1. Addiction

characterized by the three C's

1. craving to compulsion
2. continuance despite adverse consequences
3. loss of control

alcohol

drugs

gambling

sex

food

videogames

kleptomania

shopping

Experience of significant maladaptive behavioral and psychological symptoms due to the direct effect of a substance on the CNS.

drugs that tend to increase feelings or alertness, reduced feelings of fatigue, and enable a person to stay waake over sustained periods of time.

examples

1. cocaine
2. methamphetamine
3. MDMA/Ectasy
4. Ritalin

Herion

oxycontin

percoset

methadone

NMDA antagonists

NMDA is a type of glutamate receptor. If these areas are not active at a normal level, it results in subtle brain damage (cause degeneration of neurons and schizophrenia-like symptoms.

Examples of NMDA antagonists are

1. PCP
2. ketamine(K)
3. dextromethorphan/Robitussin

barbiturates-act as depressants to slow down the action of the central nervous system.

causes relaxations makes people sleepy, dangerous in large quantities.

leads to increased tolerance and physiological and psychological dependence.

HOwever, tolerance does not increase amount needed to cause death

antianxiety drugs

taken up quickly int eh digestive tract

patients become psychologically and physiologically dependent on them.  withdrawal likely.

relapse rates are high.

believed to work by enhancing the activity of GABA receptors

Addiction as a Progressive Illnes

Levels of involvement

1. Use-0 non-pathological
2. "risky"-heavy use with discrete negative consequences
3. "Problem"- problematic use without functional decline
4. DSM_IV Abuse-pathological
5. DSM-IV Dependence-pathological

impariment/distress in more than one symptoms for 12 months

• major role obligations
• physically hazardous situation
• legal problems
• interpersonal problems

impairment/distress in more than three symptoms for 12 months

• tolerance
• withdrawal
• consume more than intended
• persistent desire or unsuccessful efforts to cut back
• excessive time spent acquiring, using, reocvering
• activities reduced
• use despite exarcerbation of a health condition

• more than 1/3 US has tried an illegal substance
• Alcohol Abuse (13%) dependence (5%)
• Druge ABuse (8%) dependence (3%)
• rates are higher in Men (2:1)
• native American>Caucasion>Hispanic>African American>Asian American

~50% w/SUD have mental disorder

~50% w/mental disorder have SUD

most likely to have SUD (30%) if you have Antisocial PD

center of psychoactive drug activation in the brain. involved in the release of dopamine and in mediating the rewarding properties of drugs.

Located in the center of the brain, the ventral tegmental area, controls emotions, memory, and gratification. activation of this area stimulates gratification, interupting normal functions

Drugs of abuse produce acute increases in dopamine in the Ventral Tegmental Area (VTA) which projects to the nucleus accumbens (NAc) and on to the prefrontal cortex (PFC)

[image]

having parents who were alcoholics increases the likelihood of the child developing the abuse

whether genetics is solely the reason is still up for debate because of the possibility of environmental and personality factors

druge exposure

drug cues/contexts

stress

Pressure of family and friends

court mandates

overdoes or drug-induced psychosis

hitting "botton"--loss of health, marriage, employment, housing

desire for change

users typically feel ambivalent about trying to change

1. Pre-contemplation
2. contemplation
3. determination/preparation
4. action maintenance
5. relapse (repeat cycle over again)

alchohol withdrawal includes insomnia, anziety, nausea, headaches, alcohol withrdawal delierium, alcohol-amnestic disorder

medications used are benzodiazepines

medication

psychoeducation

stress management

relapse prevention

AA/NA support groups

behavorial couples therapy

finding new menaing and reinforcers

Failure to meet developmental goals produces unconscious conflicts (related to trust, autonomy, identity)

Person develops characteristic defense/coping mechanisms

PROS: emphasizes development, explains abnormal personality

CONS: de-emphasizes temperament, difficult to test

current dominant trait theory

openness

conscientiousness

extroversion

agreeableness

neuroticism

PROS: intuitive, descriptive

CONS: de-emphasizes situation, fundamental attribution error

temperament "x"  social learning --> behavior/personality

PROS: emphasizes interaction of innate predispositions, previous learning,and current context. Implies ways to change behavior

CONS: identifying key dimensions of persons and situations

a pattern of behavior or experience that is

enduring, inflexible, and pervasive

which deviates from cultural expectations

AND causes distress or impairment

Personality Disorder Cluster A

Paranoid

Odd, distrust or detachment

Paranoid suspiciousness and mistrust of others, see self as blameless

schizoid: impaired social relationships, inability and loack of desire to form attachments to others

schizotypal: peculiar thought patterns; oddities of perception and speech that interfere with communicaiton and social interaction

Personality Disorders Cluster B

histrionic

dramatic-emotional

Histrionic: self dramatization; over concern with attractiveness

Personality

Personality Disorder Cluster C

Avoidant

Anxious

Avoidant: hypersensitivity to rejection or social derogation; shyness; insecurity in social interactionand initiating relationships

frequent occurrence of binge-eating episodes, accompanied by a sense of loss of control of overating and

recurrent inappropiate behavior like purging food or excessive exercise to prevent weight gain

Eating Disorder

Prevalence

mostly caucasian, middle to upper class women

onset= early teens AN; late teens BN

BN 1.5% women .5% men

AN .9% women .3%men

diathesis is having a predisposition toward developing a disorder

Stress is the response of the individual to demand that are percieved as taxing or exceeding his or her personal resources

Whether a person develops a disorder is dependent on these two

the advent of TV caused a dramatic shift in women's attitude toward weight and dieting

acculturation into US society is associated with higher rates of eating disorders

perfectionism

negative body image and dieting

negative affect

no demonstrated efficacy for AN,

no long terms for bulimia, though antidepresants reduce frequency of binging and purgining

first step is weight restoration

then psychoeducation (about nutritiation and health

then target dysfunctional attitudes

body shape

thinness=worth

control

family involvement (communication about eating/attitudes about body shape

treatment still worse lon-term than bulimia

cognitive-behavior therapy (end binge-purge cycles, target dysfunctional thoughts)

interpersonal psychotherapy ( improve interpersonal functioning)

Efficacy (similar in long-run, CBT may work quicker)

Personality Cluster A disorder

schizoid

schizoid: impaired social relationships, inability and lack of desire to form attachments to others

Personality Disorders Cluster B

Narcissistic

Narcissistic: gradiosity; preoccupation with recieving attention

Personality Disorder Cluster B

Borderline

Borderline: Impulsiveness; inappropiate anger; drastic mood shifts

(more women have this than men)

• Axis I: clinical disorders, including major mental disorders, as well as developmental and learning disorders
• Axis II: underlying pervasive or personality conditions, as well as mental retardation
• Axis III: Acute medical conditions and physical disorders.
• Axis IV: psychosocial and environmental factors contributing to the disorder
• Axis V: Global Assessment of Functioning or Children’s Global Assessment Scale for children and teens under the age of 18.

Personality Disorder Cluster C

Dependent

Dependent: difficult in separating in relationships; discomfort at being alone; subordination of needs in order to keep others involved in a relationship; indecisiveness

Personality Disorder Cluster C

Obsessive-Compulsive

emotional dysregulation and invalidating environment

Emotionally Sensitive Child + Traumatic Childhood Event + A Family that does not properly nurture the child's emotional needs = an adult with Borderline Personality Disorder.

1. Linehan's Dialectical behavior therapy (improve affect tolerance and regulation; develop better coping skills)
2. Psychodynamic Therapy (help patient integrate extreme negative and positive views of the world)
3. Medications (SSRI's, mood stabilitzers, low does of antipsychotic meds)

Antisocial behavior

examples

impulsivity and sensation-seeking

irresponsible, socially deviant lifestyle, unlwaful behavior

substance abuse

absence of guilt, empathy, conscience

grandios self worth

superficial charm, pathological lying, exploitative

A: appears normal (superficial charm, intelligence, not delusional

B: behavior is antisocial

C: consistency lacking (lack of goals, failre to follow life plan)

D: deficits (lack of remorse, incapacity for love)

Developmental Precursors to Schizophrenia (Walker)

measure of the family environment based on what the family says during private interviews

three components

critism

hostility

emotional overinvolvement

EE (expressed emotion) relation to relapse in schizophrenia patients

patients in in high EE families are more likely to relapse

schizophrenia patients are more vunerable to stress.

biologically, stressed releases cortisol which lead to increased levels of dopamin and glutamate which are implicated in schiphrenia