Abnormal Psych, Week 9 Notes
Abnormal Psych, Week 9 Notes PSY 250
Kutztown University of Pennsylvania
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This 7 page Class Notes was uploaded by Kayla Mathias on Sunday April 3, 2016. The Class Notes belongs to PSY 250 at Kutztown University of Pennsylvania taught by Dr. George Muugi in Spring 2016. Since its upload, it has received 37 views. For similar materials see Abnormal Psychology in Psychlogy at Kutztown University of Pennsylvania.
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Abnormal Psych Week 9 Notes Monday, March 28 Chapter 10 I. Psychotic Disorders: characterized by strange thinking, odd behaviors, and distorted perceptions A. What is Psychosis? Psychosis is a mental condition in which people lose contact with reality. Delusions and hallucinations are common in people with psychosis. Many people believe that people are spying on them or are out to get them. Psychosis often accompanies schizophrenia, Alzheimer’s, and Parkinson’s. There are also times when a person experiences psychotic symptoms, but they do not actually have psychosis. B. What is Schizophrenia? Schizophrenia is a mental disorder that involves severe disorganization of thoughts, perceptions, and behaviors. Many schizophrenics think that the people on the radio or TV are talking to them in code that only they can understand. Schizophrenia was first defined by Emil Kraepelin and Eugen Bleuler and was known as dementia praecox. There is a difference between schizophrenia and split personality disorder and DID. C. Schizophrenia in Depth: Positive symptoms (abnormal behaviors that are present in an individual) include unusual thoughts, feelings, and behaviors such as delusions. Persecutory delusions are the belief that someone is out to get you and harm you. Delusions of influence are when a person thinks that they are much more important or higher up in society than they actually are. Hallucinations (auditory, visual, olfactory, gustatory (taste), and somatic) are also a positive symptom of schizophrenia. Disorganized thinking leads to loose associations, thought blocking, and clang associations. Catatonia is also a positive symptom. This includes waxy flexibility. Negative symptoms (lacking certain normal behaviors) include diminished emotional expression, anhedonia (unable to experience pleasure of any sort), avolition (inability to initiate or stick to plans), alogia (decreased quality and quantity of speech), and psychomotor retardation (slowed mental and physical abilities). Cognitive impairments and a lack of social cognition are also common in schizophrenics. Echolalia is when someone repeats word-for-word what someone else said and is also a schizophrenic symptom. Schizophrenics are likely to also have anxiety, depression, and PTSD, as well. D. Functional Impairment: The severity of symptoms affects how well a person is able to function normally. Schizophrenia affects not only the person suffering from it, but their family, as well. When depression goes along with schizophrenia, patients are much less likely to have a good outcome and experience frequent hospitalization and unemployment. People in developing countries seem to have better outcome than those in developed countries. E. Ethics and Responsibility: Violence is sometimes an issue with schizophrenics, but it is generally minor. More violent acts are generally done by schizophrenics who also suffer from substance abuse. Many times, people take advantage of schizophrenics because their cognitive function is not 100%. F. Epidemiology: Schizophrenia seems to be equally common across all cultures. It is most common in men who live in an urban area and have recently moved to a new place. Onset can be gradual or acute and premorbid (before onset) features often occur. Stages of onset—Prodromal phase (social withdrawal and lack of personal hygiene), acute phase (positive symptoms are experienced), and the residual phase (psychotic symptoms go away, but negative symptoms don’t). G. Sex, Race, and Ethnicity: Women develop schizophrenia at a later age than men do. Race does not seem to make a difference. Misdiagnosis sometimes occurs because of racial bias or the misunderstanding of different cultures. H. Ethics and Responsibility: Diagnosing someone whose face the clinician has not seen can help reduce and eliminate racial bias. I. Developmental Factors: Magical thinking, ideas of reference, and delusions of reference can all lead to schizophrenia. Being less social as a child can be an indicator that schizophrenia will develop in adulthood. Early-onset schizophrenia is when the disorder develops before the age of 18. Wednesday, March 30 A. Other Psychotic Disorders 1. Brief Psychotic Disorder: Sudden onset of psychotic symptoms that do not last for longer than a month (postpartum mood disorder—Andrea Yates) 2. Schizophreniform Disorder: Schizophrenic symptoms, but they only last for up to six months and daily activities are not affected 3. Schizoaffective Disorder: Psychotic symptoms with the addition of major depression, manic, or mixed episodes of both. 4. Delusional Disorder: The presence of believable delusions (such as believing that you have cancer, even though multiple doctors have said you don’t) i. Erotomanic delusions: believing that someone important (like a celebrity) is in love with you ii. Grandiose delusions: believing that you have a special relationship with a deity or famous person iii. Jealous delusions: believing that your partner is unfaithful iv. Persecutory delusions: believing that you are being mistreated v. Somatic Delusions: believing that you have some severe medical condition Chapter 9 I. Substance-Related Disorders: Substance use is simply using a substance in low to moderate doses that do not affect normal functioning. Substance intoxication is 1) reversible, 2) substance specific, 3) results in maladaptive behavior, and 4) begins shortly after or during the use of a substance. Neither substance use nor intoxication are considered to be substance abuse unless it gets out of hand. High levels of tolerance are often a good indication of substance abuse and withdrawal is an almost certain indication of dependence on a substance II. Commonly Used “Licit” Drugs: Legal psychoactive drugs A. Caffeine: Central nervous system stimulant that boosts energy, wakefulness, mood, etc. Negative effects include headaches, fatigue, trouble concentrating, etc. It is thought that the neurotransmitters adenosine and serotonin are involved with the effect of caffeine on the brain 1. Functional Impairment: Can contribute to the development of cardiovascular disorders, osteoporosis, reproductive issues, and even cancer. Caffeine can also react badly with anxiety-prone individuals and worsen their anxiety. Huge amounts of caffeine in a short period of time can cause death 2. Epidemiology: Caffeine is the most widely used drug with 80% of the world’s population consuming it daily. Energy drinks are becoming increasingly popular and generally contain more caffeine than coffee B. Nicotine: Highly addictive drug that generally comes from the tobacco plant. The most common source of nicotine is from cigarettes (chewing tobacco and nicotine patches are also common). It is both a sedative and a stimulant. Nicotine causes the brain to release dopamine. 1. Functional Impairment: A high dependence makes smokers slaves to whatever method of nicotine intake they use. Withdrawal symptoms can last up to a month. Pregnant smokers can cause harm to their unborn child. 2. Epidemiology: Numbers of smokers are decreasing. Sex, race, and ethnicity seem to have no effect on who smokes C. Alcohol: Depressant. Primarily affects the GABA system which in turn inhibits some brain activity. 1. Functional Impairment: Withdrawal symptoms can be very severe and can include hallucinations. Delirium tremens is a withdrawal symptom that includes disorientation, agitation, high blood pressure, and a fever. Alcohol cirrhosis is a disease of the liver that occurs in alcoholics. If too much alcohol is consumed, the liver loses the ability to clear the alcohol out of the blood. Wernicke-Korsakoff syndrome causes confusion, amnesia, and confabulation (filling in missing pieces of memory with made-up situations). Most people with this syndrome do not recover completely. Fetal alcohol syndrome: Passing of alcohol through the placenta and harms the developing baby. This generally causes birth defects and can even harm the baby’s brain. 2. Epidemiology, Sex, Race, and Ethnicity: Alcohol is the second most common psychoactive substance after caffeine. Alcohol use disorders are more common in males, but women are more susceptible to negative health consequences. Alcohol use is more prevalent among whites than any other race. III. Illicit Drugs A. Marijuana: Cannabis sativa plant. Most commonly used illicit drug in the US. Tetrahydrocannabinol (THC) is the active ingredient in marijuana and generally lasts 1-3 hours in the brain and causes relaxation, heightened sound and color perceptions, dry mouth, increased hunger, and sometimes fatigue, depression, or anxiety. 1. Functional Impairment: Heavy use leads to memory loss, trouble paying attention to something, learning issues, and problems with motor movement. Head, neck, and lung cancer are also possibilities. Medical uses include nausea caused by chemo, glaucoma, and appetite stimulation 2. Epidemiology: Average age of the start of marijuana use is 18 B. CNS Stimulants: Amphetamines: legal uses include treatment for asthma, nasal congestion, ADHD, and narcolepsy. Amphetamines are produced in labs, but are often mixed with toxic substances. They are generally consumed in a pill or injection. Ecstasy is a common form of the drug, as is crystal meth. 1. Functional Impairment: Damage to blood vessels in the brain which causes strokes. Paranoid anxiety, confusion, and insomnia are common effects. 2. Epidemiology: Whites are more likely to use these drugs, but sex does not make a difference C. Cocaine: Made from coca plant leaves (grown in South America). It was once used regularly in cigars, cigarettes, and Coca-Cola and was used as a pain- killer. 1. Functional Impairment: Highly addictive. Inhibits the reabsorption of dopamine. The more a person takes, the more likely they are to suffer from its negative effects. 2. Epidemiology: Most cocaine users used marijuana before trying cocaine. The highest rates of cocaine use are found among Native Americans followed by African Americans, whites, Hispanics, islanders, and Asians, respectively. D. Sedative Drugs: CNS depressants 1. Barbiturates: Work similarly to alcohol. They can be pills or injections and counteract amphetamines. Low doses cause disinhibition and euphoria and higher doses cause slurred speech, decreased respiration, impaired memory, irritability, and suicidal thoughts 2. Benzodiazepines: Originally used to treat anxiety. Higher doses can cause light-headedness and muscle control issues. Benzodiazepines include Xanax, Halcion, and Rohipnol (roofies) 3. Functional Impairment: Over-sedation and trouble thinking and/or interacting with others. Withdrawal symptoms are similar to those of alcohol. 4. Epidemiology: Average age on onset is 25. More common in women and drugs are generally used with alcohol. E. Opioids: Drugs including heroin, morphine, and codeine that are made out of opium poppy plants. These drugs relieve pain and anxiety and give feelings of euphoria, sedation and tranquility. 1. Functional Impairment: Tolerance develops in only 2-3 days. Overdose happens very easily. Drug trafficking rates are very high and people are often killed just trying to maintain these drugs. Withdrawal symptoms may occur as soon as 4-6 hours after the most recent use of the drug. When injection needles are shared, diseases like HIV can be spread. Insufficient blood flow to the brain (caused by the drugs) can result in a coma. 2. Epidemiology: Use varies based on SES, age, education, and type of drug. F. LSD and Natural Hallucinogens: Hallucinogens cause altered perceptions, sensations, emotions, detachment from oneself, and feelings of insight. Lysergic acid diethylamide (LSD) is the most common synthetic hallucinogen. 1. Functional Impairment: Emotional swings, paranoia, and panic can cause strange and dangerous behavior. These drugs are not physically addictive, but hallucinations can last for a while after the drugs are no longer in the body (hallucinogen persisting perception disorder) 2. Epidemiology: Little data, but hallucinogen use appears to be more common in men G. Inhalants: Most commonly used by teens and include cleaning fluid, paint, gasoline, and glue. These fumes generally have immediate effects. Negative effects include dizziness, confusion, impaired motor skills, etc. 1. Functional Impairment: Severe damage to vital organs and myelin. Muscle spasm and tremors result and can be permanent. Inhalants can cause changes in the structure of the brain and permanently impair motor and cognitive abilities. 2. Epidemiology: One of the top four drugs used by American teens. Males are more likely to use these drugs Friday, April 1 IV. Non-Substance-Related Disorders: Behavioral addictions including gambling, kleptomania, compulsive bullying, and excessive sexual activity. Tanning, Internet use, and computer or videogame playing can also be considered addictions A. Sex, Ethnicity, Education, and Illicit Drug Use: Men and women become addicted to drugs in different ways. Women become dependent faster and drug use is often associated with relationship issues. People living in low SES regions (especially the inner city) are at a higher risk for drug use. People with a higher education are less likely to use drugs. V. Etiology of Substance-Related Disorders A. Biological Factors 1. Family and Genetic Studies: Both genes and the environment affect the likelihood of struggling with substance abuse. A Norwegian study showed that illicit drug use is 58-81% heritable 2. Neurobiology: People with low levels of dopamine or hypodopaminergic traits may feel more of a need to use drugs to increase dopamine. B. Psychological Factors 1. Behavioral Factors—Drugs as Reinforcers: When positive feelings are caused drugs, that positive reinforcement makes the person more likely to use drugs again and at a higher capacity. Negative reinforcement also makes further drug use more likely (ex: coffee takes away feelings of tiredness and thus reinforces drinking it). Environmental factors can also be reinforcers. Being in places where drugs are usually used, seeing people you use drugs with, etc. can trigger drug use. 2. Cognitive Factors: Thoughts activated by a social situation may make someone more likely to use a substance. Thoughts about needing substances can make one more likely to actually “need” it. C. Sociocultural, Family, and Environmental Factors: Influences of family and peers, economic factors, and trauma have all been linked to greater risks of substance use and abuse. Family, social, and cultural factors can also protect an individual from substance abuse. D. Developmental Factors: Being introduced to drugs at a young age and heavy substance use during adolescence are both risk factors for further substance abuse as an adult. Substance use generally starts with nicotine and alcohol, then marijuana, and finally illicit drugs. Marijuana is often considered a “gateway” drug, but many marijuana users do not use anything stronger than that. VI. Treatment of Substance Use Disorders: Treatment depends on the drugs used and to what extent. For illicit drugs, the goal is total abstinence and no relapse. For alcohol, the goal might be to simply reduce alcohol intake dramatically, but not necessarily eliminate it. A. Therapies Based on Cognitive and Behavioral Principles 1. Avoidance of the Stimulus: Instruction to avoid stimulants that make people want to use whatever substance they have a problem with 2. Relapse Prevention: Use of functional analysis to develop alternative behavioral and cognitive skills using antecedents and consequences of drug use. Abstinence violation effect focuses on the cognitive and affective responses to the prohibited behavior 3. Stages of Change and Motivational Enhancement Therapy (MET): Transtheoretical model gives five stages of behavior change— precontemplation, contemplation, preparation, action, and maintenance 4. Skills Training: Part of CBT. Teaches people coping skills that they need to handle their addiction 5. Behavioral Therapies Based on Classical and Operant Conditioning: Aversion therapy pairs a negative stimulus with drug and alcohol use. While this should not necessarily be used by itself, it is a good element to include in comprehensive treatment. Contingency management approaches give rewards for compliance with treatment 6. Twelve-Step Approach: Steps used by Alcoholics Anonymous to help people overcome their addiction (list of steps is on pg. 346). The 12 steps have also been used for drug users and overeaters. B. Ethics and Responsibility: If a psychologist is suffering from substance abuse, they are no longer allowed to treat people with that problem. If the problem is serious enough, they can have their license revoked. C. Biological Treatments: Detoxification is a medically supervised drug withdrawal. In these situations, medication can be given to reduce withdrawal symptoms. Agonist substitution is when the patient is given a similar, but safe medication instead of their preferred substance. Methadone is the most common chemically safe medical substitute 1. Nicotine replacement therapy: This kind of therapy doesn’t necessarily change the drug intake as much as it changes the method. People can use gum or nicotine patches that help people to stop smoking 2. Antagonist Treatments: Use if opioid antagonists are used to treat alcohol disorders 3. Aversive Treatments: Antabuse is consumed with substances and gives the person a noxious feeling. The negative feelings that go with nausea, vomiting, etc. are eventually associated with alcohol 4. Vaccines: A vaccine that contains antibodies that latch onto the substance and blocks its effects before it gets to the brain. D. Sex and Racial/Ethnic Differences in Treatment: Women (especially mothers) are less likely to seek treatment so that they don’t risk having their kids taken away. Racial and ethnic minorities also appear to be less likely to seek treatment