Substance abuse

Dependence

includes more severe forms of substance abuse usually relies on a physiological  dependence on the substance

Includes more server form of substance abuse, usually resulting in a physiological dependence on the substance

Show's not only the tolerance for the drug but it also show's withdrawal

People who are dependent may try or want to cut down or stop but most likely they will not be successful (very few people can just stop)

Person will spend a great deal of time in activities to get the substance

They may give up social activities because of this use and abuse

They will continue to use the substance despite the problems that they know they have.

Tolerance

is a need for a increase amount for a drug; Leads to dependence

Withdrawal

if taken off of the substance: have nausea, tension, sweating

Short term effects

• Absorbed into the blood without digestion, when it reaches the brain the short term effects  is that it decreases the brains functioning, and .1 we are impaired, .5 the person can lose  consciousness or even die. .08 is the legal limit
• Short term effects can be influenced by a person's body weight and how much they drink  over time.
  • Feelings of happiness, reduced concentration, relaxed

• Heredity is a factor as well as the culture of the drinker
• Long term effects are more dangerous
  • Increased tolerance
  • Physical uncomforted
  • Anxiety and sometimes hallucinations

Cannabinoids

• increased from .5% to 12% because of technology
  • marijuana

Depressants

• reduced anxiety; depress the nervous system; feeling of well-being; slowed pulse and  breathing
  • barbiturates
  • GHB- associated with rape or sexual assults
  • Is a genetic componint of alchohol addiction

Dissociative Anesthetics

•  increased heart rate and blood pressure, impaired motor  function/memory loss
  • PCP

Hallucinogens

•  altered states of perception and feeling; nausea; persisting perception  disorder(flashbacks)
  • LSD

Opioids and Morphine Derivatives

• pain relief, euphoria, drowsiness/nausea, constipation,  confusion, sedation, respiratory depression and arrest, tolerance, addiction, unconsciousness
  • Codeine, heroin
  • Destroy the place that makes endorphins in your brain
    • When people come off these drugs they typically have to go on some sort of synthetic  drug

Stimulants

• increased heart rate, blood pressure, metabolism; feelings of exhilaration, energy,  increased mental alertness/ rapid or irregular heart beat; reduced appetite, weight loss, heart  failure, nervousness, insomnia
  • Cocaine, amphetamine
  • nicotine

Other Compounds

• Anabolic steroids
• Inhalants

Gender identity d/o

• Can be seen in children and adults
• Characterized by a conflict between a person's anatomical sex and his or her gender identity
  • How the person identifies themselves as male and female

• Relatively rare but we see/aware of more of it today only because of the media
• Diagnosis
  • Strong cross gender identification
    • They will insist that he or she is the other sex
  • Males prefer to dress in female clothing and females in stereotypical male clothing
  • They want to participate in the games and pass times of other sex
  • Persistent discomfort with their own sex

• Causes impairment in functioning
• They do not see themselves as homosexuals because they see themselves as the opposite sex
  • It would be natural for a man who thinks he is a female to want another man

• More common in males than in females
• We don't know what causes it
  • Some social, biological, psychological
  • Sex hormones are a big factor

• Treatment
  • The sex change treatment has the most positive outcome
  • They are usually more effective when the treatment starts early in childhood
  • The parents also receive behavior modification so they can learn to reinforce

Paraphilias

• Which the person has persistent sexual urges and fantasies regarding Non human objects

• Non consenting others
• Sexual arousal by intense fantasies of exposure of one's genitals to strangers
• Has to last over a 6 month period to make a diagnosis
  • These people are not the mythical dirty old man

• Most of them are young, in 20's and married
  • No desire to be in physical contact with their victims.

Paraphilias

• Frotteurism

• Involves rubbing and touching upon something
  • It's obvious to the victim that its not just a normal run into thing

• Most of the of the people do it in crowed places
  • 15-20 years old
  • Not dangerous 

Paraphilias

Voyeurism

• Arousal by looking on unsuspected naked people
  • Peeping tom

• Our nation is involved with how to involve yourself with sexual activities without actually  having sex
  • Porn, soap operas

• Sexual contact is not the goal

Paraphilias

Pedophilia

• When an adult has sexual satisfaction with contact with children
• They may victimize their children, stepchildren or children outside of the family
• Most prefer girls and pre-pubitile boys
• Diagnosis
  • 16 years of age and 5 years older than the child or children he or she is victimizing
  • They may look at child porn

• Child sexual abuse is common
  • 20-30%? of women report with having sexual contact with males as a child

• Recidivism rate of 35% which is the highest among sex offenders
  • If the person goes to jail 35 out of 100 people will engage sexually with children again

• We don't know what causes it

Paraphilias

• Non human objects
  • Fetishism

• A really strong sexual attraction to an enadiment object(shoes, panties)
• Object it used for sexual stimulations
• It is not normal when a person collects the items or is in a relationship with  someone who has the object
• Last at least 6 months
• Not dangerous

Paraphilias

Non human objects

• Transvestic Fetishism(cross dresser)

• Wearing the clothes of another gender is sexually stimulating

• Real or simulating suffering
• Non consenting others

Sexual Masochism

• Obtains sexual gratification by receiving pain, bondage, or humiliation
• Not dangerous to other people

Sexual Sadism

• Obtains sexual gratification by inflicting pain on others
• Considered dangerous
  • Typically these things are scripted out and really planned
  • You may find sadomasochist where people switch roles

Mood Disorder

Major Depressive Episode

• Have to show depressed mood or a loss of interest or pleasure in daily things
• Has to be most of the day, nearly every day
• Mood would be the affective symptoms
  • Sadness, emptyness

• If they show lack of interest it would have to be most of the day everyday
• Behaviorly we would see them change their patterns of behavior
• Physiologically there may be a significantly loss of weight(5%)
  • May just have an increase or decrease of appetite

• Behavior symptom is sleeping or not sleeping all the time
  • Insomnia or hyposomnia

• Psychomotor stuff
  • Pace for no reason
  • Retardation-talk slower move slower

• Fatigue
• Feelings of worthlessness, inappropriate guilt
• Cognitive symptoms like inability to concentrate
  • May think about death or suicide

• A person can have this kind of depressive episode once and never happens again
  • It could be recurrent and then it would be a disorder

Mood Disorder

Major Depressive Disorder

Mood Disorder

Dysthymia

• Milder than the mildest(number 1) depression
• It is a chronic condition that has lasted for at least two years
• The person will have two of the criteria in depressions
  • Eating to much or to little…etc

• We don't see the suicidal stuff you see in 296.3, 296.2
  • Can't have manic, hypo, mixed
  • Can't account the depression to anything else

Mood Disorder

Specifiers for depression

• Mood would be the affective symptoms
  • Sadness, emptyness

• If they show lack of interest it would have to be most of the day everyday
• Behaviorly we would see them change their patterns of behavior
• Physiologically there may be a significantly loss of weight(5%)
  • May just have an increase or decrease of appetite

• Behavior symptom is sleeping or not sleeping all the time
  • Insomnia or hyposomnia

• Psychomotor stuff
  • Pace for no reason
  • Retardation-talk slower move slower

• Fatigue
• Feelings of worthlessness, inappropriate guilt
• Cognitive symptoms like inability to concentrate
  • May think about death or suicide

• A person can have this kind of depressive episode once and never happens again
  • It could be recurrent and then it would be a disorder

Mood Disorder

Manic Episode

• The mood is elevated, expansive, irritable
• Last one week
  • Lesser period of time if person is hospitalized

• The person must have three or more of the symptoms
  • Inflated self-esteem(I think im about better than I really am)
  • Decrease need for sleep
    • Do not sleep more that 3 hours a night and they will feel completely rested
  • More talkative than usual
    • Sort of pressure to their speech like their being pressured to keep talking
  • Increase in their goal directed activity
    • Psychomotor agitation
    • Taking on more objectives than humanly possible
  • Pleasurable activities with painful outcomes
    • Shopping sprees
    • Sex
    • Foolish investment
  • Flights of ideas
    • Ideals or racing
  • Very distractible

Mood Disorder

Hypo manic episode

• Basically the same criteria and the manic
• But it only last for four days
• It differs not only in the length of time but also in the severity level
  • Its not anywhere near the severity level of mania
  • They can still go to school or work

Mood Disorder

Mixed episode

• This is when the criteria for both the depressive and manic episodes are met
• Nearly everyday during a one week period

Mood Disorder

Bipolar I Disorders Single Manic Episode

• The way the client presents to you is the episode they're in
• They have no past major depression episodes
• If recurrent
  • Two months without manic episode

• Single
  • Because they tell us they haven't had them

• Rate with the scale 1-4 

Mood Disorder

Bipolar 1, Most Recent Episode Hypo manic

• Zero has to stay in blank if it's hypo manic
• Currently in or most recently in a Hypo manic Episode
• There has previously been at least one manic or mixed episode
• The mood symptoms cause clinically significant distress

Mood Disorder

Bipolar 1, Most Recent Episode Manic

• The person is currently in a manic episode
• At least one major depressive episode
  • Manic episode or a mixed

• Put specifier
  • Rate from 1-4

Mood Disorder

Bipolar 1, Most Recent Episode Mixed

• Currently or most recently in a mixed epi.
• Previously been at least one Major Depressive epi, manic, or mixed

Mood Disorder

Bipolar 1, Most Recent Episode Depressed

• In major depression
• Previously been in at least one manic, mixed
• Specify 1-4

Mood Disorder

 Bipolar 1, Most Recent Episode Unspecified

• You know they are having bipolar stuff but you can't tell if it's mixed, manic, or hypo

Mood Disorder

Bipolar 2 (recurrent Major Depressive Episodes with Hypo manic Episode)

• One or more major depression episodes
• History of at least one hypo manic episode
• There is never been a manic episode

Mood Disorder

Cyclothymic D/o

• Mildest form of bipolar
• Chronic
• For at least 2 years the presence of numerous periods w/ hypo manic symptoms and numerous  periods w/ depressive symptoms that do not meet criteria for a major depression episode.

They are a group of disorders characterized by gross distortions of reality; these individuals withdraw from social interaction and their perception, thought and emotion are disorganized and fragmented

Schizophrenia

Positive Signs

Schizophrenia

Negative Signs

Schizophrenia

Criteria

• Only be given if
  • Delusions, auditory Hallucinations, marked disturbance in thinking or speech.
  • Patient will have deteriorated from a previous way they were.
  • Must have lasted 6 months
  • Has currently been present for at least 4 weeks

• Two or more of the symptoms have to be present for a significant portion of time during a 1-month period
  • Delusions-false beliefs
  • Hallucinations- sensory misconceptions
  • Disorganized speech
  • Grossly disorganized or catatonic behavior
  • Negative symptoms, i.e., affective flattening, alogia(without words), or avolition(without will)
    • Blank expression on the face, eyes are dull, not sad or happy(flat)

• Social/occupation dysfunction
• Duration: at least 6 months
  • Could have residual or prodronal affects after a month or two

• Schizoaffective and mood disorder exclusion
  • You have to rule this out when you diagnose Schizophrenia

• Substance/general medication condition exclusion
  • You have to rule this out when diagnosing

• Relationship to a pervasive developmental disorder
  • You have to rule this out when diagnosing

• Characterized by a lack of insight
  • Which can cause delusions

Schizophrenia

Delusions

• Types
  • Grandeur- belief that you are a famous and powerful person
  • Persecution- belief that others are plotting against you, or maybe trying to kill you
  • Bodily integration- belief that one's body is rotting away
  • Control- that people or animals or objects are trying to control your life or influencing you
  • Reference- the belief that you're always the center of attention
  • Sin- the belief that one has committed some great wrong or sin that can never be forgiven

Schizophrenia

Hallucinations (types of)

Schizophrenia

Types of thought disturbances

• Broadcasting-your thoughts are going out to the whole world
• Insertion- thoughts are being put into you hear by other things
• Withdrawal- that thoughts are being taken out of your head by something

Schizophrenia

Types of speech abnormalities

• Persistent delusions or auditory hallucinations in the context of a relative preservation of cognitive functioning and affect
• Delusions of persecutions is most common, may have grandeur delusions.
• No other symptoms are present
  • No disorganized speech flat or inappropriate affect

• Sever designations and regressive behavior
  • Speech and behavior is disorganized
  • Flat and inappropriate affect
  • Typical crazy person
  • No delusions/hallucination
    • Childish giggle, silly grin at really inappropriate

• No medication and in really bad shape

• A marked psychomotor disturbance that may involve motoric immobility, excessive motor activity, extreme negativism, mutism, peculiarities or voluntary movement
  • Catalepsy- actual or apparent unconsciousness during which muscles become rigid and remain in any position in which they are placed
    • Lose bladder control and don't eat
  • Excessive motor activity- literally run around in circles with arms out.
    • The only type that can be dangerous but they have to be in an agitated state

• When they meet symptoms for criterion a but no specific criteria for the subtypes