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Psych 270 Exam 3

Terms in this set (41)

Suicidal Ideation
Urges and thoughts of suicide.
Suicide Attempt
Attempt to take one's life.
Completed Suicide
One takes their own life.
Frequency- Attempts
These are more common then completed .
GENERAL POPULATION 10:1.
ADOLESCENTS 100:1 .
WOMAN ages 15-19 are THREE times as many attempts as males.
Frequency of Completed Suicides
1. Aprox 40,000 people die by suicide .
a. 2010, more died from suicide than car accidents.
b. 8th leading cause of death in general population .
2. Age factors.
a. Highest rate in white males over 50 .
b. Rates have increased for adolescents .
i. THIRD leading risk for adolescent ages 15-24.
c. Risk of successful suicide is highest among those 65+(esp. older white man).
3. Gender factors.
a. 70% of committed suicides are white males; highest rates was in their 80s.
b. Men 4x completion rate.
c. Women: risk increase until midlife, then plateaus.
Causes
1.Statistics.
a.50% or more of suicides occur in the context of a mood disorder.
i.15-20% of people diagnosis with mood disorders will eventually commit suicide.
b.Successful completion of suicide is higher in clinically depressed individuals.
2.Biological Factors.
a.Low Serotonin.
i.poor impulse control, increase in levels and aggressive behavior.
b. Genetic components (genes linked to both).
i. Developing mental disorders.
ii. Developing impulsive characteristics.
3. Social Factors.
i. social structures/social-emotional support.
ii. social policy.
iii. Prominent media coverage.
4.Psychological Factors.
a.Interpersonal-psychological theory:
i. Suicide as attempt to escape psychological.
ii. Pain due to lack affiliation and competence.
ii. Desire to die: social isolation and belief that one has become a burden to others.
b.Desire to end life must be accompanied by ability to enact lethal self-injury.
Treatment for Suicide
1.Crisis center/hotline.
a. Non-proffesional, trained volunteers that are available for verbal support.
b. Used in "emergency situations"- not ongoing; but will make referral for psychotherapeutic services.
2. Psychotherapeutic Interventions.
a.Reduce lethality.
b. Negotiate agreements.
c. Provide support.
d. Replace tunnel vision with broader perspectives.
3. Medication.
a. antidepressants, depression.
b. antipsychotics schizophrenia.
4. Hospitalization.
a. Can be voluntary or involuntary.
b. Safety of individual is primary concern.
c.Hospital can offer:
i. safety monitoring.
ii. Limited access to means.
iii. Various treatment options.
Non-Suicidal Self Injury
Harm to self without trying to end life .
a.cutting,burning, scratching.
b.4% many don't meet criteria for disorder.
C. can be seen in.
i.borerline personality disorder.
ii.substance use disorders.
iii.eating disorders .
iv.Depression.
v.PSTD.
Vi. But, can also be primary problems.
Cause of non-sucidal self injury
1. engage in self injury because pain serves as a useful purpose.
a.most common: maladaptive way to regulate intense, negative emotional states.
b. to punish themselves and regulate frustration and anger.
c. combat periods of dissociation and feeling of emptiness.
Facts About suicide
1. Survivors ... not always possible.. emotions may rewaken...
2.Sucicide rates...date shows that students have thought about that in their lifetime.... the rates have increased in the last 5 years....
3.Risk factors... previous suicide attempts.. history of family suicide..... Psychological disorder.... substance abuse... recent lost...
4.Suicide in UP 13 from 2007-2010....
Awareness of Suicide
1.Possiible warning signs.
a. thinking, talking or wishing about suicide.
b.substance use or abuse.
c.Social withdrawal.
d.Reckless, high risk behavior.
e. dramatic changes in mood.
f. lack of hope or purpose.
g. anger or rage.
h. suddenly happier or calmer.
i.making arrangements; setting ones affairs in order
j. giving things away, such as prized possession
2. Imminent warning signs.
a. Threatening to hurt or kill oneself.
b. looking for ways to kill oneself.
c.excessive talking or writing about death dying or suicide.
d.making concrete plans or preparation to act on suicidal thoughts.
Commons misconceptions
"People who talk about it don't really do it" false 50-75% actually do
"if a person is determined to kill themselves, nothing will stop them" false most people have mixed feelings about dying
"talking about suicide may give someone the idea"false
bringing it up is the most helpful thing to do.
How to help
1.DO
take warning signs seriously and voice your concern.
focus on listening.
let the person you know care.
ask if they.
have thought suicide.
have a plan.
what action they've taken so far to carry it out.
2. do not.
assume someone else will take action.
leave them.
act shocked or judgmental.
try to argue or persude them to feel better.
debate moral issue.
be sworn to secrecy.
Bulimia Nervosa
Symptomatology.
a. Recurrent episodes of binge eating.
b. recurrent compensatory to prevent weight gain ...like OCD..
c. BInge eating and compensatory behavior occurring at least once a week for three months.
d. Self-Evaluation is largely influenced by body shape and weight (psychological factor
Subtypes of Bulimia Nervosa
Purging type.
Non purging type.
Purging type
a. del-induced vomiting, misuse of laxatives, diuretics of enemas.
b.Direct way of preventing weight gain
Non-purging type
1.fasting, excessive diet or exercise.
a. Primary reason at gym is to prevent weight gain from binge eating
b.indirect way of preventing weight gain
Clinical Features Of Bulimia nervosa
1. Negative view of self
a. low self-esteem
b. shame and hiding behavior
c. Feel out of control (obsession with food)
2.Binge
a. Quantity of food and duration of binge various
b. Sense of lack of control
i. becomes numb, "into trance" when eating
c. Negative feelings following the binge
i. feel emotionally and physically uncomfortable, intense feeling of self loathing
d. Can last 50mins -8 hours 1,000-60,000 calories
3.Purge:
a. Method and frequency varies
i. some will purge a few times per a months, others 20 times per a day. Some will purge and continue to binge.
ii. Cycle: Reduction of anxiety with binge-> shame -> immediate relief from purge-> shame
iii. Bine and purge serves as negative reinforcements
b.secret and maladaptive method of eating control
4.Medical complications:
a. anemia, rupture of heart, electrolyte imbalance -> (leads to weakness, paralysis, irregular heart beat, GI disease, kidney problems) fertility difficulties, chronic sore throat, and vomiting blood, salivary glands swollen, irregular period, stomach cramps, constipation, cavities, acne.
b. the longer the person has had bulimia nervosa the greater chance they person will develop more serious medical complication as the rupturing heart...
Prevalence of Bulimia Nervosa
1. 1-3% in women... 10 times less in men.
a. socio-economical status and ethnicity no longer a predictor
2. 18%-30% in college population
3.. Less prevalent in non-western countries
Onset of Bulimia Nervosa
1.Most late adolescents or early adults (18 years)
a. you as 11 and old as 40
2. frequently triggered by stressful event
a. such as interpersonal problem, stress with school, or after intense period of dieting
b. looking for a sense of relief
course of Bulimia Nervosa
1. Persist for several years and is often untreated
2. Intermittent periods of remission
Comorbidity of Bulimia Nervosa
1. Mood disorders .. Up to 89%
a. manifestation of depression
2. Anxiety disorder, especially OCD and GAD
3. Personality disorder
4. Substance abuse- very frequently associated
5.Kleptomania-(due to needing money to spend on food to support binge)
Anorexia Nervosa
Symptomatology
A. Refusal to maintain body weight at or above the minimally normal weight in age gender height and physical health .
B. Intense fear of gaining weight or becoming fat or persistent behavior that interfere with weight gain even though underweight.
i. there person is constantly worried about gaining weight even though successful refusal. they are never satisfied
C. Disturbances in the way in which ones body weight or shape is experienced, undue influences in the way in which one
1. Denial of the serious clinical consequences is the most dangerous part of the this disorders.
Subtypes
Restricting type
Binge-eating/Purging type
Restricting type
During the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior(self-induced vomiting or the use of laxatives, diuretics, or enema)
Binge-eating/Purging type
During the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (self induced vomiting or the use of laxatives diuretics or enemas.)
Clinical Features
1.Depressive symptoms- may be secondary to the physiological sequel of semi-starvation
2.Obessive compulsive factors
a. Both related and unrelated to things other than food.
b. Can be due to effect of starvation
3.Fear of eating in public
a. Not an issue or social phobia but an issue of the person being constantly worried about losing control(overeating,bringing) in front of others
4.Negative evaluation of self
a. The person is never happy with himself or herself, and they have a never-ending fear of gaining weight. Measure self-worth by weight.
5.Strong need to control
a. Need to control self, other people, and environment.
b. Controlled personality:
i. Inflexible thinking
ii. Limited Social spontaneity
iii. Restrained initiative- restricting themselves to opportunities
iv. Restricted emotional expression
6. Compared to the restricting type, being-eating/purging type have:
a. Other impulse control problems
b. Substance abuse
c. Mood lability
i. The person is more able to express emotions, and more reactive to internal needs and environment. More fluctuation
d. Sexually active
i. Restricting type nervous about being romantically involved with someone because this may cause them to be in situations with food.
7. Medical Complications:
a. Same medical problems associated with bulimia nervous
b. semi-starvation also affects most major organ system
c. Hospitalization may be required
i. 10% of these people that need hospitalization will die due to consequences of starvation or suicide
Prevalence
1. 0.5-1% in women, less frequent in men
2. Sub-clincial level of anorexia nervosa are more common
3.More prevalent in industialized societies
4.More prevalent in families of higher socioeconomic status
Onset
1. Mean age:17
2.Rarely begins before puberty, but when it does, it is associated with more problems
3. Rarely begins after 40 years old
4.When it begins during early adolescence(13-18 years), it is associated with better prognosis
5.Frequently triggered by stressful events.
Course
1.Is extremely variable
a. some people will completely recover one episode, but others it could become a cycle.
Cognitive Behavior model(for eating disorders)
A. Distorted attitudes about body weight and shape
1. Society imposes on us a "Standard" of how we are suppose to look
B.Dietary restrain based on rigid rules
C. Break in dietary restrain
1. Binge
a. Immediate relief of stress
b. Anxiety because of fear of fatness
D. Purging to relive anxiety and "undo" effects of binge
E. Elimination of nutrients increase probability of a binge
1. Electrolyte imbalance and lower rate of metabolism increase probability of weight gain
2. The body must soak in everything that is given to it
F. Cycle become habitual and uncontrollable
Cognitive Behavioral Therapy for Bulimia Nervosa
A. Interventions
1. Examine available evidence
2. Search for alternative explanations
3.Realistic conséquences
B.Change distorted attitudes about body weight and shape
C. Establish a regular, healthy eating pattern
1. Daily food record
a. Time beginning and ending meal
b. Details on food eaten
c. Quantity
d. Classification- meal, snack, binge
D..Provide coping skills to deal stressful events that trigger binges
1.Rapid consumption -> pausing between bites
2. Eating directly from container -> place food in a dish
E. Change errors of thinking
a. circumstances
b. Events prior to binge
c. Mood prior to binge
d. thoughts prior to binge
e. Coping alternatives used and degree of success
F. Replace purging by other ways of reducing anxiety and depression
1. Temptation strategies
a. The client takes it out when you want to binge and it has a list of alternative activities to try
Eating Disorders-Bulimia Nervosa and Anorexia Nervosa Etiology
1.Socio cultural pressures
a. Women the most likely to develop eating disorders due to society pressures and "cultural of thinness"
2. Family environment
3.Psychological factors
a. Reflection of ineffective parenting
i. Parents have not done good jobs of reading child's needs
b. Focusing too much on how child looks, less on what they need from other people
i.disregarding important needs in their life.
ii. need to become aware to express emotions
c. Struggle for control
i. eating the only way to have control
ii. Exercise autonomy
4. Biological models
a. Based on genes and early experiences
b. If exposed early to hight fat and calorie content food, brain can be wires to keep eating that much later in life
5. Mood disorders
.g. a. Very high level of comorbidity
b. Low level of serotonin in people with anorexia and bulimia
c. High levels of depression of those in families with eating disorder
Substance Related Disorders
A. Three classes of drugs:
1. Depressants
a.E.g. alcohol
2. Simulants
a. E.g. cocaine
3. Hallucinogens
E.g. marijuana
B. Two types of of substance use disorders
1. Substance Dépendance- more intense in terms of effects on life and health
2. Substance abuse
C. Substance Dependence
1. a maladaptive pattern of substance abuse, leading to clinically significant impairment or distress ( at least three of the following) :
a.tolerance: need for markedly increased amounts to achieve desired effect
i. Postive reinforcement
ii. Withdrawal: unpleasant and sometimes dangerous symptoms when suddenly stop taking or reduce dosage
iii. Negative reinforcement
iv. Relapse is seen in those who go back to the environment in which they first consumed a certain drug
1. Reason is that withdrawal is classically conditioned-experiencing a need to decrease negative emotions and symptoms
2. Also need due to peer pressure
v. Treatment should be targeted at reducing negative reinforcement
c.Substance is often taken in larger amounts over a longer period then intended
1.Cirteria continued:
a. Persistant desire or unsuccessful efforts to cut down
b. great deal of time spent in activities necessary to obtain or use the substance, or recover from its effect.
c. Important social, occupation, or recreational activities are given up or reduced because of abuse
d. Reduces personals ability to develop actualization- what they want to achieve in life is being sacrificed
e.Use is continued despite knowledge by the substance
Substance Abuse
1. Maladaptive pattern of substance use leading to clinically significant impairment (at least I of the following)
a. Recurrent substance use resulting in failure to fulfill major obligations
b. recurrent use in situations which it is physically hazaderous
c. Recurrent substance related problems(DUI)
d.Continued substance use despite persistent problem caused by the substance
2. Symptoms have never met criteria for substance dependence
Alcohol(depressant)
1.Prevalence
a. 2/3 of americans drink at least from time to time
b.5% are heavy drinkers
c.3:1 men to female
d. 7.4-9.7% meet criteria of alcohol abuse or dependance over one year period
e.lifetime: 30% 2:1 male to female ratio (chronic alcohol abuse/dependence
i.regular/steady
ii.limited
1.weekends
iii.Binge
1.Men: 5 drinks at 1 time (64% at Pennstate)
2.Women: 4 drinks at 1 time (51% at pennstate)

2.Costs
a. to society
i. 23,000 deaths from drunk driver each year
ii. 60 billion dollars a year
b. family
i.higher level of disharmony
ii.physical and sexual abuse
c. Toe health
i.liver damage (cirrhosis)
1.7th leading cause of death
ii. heart problems
iii. impairment of immune system
iv. nutritional problems
v. Mental disorders caused by vitamins and mineral deficiencies
vi. fetal alcohol syndrome
Cocaine (stimulate)
Prevalence
a. 23 million us have tried
b.2 million currently using (once a month)
c.12 months prevalence 0.2-0.3%
d.1 out of 5 uses meet criteria for abuse and dependence
cocaine costs
to health
i. 25% increase of cocaine related er visits from 1982-1991
ii. linked to 20% of all suicides for individuals younger 61
ii. overdose
iv. heart problems
v. brain seizures
vi. cocaine syndrome
Cannabis (hallucinogens)
1.Prevalence
a. 3.4% among 12-17 year olds
b. 1.5% among adults 18+
12 month prevalence highest among 18-29 years olds 4.4%
2.Costs
a. Deficits in sensory motor skills
b.deficits in cognitive functioning
c. medical problems
d. decrease of reproduction
e.impact on immune system
3. Video clip of Michael jackson Kim basinger etc.
a. we see talented celebrities, but we do not see mental illnesses and substance abuse
b. this problems exists across a variety of populations, no matter how glamorous or famous the person may be
Etiology of substance abuse
biological ...
adoption (two different settings)
Psychodynamic- dependency oral fixation ... this is linked to a certain time in the past of the individual ..... early in life parents present
behavioral -operant conditioning positive reinforcement: the high
negative reinforcement:decrease anxiety
classical conditioning
their withdrawal symptoms are associated with the environment in which they consume
socio cultural values of family going to college
treatment of substance abuse
detoxification
drug antagonist
-make you sick or vomit
drug subsitidues
cbt
coping skills avoid relapse
aa
group interventions
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