PSYC2500 Post Midterm - Suicide Lecture Notes PDF

Lecture 9: Suicide The intentional, direct, and conscious taking of one’s own life ○ It has been extensively researched Risk factors and protective factors identified Strategies to successfully intervene identified Of people who c...

Lecture 9: Suicide The intentional, direct, and conscious taking of one’s own life ○ It has been extensively researched Risk factors and protective factors identified Strategies to successfully intervene identified Of people who contemplate suicide, up to 90% have a mental illness ○ Often undiagnosed Highest risk: depression & dipolar Suicide is the tenth leading cause of death in the United States Most do not want to die; they simply want their pain to end and are unable to see other solutions 9-1 Facts about Suicide Throughout history, people have avoided discussing suicide Psychological autopsy ○ They are systemically examining information after a person’s death in an effort to understand and explain behavior. ○ Attempts to make psychological sense of a suicide by compiling and analyzing background information Recollections of therapists, interviews with relatives and friends, information obtained from crisis phone calls, social media postings, and messages left in suicide notes Unfortunately, these sources are not always available or reliable. Common Characteristics of Suicide The belief that things will never change and that suicide is the only solution Triggering events include intense interpersonal conflict and feelings of depression, hopelessness, guilt, anger, or shame. Ambivalence about suicide: there is a strong underlying desire to live Occupational Risk Factors Jobs with high rates of suicide in men include: ○ Farmworkers, fishermen, loggers, carpenters, miners, electricians, and installers ○ A high percentage of workplace injury > possibly loss of employment > stress For women, the highest rates of suicide occur for those who were: ○ Firefighters, police, and correctional officers  ○ It is difficult to discuss mental health (trauma, etc.) because of stigma and fear of discrimination Among medical professionals, psychiatrists have the highest suicide rate and pediatricians the lowest 9-2 Effects of Suicide on Friends and Family Consistent themes among surviving friends ○ Guilt and an attempt to understand the tragedy ○ Attempts to understand and make meaning of the tragedy ○ Development of risky behaviors ○ Altered relationships with friends Surviving family members, especially parents, often feel guilt and responsibility. ○ Increased rates of depression, anxiety, alcohol abuse, and marital difficulty 9-3 Suicide and Specific Populations Possible Reasons for Increase of Suicide in Children and Adolescents Suicide rate for young people is at its highest since 2000 and appears to be climbing Social media use and substance abuse may contribute to the increase There is an increase in suicidality among African American children and adolescents ○ The reasons underlying these drastic increases include: Barriers to identification and treatment of depression The role of school experiences such as racial discrimination, low teacher expectations, or inequitable and harsh discipline practices The academic environment can function as a significant stressor for children and adolescents. Bullying ○ Victims of bullying are two to eleven times more likely to consider suicide than those subject to bullying. ○ LBGTQ+ teens are at exceptionally high risk for both bullying and suicide ○ Cyberbullying seems to be more strongly related to suicide attempts ○ This is a promising sign that people are willing to intervene when they observe bullying Copycat suicides ○ Media reports of suicides seem to spark an increase in suicide ○ Best practice guidelines for journalists include: Not sensationalizing the event Refraining from sharing specific details about the manner of death Including information on suicide prevention resources ○ Decreased Prescribing of Antidepressant Medication 2004 U.S. Food and Drug Adminstration warning of increased suicide for children taking SSRIs A warning is required to be distributed with all such medication Controversy over these actions  A recent study confirmed an increase in suicidality in youth taking antidepressants and that the black box warning is valid and should remain. Medical professionals should monitor suicidal idealization. The Impact of 13 Reasons Why After the show aired, there was a 20% increase in searches for suicide-related terms. ○ Significantly increases in mental health issues for youth. 12% in males and 20% increase in women Suicide Among Those Who Serve in the Military The increasing rate of suicides in the military Stigma and Trauma ○ Do not feel supported Factors contributing: ○ Many believe that the military creates a culture that tends to dismiss and to stigmatize emotional symptoms ○ Barriers to mental health care in military ○ Financial or personal problems associated with serving in the military ○ Mental health issues such as bipolar disorder, opioid use, depression, and PTSD ○ The rate of suicide in veterans in 2017 was 1.5 times that of nonveterans Suicide Among College Students A comprehensive study of suicidal ideation in students at 108 colleges ○ 20% of the students surveyed had thought about suicide, and 9% had attempted suicide ○ Asian American and multiracial students reported the highest rates of suicidal ideation ○ Transgender students showed elevated rates of suicidal ideation, suicide attempts, and self-injury ○ Stress from various sources was strongly related to suicide attempts and mental health diagnoses ○ Campus prevention and intervention efforts are critically important Issue of getting help Suicide Among Elderly Suicide rates for elderly men are the highest of any age group Factors: ○ Bereavement ○ Physical ailments ○ Social isolation ○ Financial difficulties ○ Discrimination, prejudice 9-4 A Multipath Perspective of Suicide Biological Dimension ○ Suicide is influenced by low serotonin levels in the brain 5-hydroxyindoleacetic acid (5HIAA) Produced when the body metabolizes serotonin Low levels of 5HIAA in those who died from suicide ○ Genetics Relationship is unclear Specific endophenotypes associated with suicide Unique DNA alterations in the hippocampus ○ Sleep difficulties (including nightmares and trouble falling or staying asleep) ○ Alcohol use is also implicated in suicide. ○ CET, or Chronic Traumatic Encephalopathy Degenerative, progressive disease after repeated traumatic injury Most noted athletes Personality and behavior changes (problematic) End stage: impulsive, angry, volatile Psychological Dimension ○ Psychological pain associated with maltreatment in childhood, particularly sexual abuse and emotional abuse ○ Rumination ○ Shame, discouragement, distress over academic or social pressures, and other life stressors ○ Many people who commit suicide have a history of mental illness ○ Personal problems that precipitate social withdrawal Depression and Hopelessness Suicidal thoughts sometimes develop when someone is experiencing overwhelming hopelessness, fatigue, and loss of pleasure. Psychache ○ Intolerable pain created from an absence of joy ○ Acute state that encompasses shame, guilt, humiliation, loneliness, and fear ○ Strongly associated with suicidal ideation Even mild depression increases the risk Drug and Alcohol Use Substance use involving alcohol, cocaine, cannabis, opioids, amphetamines, or sedatives increases the risk of suicide 40% of suicides and overdose deaths involved opioids Cannabis use during adolescence is associated with depression and suicidality Alcohol  ○ As many as 70% of suicide attempts involve alcohol ○ Strong correlation to a successful attempt ○ May lower inhibitions related to fear of death ○ Alcohol-induced myopia Social Dimension ○ Many suicides are interpersonal Occur following relationship conflicts ○ Disconnection from friends, family, religious institutions, or community Increases susceptibility to suicide ○ Factors in children who consider suicide Abuse and unpredictable traumatic events Loss of significant parenting figure before age 12 ○ Perceived burdensomeness ○ Thwarted belongingness ○ Acquired capacity for suicide Martial Status A stable marriage or relationship makes suicide less likely For women, having children decreases suicide risk People who are divorced, separated, or widowed have higher suicide rates than those who are married. Death of a spouse is associated with a 50% higher suicide rate for men. Sociocultural Dimension ○ Emile Durkheim’s sociocultural theory Inability to integrate oneself into society Lack of close ties deprives one of the support systems necessary for adaptive functioning. ○ Today’s society deemphasizes the importance of extended families and a sense of community. ○ Alienation and isolation experienced by many LGBTQ youth Gender Death from suicide occurs much more frequently among males ○ 79% of all US suicides Females have higher rates of suicidal thoughts and attempts ○ Drug overdose/poisoning is the most common means for women Males tend to choose the most lethal methods ○ Many men who commit suicide have no history of mental illness  ○ Cultural conditioning related to the male gender role combined with events that threaten a masculine idea ○ Men may avoid seeking help or confiding in others Socioeconomic Stressors Environmental and economic issues can have a significant impact on suicide rates. Mental health issues often arise during natural disasters ○ Puerto Rico: the rate of suicide increased by 29% after Hurricane Maria ○ Suicides increase during economic recessions, particularly among those experiencing poverty and unemployment ○ Those who qualify for Medicaid have higher suicide rates compared to those who can afford health insurance Religious Affiliation The suicide rate is lower in countries where the Catholic Church has a strong influence. Islam also condemns suicide. ○ Medical students in the United Arab Emirates reported a low lifetime prevalence of suicidal thoughts and attempts. Where religious sanctions against suicide are weak or absent, higher suicide rates are observed. Children of parents with strong religious beliefs have been found to have an 80% lower risk of suicide ideation or attempts. 9-5 Preventing Suicide Preventing Suicide ○ Early detection and successful intervention Understanding risk and protective factors ○ Paths to intervention Self-referrals or referrals from concerned family or friends Gatekeeper training Designed people within a system to learn about risk factors and screening methods. ○ Three-step process Know which factors increase the likelihood of suicide Determine the probability that a person will act on suicide wish (high, moderate, or low) Implement appropriate actions Lecture 10: Eating Disorders Eating Disorders Anorexia nervosa ○ Restricting ○ Bine-eating/purging  Bulimia nervosa Binge-eating disorder ** Young students struggle with EDs, even males ○ Disorders start relatively early Anorexia Nervosa Typical onset: early adolescence ○ Typically, it comes the earliest Characterized by extreme thinness ○ Individuals starve themselves, detesting any weight gain ○ Most people with the disorder continue to insist they are overweight–even when clearly emaciated ○ Anxiety about gaining weight This occurs primarily in adolescent girls and young women ○ Primarily women, but a growing percentage of men getting diagnosed Restricting Weight loss through severe dieting or exercising Individuals with this type tend to be more introverted ○ Obsession and anxiety over gaining weight–similar to OCD Binge-eating/purging Self-induced vomiting, laxatives, or diuretics Individuals are more extroverted and impulsive ○ Report more anxiety, depression, or guilt It can overlap with restricting, but usually, it is one or the other Physical Complications of Anorexia Nervosa Has the most severe physical/health complications ○ Highest mortality rate out of other eating disorders ○ Adolescents who struggle with anorexia have 6x more mortality rate than those who don’t 1. Irregular heart rate 2. Low blood pressure 3. Heart damage occurs when the body is forced to use muscle as an energy source. 4. Kidney disease 5. Bone loss 6. Purging often results in enlarged salivary glands Course and Outcome The course is highly variable ○ Some recover after one episode ○ Others fluctuate between weight gain and relapse ○ Others have a chronic and deteriorating course ○ Most difficult to address  Onset in adolescence is associated with more positive outcomes ○ Not as deeply engrained High mortality rate Bulimia Nervosa Onset: mid to late adolescent Characteristics: ○ Recurrent episodes of binge eating (rapid consumption of large quantities of food) at least once a week for three months ○ Loss of control over eating during the binge episode ○ Self-evaluation is strongly influenced by weight or shape ○ Lose the ability to determine whether they are full or not ○ Individuals learned that food means comfort Those with bulimia are aware that their eating habits are not normal ○ Distressed and ashamed, individuals hide behaviors from others ○ More prevalent with anorexia Up to 2.6% of women Up to 10% of males Physical Complications and Associated Characteristics Do not have to be extremely thin–does not have an obsession of weight 1. Erosion of tooth enamel 2. Dehydration 3. Swollen salivary glands 4. Lowered potassium (can weaken the heart and cause arrhythmia and cardiac arrest) 5. Inflammation of the esophagus, stomach, and rectal area 6. Often use eating as a way of coping with distressing thoughts or external stressors 7. Many individuals are impulsive, engage in risky behaviors, and abuse drugs Course and outcome Begins in late adolescence or early adulthood Mortality rates are elevated, especially among those who exercise excessively Prognosis more positive than anorexia ○ 22-year follow-up of one group of individuals diagnosed with bulimia 68% of participants no longer demonstrated bulimic symptoms Individuals with more excellent emotional stability and positive social support have better outcomes Psychosocial stress and low social status increase the likelihood of continued difficulties Binge-eating Disorder (BED) Onset: late adolescence or early adulthood  Involves binging, feeling of loss of control, and marked distress over binge eating episodes Bed does not involve the use of compensatory behaviors, such as vomiting, fasting, or excessive exercise. ○ Typically, individuals are prone to be more obese. Diagnosis: history of binge-eating episodes at least once a week for three months and at least three of the following: ○ Eating more rapidly than normal ○ Uncomfortable feeling of fullness ○ Eating large amounts of food even when not hungry ○ Eating alone due to embarrassment about the quantity eaten ○ Feeling depressed Lifetime prevalence ○ 4% of adults have been diagnosed with BED ○ Women and girls have 1.5x greater likelihood of receiving this diagnosis ○ 20% male ○ Overeating in childhood increases the risk fo eventually developing BED Physical Complications and Associated Characteristics Likely to be overweight ○ 20-40% of those in weight-control programs have BED Complications ○ Type 2 Diabetes, high blood pressure, and high cholesterol levels Binges often preceded by distressing emotions such as guilt, depression, or disgust Individuals with BED who become obsese tend to have difficulty: ○ Regulating negative emotions ○ Controlling impulsive behavior Course and Outcome Remission rates are higher than those of anorexia or bulimia Most individuals with BED made a full recovery over 5 years ○ 18% continuing to demonstrate an eating disorder of clinical severeity ○ Weight may remain high Stigma and bullying may cause relapse ○ Once dealt successful treatment, turn focus to weight Other Specified Feeding or Eating Disorders Disturbed eating patterns not meeting criteria for anorexia or bulimia nervosa ○ Individuals of normal weight who meet other criteria for anorexia ○ Who meet criteria for bulimia but binge less than once a week ○ Night-eating syndrome Folk who eat quite a significant percentage of their daily calories at night  Wake up periodically throughout the night to eat Rare disorder ○ Individuals who do not binge but frequently purge to control weight Many individuals who receive this diagnosis will eventually meet the diagnostic criteria for ED 10-2 Etiology of Eating Disorders Psychological Dimension Body dissatisfaction Passivity, low self-esteem, dependence, and lack of assertiveness are associated with dysfunctional eating patterns. Perfectionism Impulsivity Depression Lack of self-confidence Use of control over eating to deal with stress Social Negative family relationships may produce a self-critical style Family members can unintentionally produce pressure to be thin Peers can also pressure Friends extremely focused on dieting “Fat talk” can increase body dissatisfaction and lower self-esteem Appearance standards are influenced by social media and a desire to look attractive to an online audience ○ Appearance-related social media consciousness, or ASMC Increases the risk of developing or continuing disordered eating Sociocultural In Western culture, physical appearance is considered an important attribute. Women are socialized to be conscious of body shape and weight Social comparison appears to be a strong risk factor for eating disorders ○ High body dissatisfaction ○ Increased feelings of guilt and depression ○ Thoughts of “solutions” such as dieting, purging, and extreme exercise Mass media portrayals of lean, muscular bodies are increasing ○ 10-30% of men show body dissatisfaction ○ Gay men tend to place greater emphasis on physical attractiveness and have more body dissatisfaction and eating disorder symptoms.  Ethnic Minorities ○ Body dissatisfaction exists among women in ethnic minorities Asian American women have been influenced by Western standards of beauty Weight and body shape concerns Social comparisons based on height, facial features, and skin tone Latina/Hispanic women have body dissatisfaction equal to white women African-American women tend to be more satisfied in their body size ○ High ethnic identity and self-esteem serve as protective factors Biological Disordered eating tends to run in families Eight areas in the human genome are associated with metabolism and weight ○ They may be fighting an uphill battle against their biology Dopamine levels control appetite ○ People with lower levels desire food more Other neurotransmitters and hormones involved ○ Serotonin ○ Ghrelin Altered functioning of the appetitive neural circuitry ○ Reduced activity in the part of the brain that motivates reward-seeking ○ Increased activation of the cognitive “self-control” circuitry 10-3 Treatment of Eating Disorder Treatment of Anorexia Nervosa Treatment is provided in either an outpatient or a hospital setting ○ Severe physiological reactions can occur during re-feeding ○ New foods are introduced to supplement food low in calories ○ Phobic reactions can occur from eating new foods that were previously thought “forbidden.” Psychological interventions ○ Help the client understand and cooperate with rehabilitation ○ Help the client understand dysfunctional attitudes ○ Improve interpersonal and social reinforcing ○ Addressing other psychological conflicts Family therapy is an essential and practical component of treatment Treatment of Bulimia Nervosa Treatment goals ○ Treat physical conditions ○ Normalize eating patterns Cognitive-behavioral treatment ○ Encouraging the consumption of three balanced meals a day  ○ Reducing rigid food rules and body image concerns ○ Identifying triggers for binging ○ Developing strategies for coping with emotional distress Antidepressant medications such as SSRIs are sometimes helpful Treatment of BED Similar to treatment for bulimia ○ Fewer physical complications were presented ○ Include healthy approaches to weight loss Two phases ○ Determine factors that trigger overeating ○ Learn strategies to reduce binges Antidepressant medications are sometimes effective CBT can produce significant reductions in binge eating ○ It has less effect on weight reduction ○ Incorporates strategies for addressing interpersonal difficulties and regulating negative emotions Lecture 11: Substance-Related and Other Addictive Disorders 11-1 Substance-Related Disorders Arise when psychoactive substances are used excessively ○ Psychoactive substances alter moods, thought processes, or other psychological states Psychoactive substances alter our moods, behaviors, and psychological states Simulants: speed up the nervous system Depressants: slow down the nervous system Halluogencis: alter our sensory perceptions Addiction ○ Compulsive drug-seeking behavior and loss of control over drug use ○ Withdrawal symptoms occur when the use is discontinued due to physiological dependence ○ Increased tolerance to the drug’s effects Tolerance: we need more and more of the substance to bring the same effect DSM-5 Substance-Use Disorder Poly Substance Use Disorder: using multiple drugs Differentiated according to the specific substance used Substance-used disorder severity ○ Mild: two or three of the designated symptoms present ○ Moderate: four or five are present ○ Severe: Six or more Substance use may cause depression, anxiety, sleep difficulties, or psychotic disorders. Criteria for a Substance-use Disorder Two categories: excessive use and addictive aspect ○ The quantity of substance used or the amount of time spent using is often more significant than the intended ○ Efforts to control the use of the substance are unsuccessful due to a persistent desire for the substance ○ Considerable time is spent using the substance, recovering from its effects, or attempting to obtain the substance ○ A strong desire, craving, or urge to use the substance is present Depressants Cause the nervous system to slow down ○ Numb emotional and physical pain > alluring Alcohol ○ **The highest rate (15-20% of the general population struggled/to meet diagnostic criteria) ○ Moderate drinking Lower risk patterns of drinking No more than one drink for women or two drinks for men per day ○ Heavy drinking Level exceeding moderate ○ Binge drinking Four to five drinks or more on a single occasion for men Four or more drinks for women Five or more binge-drinking episodes in a particular month Effects of Alcohol Abuse Lowering inhibitions, impairing judgment, lowering reaction times Can increase the likelihood of suicide ○ Men and boys are more likely to consume alcohol and participate in binge and heavy drinking. ○ Asian Americans have the lowest levels of excessive drinking ○ Native Americans of both genders begin drinking at the earliest age ○ Latin American men have the highest rates of daily alcohol consumption ○ Binge drinking and heavy drinking are especially problematic among young adults Korsokoff’s Syndrome: a neurological disorder that impacts parts of our brains, primarily, motor issues (moving, etc.) and memory (dementia) ○ Shows up around 40-50s ○ Shows up with chronic to heavy alcohol use Delirium tremens ○ Life-threatening condition produced by alcohol withdrawal symptoms Can be life-threatening Alcohol poisoning  ○ Can result in impaired breathing, coma, and death ○ Aldehyde dehydrogenase (ALDH) is an enzyme that counteracts toxins that build up as our bodies metabolize alcohol. Alcohol-use disorder ○ The prevalence of alcohol-use disorder in the U.S. adult population is 18% ○ Twice as likely to develop in men ○ Alcoholism progresses more quickly in women Opioids Pain-killing agents that depress the central nervous system ○ Illegal substances Heroin and opium ○ Prescription pain relievers Morphine, codeine, and oxycodone Considered gateway drugs, leading to the use of more dangerous drugs ○ Highly addictive ○ Produce both euphoria and drowsiness ○ Liberal prescribing resulted in their widespread misuse and deaths Typically prescribed after a medical procedure > it leads to alluring effects Fentanyl, the highly lethal painkiller that killed Prince, is 50-100 times more potent than morphine Sedatives, Hypnotics, and Anxiolytics Have calming effects ○ Anxiety, sleeping medications, etc. Used to treat agitation, muscle tension, insomnia, and anxiety ○ Hypnotics: induce sleep ○ Anxiolytics: reduce anxiety Barbiturates and benzodiazepines ○ Rapid and anxiolytic effects in moderate doses ○ Hypnotic effects in higher doses Stimulants Speed up central nervous system activity Produce feelings of euphoria and well-being ○ Improve mental and physical performance ○ Reduce appetite and prevent sleep Unwanted effects ○ Anxiety, restlessness, agitation, paranoia Tolerance to stimulants develops rapidly ○ Illegal Cocaine, meth ○ Legal Caffeine, Adderall, etc. Caffeine  Stimulate found in coffee, chocolate, tea, and soft drinks ○ Most widely consumed psychoactive substance in the world ○ In North America, 90% of adults use daily Withdrawal symptoms ○ Headache, fatigue, irritability, difficulty concentrating Caffeine intake has increased due to the widespread marketing and consumption of energy drinks Amphetamines Also known as “uppers” Speed up central nervous system activity Prescribed for attention and sleep disorders ○ Increasingly used illicitly It can cause psychosis and brain damage Methamphetamine ○ Surge in dopamine > can cause delusions and hallucinations ○ It can cause permanent damage to the heart ○ High potential for abuse and addiction Cocaine High potential for addiction Crack ○ A potent form of cocaine produced by heating cocaine with other substances ○ Typically smoked ○ Produced immediate but short-lived effects Cocaine withdrawal ○ Lethargy and depression Users sometimes experience acute psychiatric symptoms > and have shorten lifespan Hallucinogens Produces vivid sensory awareness ○ Hallucinations Traditional hallucinogens are derived from natural sources Effects can vary significantly ○ Good trips versus bad trips Hallucinogen persisting perception disorder ○ Experiencing distressing recurrence of hallucinations or other sensations weeks or even years after drug intake Hallucinogens used by 2% of the population in 2018 Substances with Mixed Chemical Properties Substances that have varied effects on the brain and CNS ○ Nicotine Release both adrenaline and dopamine Vaping has gained popularity among nonsmokers and those trying to quit smoking. ○ Cannabis Marijuana is the most commonly used illicit drug worldwide ○ Inhalants  The use of inhalants by children and adolescents was once considered a silent epidemic. Any episode of inhalant use, even in first-time users, can result in a stroke. ○ Ecstasy has both stimulant and hallucinogenic properties. 11-3 Eitology of Substance-Use Disorders Typical progression from substance use to abuse ○ The individual decides to experiment with drugs ○ Drug begins to serve essential purposes; consumption continues ○ Brain chemistry becomes altered from chronic use Results in physiological dependence, withdrawal symptoms, and cravings ○ Lifestyle changes occur due to chronic abuse Psychological Huge impact Coping with psychological stress and emotional symptoms ○ The primary motive for substance use ○ Stress plays a role in the development of alcoholism and relapse ○ Almost half of abusers have a concurrent psychiatric disorder ○ Four categories of life stressors influence substance use General life stress, stress resulting from trauma or catastrophic events, childhood stressors or maltreatment, and the stress of everyday discrimination Behavioral under control ○ Personality characteristics associated with rebelliousness, impulsivity, and risk-taking Social Influence varies across the lifespan ○ Childhood Victimization and stressful events (neglect)  ○ Adolescence (particularly vulnerable period) Parental attitudes and behaviors Lack of parental monitoring Peer pressure and wish to fit in socially Desire to assert independence and rebel Willingness to have fun and take risks ○ College The first year is a vulnerable transitional period Abrupt changes in parental supervision Increased competition and pressure to achieve Easy access to alcohol Exposure to peers who drink heavily Students frequently overestimate the extent of alcohol and marijuana use by peers. Social media increases the acceptability and frequency of alcohol use in college. Fall Consensus Effect: the concept that is a self-esteem management strategy We want to maintain our view of self as a good, moral, and competent person. Alluring or beneficial to say that we don’t have a problem when we encounter an addiction > that leads to normative behaviors. > “everyone is doing it, so it’s okay to do it too.” Treatment: dispel biased perceptions Sociocultural Use and abuse of alcohol and other substances pervade all social classes Trends Biological Genetic factors account for 56% of alcohol dependence risk ○ 55% for nicotine dependence ○ 75% of illicit drug abuse Cannabis dependence has the strongest genetic risk Genes can influence individual responses to specific drugs Genes can decrease substance abuse risk Sex differences in the physiological effects of substances are also significant. **Some genes have a preventative factor ○ Asian flush 11-4 Treatment for Substance-Use Disorders There is a disparity between the millions of people who have a substance-use disorder and the small percentage who are receiving some form of intervention. Treatment and supportive intervention settings ○ Self-help groups, mental health clinics, and inpatient and outpatient treatment centers  Treatment is most effective when it incorporates best practices based on high-quality addiction research. The inclusion of integrated care that addresses underlying emotional difficulties enhances treatment outcomes. Goals of treatment; ○ Achieving sustained abstinence ○ Maintaining a drug-free lifestyle ○ Functioning productively Most alcohol and drug treatment programs have two phases: ○ Detoxification: the user ceases or reduces the use of the substance ○ Prevention: preventing relapse, a return to use of the substance Understanding and Preventing Relapse Relapse prevention considers the physiological and psychological effects Neuroplasticity ○ The ability of the brain to change its structure and function in response to experience ○ Abstinence can help recondition the brain Contingency management procedures can significantly reduce relapse Motivational enhancement therapy ○ Addresses ambivalence about giving up substance use Treatment for Alcohol-Use Disorder Alcoholics Anonymous (AA) ○ Regards alcoholism as a disease and advocates total abstinence ○ Positive long-term outcomes Controlled drinking ○ Controversial idea Medication ○ Modest effects ○ Genetic characteristics of individuals undergoing alcohol treatment were associated with differential responses to medications. More research on treatments, as well as more access to alcohol treatment, is needed. Antabuse: recreate effects of Asian flush ○ If you drink, it makes you sick. If not, you are completely fine. ○ Use as a treatment Treatment for Opioid-Use Disorder Early detoxification and therapy are critical ○ It becomes more difficult with prolonged use Synthetic opioids ○ Can reduce cravings without producing euphoria ○ A critical drawback–tolerance develop Improved outcomes ○ Behaviorally-oriented counseling  ○ Contingency management with incentives for abstinence ○ Family counseling improves treatment **Creating a vaccine to help with opioid abuse ○ Go into for an injection > injection creates antibodies > if opioids are present, antibodies latch on > molecules enlarge > cannot pass brain-blood barrier > no effect. Treatment for Simulant-Use Disorder No effective pharmacological interventions Incentives for stimulant-free toxicology reports ○ Improve rates of continuous abstinence Teaching people who use cocaine to cope with temptations and high-risk situations is beneficial. Researchers testing a vaccine to help individuals dependent on cocaine ○ Antibodies prevent cocaine from reaching the brain ○ Clinical trials are underway Treatment for Cannabis-Use Disorder Cannabis-use disorder 11-5 Gambling Disorder and Other Addiction Gambling Disorder ○ Compulsive desire to engage in gambling activities Diagnosed when a person exhibits at least 4 defining characteristics in 12 months It may be mild, moderately severe, or severe Relatively uncommon Lifetime prevalence less than 1% ○ Treatment approaches Group therapy, CBT, and improving financial management skills fMRI imaging may provide insight into which treatments increase impulse control Internet Gaming Disorder ○ A condition involving excessive and prolonged engagement in computerized or internet games Criteria are similar to gambling disorder Most common among adolescent males A significant concern in Asian countries ○ Treatment Cognitive behavioral treatment approaches include a focus on behavioral change and treating underlying emotions such as anxiety and depression. Lecture 12: Schizophrenia Spectrum Disorders 12-1 Symptoms Of Schizophrenia Spectrum Disorder Four categories:  ○ Positive symptoms, psychomotor abnormalities, cognitive symptoms, and negative symptoms Positive Symptoms ○ **The term “positive symptoms” does not refer to encouraging signs but rather refers to the “added” sensations and behaviors associated with schizophrenia Symptoms can range in severity and duration ○ Delusions ○ Hallucinations ○ Disordered thinking ○ Incoherent communication Delusions ○ A lack of insight common; false personal beliefs that are consistently held despite evidence or logic ○ Delusional themes Grandeur, control, through broadcasting, persecution, reference, and thought withdrawal ○ Paranoid ideation Often connected with persecutory delusions Safety behaviors may prevent encountering disconformity evidence **Delusions may involve a signal theme or multiple topics **Capgras delusion consists of a belief in the existence of identical doubles who replace significant others Hallucinations ○ Perception of a n nonexistent or absent stimulus ○ It may involve a single sensory modality or a combination of modalities Auditory (hearing) is the most common type of hallucination Visual Olfactory Tactile (feeling) Gustatory ○ Hallucinations are particularly distressing when they involve dominant, insulting voices. ○ The strength of hallucination and delusion can vary Cognitive Symptoms ○ Disorganized thinking, communication, and speech Common characteristics of schizophrenia ○ Loosening of associations (cognitive slippage) Continual shifting from topic to topic without apparent logical or meaningful connection between thoughts ○ Overinclusiveness Abnormal categorization ○ Response to words or phrases in a very concrete manner ○ Moderately severe to severe impairment in executive functioning Psychomotor Abnormalities ○ Catatonia  Extremes in activity level ○ Withdrawn catatonia Peculiar body movements or postures May persistently resist attempts to change their position They may exhibit a waxy flexibility, allowing their bodies to be arranged in almost any position ○ Excited catatonia Agitated, hyperactive, and lack inhibition Loud, inappropriate laughter Sleep little and are continually on the go Negative Symptoms ○ Decreased ability to initiate actions or speech, express emotions, or feel pleasure Avolition: inability to take action or become goal-oriented Alogia: lack of meaningful speech Asociality: minimal interest in social relationships Anhedonia: reduced ability to experience pleasure Diminished emotional expression: facial expression, voice intonation, and gestures ○ Over half of those diagnosed with schizophrenia display negative symptoms ○ It is essential to distinguish between symptoms that are primary from those that are secondary effects 12-2 Understanding Schizophrenia Diagnosis involves the presence of at least two of the following symptoms: ○ Delusions ○ Hallucination ○ Disorganized speech ○ Gross motor disturbance ○ Negative symptoms Deterioration from a previous level of functioning Symptoms must be present for the time for at least one month, and the disturbance must persist for at least six months Phases of Schizophrenia The lifetime prevalence of schizophrenia in the United States is about 1% May show impairment in premorbid functioning ○ Abnormalities prior to significant symptom onset Prodromal phase ○ Onset and buildup of symptoms Active phase  ○ Full-blown symptoms Residual phase ○ Sometimes, it occurs, but it does not always ○ Symptoms no longer prominent Long-Term Outcome Studies Increased optimism regarding the course of the disorder 12-3 Etiology of Schizophrenia Primarily genetic disorder Biological Genetics and heredity play a role ○ Interactions among a large number of different genes Closer blood relatives have a greater risk C4 alleles are not believed to have a strong association with schizophrenia. Correlation to brain Endophenotypes ○ Behavioral ability that is governed by our genetics ○ Hypothesized to underlie heritable illnesses (such as schizophrenia) Exist in the individual before the disorder, during it, and following remission ○ Endophenotypes associated with schizophrenia Irregularities in working memory, executive function, sustained attention, and verbal memory Neurostructures ○ fMRI scans found that areas of the limbic system associated with emotions are overactive in response to neutral stimuli This may lead to hypervigilance, delusional thoughts, and a tendency to respond to situations as “threatening.” ○ Dysfunctions in the striatum may explain the difficulties in modifying illogical thoughts/delusions ○ Decreased volume in cortex and ventricle enlargements Ineffective communication between different brain regions This may lead to cognitive, negative, and positive symptoms Biochemical Influences ○ Dopamine hypothesis Schizophrenia may result from excess dopamine activity in specific brain areas. Supported by research with three drugs  Phenothiazines: block dopamine receptor sites L-dopa: increases dopamine levels and sometimes produces schizophrenia-like symptoms Amphetamines: increase dopamine availability and produce symptoms similar to acute paranoid schizophrenia and in non-schizophrenics Side effects of antipsychotic: motor issues due to imbalance of dopamine The use of cocaine, amphetamines, alcohol, and especially cannabis increases the risk of developing schizophrenia. Schizophrenia > Increasing cannabis use Psychological Deficits in empathy ○ The tendency to focus only on one’s own thoughts and feelings appears to compromise social interactions. Deficits in the theory of mind ○ Individuals with schizophrenia may operat ebased on their own perspectives, without understanding that others have their own points of view Association between early developmental delay and schizophrenia ○ Low cognitive ability test scores in childhood and adolescence ○ Cognitive decrements may be an indication of brain abnormalities that result in less “cognitive reserve.” Misattributions and negative attitudes **Negative symptoms create this mindset in the person’s shizophrenia to their capabilities, competence, and self-esteem/self-worth/worth to others Social Dysfunctional family patterns were considered the primary cause Certain social factors ○ Maltreatment; chronic bullying; relationships within the home(severe physical abuse)  ○ Expressed Emotion: negative communication pattern among relatives of individuals with schizophrenia Critical comments, name-calling, insults, high stress/chaos environment Sociocultural Ethnic differences ○ Hispanic and African Americans are more likely to receive a diagnosis of schizophrenia than non-Hispanic whites ○ Differences may be due to the clinician's bias or misinterpretation of health paranoia ○ **Overrepresented Other factors ○ Being unemployed, of lower socioeconomic status and educational level, and living in impoverished urban areas ○ Immigration experiences appear to increase susceptibility to schizophrenia The stress of migration and experience of discrimination 12-4 Treatment of Schizophrenia Been treated by a variety of means, including performing a prefrontal lobotomy ○ Medications ○ CBT therapies ○ Cognitive enhancement therapy Antipsychotic Medication Can reduce the intensity of symptoms ○ Thorazine Introduced in 1955 ○ First-generation antipsychotics Still viewed as effective treatments Reduce dopamine levels (dopamine hypothesis) **Issuse: effective for psychotic symptoms (delusions, hallucinations) but does not help negative symptoms (loses of abilities, etc.) ○ Atypical antipsychotics Acts on both dopamine and serotonin Side Effects and Extrapyramidal Symptoms Too much-lowered dopamine can cause Parkinson-like symptoms Weight gain, feelings of restlessness, or excessive sedation Enhanced risk of cardiovascular conditions Increased risk of metabolic syndrome Mixed effects on cognitive functioning and motivation Extrapyramidal Symptoms ○ Parkinsonism – muscle tremors, shakiness, immobility  ○ Dystonia – involuntary muscle contractions in limbs and tongue ○ Akathesia – motor restlessness Psychosocial Therapy Works with individuals often focus on the direct teaching of conversational, behavioral, and social skills. Social communication may also be problematic because of difficulties with emotional perception and understanding the beliefs and attitudes of others. Social cognition and interaction training (SCIT) ○ The online program focused on communication skills ○ Then, practice these skills in a group setting Work-Focused CBT ○ Increasing positive attitudes toward work, blistering coping and problem-solving skills, and improving social interaction skills Cognitive Enhancement therapy - aims to ameliorate the neurocognitive deficits found in individuals with schizophrenia. CBT Teach coping skills to allow clients to manage their positive and negative symptoms. ○ Psychoeducation and engagement ○ Assessment and normalization ○ Cognitive restructuring and identification of negative beliefs ○ Normalization ○ Collaborative analysis of symptoms ○ Development of alternative explanations Interventions Focusing on Family Communication and Education ○ Normalize family experience; demonstrate concern, empathy, and sympathy; educate family members about schizophrenia; avoid blame; identify strengths and competencies; develop problem-solving and stress management skills strategies for coping; strengthen communication skills 12-5 Other Schizophrenia Spectrum Disorder Delusional Disorder ○ Persistent delusions that are not accompanied by other unusual or odd behaviors ○ Common themes involved in delusional disorders include: Erotomania: belief someone is in love with the individual; typically more romantic than sexual focus Grandiosity: great, unrecognized talent Jealousy: the conviction that the partner is being unfaithful Persecution: being conspired or plotted against Somatic complaints: having body odor, being malformed, being infested by parasites/insects Brief Psychotic Disorder  ○ Presence of 1 or more psychotic symptoms, including at least one symptom involving delusion, hallucinations, or disorganized speech, that continue for at least one day but last less than one month Schizophreneiform Disorder ○ Two or more of the following symptoms: delusions, hallucinations, disorganized speech, gross motor disturbances, or negative symptoms. At least one of these symptoms must involve delusions, hallucinations, or disorganized speech. This condition lasts between 1 - 6 months. Schizoaffective Disorder ○ Diagnosed when someone demonstrates psychotic symptoms that meet the diagnostic criteria for schizophrenia combined with symptoms of one major depressive or manic episode Lecture 13: Neurocognitive Disorders Types of Neurocognitive Disorders Major Minor Delirium ○ More short-lived; comes abruptly and leaves abruptly *Structural and chemical changes result in impaired thinking, memory, or perception. They result from transient (temporary) or permanent brain dysfunction triggered by changes in brain structure or biochemical processes within the brain The Assessment of Brain Damage and Neurocognitive Functioning Gather background information Evaluate overall mental functioning, personality characteristics, and coping skills. Rule out sensory conditions or emotional factors. Assessment frequently involves screening of mental status, including memory and attentional skills and orientation to time and place. Test to pinpoint areas of cognitive difficulty. Medical professionals attempt to identify and treat any physical conditions that may be causing the symptoms. ○ Blood tests ○ EEG ○ CT ○ MRI ○ PET Comprehensive baseline assessment ○ Used to minotaur progress or decline in dunctioingin Example: Trail-Making Test Major Neurocognitive Disorder For diagnosis, must show a significant decline in: ○ One or more cognitive areas Deifcits in multiple regions are common ○ Ability to independently meet daily living demands The evidence must confirm that the person is demonstrating a significant skill deficit that represents a decline Clinicians specify the underlying medical reason if they know Mild Neurocognitive Disorder Modest decline in at least one main cognitive area Individuals able to participate in everyday activities ○ It may require extra time to complete tasks ○ Overall, independent functioning is not compromised Often, an intermediate stage between aging and a major neurocognitive disorder Often goes undiagnosed ○ Early detection can allow individuals to plan for future care before the disorder develops. ○ Sometimes, major neurocognitive disorder is downgraded to a minor As a result of recovery from stroke or traumatic brain injury Delirium Acute state of confusion characterized by disorientation and impaired attentional skills ○ Differs from mild and major neurocognitive disorder based on its core characteristics Abrupt onset (develops over several hours or days) Symptoms can be mild or severe Psychotic symptoms may be present Treatment: identify the underlying cause Hospitalized individuals and the elderly are at increased risk Dementia Decline in mental function and self-help skills ○ Resulting from a major neurocognitive disorder ○ Examples of affected areas are memory, problem-solving, and impulsive control Agitation due to confusion or frustration is also common Gradual onset and continuing cognitive decline Age is the strongest risk factor for dementia  ○ Women in the US have a greater lifetime risk for dementia because they tend to live longer. ○ People who are white or well-educated tend to develop dementia much later in life ○ POC and those less educated have both an earlier age of onset and higher lifetime risk of cognitive impairment 13-2 Etiology of Neurocognitive Disorders Result from a variety of medical conditions Some involve specific events ○ Stroke ○ Head injury Some become worse over time Neurodegeneration ○ Progressive brain damage involving the death of brain cells ○ Individuals show a decline, not an improvement Neurocognitive Disorder due to Traumatic Brain Injury (TBI) Traumatic Brain Injury ○ It can result from a bump, jolt, blow, or physical wound to the head It occurs most frequently in young children, older adolescents, and older adults Neurocognitive disorder diagnosed with: ○ Persisting cognitive impairment due to a brain injury Effects can be temporary or permanent Concussion Most common type of TBI Trauma-induced changes in brain functioning Symptoms include headache, dizziness, nausea, and sensitivity to light ○ Usually temporary (a few weeks), but sometimes last much longer Physicians recommend resting and minimizing stimulation or mental challenge Many occur in competitive sports and recreational activities ○ About half are unreported Cerebral Contusion and Cerebral Laceration Cerebral contusion is bruising of the brain. ○ Occurs when the brain strikes the skull with sufficient force to cause bruising ○ It involves actual tissue damage to both sides of the impact and the opposite side ○ Symptoms similar to those of a concussion Neuroimaging can detect brain damage and monitor swelling  Cerebral laceration is an open head injury ○ Brain tissue is torn, pierced, or ruptured ○ Immediate medical care involves reducing bleeding and preventing swelling ○ Symptoms vary with the severity of the laceration Chronic Traumatic Encephalopathy (CTE) Progressive, degenerative condition Occurs when abnormal deposits of a commonly occurring brain substance, tau protein, begin to clump together, causing both gray and white matter to slowly and progressively atrophy Diagnosed in individuals who have had multiple episodes of head injury Associated with psychological symptoms, an increased risk of dementia Four stages of CTE 1. Headache and loss of attention and concentration 2. Depression, explosive outbursts, and short-term memory loss 3. Cognitive impairment, including difficulties with planning and impulse control 4. Dementia, word-finding difficulty, and aggression Vascular Neurocognitive Disorders Can result from a one-time cardiovascular event (stroke) or unnoticed, ongoing disruptions to the cardiovascular system Found in about 40 percent of brain autopsies of individuals diagnosed with dementia ○ Often begins with atherosclerosis Stroke ○ Ischemic stroke 85% of cases Much like in a heart attack, the build-up of plaque of blood flow to the brain ○ Hemorrhagic stroke 15% of cases Due to a blow to the head, blood vessels rupture and cause a stroke Stroke Obstruction of blood flow to or within the brain, leading to loss of brain function A leading cause of death in the US ○ A significant cause of disability It can occur at any age ○ One-third of strokes occur under the age of 65 Some risk factors: ○ Smoking (contributor) Chemicals irritate blood vessels, causing them to constrict ○ Stress ○ Poor eating and a sedentary lifestyle ○ Depression Vascular dementia results from a series of small asymptomatic (symptomless) strokes or other conditions that interfere with optimal blood flow) Neurocognitive Disorder Due to Substance and Alzheimer’s Disease Due to the use of drugs or alcohol ○ Can result in delirium or chronic brain dysfunction Mild neurocognitive disorder common with a history of heavy substance use ○ Symptoms continue with initial abstinence but can improve over time Due to Alzheimer's Disease – affects more than 5 million Americans ○ Involves progressive cognitive decline ○ Age is a significant risk factor ○ Clear physiological indicators required to predict whether patients with mild memory impairment will likely develop AD Characteristics of Alzheimer’s Disease Progressive decline in cognitive and behavioral functioning Early symptoms: ○ Memory dysfunction, irritability, and cognitive impairment Other symptoms that often appear: ○ Social withdrawal, depression, apathy, delusions, impulsive behaviors, neglect of personal hygiene No cure exists Shrinkage of brain tissue Abnormal structures ○ Neurofibrillary tangles Twisted fibers of TAU found inside nerve cells ○ Beta-amyloid plaques Beta-amyloid proteins aggregate in spaces between neurons Brain changes appear years before dementia ○ Associated with decreased neurogenesis (reduced production of new brain cells), as well as inflammation, loss of cellular connections, and shrinkage of the brain Types 1. Early Onset: 50s (5-10%) a. Typically, more genetic factors 2. Late Onset: aged 65 or older (80-90%) a. The average age of diagnosis is about 74 years of age b. Once diagnosed, the average life expectancy is 7-9 years after Etiology of Alzheimer’s Disease ** Believed to be influenced by hereditary and environmental factors ○ Genetically based Alzhemiers > early onset ○ Stress, smoking, lifestyle > late onset Treatment Only slow down progression, such as through medication Dementia with Lewy Bodies (DLB) The first person to identify circular bodies that invade different neurons in the brain Second most common form of dementia ○ Characteristics: Impaired thinking and significant fluctuations in attention and alertness Recurrent, detailed visual hallucinations and other psychiatric symptoms, including depression, apathy, anxiety, agitation, delusions, and paranoia Impaired mobility that occurs after the onset of cognitive decline Difficulties with the regulation of blood pressure, digestion, and sleep, including physically acting out dreams during sleep Lewy Bodies deplete the neurotransmitter acetylcholine, resulting in the perceptual, cognitive, and behavioral symptoms ○ Depletion of dopamine results in unique motor dysfunction Parkinson’s Disease (PD) Four primary symptoms ○ Temor of the lands, arm, legs, jaw, or face ○ Rigidity of the limbs ○ Slowness initiating movement ○ Drooping posture or impaired balance and coordination Motor symptoms evident at least one year prior to notable cognitive decline ○ Mild cognitive impairment affects 27% of those with PD The symptoms of PD result from the buildup of Lewy body proteins Occupational exposure to herbicides and pesticides or certain toxins appears to increase the likelihood of developing PD 13-3 Treatment Considerations Treatment approaches vary widely due to different causes, symptoms, and dysfunctions. First, any underlying medical conditions are addressed Major interventions ○ Rehabilitative services ○ Biological interventions ○ Cognitive and behavioral treatment ○ Lifestyle changes ○ Environmental support Rehab Primarily with stroke It must be comprehensive and sustained Physical, occupational, speech, and language therapy ○ Commitment and participation in treatment plays an important role ○ Depression,p pessimism, and anxiety can stall progress Neuroimaging techniques are increasingly used to document brain changes achieved through rehabilitation Biological Treatment L-dopa, levodopa Medication ○ Specific vitamins, such as B23, can decrease homocysteine levels ○ Levodopa increases dopamine available for relief from PD symptoms ○ Deep brain stimulation for PD and AD ○ Gene therapy is also being tested with PD ○ High doses of vitamin E can slow AD progression ○ Medication can help prevent the recurrence of stroke by treating hypertension or diabetes. ○ Antidepressants Cognitive and Behavior Treatment Psychotherapy ○ Enhance coping and participation in rehabilitation efforts ○ Reduce the frequency and severity of problem behaviors ○ ○ Social skills, reducing complex tasks into more straightforward steps ○ Meditation and mindfulness-based stress reduction Reduced brain atrophy Lifestyle Changes Can help prevent or minimize the progression of some neurocognitive disorders Cardiovascular fitness Smoking cessation Weight reduction Control of blood sugar, cholesterol, and blood pressure Increased social interaction and mental stimulation Environmental Support Disorders involving dementia ○ Irreversible ○ Best managed with a supportive environment Exposure to bright lighting ○ Improve sleep and decrease agitation and depression Writing answers to repeatedly asked questions Labeling family photos Family visits Lecture 14: Sexual Dysfunctions, Gender Dysphoria, and Paraphilic Disorders 14-1 What is “Normal” Sexual Behavior Understanding what is normal ○ Important when classifying or diagnosing sexual problems and behaviors It is difficult to determine what is normal  ○ It was controversial in the field of psychopathology ○ Definitions of normal sexual behavior vary widely and are influenced by both moral and legal judgments. Example: people report tremendous variation in the frequency of sexual outlet or release ○ Influenced by cultural norms and values Definitions of sexual disorders are inexact ○ Some argue that there is no need for classification systems The Sexual Response Cycle Appetitive Phase ○ Characterized by a person’s interest in sexual activity It can also be referred to as the interest phase Arousal phase ○ May follow or precede the appetitive phase ○ Heightened when specific, direct sexual stimulation occurs ○ Various physical changes occur Increased blood flow to the penis in males Blood engorges the genital region, and the clitoris expands in females Orgasm Phase Resolution Phase Sexual Dysfunctions Recurrent and persistent disruption of any part of the normal sexual response cycle ○ **DSM-5: A diagnosis is not appropriate when “Severe relationship distress, partner violence, or significant stressors better explain the sexual difficulties.” Types of dysfunctions Lifelong Acquired Generalized Situational Sexual Interest/Arousal Disorders - Appepetive Phase Problems with sexual excitement in the appetitive and arousal phases ○ Males hypoactive sexual desire disorder Little to no interest in activities ○ Female sexual interest/arousal disorder Little to no interest or diminished arousal in response to sexual cues  ○ Common around couples > seek help together 40-50% of all sexual difficulties involve deficits in interest ○ Low interest may be the consequence of pain during intercourse or another sexual dysfunction People with sexual interest/arousal disorders have little interest in or derive minimal pleasure from, sexual activity Erectile Disorder - Arousal Phase Inability to attain or maintain an erection sufficient for sexual intercourse or other sexual activity ○ A large percentage caused by limited blood flow caused by vascular insufficiency ○ This may indicate a significant health condition Distinguishing between biological and psychological causes is often difficult. ○ The distinction may be made based on the presence or absence of nocturnal penile tumescence. Younger = mental, older = physiological ○ It does not always apply; mostly, 17-40 are affected Orgasmic Disorders – Orgasm/Sexual Activity Phase Female orgasmic disorder ○ Very common among females ○ Persistent delay or inability to achieve orgasm despite receiving adequate sexual stimulation ○ Marked reduced intensity of orgasmic sensation ○ The diagnosis of female orgasmic disorder is given only if the woman has difficulty achieving orgasm through clitoral stimulation. Delayed ejaculation Premature ejaculation ○ The distressing and recurrent pattern of having an orgasm with minimal sexual stimulation before, during, or after vaginal penetration ○ Must occur within one minute of penetration ○ 21-33% of men ○ Report lower satisfaction with intercourse, poor self-confidence, and personal distress. Genito-Pelvic Pain/Penetration Disorder Involves physical pain or discomfort associated with intercourse/penetration ○ Can affect interest in sexual activity > affecting other phases. Etiology of Sexual Dysfunctions Biological Age ○ Impact on hormone levels Levels of testosterone or estrogens Medications used to treat conditions affect sex drive ○ Many antidepressants and antihypertensive medications Alcohol is a leading cause of disorders  Illnesses and other physiological factors Psychological Predipsoing or historical factors Current problems and concerns Presence of anxiety disorders Performance Anxiety and Spectator Role Situational or emotional anxiety for women Negative early sexual experience Negative thoughts and dysfunctional beliefs Social Social upbringing and current relationships Strict religious upbringing Traumatic sexual experiences Relationship issues are often at the forefront of sexual disorders ○ Marital satisfaction associated with greater sexual frequency Sociocultural Influenced by gender, age, cultural scripts, sexual orientation ○ Examples: Women have different sexual fantasies than men, are more attuned to relationships in the sexual encounter, and take longer than men to become aroused Cultural scripts for men in the United States Sexual potency as a sign of masculinity People in Asian countries consistently report the lowest frequency of sexual intercourse Lesbians and gay men deal with societal or internalized homophobia Treatment of Sexual Dysfunction Biological ○ Hormone replacement ○ Special medication ○ Mechanical means to improve functioning Vacuum pumps, suppositories, penile implants ○ Medications are often used to treat erectile disorder Injecting medication into the penis Oral medication A psychological boost may lead to feelings of enhanced pleasure Psychological ○ Education Replace myths and misconceptions with facts ○ Anxiety reduction  Desensitization or graded approaches ○ Changing negative thoughts and beliefs ○ Structured behavioral exercises Tasks that gradually increase the amount of sexual interaction ○ Communication training ○ Behavioral exercises, cognitive mindfulness-based, and communication training have been successful in treating sexual arousal disorders in women. 14-2 Gender Dysphoria Any discussion of psychopathology related to gender identity needs to begin with an understanding of gender diversity. Previously called gender identity disorder (GID) or transsexualism ○ Marked incongruence (mismatch) between one’s experienced or expressed gender and biologically assigned gender Not the same as sexual orientation Diagnosed when there is significant distress or impairment Experienced differently at different ages DSM-5 Cteriria At least two symptoms for a period lasting at least 6 months ○ A marked difference between experienced or expressed gender and one’s own sex characteristics ○ A strong desire to be rid of one’s primary and/or secondary sex characteristics ○ A strong desire to have the sex characteristics of the other gender ○ A strong desire to be a different gender ○ A strong desire to be treated as a different gender ○ A strong conviction that one has typical feelings and reactions of a different gender Etiology of Gender Dysphoria Likely an interaction of multiple variables Societal intolerance of this diversity can result in a variety of distressing experiences. Biological Influences on Transgender Development ○ Biological research suggests that genetics may be involved in the development of a transgender identity. ○ Neurohomronla factors also appear to be associated with transgenderism ○ There is no specific neurological explanation Brain alterations associated with psychosocial distress and social exclusion Treatment Both individual and family therapy are essential when treating youth with gender dysphoria. ○ Allowing gender development to occur without expectations regarding the outcome ○ Openly affirming the child’s expressed identity ○ Encouraging the child to align with the identified sex at birth Goal: Accept and support the child’s preferred gender identity as well as help them learn to deal with stressors associated with their decision  Select groups go through surgery to achieve attrition 14-3 Paraphilic Disorders DSM-5: Sexual interest in non-normative targets ○ May involve unusual erotic behavior or socially unacceptable targets ○ Diagnosed only when paraphilia harms or risks harming others and is acted on or causes the individual to experience distress or impairment in social functioning ○ Paraphilic disorders are associated with recurrent urges, behaviors, or fantasies involving any of the following three categories: Nonhuman objects, nonconsenting others, and actual or simulated suffering or humiliation Paraphilic Disorder Involving Nonhuman Objects Fetishistic disorder ○ Extremely strong sexual attraction and fantasizes involving inanimate objects Examples: shoes or undergarments ○ A person is often sexually aroused to the point of erection in the presence of the fetish item ○ A person may choose sexual partners on the basis of having that item ○ Must cause significant distress or harm to others ○ **The vast majority are men Transvestic Disorder ○ Occurs when intense sexual arousal is associated with fantasies, urges, or behaviors involving cross-dressing ○ Most people who cross-dress are exclusively heterosexual ○ The cross-dressing must cause significant distress or impairment in critical areas of functioning ○ Men may become sexually aroused by thoughts of themselves as female (autogynephilia) ○ **The vast majority are men Paraphilic Disorders Involving Nonconsenting Persons Exhibitionistic Disorder ○ Urges, acts, or fantasies of exposing one’s genitals to strangers, intent to shock ○ The exhibitionistic disorder most commonly occurs in men ○ Individuals with this paraphilia report lower satisfaction in life ○ Typically, they get satisfaction from the victim’s reaction (grossed, disgusted, etc.) ○ Treatment: Researchers remove the gratifying reactions (replace them with pleasant, happy, etc.). Perpetrators have to meet the victims, get to know them, and then expose themselves > creating negative consequences associations to action Voyeuristic Disorder ○ Urges, acts, or fantasies involving observation of an unsuspecting person disorbing or engaging in sex activity ○ Diagnosed only in those aged 18 or older ○ Individuals must be distressed by or have acted on voyeuristic urges  Frotteurisitic Disorder ○ Recurrent/intense sexual urges, acts, or fantasies of touching or rubbing against a nonconsenting person ○ The touch, not the coercive nature of the act, is the sexually exciting feature. ○ A person must be markedly distressed by urges or have acted on them ○ Prevalence is difficult to determine Behavior may go unnoticed or presumed to be accidental\ Pedophilic Disorder ○ Adult obtains erotic gratification through urges, acts, or fantasies involving children under the age of 13 ○ Individually, they must have acted on or be clinically distressed by these urges. ○ Frequently use child pornography for sexual gratification ○ Sexual abuse of children is common Females tend to be more common targets ○ Most people who act on pedophilic urges are friends, relatives, or acquaintances of their victims (and involve incest) ○ Effects of sexual abuse can be lifelong Paraphilic Disorder Invoklving Pain or Humilation Sexual Masochism Disorder ○ Sexual urges, fantasies, or acts that involve being humiliated, bound, or made to suffer ○ Individual does not seek harm or injury Find sensation of helplessness appealing Giver end ○ A sexual masochism disorder diagnosis occurs only if the paraphilia causes distress or impairment in functioning Sexual Sadism Disorder ○ Sexual urges, fantasies, or acts that involve inflicting physical or psychological suffering on others Recieving end ○ Diagnosis is when a person must have acted on the urges with a nonconsentingi person or feel distressed by the behavior Etiology and Treatment of Paraphilic Disorders Some men may be biologically predisposed to pedophilic disorder Psychological factors also contribute ○ Psychodynamic treatment of sexual deviations involves helping the client understand the relationship and the unconscious conflicts that produce it ○ Likely to have early exposure to sex, sexual violence, pornography, or a history of being sexually victimized In some states, they plan to remove the ability to inherent sexual desire (castratation, therapy, surgicial removal, etc.) Lecture 15: Personality Psychopathology 15-1 Personality Psychopathology Most people are flexible in responding to life situations ○ Shy people are not necessarily shy in all situations A diagnosis in personality disorder emcompassess enduring personlity patternst that are ○ Extreme and deviate markedly from cultural expectations ○ Inflexible and pervasive across situations ○ Evidence in adolesence or early adulthood and stable over time ○ Associated with distress and impairment Prevalence of Personality Disorder Not really sure ○ Lack of folk receiving treatment and help Estimated 12%, but it is difficult to determine 15-2 Personality Disorders Specifical disorders grouped into 3 behavior clusters ○ Odd or eccentric (A) ○ Dramatic, emotional, or erratic (B) ○ Anxious or fearful (C) Cluster A Paranoid, schizoid, and schizotypal personality ○ Share characteritistcs, including overlapping environmental and genetic risk factors, which are similar to those found in the schizophrenia spectrum disorder Characteristics: ○ Pervasive distrust and suspiciousness of others Often interpret others’ motives negatively, question people’s loyalty or trustworthiness and bear grudges ○ Exhibit unwarranted hypersensitivity ○ Tend to be rigid in the their thinking ○ May seem aloof and lacking emotion Schizoid Personality Disorder Limtied interest in social relationships Restricted range of emotions in interpersonal settings Individuals have a long history of impairment in social functioning ○ Neither desire or enjoy close relationships May be perceived by others as peculiar and aloof Prefer social isolation and the single life May be associated with cold, emotionally impoverished childhood Most likely to seek therapy if they are experiencing stress or a crisis Schizotypal Personality Disorder Characterized by odd, eccentric, or paranoid thoughts and behaviors and poor interpersonal relationships ○ Many with the disorder believe that they have magical abilities or special powers ○ Some are subject to recurrent illusions ○ Speech oddities, such as frequent elaboration, digression, or vagueness in conversation, are often present Abnormalities in cognitive processing ○ Many characteristics resemble schizophrenia ○ **Some research has suggested a genetic link between schizophrenia and schizotypal personality disorder Difference between schizophrenia is the severeity ○ Not as disturbed Cluster B- Dramatic, Emotional, or Erratic Behaviors Antisocial Personality Disorder Pervasive pattern of disregard for and violation of rights of others ○ Must have occurred since age of 15 ○ Onset begins in childhood – girls have later age of onset than boy Diagnosis applies to individuals age 18 or older Lack of anxiety and guilt over failure to conform to social or legal codes Individuals seek power over otheres Two types ○ Those with characteristics of being callous and unemotional (psychopath) ○ Without being callous and unemotional (sociopath) **Primarily males and does not have to include violence Borderline Personality Disorder Characterized by enduring pattern of volatile emotional reactions ○ Unstable interpersonal relationships ○ Poor self-image ○ Impulsive responding ○ Intense mood fluctuations ○ May engage in behaviors with negative consequences ○ Poor coping skills ○ Often display poor emotional control Biologically based vulnerability to emotional dysregulation may underlie the intense emotional reactivity Three basic assumptions ○ The world is dangerous ○ I am powerless and vulnerable ○ I am inherently unacceptable  Early childhood experiences, neglect, or abuse may play a role **CBT and DBT have shown to be effective treatment ○ How we recongize these emotions and manage them Histrionic Personality Disorder Characterized by pervasive pattern of excessive emotionality and attention-seeking ○ Intensely dramatic emotions and behaviors ○ Superficially charming and warm ○ Shallow and self-centered Biological and enivornmental factors may be important influences Narcissistic Personality Disorder Individuals with this disorder have a sense of entitlement, exaggerated self-importance and superiority ○ Grandiosity ○ Talk mainly about themselves ○ Lack of empathy ○ Show a lack of interest in others Brain scans shown differences between healthy controls and those with naracissistic personality disorder Some delusions of grandeur Cluster C - Disorders Chracterized by Anxious or Fearful Behaviors Avoidant Personality Disoder ○ Characterized by pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation ○ Individuals with disorder crave affection and an active social life ○ Caught in a vicious cycle: They are preoccupied with the possibility of rejection, they are constantly alert for signs of negativity or ridicule Believe that this disorder is on a continuum with social anxiety disorder Dependent Personality Disorder Pervasive, excessive need to be taken care of ○ Leads to submissive and clinging behavior ○ Individuals have fear of separation ○ High risk for becoming a victim of relationship violence Associated with overprotective, authoritarian parenting Attrivute dependent personality disorder to the development of distorted beliefs that discourage independent ○ Has more potential to be successfully treated compared to other disorders Obsessive-Compulsive Personality Disorder (OCPD)  Pervasive pattern of preoccupation with oderliness, perfectionism, and mental and interpersonal control Rigid behaviors in persons with OCPD can significantly impair their occupational and social functioning Differs from OCD ○ OCD involves unwanted, intrusive thoughts and urges ○ Individuals with OCPD see their way of functioning as correct OCPD have altered activity in parts of the brain that affect rumination, cognitive flexibility, and response switching ○ Brain patterns similar to people diagnosed with OCD 15-3 Multipath Analysis of Antisocial Personality Disorder Antisocial personality disorder (APD) is prevalent among individuals who are incarcerated for criminal offesnses as well as among individuals who are in positions of power Biological Involves interactions between biological vulnerabilities and enviornmental adversity Genetic influences ○ Genetic factors are implicated ○ Includes behavioral characteristics observed during childhood and adolescence Risk taking and/or impulsivity ○ Supported by twin studies and adoptive child studies Influences on brain structure involved with fearlessness, anxiety, and emapthy ○ Structural abnormalities have been found in the prefrontal cortex and parts of the limbic system ○ Abnormalities have been found in nerve pathways linking to the posterior cingulate cortex to the medial prefrontal cortex ○ fMRI studies have found hypersensitivity to threat ○ Characteristic of callousness exhibited diminished physiological responsibility in response to interpersonal stress **PREDIPOSITION ○ Genetic predisposition coupled with negative upbringing leads to the prevalence of the disorder ○ If not a bad upbringing, it could’ve been a more daredevil personality trait Psychological Psychodynamic perspective ○ Faulty superego development ○ Dominated by id impulses Cognitive perspective  ○ Core beliefs influence behavior ○ Worldview of those with APD revolves a need to perceive themselves as strong and independent so they can survive Learning perspective ○ Neurobiogloical traits that impede learning ○ Lack of positive role models ○ Type of punishment may influence learning Social Family relationships are a paramount factor Social factors ○ Childhood history of emotional and physical maltreatment ○ Lack of positive role models ○ Nurturing parenting can help minimize antisocial traits ○ Prociding positive reinforcement appears to be protective against the genetic expression of traits associated with APD Sociocultural Gender ○ **Men more likely to exhibit characteristics of APD ○ Women with APD are more likely to report childhood neglect, sexual abuse, and parental use of substances compred to men ○ Tradtional gender-role training accepts or encourages aggression in boys but not girls Men tend to engage in direct acting-out behavior Women express themselves in an indirect or passive manner (relational aggression) More frequent in urban environments than in rural areas Exposure to ethnic-political violence can result in the development of violent and antisocial behavior Any judgment regarding peresonality functioning must consider ethnic, cultural, and social influences Treatment of APD Approaches that reuqire cooperation of client may be ineffective ○ Treatment Focus on decreasing deviant activities, combined with opportunities to practice appropriate social skills Material rewards for behavior modification can lead to improvement Lecture 16: Disorders of Childhood and Adolscence Accurate assessment of mental disorders with children ○ Requires understanding normal child development and temperament  ○ Characteristics that signify mental illnesses in adult often occur in normally developing children ○ Symptoms of some disorders different between children and adults ○ Prefrontal cortext continues developing throughout childhood ○ Consdiers child age, developmental, and environmental factors Disorders are common among youth (anxiety disorders and depression) ○ Large percentage are untreated 16-1 Internalizing Disorders Among Youth Involve inward-directed emotional symptoms ○ Anxiety and depression are most common internalizing disorders Disorders prevalent in early life ○ Particular concern > led to substance abuse and suicide Anxiety, Trauma, and Stressor-Related Disorder in Early Life Anxiety disorders are one of the most prevalent mental health conditions (32%) ○ Experience extreme feelings of worry, discomfort, or fear when facing unfamiliar or anxiety-provoking situations ○ Can significantly impalct academic and social functioning ○ Overprotective or controlling parent practices, low parental warmth, or perceived parental rejection can exacerbate the issue ○ Types of anxiety disorders: Separation anxiety disorder Selective mutism (consistent failure to speak in certain social situations) Attachment Disorders Signifcant difficulties with emotional attachment and social relationships ○ Cause: stressful early environments that lack predictable caretaking and nurturing Types of attachment disorders ○ Reactive attachment disorder (RAD) Lacking trust that adults in their lives will attend to their needs; therefore, they do not readily seek or respond to comfort, attention, or nurturing Connected to an avoidant attachment style and maltreatment during early childhood Differs from teachings like stranger danger and is persistent among all known adults ○ Disinhibited social engagement disorder (DSED) Socializing effortlessly but indiscriminately and readily becomes superficially attached to strangers or casual acquaintances Opposite from reactive attachment disorder as they immediately attach to an adult at an unhealthy rate The attachment is storng to the point where separation from the subject of the attachment causes intense distress in the child Related to an anxious-ambivalent attachment style Post-Traumatic Stress Disorder in Early Life Differs in how traumatic events are perceived ○ Events that for adults may not be perceived as trauamtic can be seen as traumatic by the child observing it ○ Children who witness abuse in their home are often abused themselves so they will face the trauma of watching their caregiver benign abused and their abuse Spillover Effect: Those who are facing abuse from their partner may feel powerless and exact revenge on their children to regain power Cycle of violence > children may also transmit violence ○ Youth with PTSD expereince recurring, distressing memories of a shocking experience Direct experience with witnessing death ○ Symptoms: Distressing dreams, intense reactions to cues, playacting, or dissociative reactions Issues in school and socially The play of children who have grown up in violent homes may create scenarioes with much more violence ○ Behavorial evidence of PTSD in youth includes angry, aggressive behavior or temper tantrums; difficulty sleeping or concentrating; and exaggerated startle responses or vigilance for possible threats Nonsuicidal Self-Injuryr (NSSI) / Cutting Disorder Involves intentionally inflicted superficial wounds ○ Pain induces a temporary sense of calm and well-being Intent may be attention seeking but is used as a way to minimize their issues ○ They may use it as a way to receive love that they don’t receive ○ Used also regains a sense of power, induces endorphins Those who repeatedly self-injure sometime use self-harm as a coping strategy to avoid suicidal actions DSM-5: NSSI a category under study ○ For diagnosis: episodes happening more thant 5 times a year Approximately 14-17% of adolescents and young adults have engaged in self-injury Disruptive Mood Dysregulation Disorder (DMDD) Characterized by chronic irritability and severe mood dysregulation in children between childhood and adolescence ○ Results in episodes of temper t