Exam 4 Flashcards
(118 cards)
1
Q
Conduct Disorder
A
- Chronic transgressions of societal normal forms of behavior
- 3 symptoms in 12 months, with 1 in 6 months
2
Q
Conduct Disorder DSM5 categories
A
- Aggression to people and animals
- Destruction of property
- Deceitfulness or theft
- Serious violations of rules
3
Q
Conduct Disorder
types
A
- Childhood-onset: before age 10
- Adolescent-onset: age 10 or later
- Life-course persistent antisocial behavior
4
Q
Specifier for CD
A
Limited prosocial emotions: less reactive to fear and distress in others; less sensitive to punishment
5
Q
Oppositional Defiant disorder
A
- Less severe pattern of misbehavior compared to CD
- Negativistic, defiant, disobedient, and hostile behavior
- Onset in toddler and preschool years
- For some kids there is developmental sequence from ODD to CD
6
Q
ODD DSM-5 subtypes
A
- angry/irritable mood
- argumentative/defiant
- Vindictiveness
7
Q
Biological contributors to CD and ODD
A
- Genetic factors: Kids with CD are more likely than those without, to have a parent who has antisocial personality disorder
- Combo of abnormal MAOA gene and childhood maltreatment
- Abnormalities in prefrontal cortex
- Less amygdala activity in response to emotional stimuli
- Prenatal exposure to neurotoxins or drugs
- High blod serotonin levels
- Lower resting heart rate
- higher levels of testosterone
8
Q
Social contributors to CD and ODD
A
- Increased rates in: lower socioeconomic classes and urban areas
- difficult temperatment
- Quality of parenting: ineffective parenting, rejection, harsh and inconsistent discipline
- Physical abuse or severe neglect
- Malnutrition
- Peer delinquency
9
Q
Cognitive contributors to CD and ODD
A
- Process information about social interactions in ways that promote aggressive reactions
- Consider a narrow range of responses to perceived provocation
10
Q
CBT for CD and ODD
A
- learn to recognize situations that trigger anger, aggression, and impulsivity
- Discuss hypothetical situations and how children would react
- Teach adaptive problem-solving skills
- Practice the assertive response
11
Q
Cohesive family model for CD and ODD
A
- Family-group-oriented approach
- Goal: modify parent-child interactions
12
Q
CD and OCD medication
A
Stimulants: reduce ADHD symptoms and aggression
SSRIs and SNRIs: reduce irritable and agitated behavior
Antipsychotics: suppress aggressive behavior; side effects
Mood stabilizers: reduce aggression
13
Q
Antisocial personality disorder
A
- Persistently disregard and violate rights of others
- Inability to form positive relationships
- Behaviors that violate social norms and values
- Focus on gratifying personal desires
- Poor impulse control
- Antisocial behavior reduces with age in adolescent-onset CD
14
Q
ASPD and psychopathy
A
Overlap but are different
Psychopathy:
Superficial charm
Thrill-seeking
Lack of remorse
Cold and callous
15
Q
ASPD contributors: genetic influence
A
- Twin studies: higher rates in MZ twins
- Adoption studies: higher rate in biological parents
- More similar to biological father than adoptive father
- Serotonin system X socioeconomic status
16
Q
ASPD contributors: biological influence
A
- Verbal skills deficits
- Executive functions deficits
- Less volume in prefrontal cortex
- Chronically low arousal: leads to stimulation seeking
- History of childhood adversity and maltreatment
17
Q
Treatments for ASPD
A
- Lithium and atypical antipsychotics: control impulse and aggressive behaviors
- Antiseizure drugs: reduce impulsiveness and aggressiveness
18
Q
Intermittent Explosive Disorder
A
- Frequent impulsive, severe acts of aggression
- Verbal or physical
- Grossly out of proportion to the situation
- At least 6 years old
19
Q
What does Intermittent Explosive Disorder lead to?
A
- Legal difficulties
- Failed relationships
- Loss of employment
20
Q
Intermittent Explosive Disorder theories
A
- Imbalance in serotonin levels?
- Diminished activity in the OFC
- Hyperactive amygdala
21
Q
Intermittent Explosive Disorder treatment: CBT
A
- identify triggers
- reduce aggression and anger
22
Q
Intermittent Explosive Disorder treatment: SSRIs, SNRIs, and mood stabilizers
A
reduce aggression
23
Q
Definition of an eating disorder
A
persistent disturbances in eating behavior that interfere with functioning
24
Q
Types of eating disorders
A
- Anorexia nervosa
- Bulimia Nervosa
- Binge eating disorder
25
2 types of anorexia
1. **restricting**: dieting or engaging in excessive exercise
2. **Binge-eating/purging** : binge eating or purging behaviors
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Anorexia
* Refusal to eat
* Significantly low body weight
* Distorted view of body
* Intense fear of gaining weight
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Anorexia medical consequences
* Has highest mortality rate of psychological disorder in the DSM
* Dry, yellow skin
* Brittle hair or nails
* Sensitivity to cold temperatures
* growth of downy hair
* low bp
* Thiamin deficiency
* heart arrhythmias
* Electrolyte imbalances and kidney damage
* women stop having menstrual cycles
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Anorexia onset ages
15-19
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Bulimia nervosa
* **Bingeing**: uncontrolled eating
* **Purging**: compensatory behaviors to prevent weight gain
* negative self-evaluation
* show behavior at least once a week for 3 months
* Within 10% of expected body weight
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what is the difference between bulimia nervosa and anorexia binge-eating/purging type
weight
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Bulimia nervosa 2 peak onsets
* after puberty (age 14)
* ages 18-20
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Bulimia nervosa death rate and suicide rate
Death rate = double the general population
Suicide rate = 31% higher than the general population
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Bulimia nervosa medical consequences
* Purging: electrolyte imbalances; low potassium
* Damage to heart muscle
* Calluses on hands
* Tears to the throat
* Mouth ulcers and dental cavities
* Small red dots around eyes
* Swollen salivary gland
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Bulimia nervosa treatments: CBT
* client taught to monitor the conditions that accompany eating
* Client learns to confront cognitions
* Develop more adaptive attitudes toward body
* Re-introducing forbidden food
* Effective: 50% stop binges and purges
* Decrease depression
* Increase social functioning
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Bulimia nervosa treatments: interpersonal therapy
* Discuss interpersonal problems related to eating disorder
* Develop strategies to solve these problems
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Bulimia nervosa treatments: behavioral therapy
* Client taught to monitor food intake in a healthy way
* Introduce avoided foods into diet
* Coping techniques to avoid bingeing
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Binge-Eating Disorder
* Recurrent episodes of binge eating; no purging
* Lack of control during binge
* Significantly overweight
* Sense of shame and disgust
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Other specified feeding or eating disorder
1. **Partial syndrome eating disorders**: do not meet full criteria for anorexia or bulimia
2. **Other specified feed or eating disorder**: new DSM-5 category
3. **Atypical anorexia nervosa**: all criteria for anorexia are met except weight within normal range
4. **Bulimia nervosa of low frequency and/or limited duration**: all criteria for bulimia met, except that the binge eating and purging occur less than once a week and/pr for less than 3 months
5. **Night eating syndrome:** eating regular excessive amounts of food into the night after dinner (don't feel like they are in control of the eating)
39
Obesity definiton, associated with increased risk of, and causes
* Not in DSM-5 but associated with some mental disorder
* BMI of 30 or over (problematic)
Associated with increased risk of:
* Coronary heart disease, hypertension, and stroke
* Type 2 diabetes and cancer
* Low quality of life and emotional problems
Causes:
* Living in a toxic food environment
* Lack of exercise
40
Eating disorders biological factors
Genetic factors: twin and family studies suggest genetic risk
General risk for eating disorders
Risk interacts with puberty in girls
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Eating disorders disregulation of brain and neurochemicals
* Anorexia linked to lowered hypothalamus
* Abnormalities In hormone levels (cortisol and insulin- dont need to know)
* bulimia linked to serotonin abnormalities
42
Eating disorders sociocultural and psychological factors
* Social pressures and cultural norms
* Thin ideal promoted by media and body dissatisfaction
* Athletes and eating disorders (high prevalence rates among them)
* **Emotion and regulation difficulting:** maladaptive coping strategies for negative emotions; disordered eating patterns for binge eating: dieting subtype; depressive subtype
* **Family dynamics**: separation and individualization from one’s family; family with eating disorder; low parental warmth and high parental demands
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eating disorders cognitive factors
* Low self-esteem, perfectionism
* People who value others’ opinions are at a higher risk
* People who engage i dichotomous cognitive style (black and white thinking)
44
Sexuality: what is abnormal
* Sex is taboo
* Issues related to sexuality are divisive and controversial → difficult to obtain data
* Beliefs change overtime
45
Sexual response cycle
1. Sexual desire: urge to engage in sexual activity
2. Arousal phase:
Psychological experience of pleasure
Physiological changes in the body:
Vasocongestion: increased blood flow
Myotonia: muscular tension
1. Plateau phase: high but stable level of excitement before orgasm
1. Orgasm: discharge of neuromuscular tension from the arousal phase
1. Resolution: decreased in arousal; deep relaxation possible
46
Sexual dysfunctions
* Difficulty responding sexually or experiencing sexual pleasure
* 7 disorders in DSM-5
* Diagnosis: impairment in at least 1 stage at least 6 months
* Significant distress or impairment
* Not due to another nonsexual psychiatric problem
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Disorders of sexual interest/desire and arousal
1. **Male hypoactive sexual desire disorder**: little or no sexual desire ; Lifelong or acquired
2.**Female sexual interest/arousal disorder**: absence or reduced: interest in sexual activity and responsiveness to erotic cues; 6 months ; Lifelong or acquired
3.**Male erectile disorder**- difficulty achieving or maintaining an erection ; Lifelong or acquired; Increases with age
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Disorders of orgasm
1. **Female orgasmic disorder-** reduced intensity, delay, or absence of orgasm
2. **Early ejaculation disorder**: Orgasm and ejaculation with minimal sexual stimulation ; 1 minute or before desired 75% of the time; 6 months
3. **Delayed ejaculation**- delay or absence of orgasm
49
Genito-Pelvic Pain/Penetration Disorders
* Marked pain/tension in the pelvic area during intercourse
* Fear and anxiety related to pain
* 6 months
50
Biological causes of sexual dysfunctions
**Medical illness**: diabetes; 40% of erectile disorder causes caused by medical illness
**Men**: Low levels of androgen hormones; High levels of estrogen and prolactin
**Women**: Low levels of androgens and estrogen
Prescription drugs: antihypertensive drugs; antidepressants
**Substance-induced sexual dysfunction**: recreational drugs; alcohol
51
Psychological causes of sexual dysfunctions
* Mental disorders: Depression and anxiety
* Attitudes and cognitions: guilt-ridden cognitions; performance anxiety; spectatoring
* Stress and trauma
52
Interpersonal factors of sexual dysfunctions
* Conflicts about a couple’s sexual activities
* Anorgasmia and lack of communication
* Inhibition in discussing stimulations
* Conflicts other than sex
* Anger, distrust, and lack of respect for one’s partner
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Cultural factors to sexual dysfunctions
* Different beliefs about sexual dysfunctions
* Varied sexual preferences
* Lower educational and income
* Cultural backgrounds that teach negative attitudes toward sex
54
Sexual dysfunctions trends across life span
Age-related biological changes affect sexual functioning:
* Low testosterone levels in men
* Diminished estrogen levels in women
* Medical conditions
* Loss of loved ones
55
Treatments for sexual dysfunction: biological
Treat medical condition or adjust medication
Common disorder: erectile disorder
Medications to promote erections: Viagra
Injections of drug into penile erection chamber
Vacuum pump
Penile implants
56
Treatments for sexual dysfunction: psychotherapy
Individual and couples therapy (preferred to conquer communication difficulties)
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Treatments for sexual dysfunction: CBT
* Teaches skills
* Address cognitions that interfere with sexual functioning (asses what might be contributing to the disorder, their thoughts and beliefs about sexual behavior)
* Goal: resolving differences
58
Treatments for sexual dysfunction: sex therapies
Focuses solely on sex
Using behavioral techniques
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Sensate focus therapy
Three phase process for sexual dysfunction- focuses on sexual behavior, not intercourse
Phase 1: touching behavior (not arousing)
Phase 2: slowly introduce arousing behavior to detect where the dysfunction is coming from
Phase 3: intercourse
60
Sex therapy for early ejaculation
**Stop-start technique:** alternating stimulation to avoid early ejaculation
**Squeeze technique**: pressing the penis to cause partial loss of erection
61
Pelvic muscle tightening
Deconditioning the women’s automatic tightening of her vaginal muscles
62
Paraphilic Disorders atypical sexual activity
* Cause significant distress or impairment
* Entail personal harm or risk of harm to others
63
Types of paraphilias involve:
Consent vs nonconsenting others
Contact vs no contact with others
8 types
Fetishsitic, Transvestic, Sexual sadism, Sexual Masochism, Voyeuristic, Exhibitionistic, Frotteuristic
64
Fetishisitic disorder
Repetitive and intense sexual arousal or gratification from nonliving objects or a highly specific focus on a nongenital body part
Most common: feet, toes, hair
Divided into soft and hard fetishes (the material)
The object is needed for gratification
Course: onset in early adolescence, and is more defined in adulthood
65
Transvestic Disorder
* Cross-dressing for sexual arousal
* Men who get diagnosed with this are typically straight, married and have kids
* Arousing thing is the act of dressing of the other sex
* NOT gay or trans
* 6 months
* Onset: adolescence and more solidified when moving into adulthood
66
Sexual Sadism
* Sexual arousal or behaviors involve inflicting pain and humiliation
* For diagnosis: must cause distress or impairment & with a non consenting person
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Sexual Masochism Disorder
* Sexual arousal or behaviors involve suffering pain or humiliation during sex
* Must cause distress
68
Voyeuristic Disorder
* Most common illegal paraphilia
* Sexual arousal by watching and unsuspecting person naked, undressing, or engaged in sex
* Diagnosis: compulsive behavior for 6 months and distress or impairment
* Onset: adolescence
69
Exhibitionistic Disorder
* Sexual gratification by exposing genitals to involuntary observers
* To be diagnosed: must act on urges and it must cause distress or impairment
70
Frotteuristic Disorder
* Sexual excitement at rubbing at ones genitals against, or touching, the body of a non-consenting person
* 6 months
* Co-occurs with voyeurism and exhibitionism
* More common in men
* Onset: in adolescence or early adulthood
* At risk for more serious offending
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Paraphilia behavioral theories
**Classical conditioning**: pairing of intense early sexual arousal with a particular stimulus
**Operant conditioning:** reinforces associated (if sexual arousal achieved)
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Paraphilias social learning theory
Corporal punishments from parents
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Paraphilias cognitive theories
Develop cognitive distortions about their behaviors
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Paraphilias biological interventions
* Surgical castration
* Chemical castration: antiandrogen drugs
* SSRIs: reduce sexual drive and paraphilic behavior
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Paraphilias behavior modification therapies
* Aversion therapy
* Desensitization procedures
* Effective for non-predatory paraphilias
76
Paraphilias cognitive treatments
* Learn more about socially acceptable ways to approach and interact with people
* Combined with behavioral interventions
77
Gender dysphoria
Discrepancy between individuals’ gender identity and their biological sex
Feel like they are in the wrong body
Diagnosis: DISTRESS or impairment required
Extremely rare
comorbidity: depression, anxiety, substance abuse
78
Gender dysphoria in children vs adults
children: child persistently rejects his or her anatomic sex and desires to be or insists they are the opposite sex
adults: may cross-dress; sexual preferences vary
79
Gender identity
Transgender: transiently or persistently identify with a gender different for their natal gender
Cisgender: gender identity aligns with their natal sex
80
Gender dysphoria biological theories
**Female-to-male gender dysphoria**: prenatal exposure to high levels of androgens
**Male-to-female gender dysphoria in genetic males**: prenatal exposure to very low levels of androgens
Bed nucleus of stria terminalis abnormally small
81
Treatments for gender dysphoria: cross-sex hormone therapy
Stimulates the development of secondary characteristics of the preferred sex
Suppress secondary sex characteristics of the birth
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Treatments for gender dysphoria: full-time real-life experience in the desired gender role
Social transition to the affirmed gender (minimum of 1-2 years)
83
Treatments for gender dysphoria: gender affirming surgery
series of surgeries and hormone treatments which occur over 2 years
* Lots of pre-surgery requirements
* Controversial
* Unacceptable treatment for children and adolescents
* Gonadotropin-releasing hormone analogues: delay puberty to make more informed decisions (do not change any sex characteristics)
84
Substance
any natural or synthetics product with psychoactive effects
Changes perceptions, thoughts, emotions, and behaviors
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Substance use
Substance intoxication
Substance abuse
use: ingestion of substance
intoxication: behavioral and psychological changes from substance use
abuse: excessive use resulting in impairment and hazardous behavior; continued despite problems
86
Substance dependence indicators and DSM5
physiological need for a substance
Indicators
Tolerance: diminished effects of a substance
Withdrawal: physiological and behavioral symptoms when people stop using a substance
DSM-5: substance abuse and dependence = 1 diagnosis
Criteria: 2 or more symptoms in 1 year
87
CNS depressants
1. alcohol
2. benzodiazepines and barbiturates
88
Alcohol at
low & high doses
intoxication
Low : activate brain’s pleasure areas
Higher: depress brain functioning; inhibits glutamate
Intoxication: blood alcohol level 0.08%; Entire neural balance upset; Loss of consciousness
89
Symptoms of alcohol withdrawl
**Stage 1**: few hours; tremulousness, weakness, profuse perspiration
**Stage 2**: 2nd or 3rd day; convulsive seizures
**Stage 3:** delirium tremens: auditory visual, and tactile hallucinations
90
Long term effects of alcohol misuse
Hypertension
Cirrhosis of the liver
Malnutrition
Vitamin B deficiency
Dementia
91
Benzodiazepines and barbiturates
* Treat anxiety and insomnia
* Cause decrease in blood pressure, respiratory rate, and heart rate
* Overdose: death from respiratory arrest or cardiovascular collapse
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Cocaine
* white powder from coca plant; instant rush of intense euphoria
* High doses: grandiosity, impulsiveness, agitation; panic and paranoia
* Activates brain’s reward system: dopamine
* Effects wear off quickly: tolerance
93
Amphetamines
* Appetite suppression, treat narcolepsy, and ADHD
* Release and block reuptake of dopamine and norepinephrine
* Euphoria, self-confidence, alertness, paranoia
* Tolerance and dependence develop fast
* Abuse = cardiovascular problems
94
Nicotine
Alkaloid found in tobacco Cigarettes
Operates on CNS and PNS
Lung cancer, bronchitis, and coronary heart disease
Withdrawal symptoms: depression, insomnia, anxiety, decreased heart rate, increased appetite
95
Caffeine withdrawl symptoms
Fatigue or drowsiness
Dysphoric mood or irritability
Flu-like symptoms
96
Opioids
Sap of the opium poppy: morphine, heroin, codeine, and methadone
Smoked, snorted, or “mainlined”
Euphoria leading to drowsiness, lethargy
Death: suppress respiratory and cardiovascular systems
Withdrawal symptoms: long list
97
Hallucinogens and phencyclidine (PCP)
Produce perceptual changes
Lysergic acid diethylamide (LSD): severe anxiety, paranoia, loss of control
Phencyclidine (PCP): powder- snorted or smoked
98
Cannabis
Leaves are cut, dried, and rolled into cigarettes or inserted into food and drinks
Most commonly used illegal drug
Impairs cognitive and motor functioning
Increases the risk of chronic cough, sinusitis, bronchitis, and emphysema
99
Inhalants
Produce chemical vapors that are inhaled
Depress activity of CNSs, rapidly reach the lungs, bloodstream, and brain
Chronic use: results in permanent damage to the CNS
Degeneration and lesions of the brain
Death: depression of respiratory or cardiovascular system
100
Ecstacy
* stimulant effects of amphetamines but also hallucinogenic effects
* Popular because lower rates of dependence than other drugs
* Causes variation in serotonin levels
101
GHB
CNS depressant
Treats anxiety and narcolepsy
102
Ketamine
rapid-acting anesthetic that produces hallucinogenic effects
103
Rhypnol
a benzodiazepine; has sedative and hypnotic effects
“Roofies”
104
Substance use disorders: biological theories
* Amphetamines and cocaine: chronic use alters reward pathway
* Brain produces less dopamine
* Dopamine receptors become less sensitive: need more and more dopamine to produce desired effects
* Creates craving
* Adverse effect on biochemical and brain systems
* Genetic factors: polygenic. Not just one gene
105
Substance use disorders psychological factors: social learning theory
kids model parents and people important to them
106
Substance use disorders psychological factors: cognitive theory
expectations
People have expectations that certain substances will have a desired effect
Ex: alcohol will reduce distress; combined with poor coping
107
Substance use disorders psychological factors: personality theory
behavioral undercontrol have genetic link
108
Substance use disorders sociocultural factors
Rates of substance use higher:
People living in poverty
Women in abusive relationships
Adolescents witness interparental conflict
Cultural beliefs and expectations important
More prevalent in men
109
Biological treatments for substance use disorders
Anxiety drugs: manage withdrawal symptoms from alcohol
Antagonists drugs: reduce desire (ex: bit fingernails, make nails taste bad)
Methadone maintenance programs
Synthetic opioid: blocks receptors for heroin
Gradual withdrawal from heroin; controversial
110
Substance use disorders behavioral treatment
aversive classical conditioning
Drug antagonists
Covert sensitization therapy: uses imagery to create aversion to drug
Contingency management programs: provided with incentives to give drug-free urine ( housing, employment)
111
Substance use disorders cognitive treatments
help patient identify:
Situations in which they are most likely to drink and lose control over drinking
Expectations that alcohol will help them cope in those situations
112
Substance use disorder motivational interviewing
Assesses clients’ motivation and commitment to changing their substance use
113
Relapse prevention for substance use disorders
Abstinence violation effect
Relapse prevention programs
Alcoholics anonymous
114
Abstinence violation effect
Conflict and guilt when violating abstinence
Attribute a violation to a lack of willpower and self-control
115
Relapse prevention programs
View slips as temporary and situationally caused
116
Alcoholics Anonymous (AA)
Not therapists but organization created by and for people with alcohol-related problems
117
Prevention programs
**Solution**: focus on immediate risks of excess and the payoffs of moderation
**Harm reduction model:** accept people will drink and reduce the harm from drinking
**ASTP**- alcohol skills training program
Promotes safe drinking
Self-monitoring to become aware of their habits
Challenges effects of drinking on social skills and sexual prowess
118
Drug treatment for premature ejaculations
Drug treatment for Sexual desire disorders
Premature ejaculations: antidepressants
Sexual desire disorders: hormone replacement therapy
Effective in men; Mixed in women
