PSYC241: Final Exam Flashcards
(121 cards)
1
Q
Substance use disorders
A
10 different classes
Recurrent use leads to negative consequences
2
Q
Four general groupings of indicators of substance use disorders
A
1- impairment of control over use
2- social impairment
3- risky use
4- pharmacological criteria
3
Q
Substance-induced disorders
A
Intoxication
Withdrawal
Other substance or medication induced disorder
Can be resolved when person stops using substances
4
Q
Polysubstance abuse
A
Simultaneous misuse or dependence upon two or more substances
On the rise
More common in young people
Combining drugs is dangerous because they’re often synergistic=combined effects are more intense or different than individual effects
5
Q
Change in DSM-5 related to intoxication vs substance use disorder
A
Eliminated the distinction between abuse and dependence
6
Q
Substance intoxication
A
Reversible, temporary condition
Must show clinically significant maladaptive behaviour or cognitive changes
AND
Impaired thought processes or motor behaviour
7
Q
Symptoms related to impaired control (substance abuse disorder)
A
Symptoms related to impaired control:
1- ingestion of substance in bigger amounts over a longer period of time than originally intended
2- desire to cut down or stop without success
3- lots of time spent getting, using and recovering from substance use
4- craving
8
Q
Symptoms related to social impairment (substance abuse disorder)
A
- failure to fulfill life role obligations
- continued use despite social and interpersonal problems
- loss of activities
9
Q
Symptoms related to risky use (substance abuse disorder)
A
- recurrent substance use in situations where it’s physically dangerous
- continued use despite knowing you have a physical or psychological problems that’s caused by substance
10
Q
Pharmacological criteria (substance abuse disorder)
A
Tolerance and withdrawal
11
Q
Common element of polysubstance abuse
A
Alcohol
12
Q
Three main risks of polysubstance abuse
A
1- physically dangerous (more so than each drug by itself)
2- associated with greater commodity of other psych disorders
3- treatment challenges
13
Q
DSM-5 diagnostic criteria for alcohol use disorder
A
Problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12 month period (1 year)
- large amounts or longer period
- desire and failed efforts to cut down control use
- lots of time spent trying to get alcohol use it recover from it
- craving
- failure to succeed in life bc of it
- continued use despite social problems
- giving up past enjoyed activities
- hazardous use
- continue despite knowledge that it’s ruining your life
- tolerance (more need and diminished effect)
- withdrawal (classic withdrawal or taking substances to relieve symptoms of withdrawal
14
Q
University students statistics (alcohol)
A
Half report black outs
Males greater use than females
Students living on their own or in forms report more drinking
15
Q
Genetic factors in alcohol use
A
Support significant genetic effect for males (not females)
16
Q
Alcohol expectancy theory
A
Persons drinking is determined by other reinforcements they get from it
17
Q
Alcohol and behaviour disinhibition
A
People with alcohol problems tend to have more difficulty controlling impulsive behaviour
18
Q
Abstinence goals for alcohol
A
Based on the disease model where it’s assumed that alcoholics never be able to control drink in a controlled way
Traditional treatment programs and AA
19
Q
Transtheoretical model of change (alcohol)
A
Theoretical framework for understanding the process of behavioural change Stages of change -pre contemplation -contemplation -preparation -action -maintenance
20
Q
Precontemplation (transtheoretical model of change for alcohol)
A
Not ready to change
May not feel like they have a problem
May feel barriers or disadvantages (cons) associated with change are greater than benefits of change (pros)
21
Q
Contemplation (transtheoretical model of change for alcohol)
A
Thinking about changing behaviours, but not committed to change
Ambivalent
Weighing pros and cons
22
Q
Preparation (transtheoretical model of change)
A
Decided to change
Developing a plan for change
23
Q
Action (transtheoretical model of change)
A
Actively working at changing their problem behaviour
24
Q
Maintenance (transtheoretical model of change)
A
Working on keeping up with changes and preventing relapse
25
More details about transtheoretical model of change
Spiral model
Relapse is common and is normalized
Interventions made to match individuals stage of change
26
Integrating MI and TMC (substance abuse disorders)
Use MI at all stages of change
MI: way of interacting with clients; a stance
Use in assessments and diff types of interventions
27
General principles of MI (substance abuse disorders)
Belief that lasting change is unlikely to occur until individuals can resolve their ambivalence
Ambivalence=expected and understandable experience for individuals thinking about change
28
Miller MI: general principles (substance related disorders)
- express empathy (reflective listening, ambivalence is normal)
- develop discrepancy between present behaviours and future goals/values
- roll with resistance (don't argue and change what you're doing)
- support self efficacy
29
MI: strategies (substance related disorders)
OARS
- open ended questions
- affirmations (belief that patient's doubts in their ability to change is bad for progress; affirm/reinforce resourcefulness, previous attempts to change, qualities of patient that facilitate change)
- reflective listening (statements not questions, simple and complex reflections)
- summarizing (type of complex reflection, selective and directive but make sure to include both sides of ambivalence, transitioning between tasks, at end of session)
30
What to summarize in MI? (Substance related disorders)
Pros associated with change
Cons associated with present behaviour
Intentions to change
Space between where person wants to be and their current behaviours
31
Harm reduction model (substance related disorders)
Focus: reducing consequences substance use (ex: needle exchange programs)
Implemented usually with counselling, edu, outreach programs
32
Schizophrenia
Prevalence: 1%
Most diagnosed between age 20 and 40
Men and women at equal risk but men show symptoms earlier and more severely
33
Positive symptoms of psychosis
More obvious symptoms of psychosis
- delusions
- hallucinations
- disorganized speech and thought disorder
- grossly disorganized or catatonic behaviours
34
Negative symptoms of psychosis
Absence or loss of typical behaviours
- flat effect
- avolition
- alogia
- anhedonia
35
Delusions
Impossible beliefs that last even if there's evidence that contradicts them
36
What delusions are most common in schizophrenia ?
Persecutory delusions
37
Hallucinations
People see hear smell feel things that aren't really present
Hearing voices =most common in schizophrenia
Misinterpretations of sensory perceptions
38
Disorganized speech and thought disorder
Loosening of associations
| Least common of the positive symptoms
39
Flat effect
Negative symptom of schizophrenia
| Limited emotional expression
40
Avolition
Negative symptom of schizophrenia
| Lack of energy, limited ability to persist in daily routines (grooming and hygiene problems)
41
Alogia
Negative symptom of schizophrenia
Can take several forms;
-poverty of speech
-poverty of content of speech (vague and repetitive, doesn't communicate much info)
42
Anhedonia
Negative symptom of schizophrenia
| Inability to experience pleasure
43
Motor symptoms and catatonic behaviour (schizophrenia)
Go from agitation to immobility
| Catatonic behaviour= holding body in weird positions and not letting people change how you're positioned
44
Proposed changes about schizophrenia diagnosis for DSM-5
DSM-IV (4)
2+ of the following for a significant period of time during a 1 month period
-delusions
-hallucinations
-disorganized speech
-grossly disorganized or catatonic behaviour
-negative symptoms
Change to DSM-5 is it should include symptoms 1-3 (delusions, hallucinations and disorganized speech)
Note: only 1 required if:
1- delusions are bizarre
2- hallucinations=running commentary or convos between 2+ people
45
Subtypes of schizophrenia (5)
```
1- paranoid (delusions have themes, auditory hallucinations and absence of markedly impaired cog functioning; most common, least disabling, later onset than other subtypes, best prognosis)
2- disorganized
3- catatonic
4- undifferentiated
5- residual
```
46
2 proposed changes for DSM-5 about schizo
Removal of subtypes - accepted
Clinician-rated dimensions of psychosis symptom severity - accepted
47
5 sections of warning signs
Behavioural
Thinking and speech
Social
Emotional
Personality
48
Another proposed change for DSM-5: attenuated psychotic symptoms syndrome
All six of the following:
1- characteristic symptoms of delusions/hallucinations/disorganized speech (at least one and in attenuated/weakened form)
2- frequency/currency (present for a month and occur once a week)
3- progression (begun and worsened in past year)
4- distress/disability/treatment seeking (symptoms are distressing and disabling for the patient)
5- symptoms aren't better explained by another disorder
6- clinical criteria for any DSM-5 psychotic disorder have never been met
49
Attenuated psychosis syndrome
Added as example of "other specified schizophrenia spectrum and other psychotic disorder"
Included as condition for further study
50
Etiology of schizo
Strong evidence for genetic contribution (higher rates in biological relatives and parents)
Negative symptoms appear to have a stronger genetic component
51
Dopamine
Original belief: schizo related to an excess in dopamine
Current belief: actually related to oversensitive dopamine receptors
52
What do antipsychotic meds do for schizophrenia?
Block post-synaptic dopamine receptors
Amphetamine use can cause symptoms consistent with paranoid schizo and amphetamines cause a release of dopamine into the synaptic cleft and prevent their inactivation
53
Is dopamine most strongly related to positive or negative symptoms of schizo?
Positive symptoms
Whereas amphetamines worsen positive symptoms
And
Antipsychotics reduce positive symptoms
54
Evaluation of the dopamine theory of schizo
Discrepancy between drug action and changes in behavioural symptoms
- antipsychotics block dopamine receptors but no changes in positive symptoms for a couple weeks
- to see therapeutic gains: antipsychotics must lessen receptor activity to below normal (Parkinson's like symptoms)
55
Expressed emotion
Within families, over involvement and negative interpersonal communication directed at family member with schizo
Can play a role in relapse
Not specific to schizo
56
Congenital and developmental considerations
```
Viral exposure (influenza, rubella)
Complications during birth
```
57
Medication for schizophrenia
Chloropromazine - first antipsychotic, severe side effects
Risperidone and olanzapine - newer and less side effects
Meds improve positive and some negative symptoms (do little for cog impairments, social skills and occupational/daily living skills)
58
Three types of psychological treatment for schizo
1- CBT: symptom focused, helps with negative symptoms
2- family therapy: support, reduce negative emotional expression
3- social skill training: skills-based, purpose to help with functional disabilities associated with schizo
59
Multiple areas of assessment for childhood behavioural disorders
Developmental/medical history
Social functioning
Edu functioning
60
Role of child psychologist
Liaison between family, care providers, school
61
Three branches of mental disorders in childhood
1- externalizing problems (under controlled behaviour; ADHD ODD Conduct disorder)
2- internalizing problems (over controlled behaviour; SAD, selective mutism, RAD, anxiety and mood disorders)
3- other (eating disorders and psychotic disorders)
62
Attention deficit/ hyperactive disorder (ADHD) prevalence
In more boys than girls
Mostly in children/teens
Rate increase 10x in psychiatric pops
63
ADHD diagnostic criteria
Six or more of these symptoms for at least 6 mos:
- inattention
- hyperactivity
- impulsivity
- symptoms prior to age 12
- symptoms present in 2+ settings
- symptoms interfere or reduce quality of social academic or occupational functioning
- symptoms not better explained by other mental disorder
64
ADHD inattentive type
Difficulties in listening, learning and remembering
More common in girls than boys
Associated with more academic problems (especially in math)
Social problems less obvious than with other types of ADHD
65
ADHD hyperactive/impulsive type
Tend to get in trouble, talk to themselves and others, interrupt others, move and fidget and highly reactive
- more common in boys
- higher rate of comorbid conduct problems
- motor symptoms decrease with age
- fidgeting and restlessness persist into adulthood
66
ADHD comorbidity
50% of kids with ADHD have comorbid diagnoses
- oppositional defiant disorder
- conduct disorder
- learning
- anxiety
- depression
- substance abuse
67
Developmental trajectory of ADHD
Increased risk in developing another psych disorder
- begin substance abuse earlier
- more risk of self injury like car accidents
- greater academic problems
- less jobs
- become parents earlier
- have more STDs
- more divorce and separation
68
ADHD brain structure and functioning
Smaller brain size
- abnormalities in prefrontal cortex (executive functioning) and basal ganglia (higher motor control, learning, memory, cognition, emotion regulation)
- abnormalities in dopamine and noradrenaline
69
How much of the risk of ADHD is genetic?
More than half
70
ADHD prenatal risk factors
```
Prenatal toxin exposure:
Poor diet
Mercury and lead exposure
Pregnancy and delivery complications
Exposure to alcohol and smoking
```
71
ADHD psychosocial risk factors
```
Low socio-economic status
Large family size
Paternal criminality
Poor maternal mental health
Child maltreatment
Foster care placement
Family dysfunction
```
72
ADHD treatment
- stimulant meds helpful in increasing concentration and reducing impulsivity/over activity (lots of side effects like decreased appetite, weight loss, trouble sleeping, etc)
- combo treatments: meds and parent training
- treatments need to change as child grows to be developmentally appropriate
- drug holidays no longer recommended
73
Oppositional defiant disorder
```
Pattern of negativistic, hostile and defiant behaviour
Loses temper
Argues with authority figures
Doesn't listen
Annoys people on purpose
Blames others
Angry and resentful
Has been vindictive or spiteful in the last 6 mos
```
74
Conduct disorder
```
Repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms of rules are violated
3+ in last 12 mos and at least 1 in last 6 mos
-aggression to people or animals
-destructing property
-deceitful need or theft
-serious violations of rules
Specify if:
-lack or remorse/guilt
-callous/lack of empathy
-unconcerned about performance
-shallow or deficient affect
```
75
ODD vs conduct disorder
Less severe in nature than CD
Doesn't include aggression towards people and animals, destruction of property, pattern of theft or deficit
Includes problems of emotional dysregulation that are not included in definition of CD
76
ADHD in relation to ODD
ADHD is comorbid with ODD
to make additional diagnosis of ODD, determine that the individual's failure to conform to requests of others is not only in situations that demand sustained effort and attention
77
ODD and CD are comorbid with...
Learning disorders
ADHD
Substance use
78
Developmental trajectory
Minority trajectory: ODD -> CD -> antisocial PD
| Most common for kids with early and severe symptoms
79
Compared to CD only, children with comorbid ADHD and CD tend to have...
Younger age of onset
More severe symptoms
More aggressive symptoms
80
ODD and CD psychosocial risk factors
Maternal stress and smoking during pregnancy
Poor parenting
Peer rejection and associating with deviant peers
Parental psychopathology
One parent families
Large family size
Teen preg
81
Etiology of ODD and CD: gene-enviro interactions
Childhood maltreatment can be a risk for problems when combined with either:
1- low monoamine oxidase A (MAOA: gene that produces enzyme that breaks down serotonin, norepinephrine and dopamine)
2- high genetic risk for conduct problems
82
ODD and CD and gender
Slightly more with boys than girls diagnosed with ODD
| 3-4 times more boys than girls diagnosed with CD
83
Developmental trajectory of girls with CD
Factors associated with girls with CD:
Teen pregnancy
Suicidal behaviour
Romantic involvement with antisocial makes (assortative mating; associated with escalating negative behaviour, discord in relationship, poor parenting of future kids)
84
Four treatment methods examined in controlled trials for CD
1- problem solving skills training: targets deficits in problem solving skills, social perception and social attribution
2- pharmacological treatment
3- parent training
4- school and community based treatment
85
Intermittent explosive disorder
Recurrent behavioural outbursts representing a failure to control aggressive impulses as manifested by either of the following:
1- verbal aggression or physical aggression towards property/animals or other people happening twice a week on average for a period of 3 mos (physical aggression doesn't include damage or destruction of property or physical injury to others)
2- three behavioural outbursts involving damage or destruction of property and or physical assault involving injury against animals or other people occurring in 12 month period
86
Separation anxiety disorder
At least 3 of the following symptoms for at least 4 weeks:
Stress when leaving parent
Worry about parents safety
Worry about being separated long term from parent
Reluctance to go places without parent close by
Nightmares about separation
Complaints about physical symptoms when separation is anticipated
87
Childhood anxiety disorders
```
Equally common between boys and girls
Precursor to future health problems
-other anxiety disorders either same (homotypic continuity) or different (heterotypic continuity) than original diagnoses
-behaviour probs
-depressive disorders
-eating disorders
-suicidality
-substance abuse
```
88
Etiology of child anxiety disorders
```
Amygdala problems
Heritable component
-direct observation or instruction
-personal experiences
Stress during pregnancy causes this
```
89
CBT for childhood anxiety disorders
Coping cat
Psychoeducation about anxiety
Helps parents and children learn new ways to cope with anxiety
Exposure to anxiety provoking situations
90
Meds treatment for childhood anxiety disorders
Some support for selective serotonin reuptake inhibitors SSRIs
But there's side effects
Support for CBT and meds together
91
Affects of childhood depressive disorders
- depressed or sad mood (headaches)
- irritability (stomach aches)
- easily annoyed or angered (difficulties attending concentrating, eating difficulties)
- anhedonia (hopelessness, decrease activity, sleeping difficulties)
92
Issues looked at in mental health and the law
```
Involuntary hospitalization
Involuntary treatment
Risk assessment
Competence to stand trial
Criminal responsibility
Ethics
```
93
Forensic psych: therapeutic vs forensic assessment
Therapeutic assessment: conducted for diagnostic and treatment planning purposes
Forensic assessment: conducted to aid legal decision-making (fit or not to stand trial)
94
Therapeutic vs forensic: main areas of divergence
```
Scope of assessment
Importance of client perspective
Voluntariness
Autonomy
Pace and setting
```
95
Three sources of law of structure of the Canadian legal system
Constitutional law: charter guarantees rights and freedoms can't be denied to those with mental disorders
Statutory law: civil mental health law and criminal law
Common law: parens patriae - duty of state to care for citizens who can't care for themselves
96
Health professionals role in mental disorders and the law
Provide opinions on existence and impact of mental disorders in cases
Expert witness testimony
Consultation
Mental disorder=impairment of psychological functioning that is internal, stable and involuntary (more narrow a definition than the one used by health pros)
97
Involuntary hospitalization
Pose a risk to themselves or others due to mental disorder
Civil commitment
Infringe on basic rights of citizens
Must meet 3 criteria:
1- suffering from mental disorder
2- unwilling/unable to consent to hospitalization
3- at risk of causing harm to self or others
98
Involuntary treatment
Temporary substitute decision maker appointed by state or private representative of patient
- best interests principle and capable wishes principle
- compulsory treatment orders (outpatient involuntary treatment in Ontario, Newfie, sask, less restrictive, failure to comply leads to involuntary hospitalization, no positive evidence for it)
99
Best interests principle
Treatment should be picked to maximize likelihood of good outcome
100
Capable wishes principle
Patients own wishes should have the more importance in decision making
101
Risk assessment occurs in what areas?
Criminal and civil law
102
Approaches to risk assessment (3)
Unstructured clinical judgement (ideographic and qualitative)
Actuarial decision making approach (nomothetic and quantitative)
Structured professional judgement (bring together the other two, individual and comprehensive set of risk factors)
103
Violence risk assessment
Prediction rate increases when clinicians use quantitative methods
Usually over predict dangerousness
Considers these factors:
- nature severity frequency of violence
- imminence of violence
- likelihood violence will occur
Risk management is important
104
Three common tools for risk assessment
1- PCL psychopathology checklist (interviewer rated measure, many versions available)
2- SAVRY structured assessment of violence risk in youth (structured interviews rated measure)
3- HCR 20 historical clinical risk management scheme 20 (guided and structured approach)
105
Unfit to stand trial (UST)
Unable to participate actively or effectively in their own defends due to a mental disorder
Trial may be suspended while treatment given
Unable to understand nature or object of trial, possible consequences, communicate with counsel
Issue can be raised by defendant, judge or prosecution before or at trial
Evaluations can be done to assist in determining if defendant is UST (fitness interview test revised FIT-R)
Found unfit -> pleas are set aside and defendant can be ordered to have treatment
Cases reviewed every two years
106
Criminal responsibility: mens rea vs actus rea
Criminal offense consists of
Actus rea= prohibited act
Mens rea=bad intention
107
M'Naghten rule
Not found guilty because reason of insanity
| Either doesn't understand what he did or doesn't understand what he did is wrong
108
Three outcomes if found "not criminally responsible on account of a mental disorder" (NCRMD)
Absolute discharge
Conditional discharge
Detention in hospital with periodic assessment
109
Purpose of adult sentencing
```
Address unlawful behaviour
Separate offenders from society
Help rehabilitate offenders
Reparation for victims and community
Make offenders responsible
```
110
Sentencing options for adults in Canada
```
Absolute or conditional discharge
Probation
Restitution
Fines and community service
Conditional release
Imprisonment
**no death penalty in Canada
```
111
Types of parole options in Canada
Temporary absence
Day parole
Full parole
Statutory release
112
General psych ethics -4 CPA guidelines
Respect for the dignity of persons
Responsible caring (minimize harm and maximize benefits)
Integrity in relationships (be honest, straightforward, minimize bias and avoid conflicts of interests)
Responsibility to society (promote welfare of all humans beings)
113
3 exceptions to rule of confidentiality
Harm to themselves
Harm to others
Reveal info concerning child abuse or neglect
114
DSM-5 criteria for defining personality disorders
Criterion A: manifesting in multiple areas
B: enduring, rigid, consistent
C: causes distress
D: stability and long duration
E: cannot be accounted for by another disorder
115
3 DSM-5 personality clusters: cluster A
Odd and eccentric
Paranoid: suspicious of others
Schizoid: emotionally detached
Schizotypal: eccentric behaviour and social isolation
116
3 DSM-5 personality clusters: cluster B
Dramatic, emotional, erratic
Antisocial: disregard for others, rule breaking, impulsive
Borderline: labile mood, unstable relationships
Histrionic: attention seeking, dramatic social displays
Narcissistic: grandiosity, egocentric
117
3 DSM-5 personality clusters: cluster C
Anxious and fearful
Avoidant: sensitive to criticism, avoidance of intimacy despite desire for affection
Dependant: cannot function alone, gives up own needs
Obsessive-compulsive: inflexible and needs perfection
118
Changes to axis in Dsm-5
Removed!
Diagnostic criteria unchanged
Insurance often didn't pay for axis 2 disorders
119
Egosyntonic vs egodystonic symptoms
Egosyntonic: don't see their functioning as a problem (personality disorders)
Egodystonic: cause person distress (axis 1 disorders)
120
Features of antisocial personality disorder
```
Nonconformity
Callousness
Deceitfulness
Irresponsibility
Impulsivity
Aggressiveness
Recklessness
```
121
Two types of etiology of psychopathy
Fundamental psychopath: result of biological disposition
Secondary psychopath: result of negative experiences in childhood (neglect or abuse)
