Healthy Sleep & Insomnia Study Guide PDF

Healthy Sleep & Insomnia - Sleep duration recommendations… - Young Adults/Adults→7-9 hours - Am I getting enough sleep? - Am I satisfied with 7 hours of sleep? - Do I need more time to sleep to feel rested? - Do I have health issues or am I at ris...

Healthy Sleep & Insomnia - Sleep duration recommendations… - Young Adults/Adults→7-9 hours - Am I getting enough sleep? - Am I satisfied with 7 hours of sleep? - Do I need more time to sleep to feel rested? - Do I have health issues or am I at risk for disease? - Do I have sleep problems? - Do I need caffeine to get through the day? - Do I feel sleepy when driving? - Tips for healthy sleep/good sleep hygiene… - Have a consistent sleep schedule - Helps regulate the body’s clock - Helps you fall asleep easily and stay asleep - Have a bedtime ritual/routine - Relaxing before bed - Doing calming activities - Ex: reading, coloring, journaling, etc. - Don't take naps - Bedroom environment… - Cool→ 60-67 degrees - Quiet→ try earplugs/white noise - Dark - Comfy bed - Don't do work on your bed - You want to associate your bed with sleep not stress like doing work - Don't use electronics before bed - Classical conditioning and healthy sleep… - Classical conditioning→ Classical conditioning is a type of unconscious or automatic learning - The more you do work in your bed the more you will associate your bed and your bedroom with work and stress rather than sleep - The harder it will be to fall asleep in your bed - How thoughts and cognitions fit with healthy sleep… - Anticipatory thoughts can be stimulating and in turn make it hard to sleep - Worrying about sleep can also make the issues worse - Insomnia→ problems falling asleep/staying asleep - DSM5TR… - Dissatisfaction with quantity or quality of sleep - Sleep disturbance causes distress during daily life - Sleep difficulty occurs at least 3 nights a week and is present for AT LEAST 3 months - Prevalence→ 6-10% have symptoms that meet the full criteria  - First line of treatment for insomnia… - CBT-I→ cognitive behavioral therapy for insomnia - Psychoeducation about sleep - Changing beliefs about sleep - Extensive monitoring using sleep diary - Practicing better sleep-related habits - Other treatments for insomnia… - Stimulus control procedures→ goal is to reduce anxiety associated with sleep - Involves sleep hygiene techniques - Major components… - Reassociate bedroom with ONLY sleep - Establish a concrete sleep schedule - Transdiagnostic Sleep and Circadian Rhythm Intervention for youth… - Adolescents or emerging adults with “sleep disturbance” - Going to bed later - Pubertal shift and other psychological factors… - Ex: less parental control, technology before bed, socializing - Has core and optional modules that can be applied flexibly - Can be used for other diagnoses including insomnia - Combines interventions from CBT-I and interpersonal/social rhythms - Medication treatments for Insomnia… - NOT the first line of treatment - Over the counter sleep meds… - Can cause rebound insomnia - Benzodiazepines… - Can cause excessive sleepiness - Can become dependent on them - Best as a short term solution Substance Use Disorders - Key terms… - Substance use→ taking moderate amounts of a substance and it doesn't interfere with functioning - Substance intoxication→ physical reaction to a substance - Substance abuse→ use that is dangerous and causes substantial impairment - Substance dependence→ uses to function “normally” - Can be defined by tolerance and withdrawal - Tolerance→ need more to get the same effects - Withdrawal→ physical symptom reactions to discontinued use or using a substance to avoid physical reaction - Diagnostic criteria for substance use disorder… - Pattern of substance use leading to significant impairment and distress  - Needs 2 or more symptoms within 1 year… - Taking more of the substance than intended for longer than intended - Desire to cut down use - Excessive time spent acquiring/using/recovering from the substance - Craving for the substance - Disrupts work/home life - Recurrent social or interpersonal issues - Discontinuation or reduction of important activities - Use in physically hazardous situations - Keeps using despite causing physical or psychological problems from use - Tolerance - Withdrawal - Prevalence… - 9% of all teens and adults in the US display substance use disorders - Highest rate in the US is for american indians→ 15.5% - Lowest rate in the US is for asian americans→ 3.5% - 3 million americans are alcohol dependant - Binge drinking… - Pattern of drinking that brings BAC to 0.08 - 4 drinks for women - 5 drinks for men - In about 2 hours - 90% of the alcohol consumed by youth (under 21) is in the form of binge drinking - Risks and causal factors… - Family and genetics… - Alcohol abuse has a genetic component - Same with other substances as well - Neurobiological… - Drugs affect the pleasure or reward centers of the brain - Psychological… - Operant conditioning or reinforcement… - It makes you feel good so you keep taking it→ positive reinforcement - It takes away negative emotions→ negative reinforcement - Opponent process theory… - Withdrawal does not keep people from use→ drugs are the easiest way to alleviate it - Ex: you drink more to make the hangover less - Cravings… - Triggered cues associated with the drug - Cognitions… - Expectancy effect→ what we expect to experience effects our use and reaction to drugs  - Social and cultural… - Exposure to drugs is necessary - family, peers… - Low parental monitoring - Association with peers who use - Treatments for substance use disorder… - Biological treatment… (Best if used in combo with psychological interventions) - Agonist substitution… - Safe drugs with similar chemical composition as the abused drug - Ex: nicotine gum/patch - Works best in combo with counseling - Antagonist treatment… - Drugs that block or counteract the positive effects of the substance - Should participate in a structured treatment program alongside this treatment - Aversive treatment… - Drugs that make use of substances extremely unpleasant - Psychosocial treatment… - Inpatient care… - For those who need help with withdrawal - Highly structured - Outpatient care… - CBT - Motivational interviewing/motivational enhancement therapy - Used to increase motivation to change - Community support programs… - AA - Those who regularly participate and follow guidelines carefully are more likely to have a positive outcome - Matthew Perry Article and Shao et al. Article… - Article about dentists over prescribing pain meds to people… Personality Disorders - Cluster A→ Odd or eccentric disorders… - Paranoid personality disorder - major distrust or suspiciousness of people - their motives are interpersonal and malevolent - Schizoid personality disorder - patterns of detachment from social relationships - a restricted range of emotional expression in interpersonal (1 on 1) settings - Schizotypal personality disorder - social and interpersonal deficits and major discomfort  - a smaller capacity for close relationships - cognitive and perceptual distortions - eccentric behavior - Cluster B→ dramatic, emotional, and erratic disorders… - Antisocial personality disorder - Disregard for the rights of others - Violation of the rights of others - Clinical features… - Failure to comply with social norms - Irresponsible, impulsive and deceitful - Lack of conscience, empathy, and remorse - May be charming but interpersonally manipulative - Diagnostic criteria… - Factors… - Arousal theory→ people with aspd are chronically underarouse - Seek fearful or aversive (for most) stimulation to boost arousal - Fearlessness theory - Higher threshold for experienced fear than most others - Tend to be less anxious about antisocial acts - Positive feelings/reward more prominent - Genetic influences - More likely to have if parents history of antisocial behavior or criminality - Family influences - Families with inconsistent parental discipline - Families that have histories of criminal and violent behavior - Mutual biological-environmental influence - Early antisocial behavior alienates peers who are corrective role models - Antisocial behavior and family stress increase eachother - Treatment… - Very few seek treatment on their own - Often, incarceration is the only viable alternative to diagnosis - PREVENTION - Parent training for young kids - May need to focus on practical (or selfish) consequences - Ex: if you rob someone you'll have to serve time  - Criminality… - Antisocial disorder is NOT the same as criminality - May have legal problems while some function well in society - high risk for delinquent behavior + low IQ = legal problems - Borderline personality disorder - Instability of… - Interpersonal relationships - Self-image - Affects - Control over impulses - Clinical features… - Instability with… - Emotions, relationships, self-concept and behavior - Emotional dysfunction - Impulsivity - Fear of abandonment - Very poor self image - Self mutilation and suicidal gestures - Causal/risk factors… - High emotional reactivity - Runs in families - Early trauma/abuse - Treatment… - Antidepressant medications for short-term - Dialectical behavior therapy→ focus on dual reality of acceptance of difficulties and need for change - Focus on interpersonal effectiveness - Distress tolerance - To decrease reckless/self-harming behavior - Histrionic personality disorder - Patterns of excessive emotion and attention seeking - Narcissistic personality disorder - Grandiosity→ an unrealistic sense of superiority in which someone believes themself to be unique and better than others - Need for admiration - Lack of empathy - Cluster C→ anxious or fearful disorders… - Avoidant personality disorder - Social inhibition→ the conscious or subconscious avoidance of a situation or social interaction - Feelings of inadequacy - Hypersensitivity to negative evaluation - Dependent personality disorder  - Excessive need to be taken care of - submissive and clingy behavior - Fears of separation - Obsessive compulsive personality disorder - Preoccupation of… - Orderliness - Perfectionism - Mental and interpersonal control - All at the expense of… - Flexibility - Openness - Efficiency - Ego-syntonic→ person feels like disorder is consistent with their identity - Don't see a need for treatment - Dont experience distress - Often experience impairment Schizophrenia - Diagnostic criteria… - Serious disturbances in thought, emotions and behavior - Psychosis→ gross departure from reality - 3 Symptom clusters… - Positive symptom cluster… - Active manifestations of abnormal behavior - Distortions or exaggerations of normal behavior - Delusions→ gross misinterpretations of reality - Delusions of grandeur→ when you believe that you have more power, wealth, smarts, or other grand traits than is true - Delusions of persecution→ when you believe someone is plotting against you - Hallucinations→ sensory experiences in the absence of sensory input - Negative symptom cluster… - Absence or insufficiency or normal behavior - Symptoms… - Avolition (apathy) → lack of initiation and persistence - Algoia→ relative absence of speech - Anhedonia→ lack of pleasure or indifference - Affective flattening→ little expressed emotion - Acociality→ reduced social initiative due to low interest/motivation to engage in social relationships - Disorganized symptom cluster… - Absence or insufficiency of normal behavior - Confused/abnormal speech, behavior, and emotion  - Disorganized speech… - Tangentiality→ going on a tangent - Loose associations→ conversation moves in unrelated directions - “Word salad” - Disorganized affect… - Inappropriate emotional behavior - Disorganized behavior→ includes a variety of unusual behaviors - Ex: hoarding, child-like silliness - Catatonia→ inability to move normally - Range→ Wild agitation/extreme restlessness to immobility - During auditory hallucinations… - Broca's area is the most active - Responsible for speech - Prevalence… - About 0.2-1.5% - Develops in early adulthood - Emerges at any time - Genetics in schizophrenia… - Family studies… - Inherit a tendency for schizophrenia - Risk increases with genetic relatedness - Twin studies… - Greater risk if your identical twin has the disorder - Adoption studies… - Person adopted has a high risk if biological parent has schizophrenia - Risk is lower than for children raised by their disordered parent - Healthy environment is a protective factor - Neurobiological influences… - Structural and functional abnormalities in the brain - Viral infections during early prenatal development - Stress and family interactions… - Stress may activate underlying vulnerability - May increase relapse risk - Family interactions (NOT SUPPORTED) - Having a schizophrenogenic (cold, dominant) mother - Double blind communication - Ex: kid goes to hug mom, mom tenses up and doesn't really hug back, kid breaks away from hug, mom says “oh, so you don't love me?” - Family interactions (SUPPORTED) - High expressed emotions (EE) - predicts relapse - Criticism, hostility and overinvolvement/intrusiveness - Dopamine hypothesis… - Schizophrenia is partially caused by overactive dopamine  - Problematic because… - Overly simplistic - Many neurotransmitters are likely involved - Treatments… - Medications… - Antipsychotic (neuroleptic) medications - First line of treatment - Side effects of medications… - Permanent - Parkinsons-like side effects - Tardive dyskinesia - Involuntary movements - Psychosocial… - Behavioral for inpatient units… - Ex: token economies - Reward adaptive behavior - Social and living skills training… - Reteach basic social interaction skills - Teach basic self-care - Goal→ facilitate living in a community - Behavioral family therapy… - Classroom like - Communication skills - Problem solving skills - Assertive community treatment… - Support is provided in a community setting - 24hr coverage - Broad treatment… - Medication management - Psychosocial treatments - Vocational training and support Neurodevelopmental disorders - What are they? - Disorders diagnosed first in infancy, childhood, or adolescence - Impairment in brain development - ADHD… - Central features… - Inattention, overactivity, and impulsivity - Symptoms must be present BEFORE 12 yrs - Diagnostic criteria… - 6+ symptoms of inattentional AND/OR 6+ symptoms of hyperactivity/impulsivity - 5 for 17 yrs and older  - Symptoms present for 6+ months before 12yrs - Symptoms present in 2+ settings - Inappropriate for developmental level - Subtypes… - Hyperactive impulsive - fidgets/taps hands, feet, squirms - Often leaves seat when they shouldn't - runs/climbs in inappropriate situations (for kids) - Difficult with quiet leisure activities - “Always on the go” - Blurts out answers before question is complete - Interrupts - Difficulty waiting for turn - Inattentive - Fails to give close attention to detail - Makes careless mistakes - Difficulty holding attentions on tasks - Seems to not listen when spoken to - Does Not follow through with instructions/tasks - Difficulty organizing - Often loses things - Forgetful, distracted - Combine presentation (has both kinds of symptoms) - Prevalence… - Occurs in 5% of children and 2.5% of adults - Hyperactivity symptoms usually present around age 3-4 - 68% of kids with adhd will have it throughout their lives - Gender differences… - Boys outnumber girls 3 to 1 - Risk factors… - Biological… - Neurobehavioral disorder - Some brain areas implicated… - Smaller brain volume - Inactivity for the frontal cortex and basal ganglia - Atypical frontal lobe development and functioning - Genetics… - Siblings of kids with ADHD→ 5-7x more likely - Children of a parent with ADHD→ up to 50% chance to develop - Identical twins→ 55-92% risk - Toxins… - Food additives may play a VERY SMALL role in hyperactive behavior - Maternal smoking increases risk  - Psychosocial… - Don't play a primary role in development of the disorder - How parents/teacher RESPOND to these behaviors have important implication for the management of symptoms - Often viewed negatively - Peer rejection, social isolation - Leads to low self esteem - Treatments… - Biological treatments… - Goal→ reduce impulsivity, hyperactivity; improve attention - Stimulant medication - Ritalin, dexedrine - However, can be abused - Behavioral treatments… - Reinforcement programs→ operant conditioning - Parent training→ teach parents about reinforcement and punishment principles to better discipline - Teacher consultation… - Daily behavior report cards - Classroom management strategies - Pelham et al. - Think about the order of treatments in the reading - Parent training then medication - Autism Spectrum Disorder…. - Symptom categories… - Social interaction and communication impairment - Lack of emotional reciprocity - Impaired nonverbal communicative behaviors - Deficit in age-appropriate relationships - MUST SHOW ALL 3 - Restrictive, repetitive, or stereotyped behaviors or interests - Stereotyped or repetitive motor movements, use of objects or speech - Insistence on sameness - Highly restricted, fixated interests that abnormal in intensity or focus - hypo/hyperactivity to sensory input or unusual interest in sensory aspects of the environment - AT LEAST 2 - Specifiers… - Verbal impairment… - Language delays - 25% never develop effective spoken language - Echolalia (stereotyped behavior)  - Pronoun reversal - “Me” becomes “you” - Difficulties with syntax - “Pragmatics” - Intellectual impairment… - Wide range of intelligence - Intellectual disability→ 38% - Above average to profound - Higher IQ→ less severe symptoms - Different educational needs - Better prognosis - Lower IQ is associated with greater autism impairments - Early warning signs… - Doesn't babble, point or make meaningful gestures by 1yr old - Does Not speak a word by 16 months - Does Not combine 2 words by 2 yrs - Does Not respond to name - Loses language or social skills - Risk and causal factors… - Neurobiological influences… - Vaccinations DO NOT increase the risk of autism - Mercury in some vaccinations were thought to increase risk - High rates of vaccinations DO NOT increase risk - Genetics play a role… - Identical twins→ 60% - Fraternal twins→ 4.5% - Oxytocin receptor genes - Bonding and social memory - Amygdala… - Larger size at birth→ higher anxiety and fear - Oxytocin: lower levels - Older parents associated with increased risk - Typical and recommended treatments… - Psychosocial behavioral treatments… - Skill building - Reduction of problem behaviors - Target communications and language problems - Address socialization deficits - No clear biological treatments for CORE symptoms - Some take meds for aggression and agitation… - Tranquilizers  - SSRIs - Integrated treatments: the preferred model - Focus on children, their families, schools and home - Build appropriate community and social support - Maximize independence - Intellectual development disorder… - Overview…. - Below average intellectual and adaptive functioning - First evident in childhood - IQ typically below 70 - Prevalence… - 1-2% of the general population - Gender differences… - Occurs more often in males than females - Causes… - Environmental… - Deprivations, malnutrition, abuse, neglect - Prenatal… - Exposure to disease or a drug/toxin - Perinatal… - Difficulties during labor and delivery - Postnatal… - Head injury, toxins - Genetic… - Chromosomal abnormalities - Down syndrome - Extra chromosome - Fragile X syndrome - Abnormality on the X chromosome - Risk of having a baby with down syndrome increases with maternal age - Most cases specific causes are unknown - Treatments… - Parallels treatment of autism - Teach needed skills - Foster productivity - Foster independence - Educational and behavioral skills - Living and self care skills - Communication training