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Final Note.docx

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Konstantine Zakzanis

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Chapter 11 o Disorganized speech (aka thought disorder): Introduction problems in organizing ideas and in speaking so Schizophrenia: psychotic disorder characterized by that a listener can understand. They usually have major disturbances in thought, emotion, and behavior: incoherence(images and fragments of thought are disordered thinking in which ideas are not logically not connected). Speech may also be disordered by related, faulty perception and attention, flat or loose associations (aka derailment; person can inappropriate affect and bizarre disturbances in motor communicate better, but can’t stay on one topic). activity. Prevalence 0.2-2%, but the lifetime prevalence This isn’t the central symptom anymore because is 1%. Most measures are an underestimate because a not all schizophrenics have this and there are other lot of people don’t know they have schizophrenia and disorders (mania) that have this. research doesn’t generally include homeless or o Delusions: beliefs held contrary to reality. hospitalized people. The prevalence varies across the Persecutory delusions are found in 65% of world, with Asian countries having the lowest rates. The schizophrenics. According to Schneider, people prevalence is also higher in males (1.4 ratio may also believe they are unwilling recipients of male:female). 10% of schizophrenics commit suicide. bodily sensations by an external agent, their Most schizophrenics don’t need inpatient treatments if thoughts are broadcast or transmitted, their they get diagnosed early. The severity, development thoughts are being stolen, feelings or behavior are and course of schizophrenia is dependent on controlled by external agents, or external forces comorbidity (50% of schizophrenics have comorbid impose impulses to behave in a certain way on disorders). There are comorbid personality disorders them. Although delusions are found in more than (avoidant, paranoid, dependent and antisocial), and half of schizophrenics, they’re also found in other these affect the clinical management. Also comorbid are disorders (mania and depression). substance use disorders (37% of schizophrenics use o Hallucinations (and other perception disorders): substances; usually develops as a result of childhood sensory experiences in the absence of any conduct disorder) and mood (usually depression; 40% stimulation from the environment; in are depressed at outset, and are more likely to be more schizophrenics, they’re usually more auditory than -ank Symptoms (Schneider) violent, and report less satisfaction) and anxiety visual (74% have auditory hallucinations). disorders (usually social phobia, but include OCD According to Mellor, some people report hearing “First resulting from suicide attempts and PTSD in military their own thoughts being spoken by another veterans with schizophrenia). Further studies showed person, and others believe they hear people that in the prodromal state (before developing arguing, some people hear voices commenting on schizophrenia) people use cannabis, so it might be their behavior. The hallucinations are important in linked with psychotic symptoms. schizophrenia because they occur here more than Clinical Symptoms of Schizophrenia anywhere else. Symptoms include disturbance in major areas: thought,  Negative symptoms: behavioral deficits such as perception and attention; affect and emotion; life avolition, alogia, anhedonia, flat affect and asociality. functioning. Only a few of these problems are usually These endure more than an episode (unlike the present at one point in time. DSM determines how positive ones) and affect people more. The presence many should be present and the duration of their of many negative symptoms predicts poor life quality, presence. That’s why people with schizophrenia differ in but it’s important to understand whether these are their symptoms. The heterogeneity of schizophrenia actually negative symptoms or a result of shows that we should divide schizophrenia symptoms antipsychotic medication. further, so we have 2: o Avolition: apathy; lack of energy and a seeming  Positive symptoms: excesses or distortions absence of interest in routine activities. (disorganized speech, hallucinations and delusions): o Alogia: a negative thought disorder; can take several forms like poverty of speech (not speak much) or poverty of content of speech (conveying o People that we now know have personality disorders little information and is vague/repetitive). of borderline, schizoid, schizotypal or paranoid were o Anhedonia: inability to experience pleasure. also diagnosed as schizophrenic. o Flat affect: no stimulus can elicit an emotional o People with acute onset and recovery from response. This only refers to the outward emotions schizophrenic symptoms were also labeled as (inside may be normal, but we can’t see it). They schizophrenics. feel the same, and their physiological responses DSM-IV-TR Diagnosis: are the same, but they just can’t show it.  Diagnostic criteria are presented in explicit detail. o Asociality: severely impaired social relationships.  People with mood disorder are excluded. A new These are the first symptoms to appear. psychotic disorder was created: schizoaffective  ‘Other Symptoms’: some symptoms can’t be classified: disorder (mixture of schizophrenia and mood disorder) o Catatonia: several motor abnormalities, such as  Requirement for diagnosis is that the disturbance is a repeated gesturing, unusual increase in overall 6-month period, with one month of active disturbance level of activity, or catatonic immobility (clients (has at least 2 of hallucinations, delusions, adopt unusual postures and maintain them for a disorganized speech or catatonic behavior) and the while). Catatonic people have waxy flexibility: if remaining time as prodromal or residual (has you move their limbs, the catatonic schizophrenic withdrawal, inappropriate affect…). People that will maintain that posture you put him in. recover quickly now are diagnosed as a separate o Inappropriate affect: emotional responses are out disorder (schizophreniform disorder or brief psychotic of context. This symptom is rare, but if it’s present, disorder), that is similar but lasts from 1-6 months it means schizophrenia. (schizophreniform) or 1 day–1 month (brief psychotic). History  ‘Mild forms’ of schizophrenia identified in DSM-II are Kraeplin presented 2 major groups of endogenous now classified as personality disorders. (internally caused) psychoses: dementia praecox (early  Schizophrenia is now considered separate from term for schizophrenia) and manic-depressive illness. delusional disorder (troubled by persistent For dementia praecox, there were 3 types (paranoides, persecutory delusions, delusional jealousy that spouse catatonia, and hebephrenia) that shared early onset is unfaithful, delusions of being followed, somatic (praecox) and deterioration in intelligence (dementia). delusions or erotomania – believing a complete Bleuler broke off from Kraeplin on 2 points: (1) disorder stranger is in love with you). didn’t necessarily have an early onset and (2) disorder Schizophrenia’s symptomatic criteria were found to be didn’t inevitably progress toward dementia. Bleuler universal, but people in developing countries had better then changed the term to schizophrenia (schizein courses (healed better) and more acute onset. means to split and phren means mind). DSM-5 Proposals: there was a recommendation to Historical prevalence of schizophrenia: schizophrenia create psychosis risk syndrome where there are 6 prevalence rates have been dropping since 1960. This criterion to help diagnose schizophrenia early. So the however is not completely accurate because major change would be to make schizophrenia a mixed schizophrenia’s definition has varied across times and categorical-dimensional system. locations. The prevalence seems higher in North The types of schizophrenia (originally by Kraeplin: America than in Europe (80% vs. 20%). This may be  Disorganized Schizophrenia: aka hebephrenia; speech because several psychiatrists after Bleuler broadened is disorganized and difficult to follow, clients have the term schizophrenia. It was broadened more with: incoherency, flat affect or shifts in emotions, o US clinicians diagnosed schizophrenia whenever disorganized behavior, may deteriorate to the point of hallucinations/delusions were present, but these incontinence, and completely neglect appearance. symptoms also occur in mood disorders;  Catatonic Schizophrenia: catatonic symptoms, overestimate alternating between immobility and excitement. They resist instruction, and often repeat others’ speech. The onset is more sudden, but has previous Twin and family studies have shown that there is a experiences of apathy. This is less prevalent now, genetic predisposition of inheriting schizophrenia. probably because of drug therapy.  Family Studies: Relatives of people with schizophrenia  Paranoid Schizophrenic: presence of dominant are at increased risk of developing especially negative delusions. Clients may experience grandiose delusions symptoms of schizophrenia. (exaggerated sense of their own importance),  Twin Studies: Although MZ twins have greater delusional jealousy (belief that partner is unfaithful), concordance rates than DZ twins (43% vs. 12%), it’s or other persecutory delusions. Clients usually develop still less than 100% which means that it doesn’t ideas of reference (incorporate unimportant events necessarily mean schizophrenia is a genetic disorder with delusional framework and read personal alone. significance into others’ trivial activities). Their  Adoption Studies: children of women with language is not disorganized and they are more verbal, schizophrenia were more likely to be diagnosed as alert and emotional than other schizophrenics. mentally defective, psychopathic and neurotic (even if Although this system is the current basis of diagnosis, they were reared without their schizophrenic mother). the subtypes don’t actually serve any function. They  Molecular Genetics: several multi or polygenic models have enough overlap to prove them quite similar. seem to be a better answer than a single gene. It’s People tried to find more types: undifferentiated hard to actually find the genes because (1) lack of schizophrenia (people who meet criteria for precision in defining schizophrenia clinically, (2) schizophrenia but not for any of the 3 subtypes) or absence of biological tests that confirm diagnosis, and residual schizophrenia (when client no longer meets full (3) clinical heterogeneity and complex nature of criteria, but still shows some signs). disorder. Other methods were instead suggested, like A different approach on subtyping uses neurocognitive finding endophenotypes (characteristics that reflect differences that involve brain abnormalities. The tests the actions of genes predisposing an individual to a used are the Wisconsin Card Sorting (test of executive disorder). This would be useful because functioning), the Weschler Adult Intelligence Test endophenotypes would require fewer genes, and so (WAIS, measures IQ) and other motor function and be less complex. Other findings found a few verbal memory tests. They found 5 subtypes: correlations between serotonin, dopamine and  Normative, intact cognition chromosome problems, but they couldn’t replicate.  Executive: impairment on the Wisconsin Card Test. The Genain Quadruplets: these 4 sisters developed  Executive-Motor: deficits in card sorting and motors schizophrenia before the age of 24, and the odds were 1  Motor: deficits only in motor functioning in 1.5. What’s more fascinating is that they all  Dementia: pervasive and generalized cognitive impair. developed different life outcomes: 1 was severely Heinrich concluded that there is a primacy of cognition: impaired to even finish high school, 2 were only slightly th effect sizes of memory, attention, language and better but couldn’t hold a career, and the 4 was able reasoning are twice as large as those from to get a career and raise a family. schizophrenics (using PET and MRI). Heinrich tried to Biochemical Factors explain why: (1) disorder-related brain disturbance that  Dopamine Activity: schizophrenia is related to excess could have pervasive influence on brain systems, (2) activity of dopamine, but this is only based on cognitive deficits reflect genetically determined knowledge that drugs effective in treating constraints, and (3) influence of chronic stress on schizophrenia reduce dopamine activity. Also, anti- cognition in people prone to schizophrenia. psychotic drugs that treat schizophrenia cause side Etiology of Schizophrenia effects that resemble Parkinson’s, which is a deficit in Genetics dopamine. Amphetamines can produce a state The best bet you have in determining whether a person resembling paranoid schizophrenia. This is probably is going to develop schizophrenia without knowledge of because it releases catecholamine (norepinephrine behavior is if that person has a twin with schizophrenia. and dopamine; causes amphetamine psychosis). Because researchers found that the major metabolite when they were born, which would limit oxygen to the for dopamine (homovanillic acid) wasn’t higher in brain, and thus cause brain abnormalities. Another schizophrenics than in others, the relation of proposal is that a virus enters the baby during the dopamine to schizophrenia must then be that either second trimester, and this increases the risk for schizophrenics have more sensitive systems, or that schizophrenia. Another question proposed is that if there are excess receptors (as opposed to high levels schizophrenia results from brain abnormalities present of dopamine). Excess dopamine receptors seem to be at birth, why does it develop later? This would be only linked to positive symptoms. The region most because injury in prefrontal cortex (which has slow related to schizophrenia is over activity of mesolimbic and late maturation) would remain silent until it pathway. The mesocortical pathway that leads to the develops/ prefrontal cortex (which is related to the negative  Contemporary Research: We moved from searching symptoms of schizophrenia when it’s under activated) for a specific brain lesion to searching for is not part of the dopamine flow from the drugs. abnormalities in how neural systems interact. White That’s why dopamine meds only work on positive matter pathology plays a role in cognitive impairments symptoms. This can’t be the whole story because the (no white matter causes cognition to be more meds take a few weeks to work, but they actually deteriorated). block the receptors immediately. Another observation  Psychological Stress: Data shows that increase in is that for the drugs to work, they need to reduce stress increases likelihood of relapse. 2 main stressors: dopamine below normal (which causes Parkinson-like o Social Class: It’s found in people in the lowest SES. symptoms). It’s also unlikely that one It’s not a continuum though, rather, a sharp neurotransmitter will be responsible for all the varying difference. These findings are consistent but symptoms. Other neurotransmitters that are being difficult to interpret in causal terms. There’s the looked at are serotonin, or glutamate (transmitter sociogenic hypothesis (degrading treatment, low found all over the brain; low levels are found in education and lack or rewards OR malnutrition schizophrenics). because of poor life may be the stressors that elicit Schizophrenia and the Brain schizophrenia in people who are predisposed to it).  Enlarged Ventricles: the most consistent finding is that Another explanation is the social-selection theory of enlarged ventricles, implying loss of subcortical (schizophrenics may be leading an average life, but brain cells. Other findings include structural problems once diagnosed, will end up being poor because of in subcortical areas like the hippocampus and basal their illness). One way to study this was to study ganglia, prefrontal cortex and temporal one. The occupational mobility of schizophrenics (which enlarged ventricles suggest atrophy, especially in didn’t lead us anywhere), and another is to see if males. the father had come from lower SES or not (the  Prefrontal Cortex: (1) this is known to be important for fathers had not, which supports the social selection speech, decision-making and willed-action, all of theory). However a few findings support sociogenic which are affected during schizophrenia. (2) Lack of hypothesis (stress may cause sensitivity in the illness awareness is related to schizophrenia as well as dopamine system, and so lead to schizophrenia). prefrontal cortex. (3) Schizophrenics have a reduction o Family: schizophrenogenic mother (a mother who in grey matter in this cortex. (4) Low metabolic rates in was cold and dominant, conflict-inducing) is said to prefrontal cortex were found in studies of functional produce schizophrenia in her child. This wasn’t imaging. (5) This hypoactivation isn’t found in MZ supported by data. Expressed emotion: variable twins of schizophrenic, showing that it isn’t genetic. regarding expressions of hostility towards child; (6) People with schizophrenia, antisocial personality & 58% of patients who went home to families high in substance abuse show greater dysfunction in cortex. expressed emotions relapsed. Research shows that  Congenital and Developmental Considerations: many causal and reactive interpretations of EE interactions are correct: expression of unusual schizophrenics experienced delivery complications thoughts led to and was caused by high EE. This is symptoms. Side effects of antipsychotics include: supported by biology: high levels of stress activates dizziness, blurred vision, restlessness and sexual HPA causing secretion of cortisol, causing increase dysfunction, as well as extrapyramidal side effects in dopamine, causing schizophrenia. Yet, (resemble Parkinson`s disease; include dystonia, heightened dopamine can increase HPA activation dyskinesia, akasthisia – inability to remain still). which may make a person sensitive to stress. Another side effect is the neuroleptic malignant  Developmental, High-Risk studies: preschizophrenic syndrome (can be fatal; severe muscle rigidity boys were found to be disagreeable and girls as develops with fever and may cause client to lapse passive. Both were found to have lower IQ levels and into a coma). to be delinquent and withdrawn as children. These o Second Generation (Atypical) antipsychotics. observations aren`t accurate because they`re Clozapine was the new introduced drug, and it collected in retrospect. Better experiments chose seemed to be much preferred, internationally. It high-risk people and followed them for a couple of produced fewer motor side effects. However, side effects include: weakening of immune system (may years, then compared their observations before and after developing schizophrenia. Positive-symptom lead to death), fatigue, drooling, weight gain and differed from negative-symptom in that the positive seizures. patients had more family instability issues and Psychological Treatments negative patients had been part of pregnancy  Social Skills Training: designed to teach people complications. behaviors that can help them success in a wide variety Therapies for Schizophrenia of interpersonal situations. A major problem in treatment for those with  Family Therapy: these (1) educate clients and their schizophrenia is their lack of insight into their impaired families about biological vulnerability and signs of condition and refusal of treatment. The APA suggests impending relapse, (2) provide information about and the following steps: (1) selection and application of advice on monitoring effects of medication, (3) antipsychotic medication to control acute psychotic encourage family members to blame no one, (4) help symptoms, (2) identification and treatment of comorbid improve communication and problem-solving, (5) disorders, and (3) use of psychosocial treatment encourage clients and families to expand social approaches. contacts, and (6) instill a degree of hope. Family plus Biological Treatments medication is more effective than medication alone.  Shock and Psychosurgery: Moniz introduced  Cognitive Behavioral Therapy (CBT): maladaptive prefrontal lobotomy (surgery that destroys tracts beliefs of clients can be changed with interventions. connecting frontal lobes to lower brain centers). These CBT is effective especially for the negative symptoms. reduced the patient`s aggressiveness but were CBT plus usual treatment is more effective than usual abandoned when drugs were introduced. treatment alone.  Drug therapies: antipsychotic drugs: aka neuroleptics;  Personal therapy: This is a broad spectrum CBT produce side effects similar to symptoms of a approach to multiplicity of problems of people with neurological disease. schizophrenia who have been discharged. Clients are o Conventional drug was phenothiazine-based taught to notice signs of inappropriate affect and antihistamines. This drug calmed schizophrenics relapse. This therapy also includes rational emotive because it blocked dopamine receptors (a variation behavioral therapy to help clients avoid turning is chlorpromazine). These drugs improve positive, frustrations into catastrophes and keep stress levels but not negative symptoms of schizophrenia. low. Clients are also taught relaxation techniques. Lehmann was the Canadian psychiatrist who  Treatment focus on basic cognitive functioning: introduced drug treatments in North America. cognitive enhancement therapy (CET): focuses on Drugs like lithium and antidperessants are used in correcting cognitive dysfunctions in attention, conjunction to antipsychotics to try to treat other memory, problem-solving and social cognitive skills. Scaffolded Instruction: concept that everyone has a fired from jobs. Also, almost half agreed on rehab zone of current development that the complexity of centers, but 40% didn`t. The good thing is that most of tasks must be tailored to account for individual’s skill those that agreed were from the younger generation. and level of potential development. The ultimate goal The best way to remove that stigma is to educate is to help clients develop problem-solving skills (by people about (not expose them to) schizophrenia. Even Zakzanis). Scaffolding was found to lead to professionals in the field how more negative views improvements in self-regulation and self- about those with schizophrenia. conceptualization. Some studies suggest that the *PRIME Clinic: Prevention through Risk Identification positive improvements are due to practice though. Management and Education.  Case management/assertive community treatment: Chapter 12 case managers are brokers of services being able to There are 2 categories for pathological use under DSM: get clients into contact with providers of whatever  Substance Dependence: presence of at least 3 of the services required. One such model is the ACT model. following: (1) developing tolerance (so you either  The best treatment is an integrative one, but those are need larger doses, or the effects aren’t very apparent not widely available or accessible. Drugs shouldn’t be if you take the regular dose), (2) withdrawal (negative used alone because they change natural psychosis into physical/psychological effects when you stop), (3) iatrogenic psychosis (tranquilized psychosis), where using substance longer/more than intended, (4) symptoms decrease but apathy increases. person recognizes the excessive use, (5) most of the Schizophrenia Issues and Care time is now spent trying to get the substance or Homeless Mentally Ill: the mentally ill make up a large recover from its effects, (6) usage continues even with proportion in Canada (not in US). There are a few knowledge of the problems it causes, (7) person cuts resources available to help them but they don’t know back on participation (in work, recreation…). DSM 5 about them so they don’t get the treatment they need. wants to include other addictions (gambling and Employment and Housing: Welfare and the like try to internet) here too. help out by making housing payments more affordable.  Substance abuse: less serious; person must Many clients who have left the hospital can live on their experience one of the following: (1) fail to fulfill major own. An example: Edmond Yu had paranoid obligations, (2) get exposed to physical dangers schizophrenia and he was shot by a police officer while (intoxicated driving), (3) legal problems, (4) persistent holding a hammer onto the bus. His death caused the social problems (arguments with partner). jury to propose the creation of safe houses for Delirium tremens (DT): alcohol withdrawal. This would schizophrenics and job opportunities to keep them safe. be considered as a diagnosis for substance withdrawal Nobody did anything. Recent studies of halfway houses and substance dependence. The person becomes for former clients proved to be less expensive and much delirious and trembles when blood alcohol level drops. more effective (90% stayed out of the hospital for more DSM-5 wants to change this DSM classification system than a year). The programs had 3 set-ups: ‘standard’ into a more dimensional one, such that substance treatment, social learning (which included token dependence and abuse are on a continuum. economy) and milieu treatment (based on Pinel’s Alcohol Abuse and Dependence humanitarian treatment of psychiatric patients). DSM distinguishes between alcohol abuse and Schizophrenia and Substance Abuse: there are no dependence. Those with dependence suffer from programs to help schizophrenics with substance abuse withdrawal and increased tolerance. This used to be (mental health programs usually exclude substance believed that it resulted from liver, but researchers now abuse as disruptive, and substance abuse programs believe it’s from the CNS and changes in exclude mental illness as disruptive). number/sensitivity of GABA receptors (such that Destigmatization: a survey conducted in Montreal found without alcohol, there’s an increased activation of the that almost half of people believed that schizophrenia is system = withdrawal symptoms). Alcohol abuse also a danger to society, and that schizophrenics should get causes people to experience negative social and occupational effects, but the person isn’t dependent on interactions with neural systems: it stimulates GABA it (so no withdrawal, tolerance or compulsive drinking receptors (those responsible for reducing tension), patterns). Alcohol abuse/dependence is usually part of increases levels of dopamine and serotonin (thus being polydrug (aka polysubstance) abuse: use/abuse more `pleasurable`) and it inhibits glutamate (causing than one drug at a time. Alcohol is usually accompanied cognitive effects – slurred speech, blurred vision…). by smoking. This is because nicotine and alcohol are Long-Term Effects: Alcohol is high in calories, so cross-tolerant: nicotine induces tolerance for rewarding consumers reduce their food intake, thus becoming effects of alcohol and vice versa. Sometimes it’s malnutritioned indirectly. Directly though, alcohol dangerous to combine drugs because they may be blocks digestion of food and absorption of vitamin (e.g. synergistic (create a stronger reaction). Alcohol and deficiency of vitamin B causes amnestic syndrome – barbiturates is a common means of suicide. Alcohol and severe loss of memory for recent and old events; heroin is a dangerous combination because alcohol deficiency in protein causes cirrhosis of liver – fatal lowers the threshold at which heroin becomes lethal. disease where liver cells are stuffed with fat and they Prevalence: Substance dependence prevalence: lifetime can`t function). Prolonged use of alcohol destroys brain 17.8% and 12-month 4.7%; substance abuse: 12.5% and cells (grey matter in temporal lobes) and reduces 3.8%. Only 1 in 4 people get treated for dependence. effectiveness of immune system, increasing Drinking is higher in men, younger, and whites. susceptibility to infection and cancer. Alcohol Problem drinking is comorbid with personality consumption during pregnancy causes fetal alcohol disorders, mood and anxiety disorders, other drug use, syndrome (growth of fetus with cranial, facial and limb and schizophrenia. It’s important to understand anomalies, as well as mental retardation). There are comorbidity because it plays a role in relapsing. also the partial fetal alcohol syndrome disorder and the Canadian and American university/college students alcohol-related neurodevelopmental disorder. have experienced similar drinking trends: 1 in 6 people However, there are also some positive effects of meets criteria for heavy frequent drinker. alcohol: light drinking of wine decreases risk for Course of Disorder: It was thought that there are 4 coronary heart disease and stroke. Some researchers stages for the male drinker: begins as social drinking refute this by saying that research was conducted by and progresses to a point where he lives to drink comparing drinkers to people who abstain for other (Jellinek). This hasn`t been supported by evidence; health reasons. research instead shows that although it`s true that Inhalant Use Disorders people progress from alcohol abuse to dependence, the Peak age of inhalant use is 14-15 years, and onset is at patterns in between are fluctuating. Evidence also 6. Inhalants are dangerous because they are shows that these don`t apply to women. Women tend inexpensive and readily available. Gasoline sniffing is a to drink alone and not binge as much. major problem among Aboriginals in Canada. Most th Costs of Abuse and Dependence: alcohol is the 4 inhalants act as depressants so they act like alcohol. worldwide cause of disability. This is especially true in Nicotine and Cigarette: nicotine: the addicting agent in Russia (where short life expectancy is due to alcohol). tobacco. It stimulates nicotinic receptors to facilitate Drunk drivers kill 4 and injure 187 people daily. Alcohol neurotransmitter release (dopamine) thus producing is also mostly responsible for rape, assault, family stimulation, pleasure and mood modulation. New data violence and 50% of all homicides. indicates differences on nicotine effects on men vs. Short-term Effects: When absorbed, alcohol travels to women. There are usually cognitive differences in men the small intestines and liver to be broken down. It`s and women (naturally, without anything) but when metabolized really slowly so large quantities of alcohol nicotine is administered, they become equal. remain in the blood stream until it`s their turn. Alcohol Prevalence: cigarette smoking is responsible for 1 in is indeed a drug, and one with a biphasic effect (it starts every 5 deaths. It is the single most preventable cause off as a stimulant, and once it settles, it acts as a of premature death. Cigars have a decreased risk for depressant). Alcohol produces its effects through major health problems, but mouth cancer risk is more prevalent. The most evident health risks: lung cancer, be the network concept (using one means you’re more emphysema, larynx cancer, and cardiovascular diseases. exposed to a network of others). The harmful substances are CO, tar (made from Somatic Effects: cannabinoid receptors were found in carcinogens) and nicotine. Although destruction of lung the brain (CB), generating more research. CB receptors cells is not reversible, health risks decline after quitting. are spread along the brain, but those on the 17% of Canadians are smokers, but the rate has been hippocampus explain why people have short-term decreasing. In Canada, the rate in youth smoking memory problems. Short-term side effects include: red decreased (except in Quebec, they increased). Average eyes, higher blood pressure, dry mouth and throat, and cigarettes smoked are 14.9, with males smoking 3 more. increased appetite (but nothing about the heart). Economic costs of smoking are great (65 billion). Also, Smoking marijuana also affects respiratory system and cigarette smoking contributes to erectile problems in impairs lungs. Marijuana is more damaging than men (since nicotine constricts blood vessels). tobacco because smokers hold it in longer (1 joint is 4 Second-Hand Smoking: aka environmental tobacco tobacco cigarettes in tar, 5 in CO, and 10 in damage to smoke. This contains more ammonia, CO, nicotine and cells lining the airways). Marijuana was recently found tar than the smoke inhaled by smoker. Children exposed to be addictive because of the higher tolerance rate to ETS are more likely to suffer chronic respiratory found in Vietnam War veterans. Gender (women smoke illness, lung dysfunction, middle ear infections and food less) and start time (people who start before 17 are allergies. more likely to develop more disorders) affect disorders. Marijuana Marijuana is tricky because it has reverse tolerance: Marijuana: Dried and crushed leaves of Cannabis sativa more experienced smokers puff a little and they’re high, plant. It’s usually smoked but can be chewed or eaten in while newer ones need puff more. This is because THC baked goods. Hashish: stronger than marijuana, after metabolism is stored in fat and gets released produced by removing and drying tops of cannabis. slowly throughout a month (so smoking again within Psychological Effects: normal doses make users relaxed that month will make you high faster). and more sociable but large doses bring rapid shifts in Therapeutic Effects: marijuana seems to also reduce emotion, dull attention, fragment thoughts and impair nausea and loss of appetite in those undergoing memory. Extreme doses induce hallucinations like LSD chemotherapy. It’s also a treatment for AIDS, glaucoma, and extreme panic. It’s difficult to regulate dosage epilepsy and multiple sclerosis. because it takes half an hour for effects to be noticed. Sedatives and Stimulants The major active drug is THC (tetrahydrocannabinol). Sedatives: aka downers; slow activity of body and The body produces its own cannabis-like substance reduce its responsiveness. It’s further divided: (anandamide, bliss in Sanskrit). Marijuana use results in  Opiates: group of addictive sedatives that relieve pain an average of 4.1 points drop in IQ. Heavy smoking and induce sleep when taken in moderate doses. affects working and verbal episodic memories. Daily o Opium: principle drug of illegal trafficking; been users were more likely to have anxiety disorders. here since 7000 BC. Smoking marijuana while driving is dangerous because o Morphine: named after Morpheus – god of it impairs cognitive skills that are necessary for driving. dreams; bitter-tasting powder is a powerful Stepping-Stone theory/gateway theory: concept that sedative and pain reliever. marijuana is not dangerous of itself only, but because o Heroin: made of morphine; originally designed to it’s a first step that can lead people to become addicted cure the morphine addiction, and substituted in to more dangerous drugs like heroin. Cannabis use is cough syrups and other medicines. It became higher in males especially in the 18-19 year range. known as God’s own medicine. Later it was shown Marijuana isn’t a stepping stone in that it leads to to be more addictive and faster-acting. inevitable use of other drugs (40% of users only do  Psychological and Physical effects: they produce marijuana), but it may mean that other drug users drowsiness, euphoria, trance, and lack of started out with marijuana first. A better concept would coordination (heroin has an extra effect: rush of warmth). These produce their effects by It’s the most dangerous (esp. since it’s inexpensive). stimulating our own opioid system. Our natural Freud and Sherlock Holmes experimented with it. opioids are endorphins and enkephalins. The LSD and Other Hallucinogens addiction is evident in the high tolerance rates and Hoffman synthesized LSD (by accident): it’s a withdrawal symptoms (sneezing, sweating, tearful, psychotomimetic (brings symptoms of psychosis). It’s yawning, and muscle pain; these become more more commonly referred to now as a hallucinogen. severe in 36 hours; symptoms stay for 72 hours These started out as therapies for prisoners, but were then diminish in 5-10 days). Addiction to opiates is found to be dangerous. Currently, we are going back to highest in physicians and nurses (availability and thinking of them as treatments, especially to depression high job stress). Heroin is becoming more popular and OCD. Other hallucinogens: in middle-class college students, vying for  Mesacline: from a cactus plants, used for centuries in popularity over cocaine. Heroine is more rituals of Native Americans. dangerous than before because it’s purer (and so  Psilocybin: stimulates serotonin receptors; used by stronger). Mexicans in rituals; from a mushroom o Synthetic Derivatives: Barbiturates: type of  Ecstasy: it’s made of MDA and MDMA; it’s thought to sedatives used as sleep and relaxation aids. These increase intimacy, insight, interpersonal relationships, were found addictive and were discontinued in elevates mood and promotes aesthetic awareness. 1940s. Other types of synthetic derivatives are Usage of it also causes permanent nerve damage, benzodiazepines (Valium) and methaqualone rapid eye movement, increased heart rate, and (more of a street drug). nausea. Deaths usually also result (from hyperthermia) These are like alcohol in that they stimulate GABA. High Effects of hallucinogens: this depends on the doses are fatal because diaphragm relaxes too much psychological state of the person, the setting, as well as that the individual suffocates. the dose itself. One thing is that if a person is anxious Stimulants: uppers; act on the brain and sympathetic while taking it, he might undergo a ‘bad trip’ nervous system to increase alertness and motor activity. (experience a panic attack which may or may not  Amphetamines: inspired by effects of plant Ephedra; develop into something more serious and require synthetic originally developed to treat asthma. Then, it hospitalization). Flashbacks also often occur (these are was used to treat mild depression and appetite. They memories of something happening while the person work by releasing norepinephrine and dopamine, and was taking the drug once; they have no biological blocking reuptake (so they stay in bloodstream). explanation). Taking this for long periods of time can cause Etiology for Substance Abuse symptoms of paranoid schizophrenia. Methedrine (aka To become dependent, the person must first have a speed) is the strongest, and is injected directly into positive experience with the drug. People are arguing veins. Tolerance builds up fast. that movies that involve smoking become R-rated  Cocaine: natural stimulant from the plant coca. It’s because movie smoke seems to encourage people to used to reduce pain, increases sex desire, and smoke in real life. This model isn’t perfect since there produces feelings of self-confidence by blocking are cases where people don’t progress downhill, and reuptake of dopamine in mesolimbic area (area of other cases where users go extreme and then return to pleasure). Negative effects in overdose: chills, moderate. Variables helping abuse/dependence: paranoia, insomnia, fear of having insects crawling  Social variables: cross-national studies show that under skin (leading them to self-harm to rid although there are great differences in trends of themselves of the insects). Cocaine also has severe dependence/abuse, these differences are decreasing. withdrawal symptoms. Women on cocaine during Ready availability of a substance is also a factor pregnancy will produce disabled children, or children (bartenders and liquor store owners have high who are addicted to it. Cocaine is a vasoconstrictor dependence rates). Another variable is family (if both (narrows blood vessel
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