Especially for men, arousal problems increase with age. Several biological factors are known to influence sexual arousal, including any condition that affects the circulatory system and many types of medications and drugs. Lower urinary tract symptoms can affect female desire, lubrication, and orgasm. Among males, erectile disorder has been linked to nicotine (smokers have twice the rate of erection problems as nonsmokers), alcohol, obesity, diabetes, spinal cord injury, stress, anxiety and depression. Antipsychotic medications re known to produce sexual dysfunction, including erectile problems. Antidepressant medications, especially the SSRIs produce sexual side effects including erectile dysfunction, reduced sexual interest and ejaculatory difficulties Involves pain, or the fearful anticipation of pain, during intercourse or vaginal penetration. The DSM-5 replaces two sexual pain disorders int he DSM-IV, dyspareunia (painful intercourse) and vaginismus. The pain may occur during intercourse or persist afterwards and is not caused by lack of lubrication, a general medical condition, the effects of a substance, or another mental disorder. Involuntary contraction of the perineal muscles surrounding the outer vagina, in response to attempts to penetrate the vagina, is sometimes involved. It may be triggered by actual or anticipated penetration by a penis, finger, speculum, or tampon.
It is assumed that the dysfunction occurs in each sexual situation
Complaints tend to peak in early adulthood and near menopause
Traums such as rape or sexual assault, can be causal for sexual pain disorders although the primary causes may be painful childbirth, inadequate lubrication, and abrasion by pubic hair
Disorders in which he disturbance concerns the focus or target of sexual desire. The diagnostic criteria describe intense and recurrent sexual fantasies, sexual urges, or sexual behaviors involving objects, children, non-consenting persons, or suffering and humiliation
The fantasies or stimuli may be necessary in order to become sexually aroused; others may engage int hem more episodically.
All of the paraphilia disorders are much more common among men than women
Paraphilia's must be distinguished from non-pathological sexual fantasies and practices, which can show wide variation. In broad terms, these disorders can be clustered as courtship disorders, conditions that involve pain or suffering, and disorders involving unusual preferences in desire. The key factor is that paraphilic disorders involve clinically significant distress or impairment, such as when they are experienced as obligatory for arousal, involve non-consenting victims, create legal difficulties, or interfere with interpersonal relationships.
Diagnostic reliability was was excellent in the DSM-III
Sexual interest becomes focused on non-living objects such as fur, underwear, leather items, high-heeled shoes, or stocking, or on specific non-genital body parts such as feet or toes.
The person experiences recurrent, intense, sexually arousing fantasies, urges, or behaviors involving these objects in sexual contexts, usually masturbating while fondling or smelling them, or having the person's partner wear them.
The diagnosis requires that these urges, fantasies, or behaviors persist for at least 6 months and are distressing or cause interpersonal problems. The fetish does not include items used in cross-dressingor items specifically designed to provide sexual arousal
The person with sexual masochism obtains intense sexual arousal through fantasies, urges, or behaviors involving the act of being bound, beaten, humiliated, or otherwise force to suffer. Masochistic fantasies may involve being whipped, tortured, beaten, raped, pierced, shocked, or subject to other forms of physical or verbal abuse or humiliation; they must have persisted for 6 months and must cause distress or interpersonal problems to qualify for the diagnosis. The course tends to be chronic, and the activities may remain relatively mild or may increase in intensity and dangerousness. Specifiers include in a controlled environment and in full remission. It can also be specified for one type of masochistic act, asphyxiophilia, which involves oxygen depriving activities such as choking, hanging, or suffocating The proper order of the sexual response cycle consists of which of the following?
A. plateau phase, orgasmic phase, resolution phase, excitement phase
B. excitement phase, plateau phase, orgasmic phase, resolution phase
C. excitement phase, orgasmic phase, plateau phase, resolution phase
D. plateau phase, orgasmic phase excitement phase, resolution phase
The presence of psychosis is inferred in the same way as all other mental disorders: from what people say during an interview and how they act when observed. Some symptoms- such as delusions, hallucinations, and grossly impaired speech or movement- are considered direct evidence of psychosis, almost as if bizarre attributes have been added to a person's psychological repertoire. Other symptoms provide indirect evidence of psychosis: impairment in self-care, restricted range of emotion, poverty of speech content, inability to initiate goal-directed behavior. In a sense, these indirect symptoms seem as if something has been lost or removed from a person's psychological state. The direct (or positive) symptoms and indirect (or negative) symptoms can be described as disturbances of language and though, disturbances of sensation and perception, disturbances of motor behavior, emotional disturbances, and social withdrawal The person hears voices that may condemn, praise, direct, or accuse.
They may be identified with a specific agent such as God, the devil, parents, past acquaintances, or unspecified 'others.' While experiencing a hallucination, the person may or may not realize it is unreal; often it may seem to come from an external source. The individual may listen passively to the voices, act upon their commands, or talk back to them.
Brain imaging studies have shown that individuals experiencing auditory hallucinations display activation int he expressive rather than receptive language areas of the brain; in many ways auditory hallucinations appear to involve faulty interpretation and monitoring of self-talk.
There is no assumption that these disorders share a common cause, a common pathway, or even a common fundamental set of symptoms. Psychotic symptoms can appear briefly (transiently) during periods of stress in individuals with many different conditions and do not, in themselves, verify the presence of a psychotic disorder. The symptom patterns and degree of impairment differ within the psychotic disorders.
Many medical conditions can produce psychotic symptoms. Neurological conditions (such as epilepsy and multiple sclerosis), endocrine disorders (including hypothyroidism), metabolic conditions, fever, and nearly any other disorder with CNS involvement could be responsible for psychotic states. Inanition, a wide variety of legal and illegal substances can produce hallucinations, delusions, verbal incoherence, and other psychotic behavior as a direct result of use eruption abrupt withdrawal. The appropriate diagnostic categories for these conditions are 'psychotic disorder due to another medical condition,' and 'substance/medication induced psychotic disorder,' respectively.
Currently, the diagnosis of schizophrenia requires two psychotic symptoms during a 1-month active phase, one of which must be delusions, hallucinations, or disorganized speech.
Schizophrenia involves either a decline from a prior level of function or a failure to meet expected levels, and this change is usually apparent to others who know the person.
As a condition of the diagnosis, signs of disorder must persist for at least 6 months; however, for much of that time (except for 1 month) the symptoms can be either residual (attenuated symptoms that follow an active phase) or prodromal (symptoms that precede an active phase)
Specifiers describe the course of schizophrenia as first episode, multiple episodes, or continuous, and whether the condition is in full or partial remission. The DSM-5 encourages a dimensional rating of severity
Although most cases have onset between the late teens to mid-30s, schizophrenia can be diagnosed at nay age. Men have somewhat earlier age of onset than women, who tend to show better outcome. Men also tend to show more negative symptoms, whereas women are more likely to display paranoid delusions, mood symptoms, and hallucinations.
Sudden onset of psychotic symptoms that last more than 1 day but do not persist more than a month, with eventual return to full functioning.
The psychotic indications involve at least one positive symptom (delusions, hallucinations, disorganized speech, or disorganized or catatonic behavior) and are not explained by the effects of drugs, medical conditions, or another mental disorder that can cause transient psychosis.
Usually people displaying this disorder are experiencing severe stress or turmoil in their lives, and they appear overwhelmed and confused.
Specifiers: 'with marked stressors,' 'without marked stressors' or 'with postpartum onset' (if the condition began within 4 weeks of giving birth)
Up to 9% of cases of first-onset psychosis may be accounted for by brief psychotic disorder
Twice as common among females as males
Prognosis tends to be much better than for other psychotic conditions. However, in their acutely disturbed state, people with the condition may be at much higher risk for suicide
Delusional disorder involves a more limited range of psychotic symptoms. The delusions may be bizarre but may not include prominent auditory or visual hallucinations. Although the delusions are persistent (at least 1 month in duration), they are focused on a theme apart from which here may be little impairment in behavior or functioning.
The delusions usually concern being followed, poisoned, deceived, infected, or loved at a distance.
The diagnosis is subtype according to the predominant theme- erotomania, grandiose, jealous, persecutory, somatic, mixed or unspecified
Appear to be uncommon with population incidence as low as 0.2%
Occur at equal rates in males and females, although males may be more likely to show the jealous subtype.
Diagnoses of delusional disorder are rare, in part, because such individuals do not seek help. In spite of a chronic course, the disorder does not seem to interfere with other aspects of the individual's thinking and behavior; the disorganization in these areas evident in schizophrenia or the extremes of elation and expression seen in the mood disorders are not present. Except for those parts of life related to the delusional beliefs, many affected persons may seem normal.
The brains of schizophrenic patients real no specific anatomical deviations or lesions that consistently distinguish them from the brains of normals. However, evidence collected over the past 50 years does suggest some possible impairment ingrain functioning in schizophrenia
Evidence for 'soft signs' of neurological impairment (abnormal speech, abnormal gait, poor coordination, impaired attention span, and hyperactivity) when they examined guidance clinic records of adolescents who were subsequently hospitalized for schizophrenia
EEG studies suggested higher incidence of abnormal brain wave patterns among schizophrenics, along with evidence that points to dysfunction in the left hemisphere of the brain in samples of schizophrenic patients
Some proportion of schizophrenics, variously estimated at between 25-60%, show evidence of enlarged brain ventricles. unfortunately, brain ventricle enlargement is not unique to schizophrenia; it occurs in several other conditions.
Other neurological reports suggest that some schizophrenics show cerebral atrophy, decrease in the size of the thalamus, and reduction in size of the hippocampus.
One kind of parent-child interaction is especially important int he development of schizophrenia, the double bind. The double bind arises when 1. the child is emotionally dependent upon the parent and it is therefore extremely important for him or her to understand communications accurately and respond appropriately; and 2. the parent expresses two contradictory messages. The content of what the parent says may be the opposite of the message contained in tone of voice or facial expression, or the content itself may simply consist of two incompatible messages. The child cannot comment on the incongruous messages, withdraw from the situation, or ignore the messages. Caught in a bind from which there is no escape, the child uses 'crazy' thinking and actions to cope with this intolerable situation
The double bind notion thus proposed that psychotic symptoms were a form of adaptation to an impossible situation
The basic thesis is that the behavior and thought processes of people diagnosed as schizophrenic , indeed, seem crazy outside of the family context, but seen from the family perspective are not crazy or irrational at all. In fact, such behavior is just how a person might rationally react to such an environment
These hypothesized family influences could be conceptualized within the framework of social learning theory. Parents might model and perhaps reinforce disturbed communication and peculiar ideas; then punish attempts at interpersonal intimacy, 'straight' communication, and developing a distinct identity, ultimately forcing the child to withdraw in order to escape this aversive experiences
A strong medical-model perspective considers schizophrenia to be a biological disease of the brain, unrelated to psychological influences, in which a genetic predisposition is triggered by a biological event such as a viral infection either in utero or in infancy. Some schizophrenia cases are considered to be the direct result of childhood trauma and abuse, even in the absence of genetic susceptibility. A more centrist position is represented by those who believe that a simple neurodevelopmental model cannot explain many factors about onset and severity and look, instead, to a dopamine dysfunction that can have multiple causes- including genetic, environmental, social, and psychological ones.
The current state of affairs is one of a wealth of data, but a poverty of conclusions.
The most practical view of schizophrenia etiology remains the diathesis-stress model, which proposed that the disorder is triggered by stressful events in someone whit a diathesis (predisposition or a vulnerability) to the disorder. Vulnerability within the diathesis-stress model could be traced to genetic, biological, or psychological history
The episode involves a 2 week period of nearly constant depressive symptomatology: sadness, loss of interest or pleasure, changes in weight, changes in sleep, loss of energy, agitated or slow movement, difficult concentrating, guilt, and/or thoughts of death. Obviously, many people experience occasional depressed mood, including some of these symptoms. A major depressive episode is distinguished by its duration (nearly constant for two weeks), the degree of disturbance (at least five of the symptoms are present), and the impairment that it causes in life.
The presence of psychotic symptoms in a major depressive episode requires differentiation from schizoaffective disorder, in which psychotic symptoms are also present in the absence of the mood episode
The mood disorders include a variety of qualifiers that further describe their onset, pattern, or severity, in addition to the 'with mixed features' specifier. With the exception of the less extreme disorders (dysthymic and cyclothymic disorder), the qualifiers can include a rating of severity (mild, moderate, or severe); if the severity is high, an indication is included as to whether psychotic symptoms are present or not. If echolalia, echopraxia, or disturbances in motor activity are dominant among the symptoms of bipolar I disorder or major depressive disorder, the qualification 'with catatonic features' can be added.
'melancholic features' qualifier describes particularly deep depression, which tends to be worse in the morning and is characterized by loss of pleasure in nearly all things, significant anorexia or weight loss, psychomotor changes, and early morning wakening.
'with postpartum onset'- if the mood disorder has onset within 4 weeks of childbirth
'seasonal pattern' qualifier- symptoms appear to cycle with the time of year
'anxious distress'- mood conditions with anxiety symptoms
Because it is known that some types of brain damage are associated with increased depressive symptomatology, efforts to identify abnormalities in the brains of depressed persons are continuing. Findings of reduced activity in the prefrontal cortex are consistent with other studies suggesting reduced volume of that area among depressed patients. Evidence of various other differences in activity int he hippocampus, the amygdala, and the anterior cingulate cortex indicate that the brain is working differently in depressed people compared to normal people. EEG differences in activity between the brain hemispheres have also been found in some, but not all, studies with lowered left hemisphere activity more characteristic of depression. In general, depression appears to be associated with increased activity in the limbic system, perhaps together with decreased activity in a real that regulate limbic activity. However, none of these differences appear to be necessary for the disorder, and it remains unclear whether these neuroanatomical indicators precede depression onset, co-occur with the disorder, or result from expression of the disorder. Medication is the most common intervention, and effective antidepressants have been developed that have milder side-effect profiles than earlier-generation drugs.
ECT is an effective and rapid intervention for severe depression, but it is associated with memory loss and high rates of relapse
Several psychotherapies appear to be as effective for depression as medication, including cognitive therapy, behavioral therapy, and interpersonal therapy
In general, psychotherapy is associated with lower risk of relapse when compared to antidepressant medication.
The existence of a significant placebo response, and a high rate of natural remission, may influence reported rates of effectiveness, as may selective publication of research presenting the positive, but not negative, outcomes in medication trials
Suicide is by no means always associated with severe depression, but it is clear that a much higher proportion of individuals with diagnosed depressions commit suicide than in the population at large
As core symptoms for the mood disorders- or in association with substance use disorders, eating disorders, psychoses, anxiety, or personality disorders- emotions such as hopelessness and despair are often present in suicidal crisis.
Suicide ranks among the top 10 leading causes of death in the US.
Bipolar disorder was associated with the highest risk of suicide among male veterans, while among female veterans the highest risk was among those with substance use disorders
Males succeed at suicide at nearly 4 times the rate of females and represent almost 80% of suicide deaths
Although males complete suicide more often, females make nearly 3 times as many suicide attempts
Most males used firearms, while the most common female attempts involved poisoning.
Suicide rates are much higher among White and Native American/Native Alaskan males than other groups.
Age is a more significant factor in the likelihood of male suicide than female suicide. For white males, the risk of suicide increases throughout life, reaching its highest levels after age 65. In American Indians/Alaska Natives suicide is highest before age 25 and declines thereafter. Female rates show a decline after age 65.
The likelihood of suicide attempts drops as people move beyond middle age, but the risk of completed suicided does not
Substance withdrawal is a substance-specific syndrome- involving behavioral, psychological, and cognitive changes- that occurs after the cessation or reduction of substance use, following a period of prolonged use.
The symptoms of withdrawal are usually the opposite of the symptoms of intoxication. It is nearly always accompanied by craving for the substance, the administration of which reverses the withdrawal syndrome
Withdrawal syndromes occur with many, but not all, substances of abuse
The DSM-5 does not identify a substance withdrawal classification for either hallucinogens or inhalants (including solvents) Withdrawal symptoms generally subside within a few days
Withdrawal syndromes are described int he DSM-5 for alcohol, caffeine, cannabis, tobacco, stimulants, opioids, and sedatives, hypnotics or anxiolytics (anti anxiety drugs)
In addition to intoxication and withdrawal, the substance-induced disorders includes conditions in which other mental disorders, such as depression and anxiety, are induced by substances. In general, the more sedating drugs tend to induce depressive disorders, while the more stimulating drugs tend to induce psychotic disorders; both can produce sleep and sexual dysfunctions
Generally, faster-acting substances present more of a risk of dependence than slower-acting ones, and methods of administration that deliver the psychoactive components of the drug to the brain more quickly are associated with higher degrees of dependence.
Nicotine, a widely available substance, tops the list of most dependence-producing substances. Even though its psychotropic properties may seem mild compared to other substances, Nicotine is noteworthy in the devastation it produces. Tobacco use accounts for 442,000 deaths annually.
Nicotine dependence is connected to nearly 1 in 5 of all deaths in the country, making it the leading preventable cause of death. In contrast, alcohol consumption directly caused 85,000 deaths, or 3.5% of the total. Tobacco kills more Americans than human immunodeficiency virus, illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined, each year.
Evidence appears to support substantial contributions from both genetics and environment to the development of substance use disorders. Biological susceptibility to the unconditioned effects of drugs can be influenced by a history of drug experiences to produce alterations int he brain's response to a substance. The reinforcing value of drugs strengthens and maintains drug use. As use continues, tolerance, withdrawal, and craving can be produced as anticipatory responses of the brain as it attempts to compensate for the onset of drug effects. These brain responses can be elicited by stimuli that have accompanied and predicted drug onset in the past, such that tolerance can be associated with he settings of drug use, and withdrawal, craving, and relapse can be triggered when drug cues are not followed by the drug. The development of these bio-behavioral patterns is a function, in part, of genetic history, cultural influence, environmental setting, drug availability and experience, and the degree of parental and peer-group support Cannabis intoxication, cannabis intoxication delirium, cannabis-induced psychotic disorder, cannabis-induced anxiety disorder, and cannabis induced sleep disorders, as well as cannabis withdrawal- are all included int he DSM-5
Cannabis (most often in the form of marijuana that is smoke or eaten) is the most widely used illicit drug int he US. Nearly 1/3 of Americans have ingested a cannabinoid at some point.
Lifetime prevalence of cannabis use disorders was nearly 5%
Cannabis intoxication occurs within minutes of smoking, or within a few hours of oral ingestion, and typically includes euphoria, altered time judgement, anxiety, and increased heart rate
Typically involves toxins or solvents such as paint thinner, gasoline, glue or paint, or other volatile compounds containing toluene, benzene, acetone, and other substances. Typically the substances are concentrated on a rag or in a paper bag and inhaled.
Intoxication is rapid and can involve euphoria, perceptual disturbances, dizziness, impaired judgement, slurred speech, and stupor.
DSM-5 recognizes inhalant intoxication, inhalant intoxication delirium, inhalant-induced persisting dementia, and inhalant-induced psychotic, mood, and anxiety disorders
Opiates- or narcotics- are depressants that have their major effect not he central nervous system and respiration
Most commonly used as analgesics, or painkillers, although they are also frequently prescribed for use in cough suppressants and for diarrhea
Today, prescription opioids (synthetic opium) such as oxycodone are responsible for more overdose deaths than any other substance, twice as many as cocaine and heroin combined
Opioid-induced disorders include opioid intoxication, opioid withdrawal, opioid intoxication delirium, and opioid- induced psychotic, and mood, sexual, and sleep disorders.
During intoxication, the pupils become constricted, and drowsiness, slurred speech and impairment of memory or attention occur.
Opioid use disorder occurs at a prevalence of less than 1% of the population, with lower rates among African Americans and higher rates for Native Americans. More males than females use opiates; the male to female ratio for heroin use is 3:1.
Sedative or tranquilizing drugs have been widely prescribed for relief of anxiety and insomnia
about 15% of adult Americans ingesting them within the past year
Women may have a higher incidence of substance use disorder in this class than men. The incidence of sedative, hypnotic, or anxiolytic use disorder appears to be lower than 0.5%
Includes intoxication, intoxication delirium, withdrawal, withdrawal delirium, persisting dementia, persisting amnestic disorder, and induced psychotic, mood, anxiety, sexual, and sleep disorders.
Intoxication involves clouding of consciousness, impairment in memory or attention, disequilibrium, poor judgement, slurred speech, and stupor.
The correct order of Jellenek's four stages of alcoholism is ________.
prealcoholic, crucial, chronic, prodromal
prealcoholic , crucial, prodromal, chronic
prealcoholic, chronic, crucial, prodromal
prealcoholic, prodromal, crucial, chronic
13th EditionLori Watson, Patrick J. Hurley 1st EditionRichard A. Kasschau