin: temporal lobes (75%), or basomedial frontal lobe (25%)

- Almost always involve the limbic system (smell, emotion, motivation, memory) . May come alone/in association with other seizure types

. May be confused with variety of mental disorders

. TLE manifestations divided in ictal and interictal phase: ictal typically longer than for most  seizures (up tp ½ h)

. Symptoms:

- Auditory distortions/hallucinations

- Visual distortions/hallucinations: micro/macropsia (see things smaller/bigger), oscillopsia  (gos back and forth)

- Disagreeable tastes/odors

- Visceral sensations (eg: “gastric rising”) involvement of limbic system

. Psychological symptoms:

- Feelings of impending doom

- Depersonalization

- Abnormal clarity of perception/insight (perception of things suddenly making sense) - ONEIRISM= dreamy/twilight states

- Forced thoughts/emotions (negative mostly): out of their control or agency - Déjà vu, jamais vu, deja entendu, jamais etendu

- Complex hallucinations

. Autonomic/Physiological symptom:

- Palpitations - Hunger pangs

- Piloerection - Abdominal sensations/pain

- Nausea - Sexual sensations

- Increased/decreased salivation

. Somatomotor symptoms: (behavior)

- AUTOMATISMS= stereotyped, repetitive movement/actions (blinking, spitting, swallowing, etc.) unconscious

- Patient may be marginally responsive/resistive

- May be combative if restrained (but directed aggressive behavior is rare) - Complex activities and prolonged fugue states (“blackouts) NOT common in TLE

INTERICTAL TLE PERSONALITY SYNDROME

. Not an ictal event

. Usually associated with TLE seizures that begin before puberty and continue throughout  adolescence

. The more frequent the TLE seizures  more severe the interictal syndrome . Medical control of seizures leads to more severe ITLEPS symptoms (may titrate medication) . Ddx other clinical syndromes

. Signs/symptoms:

- Emotional deepening= take everything seriously (little sense of humor)

- Hypermoralism/religiosity/philosophisity

- Circumstantiality and personal reference= everything tied to own personal interests - Obsessionalism

- Existential depression and general sadness

- Preservation of warm affect (not like schizoid/autism)= respond to human emotions - Hypographia (obsessionalism)= don’t leave any part of page blank when writing - Viscosity= interpersonal presentation (give you creepy/invasive engagement) - Hyposexuality

- Fetishism

- Irritability/impulsivity

- Lateral effects= which side seizure begins in

1) Right focus: emotive phenomena

2) Left focus: ideational phenomena

SEIZURE-LIKE DISORDERS

. Episodic dyscontrol= now called Intermittent Explosive Disorder (attacks of uncontrollable rage  disproportionate to  

 situation, which they claim not to remember/recognize)

. Limbic psychotic trigger reaction= rage/sexual reactions triggered by traumatic memory . Kindling: limbic system static (electrophysiological disorders)

- Bipolar, borderline, other disorders

- Some epileptic medicine used to treat these mood disorders

PSEUDOSEIZURES: PNS

. Somatoform or malingering?  real or faking it?

. Can occur in subjects with or w/o seizures

. Atypical presentation: have coordinated movements when faking it

. Amnesia is selective

. Sphincter incontinence usually not present

. No postictal depression usually

. EEG usually normal

. What does person have to gain w/pretending seizure?  eg: inmates in prison

Substance Use Disorders 

. Disorder when substance use disturbs health/lifestyle

- Dichotomy or continuum: at what point does it become disorder?

- Intoxication and withdrawal

- Tolerance: synapsis tune themselves to larger doses (brain compensates overflow of  toxics by becoming less  

 receptive)

- Use, abuse, dependence self-medication or addiction?

- Social and cultural factors

The addictive brain 

. Any substance that makes you feel good involves DOPAMINE (produces feeling of pleasure and  want more reward)

- Causing either RELEASE of dopamine (secrete more)

- Interfering with REUPTAKE of dopamine (more in synaptic cleft: effects last longer)

Sedative- Hypnotics 

ALCOHOL

. Intoxication= biphasic response, lowering of inhibitions

. High tolerance, dependence and withdrawal symptoms

. Delirium Tremens= syndrome of delirious state characterized by extreme fear and formication  (feeling you have things  

 crawling on you) during the period of withdrawal

. Wernicke-Korsakoff Syndrome= alcohol + nutrition deficiency

. Alcoholic dementia

. Different patterns and trajectories of drinking behavior

. Comorbidities= mood disorders, personality disorders, other addictive disorders - Highest: daily drinking (worse than binge drinking: you don’t let body dry out and have  worst long-term effects)

BARBITURATES and BENZODIAZEPINES

. Barbiturates= slow acting

. Benzodiazepines= less lethal

. Cross-tolerant with alcohol= when alcoholics are detoxifying, they’ll give them benzodiazepines  (reintoxicate them and  

 withdraw that much more slowly, alleviating withdrawal symptoms) . Operate on GABA receptors

. Intoxication= sedation, memory impairment, disinhibition with greater risk of impulsive  behavior

. Comorbidities= anxiety/mood/substance abuse disorders

Stimuants 

. COCAINE, AMPHETAMINES, NICOTINE, CAFFEINE

. Dopamine Norepinephrine Depletion of both catecholamines (rush then crash) - As they stimulate dopamine system, dopamine metabolizes in norepinephrine  (neurotransmitter for alertness)

. Intoxication= mania (with dopamine), fearful (with norepinephrine), crash with depletion - Increases arousal, energy level impulsivity, aggressiveness, may impair judgment and  self-control

. Withdrawal= irritable-dysphoric, depressed state

. Cycle similar to bipolar mood cycling

. Comorbidities= bipolar disorder, other mood disorders, psychotic disorders

Hallucinogens 

MARIJUANA

. THC= active ingredient (fat soluble: can be found in body even months later) . Low doses= calm euphoria, increased appetite, time dilation, impaired memory . High doses= tachycardia, panic, hallucinations

. No known lethal doses

. Syncope= fainting (increased heart rate/low blood pressure)

. WPW Syndrome= mild heart arrhythmia producing fainting

. Inconsistent long-term effects

. Addiction?  Sensitization vs. Tolerance (more sensitized than tolerant) . Medical uses fact or folly?

. Comorbidities= mood/anxiety/schizotypal disorders

OTHER HALLUCINOGENS

. LSD, PCP, designer/club drugs

. Depending on dose, usually produce dreamy/perceptually altered state . Lethal dose= depends on substance

. Long-term effects= depends on substance and user

. “Bad trips”= present agitated delirium (often comorbid risk factors)

. New combos= hallucinogens + stimulants (eg: “ecstasy”)

OPIATES

. Have effects since there are opiate receptors in brain ENDORPHIN RECEPTORS (endorphins:  endogenous opiates)

. Natural and synthetic

- Pain killers: opium, morphine, heroin (supposed to be less addictive than morphine in  treatment), subutex, etc.

- Medicinal uses and abuse potential

- New synthetic “nuclear opiates”= 100s of times stronger than natural substances - Combination drugs= “speedballs”

. Addiction= tolerance and withdrawal

. Lethal overdose potential

Other substances 

ORGANIC HYDROCARBONS  

. Inhalants= glue, paint thinner, cleaning products

. Produce a toxic delirium, and effects ranging from somnolence to violence . May be highly toxic/lethal

ANABOLIC STEROIDS

. Testosterone and testosterone analogs= secondarily have effects on dopamine  . High dose= manic-like aggressive psychosis (‘roid rage)  

. Lower dose= heighten susceptibility to aggressive reaction to minor challenges . Side effects= with excess hormone, hypothalamus compensates by reducing amount of  releasing factor and  

 endogenous testosterone volume

- Involution (shrinking) of testes

- Breast development: due to estradiol (product of testosterone breakdown)

Mother  Nature  has last  laugh

Personality Disorders 

. Personality: traits, types, clusters, disorders (rigid/maladaptive traits)

. General features of disorders (when personality disturbs life)

- Short-term changeability/long-term stability: unpredictable behavior but w/some lock  pattern over situations

- Multiple life crises

- Come to mental health, criminal justice, and/or victims attention (problems typically 1st identified by others)

Clusters 

A) “ODD/ECCENTRIC”

. PARANOID

- Pervasive distrusts/suspiciousness

- Bias toward interpreting other’s motives as deceptive/persecutory

- Cynical view of world

- Comorbidities: bipolar, obsessive-compulsive disorder

. SCHIZOID

- Detachment from social relationships

- Restricted range of interpersonal emotional expressions

- Don’t need other people (unlike AVOIDANT in cluster C, which are afraid of people) - Comorbidities: substance use disorders

. SCHIZOTYPAL= more progressed form of schizoid

- Deficient interpersonal relationships

- Cognitive/perceptual distortions

- Behavioral eccentricities

- Comorbidities: substance abuse disorders

B) “DRAMATIC”

. HISTRIONIC= theatrical

- Excessive/shallow emotionality: good at playing roles they think other would like - Dramatic-seeking behavior

- Impressionistic/suggestible cognitive style

- Manipulate you to love them (may be good in jobs w/people)

- Comorbidities: mood/somatic symptoms disorders (suicidal risk: can’t cope with lack of  love)

. BORDERLINE= main goal is to feel good (get people to like them while they distrust them) - Between neurosis (anxiety/depression) and psychosis (mania: long rage/aggression until  they say it’s over)

- Fragile self-image/identity

- Unstable interpersonal relationships: altering idealization/devaluation in relationships - Behavior impulsivity

- Self-harm, suicidal risk: pain is the only thing that makes them feel real (physical  stimulation)

- Fear of abandonment: they’ll quickly like you too much, become demanding, flip around revenge if betrayed

- Comorbidities: bipolar/mood/somatic symptoms/substance use disorders . NARCISSICTIC

- Pervasive pattern of grandiosity, need for admiration, hypersensitivity to criticism and  lack of empathy

- Sense of entitlement may lead to manipulation/exploitation of others

- Narcissism (really believe they’re perfect) and “narcissistic rage” (when ego is attacked:  insecure)

- Make good politicians: people attracted to those who show themselves as secure - Often couple with borderlines: usually narcissistic male + borderline female (attracted to  superficial strength  

 narcissists display that can be their rock, while they serve as reassuring people to  narcissists)

- Comorbidities: bipolar, substance use disorders

. ANTISOCIAL= live for thrill of taking advantage of people

- Pervasive pattern of disregard for and violation of the rights of others occurring since age 15 as indicated by 3  

 or more of the following:

1) Repeated failure to conform to social norms and lawful conduct (confrontations  w/criminal justice)

2) Deceitfulness, lying conning, manipulation of others for personal gratification/profit 3) Impulsivity, failure to plan, little regard for consequences

4) Irritability/aggressiveness (but not resentful like borderline: only seek to have good  time, don’t get hung up)

5) Hypersensitivity to challenge (result in physical fights/assaults)

6) Reckless disregard for safety of self/others

7) Consistent irresponsibility, failure to sustain financial/social/work obligations 8) Lack of remorse, indifference to/rationalization of harm to others (pleasure in  humiliating them)

- Comorbidities: bipolar, substance use disorders

C) “ANXIOUS”

. AVOIDANT

- Social inhibition

- Feelings of inadequacy

- Hypersensitivity to criticism

- Comorbidities: anxiety/mood/substance abuse disorders

. DEPENDENT

- Submissive/clinging behavior from an excessive need to be taken care of - Difficulty making decisions w/o guidance or support

- Comorbidities: mood/somatic symptoms disorder (hysterical conversions reactions: react  w/bodies)

. OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

- Preoccupation with orderliness, perfectionism and/or cleanliness

- Obsessive thoughts and compulsive/ritualistic behaviors (detriment of  

openness/spontaneity in relationships)

- BUT not necessarily show behavior like in obsessive-compulsive disorder: just attitude of  desire of perfection

- Comorbidities: anxiety/mood/somatic symptoms/obsessive-compulsive disorder