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Final Quizlet

Terms in this set (180)

Criteria for Civil Comment
1. The person has "mental illness" and needs treatment

2. The person is dangerous to themselves or others

3. The person is unable to care for themselves; a situation considered a grave disability
Civil Commitment Laws
Laws determined by each state that detail when a person be legally declared to have a mental illness and who can be placed in a hospital for mental treatment
types of action for civil commitment
1) Police Power: government takes responsibility for protecting the public health/safety/welfare and makes laws and regulations to do that.

2) Parens Patriae: Refers to public policy power of the state to intervene and to protect any individual not likely to act in their own best interest
Criminal Commitment
Whether people should be held responsible for their criminal behavior despite the possible presence of mental illness
Criteria for Criminal Commitment: People with mental illness are held because
1) accused of crime and detained in a mental health facility until they are deemed fit or unfit to proceed in legal processes

2) not guilty of a crime by reason of insanity (NGRI)
Mental Illness (Legal Term)
Legal Concept: Meaning severe emotional or thought disturbances that negatively affect an individual's health and safety.

Each state has its own definition of mental illness. So, Having a DSM diagnosis of a mental illness does not mean that a person's condition meets the legal definition of their state for mental illness.
Mental Illness vs Psychological Disorder
DSM is quite specific about criteria that must be met for diagnosis; there is ambiguity with legally defining mental illness
Criminal Competence
US law requires criminal defendants be competent to assist their own defense by making choices among available options. They must understand and appreciate the criminal proceedings against them - must understand their actions were wrong

(Informed by the Dusky Standard: Influential 1960 Supreme Court case)
When is competence assesed?
Before the trial, in order to asses if they are able to participate in the trial

(note: insanity is measured "at the event" but this is done historically through documentations, searches, etc.)
What happens if someone is not competent?
They cannot participate in their trial or speak on behalf of their actions
What does NGRI mean?
Not guilty by reason of insanity (lacks mens rae - "guilty mind" or criminal intent)
Insanity (legal term)
At the time of the crime, they lacked the capacity to appreciate wrongfulness of conduct, and they are unable to conform their behavior to the law's requirements
Insanity vs competence
Competence is ability to comprehend allegations. It is measured before legal proceedings begin (after arrest).

Insanity is mental state of person. It is measured at the time of the offense
Why do we have Guilty But Mentally Ill (GBMI) as a plea option?
Some states have abolished NGRI. This middle ground was created for individuals who have a mental illness and commit crimes. GBMI allows judicial system to both "treat" and "punish" individual. These people will be imprisoned or be held by mental institutions.
Pros and Cons of GMBI
Pro: mentally ill individuals are able to receive treatment, receive punishment that fits the crime, and gain the knowledge of why they are being punished.

Con: Individuals are more likely to be imprisoned and sentenced longer than NGRI and less likely to receive treatment
What is the psychologist's role with duty to warn?
They have the responsibility of warning those individuals who are in danger from the client reporting them.

(Tarasoff vs. Regents of the University of California: client disclosed to therapist that he was going to kill someone, therapist did nothing)

Clinical psychologists have a duty to warn potential victims of clients whom therapists believe are dangerous
Sexual Dysfunction Disorders
Difficulty functioning adequately:
1) Male hypoactive sexual desire disorder, 2) female sexual interest/arousal disorder, 3) female orgasmic disorder, 4) premature ejaculation, and 5) genito-pelvic/penetration disorder
Male hypoactive sexual desire disorder (desire phase)
Lowered sexual interest, 6 mos+, causes distress, not due to another disorder/medical cause

Specifiers: lifelong or acquired; generalized or situational
female sexual interest/arousal disorder (desire phase)
Lowered sexual interest AND lowered arousal/sensation, 6+ mos, causes distress, not from another disorder/medical cause
female orgasmic disorder (orgasm phase)
Delay/absence of orgasm, reduced intensity, 6+ mos, causes distress, not another disorder/condition

Specifiers: lifelong or acquired; generalized or situational; never experienced an orgasm under any situation
premature ejaculation (orgasm)
Pattern of ejaculation within 1 min of penetration AND before desired, 6+ mos, causes distress, not another disorder/condition

Specifier: lifelong or acquired; generalized or situational
genito-pelvic/penetration disorder (pain during/after sex)
difficulties with pain during intercourse OR difficulty with muscle contractions, 6+ mos, causes distress, not another disorder or condition.

Types: lifelong or acquired
Social causes of sexual dysfunction
Many people learn early on that sexuality can be negative & threatening. Erotophobia- Negative cognitive set. Early traumatic sexual events negatively impact later sexual functioning (Women especially) Sexually Victimized before puberty: Women = 2x more likely to have orgasmic dysfunction; Men= 3x more likely to have erectile dysfunction.
Paraphilic Disorders
Sexual arousal occurs in context of inappropriate objects or individuals:
1) Frotteuristic disorder, 2) Fetishistic disorder, 3) Voyeuristic and Exhibitionistic disorder, 4) Transvestic disorder, 5) Sexual Sadism disorder and Masochism disorder, 6) Pedophilic disorder, and 7) Gender dysphoria
Frotteuristic disorder
6+ mos of arousal from touching/rubbing against non-consenting person
Fetishistic disorder
6+ mos of attraction from non-living objects or non-genital body parts, causes distress
Voyeuristic And Exhibitionistic Disorder
Voyeuristic: 6+ mos of arousal from observing unknown person engaging in sexual activity

Exhibitionistic: 6+ mos of arousal from exposing one's genitals to an unsuspecting person
Transvestic Disorder
Sexual arousal associated with dressing in opposite sex clothes, causes distress/impairment,
specify Autogynephilia & Fetishism
Sexual Sadism Disorder and Masochism Disorder
Sadism: 6+ mos of sexual arousal from another suffering

Masochism: 6+ mos of sexual arousal from being humiliated
Pedophilic disorder
6+ mos of sexual arousal involving 13 or younger

◂Have acted on arousal or cause distress.

◂Person is at least 16 and 5 years older than the child
Gender dysphoria
Incongruence between sex and gender
desires to be other gender, distress or impairment, a strong desire to be rid of one's primary/secondary sex characteristics
a strong desire for the sex characteristics of the other gender
a strong desire to be treated as the other gender
a strong conviction that one has the thoughts and feelings of the other gender
Sexual Response Cycle
Desire Phase --> Arousal Stage --> Plateau Phase --> Orgasm Phase --> Resolution Phase
Desire Phase
Sexual urges in response to sexual cues or fantasies.

Dysfunctions of this phase: male hypoactive sexual desire disorder and female sexual interest arousal disorder
Arousal Stage
Subjective sense of sexual pleasure and physiological signs of sexual arousal

Males: Tumescence (increased penile blood flow)

Females: Vasocongestion (increased pelvic blood flow), vaginal lubrication, breast tumescence (erect nipples)
Plateau Phase
Brief period before orgasm
Orgasm Phase
Males-Feelings of the inevitability of ejaculation, then ejaculation

Females- contractions of the lower third of vaginal walls

Dysfunctions of this phase include: premature ejaculation, female orgasmic disorder
Resolution Phase
Decrease in arousal after the orgasm (particularly in men)
Most predominant leading causes of sexual dysfunction
Social factors:
1) many people learn early on that sexuality can be negative and threatening

2) Erotophobia: negative cognitive set- excessive fear of sex

3) Early traumatic sexual events negatively impact later sexual functioning (esp. women) -- sexually victimized before puberty

4) Women 2x more likely to have orgasmic dysfunction

5) men 3x more likely to have erectile dysfunction
Treatment for sexual dysfunction
1) Education- misunderstandings about sex can lead to long lasting dysfunctions

2) Sensate focus and non-demand pleasuring (developed by Masters and Johnson)

3) Medical Treatment: Viagra, testosterone, penile pumps, and penile implants

4) Having a positive mindset: focus on negative thoughts can make arousal difficult
Treatment for paraphillias
Early, comprehensive, wrap around care, sometimes residential care lasting 6-12+ months

Behavioral interventions for decreasing unwanted arousal have patients associate sexually arousing images with how the behavior is harmful or dangerous (Covert sensitization)
Mind Body Conection
- Psychological symptoms impact physical conditions
- Cognitive behavioral factors can influence the likelihood of developing future chronic health conditions (smoking --> lung cancer)
- Basic biological processes implemented in disease states (inflammation)
Health Psychology
- subfield of behavioral medicine
- practitioners study psychological factors that are important to the promotion and maintenance of health; they also analyze and recommend improvements in health-care systems and health-policy formation within the discipline of psychology
Stress continuum
1. Alarm- endocrine system secretes stress hormone
2. Resistance- Various coping mechanisms to stress (motivation)
3. Exhaustion- Sustained stress leads to damage
What is Stress?
A negative emotional or physiological process when circumstances disrupt daily functioning or one's ability to effectively employ coping strategies.
What are antecedents? (stress)
Stressors, everyday things that make us feel the negative emotion of stress
What is the stress response?
The reaction we have to stress that often has downstream effects of ability to effectively cope with additional or similar stressors encountered in the future.
Describe the phases in the general adaptation syndrome (GAS)
Phase 1: alarm reaction- danger to threat

Phase 2: Resistance- mobilize multiple mechanisms to respond to stress

Phase 3: Exhaustion- sustained stress that can lead to permanent damage
Internal Locus of Control
Means that a person believes the outcomes of their actions are results of their own abilities. That they are in control of their actions and its outcomes. A person who has an internal locus of control perceives less threat and experiences less stress than a person with external locus of control.
External Locus of Control
Means that a person believes their outcomes in life are not within their control. So everything is determined by chance or an external factor. These people experience lots of stress and anxiety because they believe they can't stop or intervene threats.
Health Psych and COVID-19
Characterized by 5 major factors:
1) danger and contamination fears, 2) socioeconomic concerns, 3) xenophobia, 4) traumatic stress, and 5) compulisive checking and reassurance seeking. People with a more severe case are more likely to stockpile supplies, feel depressed or anxious, voluntarily self isolate, and avoid public transportation.
Health Psych and HIV/AIDS
Most people with aids die within 1 year of diagnosis without treatment. 37.7 million people in 2020 have aids worldwide. Minority groups are disproportionately affected. 16% are unaware they have HIV.
Health Psych and Cancer
Psychological factors can contribute to to development of cancer, diagnosis may lead to a sense of lack of control, they may also want to avoid the painful treatments all together.
Health Psych and Cardiovascular Disease
Psychosocial etiology: high exposure to stress and inappropriate/ ineffective means of coping with anger and hostility
Health Psych and Chronic Pains
Pain is the single most common physical symptom experienced by medical patients

2 types of pain:
Acute: follows an injury and remits once healed/treated (<1 month)
Chronic: pain that does not decrease over time, even after the injury is healed; Usually in the muscles, joints, and tendons.

2 different pain experiences: Subjective: reported by individual. Pain behaviors: overt manifestation of experience

Factors at play:
∙Individual's general sense of control over pain experience
∙Active attempts to cope
∙Emotional states (negative emotions enhance pain severity)
∙Social support
Gate Control Theory of Pain
- Leading theory of how our body alters pain signaling

- nerve impulses from painful stimuli --> dorsal horn of the spinal cord --> a "gate" that either opens or blocks the transmission of pain to the brain --> emotions and arousals dictate how "open" or "closed" the gate is
Reasons noncompliance to medical treatment regiments
1. Concern about side effects (19%)
2. Concerns about cost (14%)
3. Forgetfulness (14%)
4. Concerns about dependency (13%)
5. Skeptical about benefits (11%)
How can we improve adherence?
- educate patients to instill an active role in treatment

- CBT techniques to minimize fears

-motivational interviewing

-Address systemic level factors impairing engagement (ex: racism)
Neurodevelopment Disorder
Developmental disorders that are neurological based.

Examples:
ADHD/ADD, Autism Spectrum disorder, Communication disorders
Key features of ADHD
Pattern of inattention AND/OR hyperactivity/impulsivity (combined presentation).

Must be present for at least 6 months and 6+ symptoms of each type

Symptoms emerge at 3-4 years old

Impulsive symptoms lessen with age, but they can persist in almost 50% of people
Prevalence of ADHD
3.4% in adults, 5.2% in children. 4.1% in men vs 2.7% in women.

Boys are more likely to have hyperactive subtype. Girls are more likely to have inattentive subtype and be diagnosed later
Hyperactive Type (ADHD)
- Fidgeting, having trouble sitting still for any length of time
-"on the go"
- Blurting out answers/having trouble waiting turns
- Less impulsive over time
- Running/climbing in inappropriate situations
- Excessive talking
Inattentive Type (ADHD)
- May appear not to listen to others
- lose necessary materials
- not may enough attention to detail/make careless mistakes
- inattention persists over time
organizational difficulties
-easily distracted
-difficulties sustaining attention
ADHD combined type criteria
Individuals who meet criteria for both inattention and hyperactive/impulsivity for 6 months

Combination of inattentive features and hyperactive/impulsive features
Comorbidities of ADHD
Disorders that resemble or are frequently comorbid:
- oppositional defiant disorder
- conduct disorder
- bipolar disorders
- PTSD
- Sleep disorders
Genetic Contributions of ADHD
ADHD is associated with deficits in certain areas of executive function (set of processes required for willful cognitive control of behavior)

ADHD may negatively impact cognitive flexibility (influences attention), inhibition of impulses, and working memory

(3-4% small volume in certain regions)
Smaller volume of brain regions effects executive function
executive function
•Cognitive flexibility (attention)
•Inhibition
•Working memory
Psychological Treatments for ADHD
- Behavioral reinforcement programs
- parent-child interaction therapy, triple p (positive parenting program), and incredible years
- Reward for improvement and punish misbehavior by loss of rewards
- Parent education for how to respond to child outburst
- Social skills training
- Adults: CBT + organizational skills
Multimodal treatment of ADHD (gold standard)
carefully monitored medication with monthly follow-up is more effective than intensive behavioral treatment alone, for up to 14 months.

psychological interventions + medication management
ADHD Medications
- Stimulants: reinforce brain's ability to focus attention (adderall, ritalin, concerta, Vyvanse)

- Non stimulants: guanfacine, clonidine

-Some antidepressants are used

**potential for abuse
Side Effects of ADHD medication
insomnia, drowsiness, irritability, changes in appetite
Gender differences in ADHD
Boys: more likely to have hyperactive subtype

Girls: more likely to have inattentive subtype (and diagnosed later)
Key Features of Autism Spectrum Disorder
Persistent deficits in social interactions and other behavioral areas beginning in early life
- social-emotional reciprocity
- non-verbal communication
- initiate/maintain relationships
- restricted, repetitive patterns of behavioral/ interests/ activities
Genetic contributions for ASD
Male to female avg.:
4.5 to 1

Families with 1 child with ASD --> 20% more likely to have another child with ASD

Older parents --> higher risk of having a child with ASD (fathers 40 years old & up are 5x more likely)

De novo mutations
Areas of the brain impacted with ASD
- Amygdala --> enlarged as a child --> increased anxiety/fear --> cortisol damages the amygdala --> absence of neurons in adulthood --> difficulties in social situations

- Neuroleptic oxytocin --> important social neurochemical which increases trust/reduces fear: lower levels of oxytocin in ASD
Psychological treatment for ASD
- integrated treatment and parent support is recommended

- enhancing communication through discrimination training and shaping
- speech therapy and social skills may also be integrated

- improve daily living skills

- reduce problem behaviors such as tantrums and self-injury

- behavioral treatments using operant conditioning. (ex: applied behavioral analysis)
Medication treatment for ASD
- No 'cure' for ASD and few meds have positive impact

- tranquilizers or SSRIs can be helpful to decrease agitation
What is a psychological disorder?
- Psychological dysfunction associated with distress and/or impairment in functioning

- involves a response that is not typical or culturally expected

- includes cognitive, behavioral and/or emotional elements
The three historical traditions to explain abnormal behavior
- Supernatural: deviant behavior as a battle of good and evil. treated with exorcism, religious services, torture

- Biological: 4 humors: blood, yellow bile, black bile, phlegm. Linked abnormality with brain/chemical imbalances. treated with "balancing"--> bloodletting, vomiting, etc.

- Psychological
Community mental health act of 1963
The Community Mental Health Act of 1963 was an act to provide federal funding for community mental health centers and research facilities in the United States.

Kennedy and Congress sought to decrease the number of institutionalized individuals by incubating self-sufficient and local mental health care centers.
What are some historical approaches to abnormal psychology that we still use today?
1. Behavioral reinforcement/token/economies/contingency management

2. Electro convlusive therapy

3. Milieu therapy: safe, structured, group treatment method for mental health issues. It involves using everyday activities and a conditioned environment to help people with interaction in community settings.

4. Industrial therapy (compensated work therapy programs)
What are multidimensional models?
Interdisciplinary, eclectic, and integrative system of influences that cause and maintain suffering. Draw upon information from several sources, abnormal behavior results from multiple influences
Multidimensions
- biological/genetic
- behavioral/cognitive
- emotional
- social/cultural
- development
How much do genes account for variations in psychopathology
less than 50%
Adverse Childhood Experiences (ACEs)
- can influence how genes are read and transcribed

- events in the environment may trigger genetic vulnerability or "turn on" specific genes
Diathesis stress model
Disorders are the result of underlying risk factors combining with life stressors that cause a disorder to emerge

Ex: risk factors (intolerances and sensitivities) make someone more likely to develop a disorder when dealing with life stressors
Serotonin
regulates behavior, mood, and thought process
Glutamate/GABA
reduces anxiety
Norepinephrine
alarm responses (blood pressure, heart right)
Dopamine
inhibits or facilitates emotions or behaviors
social learning theory
Modeling/observational learning: learn to copy behaviors that seem to turn out well for other people
What are emotions?
Subjective feeling following cognitive appraisal, complex physiological response, and a strong motivation for behavior
Clinical assessment
Systematic evaluation and measurement of psychological, biological, and social factors in a person presenting with a possible psychological disorder.
Diagnosis
the process of determining if a particular problem afflicting a person meets criteria for a psychological disorder (DSM-5)
The components of a good clinical assessment
Uses multiple assessments with the highest psychometric properties related to the referral question
Reliability
consistency in measurements across time and people (test-retest, inter-rater)
Validity
Whether a test is measuring what it is supposed to accurately measure (predictive, concurrent)
Projective tests
- unstructured stimuli are presented
- meaning or structure projected onto stimuli
- projections reveal hidden motives

Ex: Roschach inkblot, TAT

Issues: reliability, validity, standardization, subjectivity

pros: they are not transparent to respondents, the indirect approach used in these tests may make them especially sensitive to unconscious latent features of personality.
Objective tests
- clinician scoring and interpretation is minimal
- less ambiguous test stimuli
- typically consist of inventories, which include a series of prompts aiming to predict psychological dysfunction

Ex: personality tests, intelligence tests

Pros: relatively cost effective, reliable, valid
Criticisms of DSM-5
- Many disorders have high comorbidities
- large degree of symptom overlap for many disorders
Provisional diagnosis
You would need further assessment, but all arrows are pointing to dx. just not 100% sure
Rule out diagnosis
You will need further assessment, and additional information will help to rule out that dx
primary/anchoring diagnosis
The most salient, what you are saying, yes this is the disorder
Anxiety
Apprehensive, future-oriented. Somatic symptoms = tension.

high rates of comorbidities
Fear
Immediate, present-oriented. Sympathetic nervous system activation.
Fear and Anxiety similarities
negative affect, everyone experiences them, they both contribute to anxiety disorders.
Relationship between performance and anxiety
Moderate anxiety = good
low and high = bad

(inverse U)
Generalized Anxiety Disorder (GAD)
Clinical description:
- shift from possible crisis to crisis
- worry about minor, every day concerns
- job, family, etc.
- leads to behaviors like procrastination, over-preparation
GAD Prevalence
- 2.9 % 12 months
- 9.0 % lifetime
- Age of onset is 30
female > male
GAD medication treatment
benzodiazepines, antidepressants
GAD psychological treatment
CBT and ACT
Panic Attacks
Panic Disorder
- unexpected panic attacks
- anxiety, worry, or fear of another attack
- persists for 1 month or more
- Agoraphobia (fear/avoidance of situations)
Panic Disorder prevalence
- 2-3% 12months
- 4.7% lifetime
- Female: male = 2:1

Acute onset, most common in young adulthood (e.g. ages 20-24)
Specific Phobia
Examples:
1. Blood-injection-injury phobia: onset is childhood ~9 years

2. Natural environment phobia (heights, storm): onset is childhood ~7 years

3. Animal Phobia: onset is childhood ~7 years

4. Situational phobia: onset is early to mid 20s
Treatment for Phobias
Cognitive-behavioral therapies: exposure and relaxation
Social Anxiety
- Extreme/ irrational concern about being negatively evaluated by other people

- Sometimes (not always) manifests as shyness

- Leads to significant impairment and/or distress

- Avoidance of feared situations, or endurance with extreme distress

-Subtype
Performance only: Anxiety only in performance situations (e.g. public speaking)
Medication Treatment for Social Anxiety
Beta blockers, benzodiazepines, SSRI, D-cycloserine
Psychological treatment for social anxiety
CBT, psychological intervention (exposure: pain control treatment, PCT)
PTSD criterion clusters
Criteria A: Trauma

Criteria B: Re-experiencing
- 1+ intrusion symptom after trauma (memories, distressing dreams, flashbacks)

Criteria C: Avoidance

Criteria D: Negative cognitions and moods (2+ of negative alterations)

Criteria: Alterations in Arousal
- 2+ alterations in arousal and reactivity
Psychological treatment for PTSD
CBT, Prolonged exposure (PE), CPT (CPT)
Medication treatment for PTSD
SSRIs
Major depressive episode pt. 1
Major depressive episode pt. 2
Major depressive disorder
Hypomanic episode
Manic episode pt. 1
Manic episode pt. 2
Persistent Depressive Disorder pt. 1
Persistent Depressive Disorder pt. 2
Persistent Depressive Disorder pt. 3
Bipolar I
Bipolar II
Depression specifiers
Psychotic Features
- hallucinations
- Delusions
- Mood congruent
- Associated with poorer responses to treatment

Anxious Distress
- predicts poorer outcome

Mixed features
- Depressive episode with at least 3 manic symptoms

Melancholic features
- severe somatic symptoms, early morning awakenings, excessive guilt

Catatonic Features
- rare muscular symptoms (stupor, waxy limbs)

Atypical Features
- oversleeping, overeating

Seasonal pattern
- changes in melatonin and circadian rhythm
Gender differences in suicide
Men complete more suicides than women by a rate of about 3.63x more often
- More lethal methods
- Highest among middle-aged White men

Women attempt suicide more often than males by a rate of about 3x more often
- Women more likely to have suicidal thoughts
Medications for depression
SSRIs, Mixed reuptake inhibitors, Tricyclics, MAO (fewer side effects than tricyclics, food limitations)
Medications for bipolar
Litium (50% effectiveness)
Psychotherapy for depression
CBT, interpersonal psychotherapy, problem-solving therapy, mindfulness-based cognitive therapy
Psychotherapy for bipolar disorders
Family-focused therapy (strong for depression), psychoeducation for bipolar (strong for mania, modest for depression), Systemic care (strong for mania)
Anorexia Nervosa
Extreme weight loss/self-starvation
- restriction of calorie intake: ~15% below expected weight
- intense fear of weight gain or becoming fat
- often begins with dieting

*second highest mortality rate of all mental health disorders
Bulimia Nervosa
Binge eating (eating excessive amounts of food in discrete period, uncontrollable) + Compensatory behaviors ("make up" for binge eating: purging)
Binge eating disorder
Binge eating without associated compensatory behaviors.
what are the two types of anorexia?
Restricting (diet to limit calorie intake) and bing-eating-purging (purge to limit calorie intake)
When do compensatory behaviors show up?
Bulimia Nervosa- designed to "make up" for binge eating
What is the most predominate influence of eating disorders?
SOCIAL FACTORS
- Idealization of thinness (media, culture, "ideal" body size only achievable by 5% of population)

- weight stigma (discrimination/stereotype)

- bullying
Important info about medications and eating disorder
Antidepressants can help reduce binging and purging behavior, but they are less successful for anorexia.

They are usually not efficacious in the long-term; greater relapse and drop-out
Dyssomnias
Insomnia**, Hyper-somnolence disorder, circadian rhythm sleep-wake disorders
Most common dyssomnia
Insomnia: problems initiating/maintaining sleep
Parasomnias
Non-REM Sleep arousal disorders (sleep terrors, sleepwalking), Nightmare disorder**
Most common parasomnias
Night mares: repeated episodes of extended, extremely dysphoric dreams leading to distress and/or impairment in daily life
Psychological factors that influence sleep
Stress, negative/unrealistic cognitive beliefs ("I need 8 hours of sleep"), poor bedtime habits (eating, caffeine, inconsistent schedule)
Rebound insomnia
sleep disturbance that occurs on discontinuation of benzodiazepine hypnotic drugs.
Three sleep hacks
1. Consistent sleep schedule
2. stimulus control (engage in relaxing, non screen related activities 20 minutes before bed)
3. take power minutes (20-30 minutes, or 90 minutes)
Difference between tolerance and dependence
Tolerance: needing more of the substance to get the desired/same effect.

Dependence involves tolerance PLUS withdrawal: physical symptom reaction when substance is discontinued after regular use
Criteria for any substance use disorder (time frame and # of symptoms needed)
recurrent use of substance causes impairment and use is continued

Psychological dependence, desperate need to ingest more, likelihood that use will resume after period of abstinence
Long term consequences of alcohol use disorder
Withdrawal
- delirium
- nausea/vomiting
- anxiety/agitation
- insomnia

Physical health
- liver disease
-pancreatitis
- cardiovascular disorder
-brain damage

Wernicke-Korsakoff syndrome (intellectual abilities)
- loss of muscle coordination
- confusion
- unintelligible speech
Which type of substances are most widely used in US? Why?
alcohol, caffeine (85%), tobacco (20%)
Which stimulant is the most difficult to quit? Why?
tobacco/nicotine in small doses, relieves stress and improves mood. enters the brain in 7-19 seconds.

nicotine users dose throughout the day to keep nicotine at a stead level in the blood stream
What are symptoms of caffeine intoxication?
5+ of symptoms:
restlessness, nervousness, excitement, insomnia, flushed face, diuresis, muscle twitching
How does reinforcement impact substance use?
Positive reinforcement: take the substance > make you feel pleasurable > more likely to happen

Negative reinforcement- ineffective coping: take substance > relieves pain/stress/panic > more likely to take substance in the future
How does the expectancy effect impact substance use?
What people expect to experience with substances influences how they react.
- positive expectancy predicts increase likelihood of future use and vis versa.

Cravings > powerful cognitions to use

triggered by contact with things associated with substance, moods, and availability
Treatment recommendations for substance use disorders
Personality Cluster A
Paranoid personality, Schizoid personality, Schizotypal personality
Personality Cluster B
Antisocial personality, Borderline personality, Histrionic personality, Narcissistic personality
Personality Cluster C
Avoidant personality, Dependent personality, Obsessive-compulsive personality disorder
Differentiate cluster A from schizophrenia and other psychotic disorders
Cluster A is missing positive symptoms (hallucinations, delusions)
Differentiate antisocial personality disorder from narcissism personality disorder
Antisocial:
- disregard for safety/rights of others
- no remorse for actions
- violates rules and social norms/laws

Narcissistic:
- need for admiration, grandiosity, lack of empathy
- inflated self esteem
- takes advantage of others to achieve own needs
Causes of ASPD
under-arousal hypothesis: low levels of arousal > behaviors to boost arousal

Fearlessness hypothesis: higher threshold for fear > engage in more high-risk behaviors

- coercive family process
- gene-environment correlation (family history of criminal and violent behavior)

**conduct disorder is considered precursor
Prevalence of borderline personality disorder
-1 in 5 people with borderline meet for depression
- 2 in 5 meet for bipolar disorder
- 2 in 3 engage in substance abuse
Treatment of borderline personality disorder
Dialectic behavioral therapy (DBT)
-focus on duality and acceptances/difficulties and need for change

- 4 core components: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness
Differentiate avoidant personality disorder from dependent personality disorder and social anxiety
OCPD vs OCD
OCPD: strong preference for things being done 'perfectly or correctly'

OCD: obsessions: unwanted urges/thoughts that cause distress, compulsions: behaviors done to alleviate distress from obsessions
Clinical prevalence rates of personality disorders
borderline (29%), avoidant (25%), narcissistic & histrionic (10%)
Positive schizo symptoms
Delusions (gross misrepresentations of reality), Hallucinations
negative schizo symptoms
5 A's:
- Avolition (apathy)
- Alogia (absence of speech)
- Anhedonia (lack of pleasure)
- A-sociality
- Affective flattening
Disorganized symptoms
Confused or abnormal speech, behavior, emotion
Schizophrenia spectrum disorders organized by time frame ( 1 mo, 1-6 mo, 6+ mo)
1. Brief psychotic disorder: 1 mo

2. Schizophreniform: 1-6 months

3. schizophrenia: 6+ mo
Results from twin studies regarding the development and prognosis of schizophrenia
risk increases with genetic relatedness

•Identical quadruplets (same genetic predisposition) and "same" environment, but different time of onset, symptoms, course, and outcomes to treatment

•Explanation?
•De novo mutations at conception
•Unshared environments
Dopamine hypothesis
Schizophrenia is partially caused by overactive dopamine.

Drugs that increase dopamine result in schizophrenic-like behavior
Psychosocial treatments for psychosis
1. behavioral (token economies) on impatient units: reward adaptive behavior

2. social and living skills training

3. behavioral family therapy

4. vocational rehabilitation
Medication treatments for schizophrenia and psychosis
Trial and error
1. first generation
- reduce/eliminate positive symptoms
- affect dopamine system
- extrapyramidal side effects

2. Second-generation
- no extrapyramidal side effects
- no more effective or better tolerated than 1st gen
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