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Abnormal Psych 3

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Rutgers University
Mc Kenna

CH. 11 SUBSATNCE-RELATED-IMPULSE CONTROLDISORDERS Substance related disorders: use and abuse of psychoactive substances • Wide ranging effects o Psychophysiological behavioral • Significant impairment Impulse-Control Disorders: inability to resist acting on drives or impulses • Levels of involvement: o Substance use: coffee, cigarettes, occasional marijuana, occasional cocaine, amphetamines, barbiturates, benzodiazepine  Doesn’t do any harm if done in moderation o Substance abuse: when it interferes with your life (work, relationships)  Your attitude is in denial over everything  You don’t have dependence, withdrawal or tolerance  You are in denial o Substance dependence: “addiction”  Tolerance developed—take more to get high  Experience withdrawal when trying to quite Types of Substances: • Depressants: alcohol, benzodiazepines, inhalants, marijuana, nicotine o CNS depressant: Inhibitory centers: their brain doesn’t inhibit what it should (things you shouldn’t say)  Global o Neurotransmitter systems  GABA: fight/flight  Glutamate  Serotonin: mood o Primarily affects the frontal lobe of the brain—judgment, impulse, control, decision making. And the cerebellum—balance, posture o Good correlation with aggression/violence affected by quantity, timing, history, o Positive reinforcement for dependence: activates dopamine (pleasure center) making i o Negative dependence: don’t want withdrawal • Stimulants: “up”—more alert and more focus, though it has a “crash” o Stimulate CNS o Most commonly consumed drug o Reduce appetite o Effects of amphetamines:  Norepinephrine  Dopamine  Hallucinations and delusions o Cocaine: increased blood pressure, insomnia, decreased appetite, paranoia  Highly addictive  Develop slowly • Tolerance,Atypical withdrawal o Nicotine: gives sensation of relaxed state, wellness, pleasure  Highly addictive  Withdrawal causes irritability, anxiety, difficulty concentrating, restlessness, weight gain o Caffeine: over 90%Americans take  In small doses wont cause addiction  Can develop a tolerance, withdrawal symptoms both psychological and physiological • Opiates: pain regulation commonly diagnosed by doctors o Heroin, opium, codeine, morphine o Calm, euphoric, drowsiness o Acts as a depressant too:  Low dose: euphoria, drowsiness, slow breathing  High dose: fatal o Withdrawal symptoms: vomiting (1-3 days) • Hallucinogens: alter sensory perception, delusions, paranoia, hallucinations, depersonalization o LSD:  Tolerance is rapid  Withdrawal is uncommon o Marijuana “cannabis”: most frequently used drug  Variable, individual reactions  Tolerance is questionable  Withdrawal and dependence is uncommon  Altered sensory perceptions: tactile, visual, and auditory hallucinations, depersonalization, altered sensory perceptions • Inhalants: fastest. Goes straight to your brain o Spray paint, hair spray, paint thinner, gasoline, nitrous oxide o Effects are similar to alcohol intoxication o Produce tolerance and prolonged withdrawal symptoms • Medications Sedative/hypnotic Disorders: • Barbiturates: can cause comas, similar to alcohol • Benzodiazepines • DSM V Criteria: o Maladaptive behavior changes o Impaired judgment o Variable moods o Impaired function Psychological dimensions • Positive reinforcement • Negative reinforcement o When you try to quite and you get terrible withdrawal symptoms so you start it back up so that you don’t go through it anymore Biological treatment: • Aversive treatment: make use of drugs extremely unpleasant o Antabuse for alcoholism • Medications: cope with withdrawal symptoms • Efficacy: limited when used alone o Better with psychosocial therapy Treatment—psychosocial • Inpatient facilities: o Expensive o Efficacy is equal to outpatient • Alcoholics anonymous (12 step) o Most popular o Social support o Limited research o Effective for highly motivated • Controlled use-- o Controlled drinking o Moderation o Possible benefits o Limited research Impulse Control Disorder • Intermittent explosive disorder: frequent aggressive outbursts o Lash out physically o Injury and/or destruction to property o Biological: serotonin, norepinephrine, testosterone o Psychosocial: stress, disrupted family life, parenting o Treatment: CBT, medication (best method) • Kleptomania: failure to resist urge to steal unnecessary items o They feel a tension when in the store, and when they have it with them (without paying) they feel a release  Considered an antidepressant because stealing regulates their mood in a sense o Some say that they are amnesiac to the event. There has been some brain imaging proving it as well o High comorbidities: mood disorders, substance abuse/dependence o Treatment: antidepressants • Pyromania: irresistible urge to set fires o Usually younger kids, short lived o NOTArsonists o Little etiological and treatment research—CBT in that it can identify what the triggers are • Pathological gambling: MOSTADDICTIVE OUT OFALL o Even when they’ve lost all their money and their family wont speak to them anymore, they will still believe that if they gamble one more time, it will fix everything and they’ll make their money back o Biological influences: poor impulse regulation, dopamine (pleasure), serotonin (moods) o Treatment: similar to substance dependence—go to meetings, get social support • Trichotillomania: irresistible urge to pull hair (eyelashes, head) to relieve anxiety o The unattractiveness wont even bother them o Treatments: SSRIs, CBT Video: mother says that people put her down for not being there. She claims that she was always there and that she had her child in “everything”. This seems to look like a perfectionistic family, pressuring the child to be perfect and do what the parent wants. As a clinician, you must keep your ears perked to hear certain things so that you haveALL of the information to properly diagnose and treat the patient. CH 12 PERSONALITY DISORDERS Personality disorder: inflexible ,maladaptive way of perceiving the world and relationships and themselves. So they are very difficult to treat. They feel that any internal difficulties they have are because of others and there is nothing wrong with them, its everyone else’s fault Enduring and pervasive predispositions: these disorders develop very early on in life, thus altering • Perceiving, relating, and thinking Inflexible and maladaptive: much like mental retardation, thus the both of them get mixed up and put into the same categories • Distress, impairment —High comorbidity with many other disorders —Poorer prognosis —Prevalence = 0.5-2.5% • Outpatient = 2-10% • Inpatient = 10-30% —Gender: differences in diagnostic rates • Borderline—75% female • Clinician bias • Criterion bias o Histrionic = extreme “stereotypical female o No ‘macho” disorder o Comorbidity ClusterA: Odd or eccentric • Paranoid Personality Disorder: mistrust and suspicion, paranoid o They view the world as a dangerous place and believe people will stab them in the back, so being their doctor can be very difficult o Have very few relationships, sensitive to criticism, vulgar, antisocial, parents can be criminal o Treatment: unlikely to seek help, there must be a crisis  Focus on developing trust  CBT: assumptions, negative/distorted beliefs • In a movie theater, when teenagers are noisy and talking, they believe that the teenagers are doing it on purpose to upset them.  No empirically-supported treatments o Etiology:  Possible relationship to schizophrenia—they might have a predisposition to think this way  Possible role of early experience: trauma, abuse, learning (“world is dangerous”) o Prognosis: not good, especially if not treated o Course: chronic if not treated • Schizotypal Personality Disorder: psychotic-like symptoms o Magical thinking (you can read peoples minds), Ideas of reference (see a message on the TV and think its about/for you), illusions o Odd/unusual behavior and appearance—but you can still understand them clearly… o Socially isolated o Highly suspicious o Etiology:  Lack full biological or environmental contributions: Preserved frontal lobes  Cognitive impairments: left hemisphere, more generalized o Treatment: treatment of comorbid depression  Multidimensional approach: social skill training, antipsychotic medications, community treatment • Schizoid Personality Disorder: o Appear to neither enjoy nor desire relationships o Limited range of emotions: Appear cold, detached o They don’t notice/care for social cues (things that make you laugh, smile, frown…) o Appear unaffected by praise: Unable or unwilling to express emotion o No thought disorder o As children, they grow up shy, don’t participate, like to observe o They are high functioning—choose to work in places where they are on their own o Etiology: limited research, precursor—childhood shyness, abuse, neglect, autism, dopamine o Treatment: unlikely to seek on own, must be a crisis  Focus on relationships  Social skills therapy: empathy training, role playing, social network building  No empirically-supported treatments Cluster B: Dramatic, emotional, erratic • Antisocial Personality Disorder: noncompliance with social norms o “Social predators”: violate rights of others, irresponsible, impulsive, deceitful o Can be criminals, or day-to-day workers o Don’t feel fearful, don’t consider consequences o Nature of psychopathy:  Glibness/superficial charm  Grandiose sense of self-worth  Proneness to boredom/need for stimulation  Pathological lying  Conning/manipulative  Lack of remorse, empathy, and consciousness o Etiology:  Inconsistent parenting, learn from parents in how they think and act, variable support, history of criminality and violence  Early histories of behavioral problems  Gene-environmental interaction: genetic predisposition, environmental triggers • Amygdala is overactive and they are under-aroused  Arousal hypotheses: under-arousal, fearless  Gray’s model of brain functioning: • Behavioral inhibition system (BIS)—low o Whatever they think about doing, they do it. Nothing holds them back • Reward system (REW)—high • Fight/flight system (F/F)  Interactive, integrative model: genetic vulnerability (neurotransmitters), environmental factors o Treatment: unlikely to seek own  High recidivism, incarceration, early intervention—parental training o Prevention: Rewards for pro-social behaviors, skills training, improve social competence • Borderline Personality Disorder: clinicians have the most difficulty with these people o Patterns of instability: CANNOT regulate their emotions, don’t have an emotional skin  Labile—intense mood swings, cutting  Turbulent relationships—go from person to person and always put the blame on them o Very impulsive, extreme fear of abandonment, self mutilating, very suspicious o Many attempts at suicidal. They aren’t looking for attention, they truly feel empty inside and don’t know how to fill that void so they look for people to help them. They will create relationships with people that doesn’t exist. They assume way too much o They come in with crisis after crisis o Comorbid disorders: depression (suicide), bipolar, substance abuse, eating disorders o Etiology:  Genetic/biological components: overactive amygdala, low BIS  Early childhood experience: problem in mother child relationship, usually connected to abuse. Very bad abuse. The mother is very rejecting and unaffectionate o Treatment: highly likely to seek treatment  First get them healthy, then help them deal with everyday things that they normally get upset about. Teaching them how to deal with them so they can function on a day-to-day basis  Antidepressant medications:  Dialectical behavioral therapy (DBT): o Outcomes: demonstrated efficacy, cortical activation changes • Histrionic: overly dramatic o Attention seeking, like to be in the spotlight, overly seductive, o Don’t think about the long-term consequences of behavior o Etiology: little research  Links with antisocial personality: Sex-typed alternative expression  Childhood—may be reinforced by accident if they liked to act o Treatment: problematic interpersonal behaviors  Little empirical support because it is hard to identify them and bring them in because they don’t think anything is wrong with them  • Narcissistic: exaggerated and unreasonable sense of self-importance o Expect to be treated differently. They are very entitled. Over exaggerated sense of importance o Requires attention o Hypersensitivity to evaluation o Co-occurring depression o Etiology: parental reinforcement. They praise their parents maybe a little too much  Not taught empathy o Treatment: not much. Teach them what they hadn’t learned as a child Cluster C: Fearful or anxious • Avoidant: o Extreme sensitivity to opinions of others, of being evaluated by others o Avoids most relationships because they are afraid of being dumped…they want them though o Interpersonally anxious, fearful of rejection, low self esteem o In a relationship, they are very careful and passive about how they feel. They don’t want to rock the boat o Etiology: difficult temperament, early parental rejection, interpersonal isolation and conflict o Treatment: similar to social phobia • Dependent o Rely on others for major and minor decisions. Like others to make decisions for them o Unreasonable fear of abandonment o Clingy, submissive, timid, passive, feelings of inadequacy o Sensitivity to criticism o High need for reassurance o They will create relationships with people who are very stable and independent (have a job with money, home, normalcy)….like looking for your dad o Etiology: little research
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