PSYCH 239 Lectures 4-6 Flashcards

Question

What is the DSM-5 Criteria for Bipolar II Disorder?

Answer 1

A. Criteria have been met for at least one hypomanic episode and at least one major depressive episode (Criteria A-C under “Major Depressive Episode” above) B. There has never been a manic episode C. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders. D. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

Answer 2

Mood disorder characterized by a chronic pattern of mild mood swings between depression and hypomania that are not of sufficient severity to be classified as bipolar disorder. - involves a chronic cyclical pattern of mood disturbance characterized by mild mood wings of at least 2 years (one for children and adolescents) - has numerous periods of hypomanic symptoms that are not severe enough to meet the criteria for a hypomanic episode and numerous periods of mild depressive symptoms that do not measure up to a major depressive episode.

Answer 3

- Numerous periods of hypomanic symptoms for at least 2 years that fail to meet the criteria for hypomanic episodes - Numerous periods of depressive symptoms that fail to meet the criteria for a major depressive episode. - The person has experienced the periods mentioned above for at least half the time, and the person has not been without symptoms for longer than two months. - The symptoms experienced are not caused by a medical condition or substance. - The symptoms experienced impair the person’s ability to socialize, work, or function in other areas of his or her life.

Answer 4

- Stress and Mood Disorders - Strong correlation - Even childhood experiences can later emerge as risk factors. - Symptoms of depression may lead to interpersonal conflict and job loss = more stress. - Strong social supports and healthy coping style can be protective.

Answer 5

- Anger at an internalized (introjected) love object is inwardly directly. - eg. sb you loved died and “I feel like I lost a part of myself…” - Mourning (uncomplicated) is healthy and represents a form of psychological separation. - eg. it hurts most at first (most raw) and then gets less painful over time → healthy bc it shows you did love sb so much - Becomes pathological as a result of ambivalence (ie. anger *and* guilt). - eg. having a tough time after losing a partner, parent, and then will periodically say things about them that annoys them “why did they have to do that?” “parent used to hit me” → as a result of that you feel anger and guilt (bc you feel bad about bringing up their faults too) - Chronically depressed patients appear to engage in excessive *self-focusing* following loss or failure, but so do other clinical groups.

Answer 6

- What happens when we lose our sense of direction? - According to the humanistic-existential perspective, depression may result from the inability and purpose in one’s life.

Answer 7

- Reinforcement and Depression - When we work and do things and go through the motions and have very little pleasure, that is the building blocks of depression - depression may result when a person's behaviour receives too little reinforcement from the environment. -> lack of reinforcement can sap motivation and induce feelings of depression. - cure is to go find things that give us joy: hobbies, spirituality - Learned Helplessness - expose an organism to situations where they are non-contingently (nothing they can do about it) traumatized by negative events and no matter what they do there is no way to escape it - if you know that you are going to face sth adverse and you think you’re going to survive it → it does not cause you to lose your self control - if you know there’s nothing that you can do, you’ll be depressed - Interactional Theory (James Coyne, 1999) - proposes that the adjustment to living with a depressed person can become so stressful to living with a depressed person can become so stressful that the partner or family members becomes progressively less reinforcing toward the depressed person. - Reciprocal interaction -> ppls behaviour influences and is influenced by the behaviour of others. -> at first ppl who become depressed may succeed in garnering support. -> over time their demands and behaviour begin to elicit anger or annoyance. -> although loved ones may keep their negative feelings to themselves so as not to further upset the depressed person, these feelings may surface in subtle ways that spell rejection -> depressed ppl may react to rejection with deeper depression and greater demands -> cycle.

Answer 8

- Training phase: 3 groups 1. No shocks 2. Avoidable shock 3. Non-avoidance shock - shocked whether they stay put or jump to the other side - Test Phase: All in shuttlebox (below) → same situation but is the avoidable shock → if the red light comes on and you jump toward the sign and hear the tone → avoid shock - Groups 1 and 2 (group who got no shock and who were exposed to avoidable shock): Learned avoidance - negative reinforcement → you’ll stay on the side the tone is played on - Group 3: Failed to learn avoidance response - Affective and behavioural differences - behavioural → even when given the opportunity to learn the contingency, the dogs who were in the non-avoidable shock and given opportunity to avoid the shock, never learned that contingency → no matter what they would do, nothing would get better - Dogs in no-shock learned the contingency - Dogs in the avoidable shock learned the contingency too - Clinical implications? - if you have a person who’s life experiences taught them no matter what they do they will suffer, they will be depressed. - It is a demonstration of a process which can have profound effects on us - If we are going to establish contingencies that ppl have to live up to, or require them to suffer you need to be able to teach them a sense of optimism and self-efficacy

Answer 9

- Learned Helplessness (Seligman) - Attributional Style → how do we explain things that happen in our environment and how do we see ourselves in terms of that - Internal Attribution - you see yourself as the person being in charge - if you fail sth → fundamental belief is that if you try harder or a little differently you may be able to succeed next time around - ppl who feel like they can’t do anything about anything → depressive - Stable vs. Unstable Attribution - stable → it will always suck and stay this way - unstable → i do believe that this condition is impermanent and can improve so i will get through it - Global vs. Specific Attribution - global → are things specific to now or is a global thing - Specific → see it as sth you can leave

Answer 10

- Aaron Beck’s Cognitive Theory - Cognitive Distortions - fact of the matter is we have a distorted way of how we view the world, that distorts our thoughts about the world and ourselves - so if our “basic perceptual lens” (socially and psychologically) is “those ppl are looking at me funny, they must have heard sth about me is unpleasant” → the automatic thought of that, if repeated, tends to become the norm - even things that are neutral or positive tend to be interpreted in a way that has a downward effect on sb’s mood - Automatic Thoughts - not just true for depression - eg hostile attribution bias → when faced with a neutral stimulus, the person is likely to interpret it as hostile, warring - when these thoughts become automatic, ppl tend to see them as realistic - So therapy for Beck involves finding out what those distortions are and then challenging those thoughts - eg. collaborative empiricism → do some social skills training etc, and then the client will go out and try it and then next sessions they will interview the client on how it worked and adjust from there

Answer 11

- Negative views of: 1. **Self** 2. **Environment** - includes the people that they normally interact with 3. **Future** - IMPORTANT → especially when it comes to risk of suicide - If you can affect a change in even 1 of these, but better would be 2 or all, then you can greatly reduce negative affect - Thinking positively toward any of these would likely lessen negative affect.

Answer 12

- All-or-nothing thinking - well I failed at this job attempt, therefore I will fail at them all - Overgeneralization - more about taking a small sample and not just changing in terms of intensity but applying it to different things - Mental filter - not being able to see positive things as they come - or disqualifying positive things → they’re waving at my bc theypity me - Disqualifying the positive - Jumping to conclusions - Magnification/minimization - making positives too small and negatives too large - Emotional reasoning - whatever cognitions follow these negative feelings must be correct - “Should” statements - can be badly used by parents “as a parent, my kid should be doing this, my partner should be doing this for me…” - setting up a set of expectations, usually unreasonable, that sets a trap → usually setting themselves or sb else up for failure - often leads to downturn in affect - Labelling/Mislabelling - person can be quite neutral but the person who is depressed interprets it as annoyance, unlikeability, etc. - Personalization - “this was personal wasn’t it?” → eg getting a bad mark on sth if you sit at the back of the class and can’t see the board - more often in interpersonal things → eg as a contact-lens wearer, heard emergency alarm and went without glasses or contacts outside → but was blind as a bat without them → between not seeing properly they didn’t answer someone → the person was mad and said that Dr. Frenzel was rude to him today → cognitions, “oh he probably didn’t hear me” , or “how rude he saw me and didn’t say anything” → person didn’t know he wore glasses and couldn’t see without them. → even learning this may not change the feeling right away - Is a cognitive distortion if it is irrational and persists - If a person is aware of it and can’t shake it, it doesn’t stop being a cognitive distortion - is that they are not intentionally doing it but they can become aware of it through learning

Answer 13

- Genetic factors - Could you have a diathesis toward sth? - Even in learning, we take cues from our parents. - eg. mom could stew about things for hours → if you hear it enough you could develop the same patterns → but this is what happened objectively, it wasn’t just to you, etc. - Biochemical Factors and Brain Abnormalities in Depression - eg. certain street drugs can bring about things like psychosis or depression - in addition to showinf behavioural irregularities, these ppl will show mood changes that are also resistant to treatment - Heritability - recognizes there is a genetic impact and environmental impact and an interaction between those two - sb with a diathesis that is higher is more likely to be affected by sth

Answer 14

- Whatever the psychological and environmental things may be, they interact and can result in depression - Diathesis → predisposition - Can be a behavioural component as well - Most of our opportunity to intervene occurs at the protective factors - Diathesis: Psychological Vulnerability or Biological Vulnerability + - Potential Stress Factors: Unemployment, Divorce, Sociocultural Factors (Potential Protective Factors should go in after this: Coping Resources, Social Support) -> Depression (if you don't get protective factors)

Answer 15

- Interpersonal Therapy (IPT) - basically places the source of depression in the context of relationships - usually loss: break up, death, cahnge in the nature of the relationship - focuses on symptoms → eg cycle → if you have known sb who is characteristically depressed → sth about them that triggers your caretaker response → can become frustrating if they are not taking advice on how their condition can imporve → can get annyoing and hard to deal with if the yrepeat the same thoughts, behaviours → as a result, ppl might distance themselves from that → they internalize it → cycle - helps clients express grief and come to terms with their loss while providing insight into what kind of changes, especially relationship, take place - and give them skills to not inadvertently perpetuate that -> developing new activities and relationships to help renew their lives. and identify areas of conflict in their present relationships, understand the issues that underlie them, and consider ways of resolving them - brief form of therapy that focuses on the client's current interpersonal relationships. -> believe that depression occurs in an interpersonal context and that the relationship issues need to be emphasized in treatment. -> differs from traditional psychodynamic therapy by focusing primarily on clients' current relationships, rather than helping them acquire insight into unconscious internal conflicts of childhood origins.

Answer 16

- “Coping With Depression” (CWD) Course - eg. you attempt something and it has a pleasurable outcome → triggers serotonin and stuff so improve mood - so psychologists will train ppl to seek out things that are positively reinforcing → aka behavioural activation - it’s effectiveness is as high as some forms of medication - eg. get up, go out, meet people → it does fundamentally affect our reward centre

Answer 17

- Cognitive Therapy 1. educate the patient on what kind of thinking errors there are 2. teaching a skill → eg. keeping a log of cognitive blocks - >they had an event occur in the week that was depression-inducing, etc → write down objectively what happened → eg. if your coworkers go out for lunch without you → write down what thoughts you had and feelings that went along with it → eg. felt they didn’t want you around, sad, upset - >start thinking aw man life is always like this, no one wants me around. - eg. personalization - >it’s about me, not the circumstance - emotional reasoning → i’m unhappy, so it must be that they do not want me there - but maybe they were so swept up in the conversation they didn’t even think about it → or there were 15 other ppl they also didn’t invite → or get them to rate on a scale of 1 to 10 how likely the case was - maybe they just forgot, or maybe they’re going by car and the car they’re taking only has room for that many ppl - cognitive therapy - a form of psychotherapy in which clients learn to recognize and change their dysfunctional thinking patterns.

Answer 18

- Antidepressant drugs - All antidepressants rely on serotonin at some level - In the case of an SSRI and tricyclic antidepressants, the process of pyrocytosis (re-uptakes), they increase the availability by stopping it from being re-uptaken by the synapses too quickly -> increase the availability of neurotransmitters - MAO breaks down seratonin → inhibitors interfere with that process so it can be released again - MAO inhibitors work by inhibiting the action of monoamine oxidase, an enzyme that normally breaks down neurotransmitters in the synaptic cleft. - if you can use antidepressants to get them to go to psychotherapy you may be able to slowly scale back - but meds and psychotherapy often has synergistic effects for improved outcomes - Mood stabiliziers - keep ppl on a relatively even keel - Lithium - Electroconvulsive Therapy (ECT) - the way it is delivered today is not as barbaric as it was in the past - idea is to create a brain seizure → not whole body - is actually v safe - ppl don’t typically remember what happened around that time - primarily for depression - sometimes for bipolar ppl who are in the depressed phase

Answer 19

- Hypericum perforatum. Used for centuries to heal wounds. - Early small-scale studies supported benefits of St. John’s Wort with a few reported side effects in cases of mild to moderate depression. - Has been used for a long period of time for treatment of depression - Unclear as to whether it is effective in treating severe depression - Continues to be evaluated

Answer 20

- 24% of deaths in Canada for 15-24 year olds. - Suicide is one of the leading causes of death in both men and women from adolescence to middle age.

Answer 21

- list for factors of depression is similar - discouraged, feeling trapped, hopeless - substance abuse, intoxication - stress - life events - personality disorders, in particular borderline personality disorder - more likely to engage in self harm up to suicide

Answer 22

- tend to follow closely the theoretical orientations discussion of depression itself - intermittent reinforcement - >to make behaviours more resistant to extinction you reinforce them less often → eg. rats with food, will do the behaviour over time if you don’t feed them as option - eg. sb who is making multiple attempts, self-harming, drug overdose → eg. downing a whole thing of Tylenol → next time they call, the person is a little bit angry that they have had this dropped in their lap - >less likely to respond as quickly → so what happens through a process of reinforcement is that they’re not getting that attention → as ppl react to it less and less → the intensity and risk of that behaviour increases → so that the people will respond → learning perspective on it - Sociocognitive - ppl who commit suicide that fantasize about how others will ulegize them → punishing sentiment - >i’ll show them, make them suffer for my passing - social contagion → eg. self-harming to deal with psychological disorder → now it is epidemic → through others doing it, learns it is a behaviour you can do for this - Quasi-spiritual - can reunite with a loved one who passes prior

Answer 23

- Predicting Suicide (concussions) - actualarial scales → based on data → suicide probability scale - difficult to predict → ppl who carry out self harming behaviours may never actually try to kill themselveds - concussion - >brain damage without structural change but possible functional change → probably bc the frontal lobes tend to be disproportionately impacted (which are response for impulse control)

Answer 24

Gender. - women and girls are 3x more likely to attempt suicide than men and boys, but boys are more likely to succeed. Age - 15 to 24 more likely than younger. Ethnicity - Suicide rate for Canadian FN is 5-7x higher than for youth in the general population Depression and Hopelessness - especially combined with low self-esteem are major risk factors Previous suicidal behaviour - 1/4 of adolescents who attempt suicide are repeaters. Family Problems - present among 75% of adolescent suicide attempters Stressful Life Events - many suicides among younger people are preceded by stressful life events Substance Abuse - by family member or adolescent Social Contagion - sometimes occur in clusters, especially when a sucide or groups of suicides receives widespread publicity.

Answer 25

- Usually evident in childhood, often before grade school - Disorders that begin in the developmental period. - are associated with personal, social or academic impairments. - eg. if you don’t see autism before 10 years old, it isn’t autism - Eg. - Autism spectrum disorder - Intellectual developmental disorder (intellectual disability) - Communication disorders - Attention-deficit/hyperactivity disorder

Answer 26

- Neurodevelopmental Disorders - Intellectual Disability - Autism Spectrum Disorders - Attention Deficit/Hyperactivity Disorder (ADHD) - (Motor Disorders) - (Communication Disorders)

Answer 27

- Caring for congenitally ill children is a relatively recently adopted social value. - Ancient Greece: Left to die, or thrown from a cliff? - Do we universally think of this as abhorrent? - Terminating pregnancies where testing of fetal cells has shown evidence of Down’s Syndrome. - Lower surgical and medical priority for severely disabled individuals. - eg. ppl who are mentally slower needs a hearing aid vs one who has no developmental delay → one without delay will get the hearing aid sooner bc it is seen that they need it more

Answer 28

Levels of Intellectual Disability - Based on level of *adaptive* *functioning, not IQ alone.* - Mild - eg if person is socially functional - Moderate - Severe - Profound - Social adjustment can have a significant bearing on life success. - Intelligence is not enough bc even for those who are intellectually disabled, their social adjustment (how much they’re liked by others) has a say in their life success.

Answer 29

- DSM-5-TR classifies intellectual developmental disorder according to level of severity. - Mild: - Range of IQ scores: 55-70 - Academic limitations: Academic skills rarely go beyond elementary school levels. The individual may be able to live independently. - Percentage of Developmentally Delay Population: 90% - Moderate: - Range of IQ scores: 40-55 - Academic limitations: Academic skills resemble those in the first two years of elementary school. The individual may be able to work in sheltered workshops but will require support both at work and in their living arrangements. - Percentage of Developmentally Delayed Population: 6% - Severe: - Range of IQ Scores: 25-40 - Academic limitations: The individual typically develops language and self-care skills but requires ongoing supervision. - Percentage of Developmentally Delayed Population: 3% - Profound - Range of IQ scores: Below 25 - Academic limitations: The individual may comprehend simple instructions or gestures but is dependent on others for self-care skills. Language skills may be very limited.

Answer 30

- Cytomegalovirus (CMX) - transmitted through blood, transplanted organs - 60% of adults have this it does not effect us - if it infects us after a certain age it will have little effect on it - if you have it very young → damage to central nervous system - higher prevalanece in lower SES groups - can cause intellectual disability - Inadequate diet during pregnancy - but malnutrition will affect the mum first →bc body is focused on supporting the baby - Maternal (while pregnant) - Drinking (FASD) - teratogenic effect → sth that has the capacity to affect cell development - is sth like alcohol, radiation, some sort of poison - have an individual who is not abnormal genetically but a substance came in that affected the development of the cells - changes when mum is drinking during pregnancy: affect central nervous system (damage), height, abnormally small brain, facial features → eyes tend to be relatively narrow and further apart, folds on forehead, short chin - consuming alcohol during days 19, 20 and 21 will cause facial features to appear but all other damage occurs whenever she drinks - Valproate - reduced height, neurological damage, facial features as above - Smoking - increases anti-social behaviour by factor of 2.4 if they are raised in a home that is also conductive to anti-social behaviour - Antidepressants, antihypertensive drugs - Heavy metals (lead, mercury) -> ingestion may cause brain damage

Answer 31

- Cultural-familial intellectual impairment - milder form of intellectual development disorder that is believed to result, or at least by influenced by, impoverishment in the child's home environment. - eg. the kind of toys ppl expose their children to: TVs vs doing a stimulating puzzle - eg. parents who are doctors, model that to their kids, kids become doctors - psychosocial factors such as an impoverished home, a social environment that is not stimulating, or parental neglect or abuse may play a contributing role in the development of intellectual developmental disorder in children. -> eg. child lack's toys, books or opportunities to interact with adults in intellectually stimulating ways. -> unmotivated to learn skills that are valued in contemporary society.

Answer 32

milder form of intellectual development disorder that is believed to result, or at least by influenced by, impoverishment in the child's home environment.

Answer 33

- Mainstreaming - the practice of having all students with disabilities included in the regular classroom. - *Diagnostic overshadowing* - there can be a mental disorder (including behavioural) that overcome some sort of intellectual disability → eg middle school where kid is rambunctious → fear being called on by teacher to answer question that they could get wrong so may become lippy so that their attention is drawn to sth within their control → so they are labelled as a badass, troublemaker as opposed to unintelligent - eg overshadowing of mental health conditions can take place in that ppl are not bright enough to say what they are feeling - eg. conduct issues → may be sent to special class - if ppl are placed in special classes, may lose out on that social adjustment - Social skills training - Anger management training

Answer 34

- Some medical conditions that may cause intellectual disability - Down Syndrome - trisomy 21 (cause by chromosomal abnormality involving an extra chromosome of the 21st pair) - visible facial features → can lead to earlier identification - Fragile X Syndrome - sth broken off: caused by a mutated gene on the X sex chromosome. - Phenylketonuria (PKU) - inability to digest or metabolize phenyl - eg. if they eat artificial sweeteners → toxic in body - caused by a recessive gene that prevents the child from metabolizing the amino acid phenylalanine (Phe), which is found in many foods. - Consequently, phenylalanine and its derivative, phenylpyruvic acid, accumulate in the body, causing genetic damage to the central nervous system that results in intellectual developmental disorder and emotional disturbance. - Children with the disorder may suffer less damage or develop normally if they are placed on diet low in phenylalanine soon after birth. - Smith-Lemil-Opitz Syndrome - cholesterol - has consequences for neural pathways - Tay-Sachs disease - attacks nerve cells in brain, spinal cord, retina in eyes -> disease of lipid metabolism that is genetically transmitted and usually results in death in early childhood. - it is a fatal degenerative disease of the central nervous system, mostly afflicting Jews of Eastern European ancestry and French Canadians of the Gaspe region of Quebec. - Children afflicted by Tay-Sachs suffer gradual loss of muscle control, deafness and blindness, intellectual developmental disorder, and paralysis, and usually die before the age of 5.

Answer 35

- Savant Syndrome is a condition where a person with a neurodevelopmental disorder can perform exceptionally in a specific domain such as mathematics. - Savant Syndrome occurs in 0.06% of those with intellectual disability and is closely linked to autism spectrum disorder. It occurs about 6 times more often in males than females. - perform low in all others but 1

Answer 36

- A disorder that involves markedly impaired behaviour or functioning in multiple areas of development. - Autism Spectrum disorder becomes apparent in the first few years of life and is often associated with intellectual disability. - often see it when they interact with other ppl - but not always associated with intellectual disability - DSM 4 used to have aspergers → now we include it with autism as “high functioning autism disorder” - DSM → number of ppl who received an autism diagnosis in the low, moderate high range increased bc we are diagnosing it differently

Answer 37

- lack of emotional reciprocity - can have language impairment (but not always the case)

Answer 38

- L. Kanner, B. Bettelheim - Kanner Syndrome → Autism before it was labelled autism - trying to find neurological differences → parents with these kids were often unaffectionate, dynamic probably caused child to turn away from them and seek solace in solitude - the obsessive preocupations and sometimes improved memory may show child’s strive for parental approval → psychodynamic - Bruno Bettelheim - placed it on mother’s - “refrigerator mother theory” → cold mother as opposed to dad → gave way to some genetic component to this

Answer 39

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or history (examples are illustrative, not exhaustive, see text): 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect to failure to initiate or respond to social interactions. - eg. “i love you” “okay” → “merry Christmas to you and your family” “uh huh” 2. Deficits in nonverbal communicative behaviours used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication. - makes it hard for them to read social cues - eg. they’re showing you their pokemon cards and you keep telling them you need to go, but they keep on talking. - facial expressions too → trying to guess emotional state, cannot - can’t tell anger, happiness, sadness from voice 3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behaviour to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers. B. Restricted, repititive patterns of behaviour, interests or activities, as manifested by at least two of the following, currently or bu history (examples are illustrative, not exhaustive, see text): 1. Stereotyped or repetitive motor movements, use of objects or speech (ef. simple motor stereotypies, lining up toys or flipping objects, echolialia, idiosyncratic phrases) 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal nonverbal behaviour (eg. extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food everyday) 3. Highly restricted, fixated interests that are abnormal in intensity or focus (eg. strong attachment to or preoccupation with unusual objects, excessively circumscribed or preseverative interest) 4. Hyper- or hyporeactivity to sensory input of unusual interests in sensory aspects of the environment (eg. apparents indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement) C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacitiesor may be masked by learned strategies in later life). D Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. E. E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global development delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Answer 40

Theoretical Perspectives - O. Ivar Lovaas - Hypothesized inability to process more than one sensory datum at a time - eg. being breastfed → knows that the caregiver is feeding them, holding them safely, → see them affectionately - Leads to conditioning stimulus - eg. being breastfed → knows this person is feeing them, knows it’s their mother, can’t connect the two to form affection - As a result, they are slow to learn by means of classical conditioning (association of stimuli). - From the learning theory perspective, children become attached to their primary caregivers because they are associated with primary reinforcers such as food and hugging. → children with ASD, however, attend either to the food or to the cuddling and no not connect it with the parent. - Simon Baron-Cohen - *Theory of Mind* - we all develop it - is a practical exercise of putting yourself in another person’s shoes and what do you think this person is thinking in that particular circumstance - eg. Johnny and Suzy and sitting in the back of the car with their parents, see a restaurant → parents are tired and hungry and stop t eat → play area outside the restaurant → ask to play while their parents sit → they go out and play → Johnny realizes he has to use the bathroom → hides his ball and tells Suzy not to play with it while he is in the bathroom → she turns, watches him hide it, plays with it and hides it behind a different tree when Johnny comes back → Johnny will look for it behind the original tree - knowing where he will hide it is theory of mind → the last available info on where the ball was - ppl who do not develop theory of mind cannot answer that question - Neurological Deficits - Evidence of structural abnormalities is inconsistent

Answer 41

- Intensive behavioural intervention - Structured treatment programs have yielded the best results. - Most effective treatment programs focus on behavioural, educational, and communication deficits and are highly intensive and structured, offering a great deal of individual instruction. - Lovaas: - children suffering from ASD received more than 40 hours of one-to-one behaviour modification each week for at least 2 years. - Significant intellectual and educational gains were reported for 9 out of the 19 children (47%) in the program. - Treatment gains were well maintained at the time of the follow us when the children were 11 years old. - Treatment must begin early. - Biological approaches only have a limited impact in the treatment of ASD. - Lovass (1987) 40 hours/wk x 2 years = normal IQ scores for just under half of 19 subjects - what’s conspicuosly absent from that is a control group - whether or not it remediates the intelligence is a separate question - Social simulations (eg. FaceSay) - Interactive program called FaceSay has been shown to improve the ability of children with ASD to recognize faces, facial expressions, and emotions. - features interactive games that let children with ASD practice recognizing the facial features and expressions of an avatar, or software “puppet.” - the program teaches the children where to look for facial cues, such as an eye gaze or a facial expression.

Answer 42

- A. 6 or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for developmental level: - Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. - Often has trouble keeping attention on tasks or play activities - Often does not seem to listen when spoken to directly - Often does not follow throughout on instructions and fails to finish schoolwork, chores, or duties in the workplacce (not due to oppositional behaviour or failure to understand instructions) - Often has trouble organizing acitivities - Often avoids, dislikes or doesn’t want to do things that take a lot fo mental effort for a long period of time (such as schoolwrok or homework) - Often loses things needed for tasks and activities (eg. toys, school assignments, pencisl, books or tools) - Is often distracted - Is often forgetful - B. 6 or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level: - Often fidgets with hands or feet or squirms in seat when sitting still is expected. - Often gets up from seat when remaining in seat is expected. - Often excessively runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless) - Often has trouble playing or doing leisure activities quietyl - Is often “on the go” or often acts as if “driven by a motor” - Often talks excessively - Impulsivity - Often blurts out answers before questions have been finished. - Often has trouble waiting one’s turn. - Often interrupts or intrudes on others (eg. butts into conversations or games)

Answer 43

- ADHD, *Combined Type*: if both criteria A and B are met for the past 6 months. - ADHD, *Predominantly Inattentive Type:* if criterion A is met but criterion B is not met for the past 6 months. - ADHD, *Predominantly* *Hyperactive-Impulse Type:* if criterion B is met but criterion A is not met for the past 6 months. - Also specify level of severity based on number of signs present: - Mild - Moderate - Severe

Answer 44

SEE IMAGE - Excessive daytime sleepiness bc they have problems sleeping at night - Learning disabilities in - math - reading - written expression - Some ppl with ADHD will use substances like alcohol to calm themselves down or help them sleep

Answer 45

- both biological and environmental factors are believed to be involved. - Genetic and environmental - if one parent has it, more likely to get it - higher concordance rates for ADHD among monozygotic twins than dizygotic. - Prenatal risk factors: Drinking, smoking, antidepressants, antihypertensive drugs, poor nutrition, heavy metals (lead, mercury) - 2.5x more likely to have been exposed to prenatal environmental tobacco smoke - lead exposure also a potential factor

Answer 46

- Stimulants - ascending reticular system is constantly underaroused - low levels of arised activity is highly uncomfortable - opposite is true too → high levels of arousal activity → introvert, may want to be alone - meds that raise cortical arousal can help ppl with ADHD - approve attention in children with ADHD as well as reduce impulsivity, overactivity, and disruptive, annoying or aggressive behaviour. - Behaviour therapy (for motoric excesses) - praise them for sitting still - modify the environment so it’s not as provoking, or stimulating in that they can focus on their work (eg. let them listen to white noise while working) - EEG biofeedback - electroencephalograph measures activity in brain → interested in recording 2 wave bands → beta (2nd faster) → lots of beta activity is incorporated with attnetion and focus - theta → second slowest → associated with slow, unfocused state, distracted - ADHD ppl tend to be excessive in theta activity and missing in beta activity - can train them to advance a horse by suppressing theta and increasing beta output → don’t know how they are doing it, but know they are - they are converting sth inside into a sign you can observe - operant control → conditioning takes place → can. condition ppl to suppress theta activity and increase beta activity → can suppress some ADHD symptoms - biofeedback training is so expensive but adderall is not - healthcare providers will happily pay for a cheap bill, but not for this training bc it is expensive - eg. type A personality → increase incidence of heart disaease, marital break down, higher blood pressure → can teach them the opposite → to increase theta activity and decrease beta

Answer 47

noted deficiency in a specific learning ability. - noteworthy bc of the individual's general intelligence and exposure to learning opportunities. Eg. Dyslexia - - A type of learning disorder characterized by impaired reading ability and may involve difficulty with the alphabet or spelling (or may not) - DSM-5-TR classifies specific learning disorder as a single disorder with 3 subtypes: impairment in mathematics, impairment in written expression, and impairment in reading.

Answer 48

- A type of learning disorder (specific learning disorder) characterized by impaired reading ability and may involve difficulty with the alphabet or spelling (or may not) - Problems differentiating similar-looking letters (e,c,o **OR**, p d, q) - Words may appear reversed or blurred. - Problems identifying speech sounds and learning how they relate to letters and words (*decoding*). - Affects areas of the brain that process language. - - For Dyslexia → there must be a phonological component → identifying words to certain speech sounds - must have a phonological deficit to have dyslexia - can also have speed/naming deficit - can have comprehension deficit - can have speed naming/deficit, but does not mean you have dyslexia

Answer 49

1. Acquired (stroke/trauma) - Deep -> difficulty with semantics can’t decode individual words → production of semantic errors and inability to read aloud non-words successfully. - Surface -> difficulty with sight words: words in the English language that cannot be unpacked through phonetics → eg. “the” → has to be read as a whole. → memory → have to memorize these words. -> More Dyseidetic (difficulty with whole words) -> More visual 2. Developmental (Hereditary and Most Common) - Phonological (difficulty with phenomes) -> More Dysphonetic (difficulty with word sounds) -> More Auditory

Answer 50

- Impairment in mathematics - Impairment of written expression - person who can’t write but may be able to read just fine - Impairment in reading - can get one that has impairment with reading but not deficits in written expression → can write sth down ,come back later and not be able to decode it

Answer 51

**Theoretical Perspectives** - Neurobiological - Wernickes area → comprehensions of written and spoken language - Brocas area → speech production and articulation - Arcuate fasciculus - arcuate fasciculus → bundle of axons that connects the brocas area and Wernicke’s area in the brain → structure could possibly have an effect on specific learning disorders, especially those to do with reading and writing. - Genetic factors - tend to be highly heritable - eg. parent who has porblems comprehending speech in some way → child who also has trouble → child will have similar to parents

Answer 52

- Individual Education Plan - Specific skills instruction - psychologist looks at their levels of achievement and teacher breaks them down through use of specialized tests → eg. pseudo word decoding → can you use your understanding of english pronounciation to sound out fake words similar to what they should sound - Accommodations - ppl are quite capable but need different environment or set of opportunities to prosper - Compensatory Strategies - eg. kids can use chromebook instead of writing things down - get a notetaker to take notes on their behalf - eg. allowed to use a calculator if they do not have the ability to do the arithmetic - Self-advocacy skills - can we equip the person with the language and confidence to approach ppl and tell them what’s going on and what they need to prosper in certain areas - being able to describe which parts of a job they need help with, or if they need extra time

Answer 53

- People whose parents have dyslexia are at greater risk themselves. - do not say what exactly it is tho - Higher rates of dyslexia are found between identical (MZ) then fraternal (DZ) twins: 70% versus 40%. - Genes may play role in causing defects in the brain circuitry involved in reading. - any where along occipital tract you could have a disruption of the skills that occur in dyslexia - more often than not is Wernicke’s area

Answer 54

- Disruptive, Impulse Control, and Conduct Disorders - ODD - Intermittent Explosive Disorder - Conduct Disorder (Antisocial Personality Disorder) → all 3 more correctly incorporated under personality disorders - pyromania - kleptomania

Answer 55

- Theoretical Perspectives in ODD - Behavioural: Ineffective parenting: Inadvertent reinforcement of difficult, demanding behaviour -> learning theorists view oppositional behaviours as arising from parental use of inappropriate reinforcement strategies. - parents have the responsibility to lay down boundaries - some kids will accept it - other kids will not → eg. get whiny - in the interests of avoiding intermittent reinforcement → giving in to it → reinforces that behaviour → best would be to ignore it - coercive exchange → a caregiver who is asking a child or adult to do sth → they say “no” “why do I have to do it?” and it escalates to the point where it comes frustrating → person who has to deal with it has had it → decides they should do it themselves → reinforced the defiant behaviour and the person who was trying to get the kid to do it has been punished → so is less comfortable asking that person to do sth. → if you are going to come into contact with that individual again, you are shooting yourself in the point - if you are going to ask the kid to do sth, you need to know what, ahead of time , you’re going to do in the event of their refusal.

Answer 56

- Treatment - Ecological theory - Multisystematic Therapy (MST) - PMT (Russel Barkley, Alan Kazdin)

Answer 57

- A pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting at least 6 months as evidence by at least 4 symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling. - Angry/irritable Mood - Often loses temper - Is often touchy or easily annoyed - Is often angry and resentful - ppl who are essentially, miserable - Can compartmentalize in some circumstances - eg, kid might be like this at home and school, but model of perfect behaviour at soccer practice Argumentative/Defiant Behaviour - Usually with authority figures - Often argues with authority figures or, for children and adolescents, with adults. - Often actively defies or refuses to comply with requests from authority figures or with rules. - Often deliberately annoys others. - Often blames others for his or her mistakes or misbehaviour. Vindictiveness - Has been spiteful or vindictive at least twice within the past 6 months - eg. peeing in his brother’s laundry when he was mad at him

Answer 58

- Impulsive or anger-based aggressive outbursts that begin rapidly and have very little build-up. - say it’s explosive bc it doesn’t look like its pre-meditated → is very rapid → out of nowhere - Outbursts often last fewer than 30 minutes and are provoked by minor actions of someone close, often a family member or friend. - Aggressive episodes are generally impulsive and/or based in anger rather than premeditated. - They typically occur with significant distress or psychosocial functional impairment. - can be detrimental to relationships as well - usually end up feeling quite bad after it occurs - The person is at least 6 years of age (or developmentally similar). - Verbal aggression like temper tantrums, tirades, arguments or fights; or physical aggression toward people, animals, or property. - This aggression must occur, on average, twice per week for 3 months. - The physical aggression does not damage or destroy property, nor does it physically injure people or animals. or - Within 12 months, three behavioural outbursts resulting in: - Damage or destruction of property, and/or - Physical assault that physically injures people or animals. - Not a function of a antisocial or criminal mindset - is distonic → unpleasant for the person

Answer 59

- A repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of 3 (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months: - Usually see in young people - has to be present in the person before they reach 15 - This type of behaviour can be normative - adolescents do show some anti-social behaviour in the course of development - Aggression to people and animals 1. Often bullies, threatens, or intimidates others 2. Often initiates physical fights 3. Has used a weapon that can cause serious physical harm to others (eg. a bat, brick, broken bottle, knife, gun) 4. Has been physically cruel to people - inflicting some kind of discomfort: psychologically, physical, emotional to another person for their own enjoyment 5. Has been physically cruel to animals 6. Has stolen while confronting a victim (eg. mugging, purse snatching, extortion, armed robbery) - robbery → taking sth away from them → don’t need to be holding a gun or using force → taking it alone is robbery - extortion → making a threat 7. Has forced someone into sexual activity - eg. intimate pictures without their permission, rape, etc. - Destruction of property 1. has deliberately engaged in fire setting with the intention of causing serious damage 2. has deliberately destroyed others’ property (other than by fire setting) - Deceitfulness or theft 1. Has broke into someone else’s home, building, or car 2. Often lies to obtain goods or favours or to avoid obligations (ie. “cons” others) 3. Has stolen items of nontrivial value without confronting a victim (eg. shoplifting, but without breaking and entering; forgery) - drawing the line at about 50 bucks - eg. an xbox, car - shoplifting → enter a business that is open and take sth on the spot - Serious violations of rules 1. Often stays out at night despite parental prohibitions, beginning before age 13 years 2. Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period) 3. Is often truant from school, beginning age 13 years.

Answer 60

- Differential include ODD and Antisocial Personality Disorder - ODD kids are generally miserable, not charming - sb with conduct disorder can be quite charming - ASPD → 18 years of age or older - Most effective treatments are delivered in a structured setting and include: - Continued education - Anger management - at least to the extent that much of the person’s behaviour is due to anger caused by things like interpersonal relationships - Victim empathy training - exercises that invite the person to reflect on the damage they are doing to other ppl and not distance themselves from what their actions do to others - psychopathy → highly callous - conduct disorder → can have a few that are callous too → for those types, you want to do the opposite → what are the consequences for YOU? - Relapse prevention - from substance-related literature - to those that their behaviour is motivated by substance-abuse - Substance abuse desistance - Family therapy - Individual psychotherapy of little use - Meds of limited value but some possible success with mood stabilizers and neuleptics (set of antipsychotics) , but not for frankly antisocial kids. - SSRIS given to reduce ppls impulsivity - neuleptics → just drains their energy → makes them less likely to act on their thoughts and feelings

Answer 61

- Major and mild Neurocognitive Disorders - Delirium - often seniors - but can affect younger ppl - Dementia - often seniors but can affect younger ppl - Traumatic Brain Injury - trauma has procured some damage to the brain --> Brain reduction is the main thing in Alzheimer’s causing reduction in functioning

Answer 62

- There is a natural degradation in new memory formation and task speediness - Can be an improvement in integrated thinking - Calmness, able to draw connections between things - An individual who slows down in the way just described can functioining normally, but when the level of degradation leads to disturbance in functioning. - It is more realistic to read this as mental disorders in adults who are aware of it → / get help for it - When we look at newly diagnosed cases they actually reduce over time - You’re going to find less mental illness in 70 or up than younger age groups

Answer 63

- We are talking about ppl who’s functioning was normal or not pathological before then - Need to differentiate on the basis of severity: - *Major* - Significant cognitive decline - Interference with independence in daily activities - cannot live alone without assistance - *Mild* - Moderate cognitive decline - Still capable of functioning with independence

Answer 64

- Alzheimer’s Disease - one of the primary degenerative dementias → primary → not brought on as a temporary condition - Frontotemporal lobar degeneration (eg. Pick’s) - swiss-cheese disease bc you see holes forming in the brain → brain starts to look like a sponge - progressive decline in behaviour, language functioning, worse over the course of time - Lewy body disease - emloid plagues → can see them after sb has died - develop inside neural cell - >contribute to Parkinson’s Disease - Vascular disease - there’s been an interruption of blood flow → vascular dementia → happens when there has been poor control over vascular risk factors (eg. cholesterol) - TBI - Substance/medication use - Korsakoff symptom → swelling in large intestine → can cause Wernicke's Disease -> due to poor absorption to Alcohol abuse and poor absorption of thiamine - Prion disease (**PR**oteinacious **IN**fectious particle) (Jacob-Creutzfeldt) - Sponge-like presentation in brain

Answer 65

- Note “Spongiform” presentation - ventricles have increased considerably - cerebral mass has increased - shows up easily on diagnostic imaging

Answer 66

SEE IMAGE - Most seniors are going to be wherever they were and when this process starts, it’s going to be gradual - occassional word-finding problems → train of thought is not interrupted, just sth like forgetting a word - forgetting about dentist appointment - can be exacerbated by - intoxication - sleeplessness - > can undermine your cognitive functioning significantly - being occupied with stress and preoccupation - when dealing with seniors, higher correlation between depression and cognitive impairment - if they are depressed and non-dementing, they may present clinically as depressed → slow responses - Anywhere before the normal functioning line, cannot tell - Dementia and cognitive decline is fatal - Personality change can occur - suspiciousness, paranoia, anger with well-meaning child → what do you mean you want access to my bank account - if you have two parents who are demented → the one who has been looking after them all along → the other children will try to tell them what they have done wrong → common pattern

Answer 67

SEE IMAGE: - Step-wise Decline - bc nerve cells have been damaged by the volume of blood - sometimes referred to as mini-strokes or TIAs - reduction in functioning → return of some functioning → another stroke → loss of some functioning → stay at some functioning → cycle

Answer 68

- May produce dementia-like impairment - Disturbances in orientation, memory, concentration, perception. - Reduced/clouded consciousness - Often attributable to medical illness (eg. bladder infections/urinary tract infections) - Will generally clear within a few days of underlying physical illness resolving - Therefore always check white cell count and assess for other symptoms and signs of infection. - Anywhere from 10 to 50% of seniors admitted to hospital for surgery will have, or develop in the course of their hospitalization, delirium. - Onset tends to be rapid (ie. hours to days) - AD and vascular dementias much more gradual - is why taking history is important: if its fast it could be delirium

Answer 69

- **Dementia:** A form of cognitive impairment involving generalized progressive deficits in a person’s memory and learning of new information, ability to communicate later on, judgment and motor coordination. - Type of memory most likely to be affected is new memory - can probably tell them old memories - eg. ask them what season it is outside now → shows that if they can’t remember what it is like outside, that they have problems consolidating new memories Mixed: Co-occurrence of both forms. (eg. dementia and vascular dementia)

Answer 70

- **Alzheimer’s Disease (AD):** Fatal neurodegenerative (brain is shrinking → cell death) disorder that accounts for the majority of dementia cases. - First line of Tx: Cholinesterase inhibitors - decrease the breakdown of acetylcholine -> which is good bc Alzheimers damages cells that produce acetylcholine and also decreases concentration and function of it (its required for memory, learning, attention, involuntary muscle movement) - Hx = history - Conclusively diagnosed posthumously - Amyloid Plaques, neurofibrillary tangles, cell death, substantial cortical atrophy - Amyloid plagues - accumulation of protein fragments, normally broken down in healthy brains, that accumulate to form hard, insoluble plaques between nerve cells (neurons) in the brain. - Neurofibrillary tangles - pathological protein aggregates (or brain lesions) found within brain cells (in the central cerebral cortex and hippocampus) in patients with Alzheimer's disease and thought to contribute to the degradation of neurons in the brain. - Neuropsych testing very sensitive and specific

Answer 71

- **Vascular Dementias:** Best addressed by controlling cardiovascular risk factors (BP, Diabetes, Smoking, Cholesterol) - Step-wise decrement in functioning - Tends to show up with diagnostic imaging (structure, not function) - especially in temporal lobes

Answer 72

- hippocampus important for memory consolidation - and emotional regulation - Mild Alzheimer’s Disease - Cortical Shrinking - Moderately enlarged ventricles - shrinking hippocampus - Severe Alzheimer’s Disease - Severe cortical shrinkage - Severely Enlarged Ventricles - Severe Shrinkage of Hippocampus - Dendrites shortening, getting production of emloid plagues

Answer 73

YES! - process addictions/dependence → not substances → gaming, pornography - some of the processes, especially learning, do not just apply to things that cannot be consumed

Answer 74

- **Substance use disorders:** Patterns of maladaptive behaviour involving the use of a psychoactive substance (anything that can affect your moods, cognitions). Substance-use disorders include substance-abuse disorders and substance dependence disorders. - **Substance-induced disorders:** Disorders induced by the use of psychoactive substances, inducing intoxication, withdrawal syndromes, mood disorders, delirium, and amnesia. - eg getting drunk or high

Answer 75

- Problem gambling behaviour was considered an impulse control disorder in former editions of the DSM. In DSM-5, *gambling* *disorder* is classified with other substances use disorders. Gambling disorder has commonalities in expression, causes, comorbidity, and treatment with substance use disorders. - The broader category, though not formally mentioned in DSM is *process* *addictions* - Partial exception is *Internet* *Gaming Disorder* (Conditions for further study: in Appendix 3) - seems to be a social component to it that even encourages it

Answer 76

- Tachyrcardia - racing heart rate - Delirium tremens - v extreme alcohol abuse - probably 2 or 3 days after alcohol use - twitching, tremors, sweating - diagnosably in the state of delirium → toxicity - Delirium - Disorientation - Physiological dependence (Addiction) - → anticipatory and the fear associated with not being able to get the next dose - Tolerance - → the recreational benefits tends to decrease over the course of time unless you increase the dose → one of the mechanisms through which overdose occurs - Withdrawal - what happens if they stop using it → psychological and physical symptoms that encourage them to continue using - withdrawal syndrome - involves a characteristic cluster of withdrawal symptoms following the sudden reduction or abrupt cessation of of use of a psychoactive substance after physiological dependence has developed. - aka negative reinforcement → terrible withdrawal symptoms → take substance → causes discomfort to go away → taking the substance is therefore negatively reinforced - Psychological Dependence -> one's body has changed as a result of the regular use of a psychoactive drug such that it comes to depend on a steady supply of the substance.

Answer 77

→ pattern will be the same for all substance-use disorders A. A problematic patterns of alcohol use leading to clinically significant impairment or distress, as manifested by at least 2 of the following, occurring within a 12-month period: 1. Alcohol is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. 3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 4. Craving, or a strong desire or urge to use alcohol. 5. Recruitment alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. 7. Important social, occupational, or recreational activities are given up or reduced bc of alcohol use. 8. Recurrent alcohol use in situations in which it is physically hazardous. 9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. 10. Tolerance, as defined by either of the following: - a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of alcohol. 1. Withdrawal, as manifested by either of the following: - The characteristic withdrawal syndrome for alcohol - Alcohol (or a closely related substance, such as benzodiazepine) is taken to relieve or avoid withdrawal symptoms; - Withdrawal symptoms will be the opposite of intoxication symptoms: eg. stimulant withdrawal → sleepiness

Answer 78

Top 3 commonly used drugs in North America: - Tobacco (about 25% of population) - Alcohol (about 15% of population) - Marijuana (about 5% of population) - has increased to 17% single legalization in Canada

Answer 79

- Experimentation - Most often in a social context - No loss of control - feel good, even euphoric. - Routine Use - Alterations to lifestyle and personal values around the drug: days lost from work, missing kids' b-days, strained family relationships - when ppl start making excuses: “can I borrow $10 for a gram of weed?” - Borrowing, pawning, theft, lying, manipulation - “I’ll pay you back next week” - May still believe they have control - Addiction or Dependence - Efforts centre on avoiding withdrawal symptoms - Life is centred on getting the drug - eg. engage in prostitution → eg. mom put her children into the sex trade - eg. onlyfans to get drug → slave to the substance of addiction - user feels powerless to resist durgs

Answer 80

- Depressants — “Depress” CNS activity - Alcohol - Barbituates - Opiates - Stimulants — Heighten CNS activity - Amphetamines - Cocaine - Nicotine - Hallucinogens — distort sensory perceptions (eg. *synesthesia*, colours, sounds, textures) → eg they report that they can taste colour, smell textures - LSD - acid - Phencyclidine (PCP) - dangerous if taken in large quantities - Marijuana - Inhalants - GABA effects - inhibiting effect - withdrawal symptoms → high levels of anxiety - eg. gasoline - solids

Answer 81

- Risk factors for alcoholism - Gender - Rates about equal, but women start later and progress faster. - Age (starting before 40) eg. late adolescence - Antisocial Personality Disorder - one of characteristics of ppl with APD is they tend to be sensation seeking → hammered, the rush - a failure to profit from experience → ppl with APD tend to not think “oh i had a nasty hangover, I better lay off a bit” -> increases risk of later alcoholism - Family History - Both heritable and modelling effects - Does seem to be a diathesis in terms of tendency to become addicted (predisposition inherited from parents with substance use disorder) - modeling → eg. parents → wine always on the table at social events - eg alcohol is taboo by parents → sometimes among the first kids who wanted to experiment with it - one’s social mieliu, advertising - Sociodemographic factors - Lower SES and education, Aboriginal > no-Aboriginal - alcohol dehydrogenase - marked increase in mental illness due to colonization - The damaging effects of alcohol abuse vary across ethnic groups in Canada, likely because of different cultural constraints and biological tolerance of alcohol.

Answer 82

- Specifiers: - Mild: Presence of 2-3 symptoms - Moderate: Presence of 4-5 symptoms - Severe: Presence of 6 or more symptoms - In early remission (3 to 12 months) - In sustained remission (12 months or longer) - if they can get to that point and manage environmental factors that in the past contributed to substance-use, their prognosis is pretty good - In a controlled environment - if they have been off of the substance but bc they have been in jail, or a country where that substance is banned

Answer 83

From of brain damage associated with chronic thiamine deficiency. The syndrome is associated with chronic alcoholism -> causes nutritional deficiency. and characterized by memory loss, disorientation, and the tendency to invent memories to replaced lost ones (confabulation). - also called alcohol-induced persisting amnestic disorder. - treatments - supplementation of thiamine: injected or oral - abstaining from alcohol and a healthy diet can be good treatment too

Answer 84

- Increased HDL - Deceased Clotting Risk

Answer 85

- no more than 14/wk for men - no more than 9/k for women → no more than 2 /day for either

Answer 86

- Alcohol plays a role in deaths due to: - SNOWMOBILE ACCIDENTS: about 77% of cases - Homicides: over 50% of cases - Traffic Accidents: over 40% of cases - Boating accidents: about 40% of cases - Suicides: 20% of cases

Answer 87

Barbiturates

Answer 88

Types of depressant drugs that are sometimes used to relieve anxiety or induce sleep but that are highly addictive. - Sedatives - Mostly among middle aged adults - used for sleep issues, anxiety - Synergistic effect with alcohol (about 4x) - intoxication when combined with alcohol is 4x - Requires medically supervised withdrawal - bc their physiologically withdrawal symptoms can be so profound they need medical assistance

Answer 89

Types of Depressant Drugs with strong addictive properties that are derived from the opium poppy; provide feelings of euphoria and relief from pain. - Intense rush or feelings of pleasure. - Narcotics - Analgesics - Endorphins

Answer 90

- Cocaine - Amphetamines - Amphetamine Psychosis - Most often, if the person is not an experienced user, the psychosis will subside with sobriety eg. speed, meth

Answer 91

Stimulants.

Answer 92

Stimulants.

Answer 93

- Snorted or injected - Often consumed in binges - buy large amount and use for extended period of time - Crack — for smoking, fast, concentrated rush - arrives in brain v quickly and at much higher level of intoxication - Freebasing (heating with ether) - ether → solid, highly volatile gas - concentrates effects of crack with heating - Effects of Cocaine - Birth defects - Auditory information processing → babies who are born to mom’s who are cocaine users have higher incidence of this → usually due to damage to temporal lobe - Sexual dysfunction - Increased body temp, respiratory distress, appetite suppression

Answer 94

- Snorted or injected - Often consumed in binges - buy large amount and use for extended period of time - Snorting -> rush is milder and takes a while to develop, but it tends to linger longer than the rush of crack. - Crack — for smoking, fast, concentrated rush - arrives in brain v quickly and at much higher level of intoxication - Freebasing (heating with ether) - ether → solid, highly volatile gas - concentrates effects of crack with heating -> separates its free base -> smoke the extract. - Effects of Cocaine - Birth defects - Auditory information processing → babies who are born to mom’s who are cocaine users have higher incidence of this → usually due to damage to temporal lobe - Sexual dysfunction - Increased body temp, respiratory distress, appetite suppression

Answer 95

1. **Effective vs. Toxic Doses (Primarily Physiological)** - Tolerance to intoxicating effects to a drug and the lethal dose both increase over time. - Tolerance builds more quickly - Over time, the amount of drug necessary to produce the high gets closer and closer to the lethal dose level. - *Neuroadaptation*L Brain changes that can take place over time to compensate for presence of foreign chemicals. 1. **Compensatory Conditioning (Primarily Psychological)** - Over the course of the conditioning, a CS may elicit physiological CRs that *oppose* the US (compensatory CRS). These CSs may include *contextual* *cues* present during conditioning. Eg. Cytochrome P450 - eg. like ringing the bell causes the mouth to dry out → with drugs this can happen - UR is to assist the organism in coping with whatever the unconditioned stimulus is - if some kind of conditioning process were to to take place that alerts the organism sth bad was about to enter their body → reduces the effect - cues the body utilizes to produce a response which will be protective in nature - This contributes to withdrawal symptoms as well as tolerance - Siegel et al. (1982) suggested that a failure to elicit such responses might play a part in drug overdose. - Phase 1: (Conditioning Trials) - Two groups of rats were heroin addicted over 30 days. Three conditions: Same Room, Different Room, Control - Same and Different Room groups got heroin every second day, and a saline infusion on odd days. Saline and heroin were given in different rooms. - Phase 2: (Test day) - Same Room group: got a double dose of heroin in the room where heroin was usually delivered - Different Room group: Got double dose of heroin where they usually got saline. - Control group: Never had heroin before but also got a double dose. Results: - Control group had highest level of mortality → 100% died - Rats that got heroin in the room where they usually got saline had a 64% mortality rate - bc of conditioning that took place → Cytochrome P450 was not produced in anticipation for the drug - Rats that got heroin in the room where they usually got heroin, had a 32% mortality rate. - be of conditioning that took place → in that room the body produced anticipatory Cytochrome P450

Answer 96

Brain changes that can take place over time to compensate for presence of foreign chemicals. 1. **Compensatory Conditioning (Primarily Psychological)** - Over the course of the conditioning, a CS may elicit physiological CRs that *oppose* the US (compensatory CRS). These CSs may include *contextual* *cues* present during conditioning. Eg. Cytochrome P450 - eg. like ringing the bell causes the mouth to dry out → with drugs this can happen - UR is to assist the organism in coping with whatever the unconditioned stimulus is - if some kind of conditioning process were to to take place that alerts the organism sth bad was about to enter their body → reduces the effect - cues the body utilizes to produce a response which will be protective in nature - This contributes to withdrawal symptoms as well as tolerance - Siegel et al. (1982) suggested that a failure to elicit such responses might play a part in drug overdose. - Phase 1: (Conditioning Trials) - Two groups of rats were heroin addicted over 30 days. Three conditions: Same Room, Different Room, Control - Same and Different Room groups got heroin every second day, and a saline infusion on odd days. Saline and heroin were given in different rooms. - Phase 2: (Test day) - Same Room group: got a double dose of heroin in the room where heroin was usually delivered - Different Room group: Got double dose of heroin where they usually got saline. - Control group: Never had heroin before but also got a double dose. Results: - Control group had highest level of mortality → 100% died - Rats that got heroin in the room where they usually got saline had a 64% mortality rate - bc of conditioning that took place → Cytochrome P450 was not produced in anticipation for the drug - Rats that got heroin in the room where they usually got heroin, had a 32% mortality rate. - be of conditioning that took place → in that room the body produced anticipatory Cytochrome P450

Answer 97

hallucinogen

Answer 98

- Over the course of the conditioning, a CS may elicit physiological CRs that *oppose* the US (compensatory CRS). These CSs may include *contextual* *cues* present during conditioning. Eg. Cytochrome P450 - eg. like ringing the bell causes the mouth to dry out → with drugs this can happen - UR is to assist the organism in coping with whatever the unconditioned stimulus is - if some kind of conditioning process were to to take place that alerts the organism sth bad was about to enter their body → reduces the effect - cues the body utilizes to produce a response which will be protective in nature - This contributes to withdrawal symptoms as well as tolerance - Siegel et al. (1982) suggested that a failure to elicit such responses might play a part in drug overdose. - Phase 1: (Conditioning Trials) - Two groups of rats were heroin addicted over 30 days. Three conditions: Same Room, Different Room, Control - Same and Different Room groups got heroin every second day, and a saline infusion on odd days. Saline and heroin were given in different rooms. - Phase 2: (Test day) - Same Room group: got a double dose of heroin in the room where heroin was usually delivered - Different Room group: Got double dose of heroin where they usually got saline. - Control group: Never had heroin before but also got a double dose. Results: - Control group had highest level of mortality → 100% died - Rats that got heroin in the room where they usually got saline had a 64% mortality rate - bc of conditioning that took place → Cytochrome P450 was not produced in anticipation for the drug - Rats that got heroin in the room where they usually got heroin, had a 32% mortality rate. - be of conditioning that took place → in that room the body produced anticipatory Cytochrome P450 - Note: CS’s (cues) for drug use will also frequently trigger cravings and withdrawal symptoms. - If you put substance users in a different environment at the time they will use and there is a tendency for them to use higher, higher doses, then the risk of overdose is high. - eg. ppl who are treated in a facility and then return back to the neighbourhood they used to shoot up in → get cravings → conditioning process as well - is likely Cytochrome P450 is kicking in too - so learning at the physical level and psychological level likely plays a role in those withdrawal symptoms

Answer 99

- DA (dopamine) and GABA effects - Solvents - Gasoline - Glue

Answer 100

- Brain’s Reward Centres (Mesolimbic pathways → is dopaminergic pathway in brain, acts as Brain’s Reward Centre, nucleus accumbens) - drugs mimic stimulation of this - neuroadaptation is trying to counter constantly intoxicated state of person so when they are sober they feel in a worse mood, etc than you normally would

Answer 101

**Learning Perspective** - Operant Conditioning - Alcohol and Tension Reduction - “man could I really do with a beer now” - Originally positively reinforcing bc feelings of euphoria, reduction in states of anxiety and tension. - Negative Reinforcement and Withdrawal - substance use takes away the negative feelings of withdrawal → reinforces the substance use - The Conditioning Model of Cravings - Cues for substance use - eg. being able to buy beers for your friends → assumed you will → - eg. sight of an alcoholic beverage or sight of a needle may elicit responses in the form of alcohol or drug cravings. Positive Reinforcement - Observational Learning - eg. parents who model inappropriate or excessive drinking or use of drugs may set the stage for maladaptive drug use in their children.

Answer 102

- Neurotransmitters - Dopamine - Brain’s Reward Centres (Mesolimbic pathways → is dopaminergic pathway in brain, acts as Brain’s Reward Centre, nucleus accumbens) - drugs mimic stimulation of this - neuroadaptation is trying to counter constantly intoxicated state of person so when they are sober they feel in a worse mood, etc than you normally would - Genetic Factors - Addictions tend to run in families - to both substances and process addictions - comes down to what is being inherited → eg. if you have relative absence of alcohol dehydrogenase → more susceptible to addiction - Alcohol dehydrogenase - Ability to metabolize alcohol - some groups are lower in this → takes a longer period of time for alcohol to leave the body - Flushing of face, nausea, intoxication at lower doses

Answer 103

- Outcome Expectancies, Decision Making, and Substance - Self-Efficacy Expectancies - Does one slip cause people with substance abuse on dependence to go on binges? - *Abstinence violation effect* (attribution to stable internal factors) - once person has taken that step a number of cognitive processes kick in that tell them they are a failure and to give in → have broken the seal and will continue drinking - What you Believe is What You Get - Amount consumed is influenced by expectation of alcohol - Actual alcohol content didn’t matter. - Some ppl given tonic water - some given alcohol - some people told given tonic water and given tonic - some people given tonic and told alcohol - drank much more than those given alcohol - what they beleived they were going to get played a much stronger role than what they actually drank - some given alcohol and told tonic - even alcoholics drank much less - some givnen alcohol told alcohol - drank most - Difference between two groups is based on what they believe they are being given. - The expectation of what they’re going to get is a stronger determinant of how much they’re going to drink than what is actually in their glass.

Answer 104

- Does one slip cause people with substance abuse on dependence to go on binges? - *Abstinence violation effect* (attribution to stable internal factors) - once person has taken that step a number of cognitive processes kick in that tell them they are a failure and to give in → have broken the seal and will continue drinking - happens when sb who is striving for abstinence from a particular behaviour or substance experiences a set back such as a lapse or relapse. -> instead of viewing it as a temporary setback, the individual perceives it as evidence of personal failure -> increased feelings of guilt, shame, hopelessness ->

Answer 105

- What you Believe is What You Get - Amount consumed is influenced by expectation of alcohol - Actual alcohol content didn’t matter. - Some ppl given tonic water - some given alcohol - some people told given tonic water and given tonic - some people given tonic and told alcohol - drank much more than those given alcohol - what they beleived they were going to get played a much stronger role than what they actually drank - some given alcohol and told tonic - even alcoholics drank much less - some givnen alcohol told alcohol - drank most - Difference between two groups is based on what they believe they are being given. - The expectation of what they’re going to get is a stronger determinant of how much they’re going to drink than what is actually in their glass. - Explains the "one-drink effect/abstinence violation effect" as a self-fulfilling prophecy: if people with alcohol related problems believe just one drink will cause a loss of control, they perceive the outcome as predetermined when they drink. -> may thus escalate into a binge -> mechanism of falling off the wagon after one drink is cognitive

Answer 106

- Oral fixation - sources of sustenance in pleasure to a baby come in through its mouth → breast milk, food - idea is that an adult who struggles with overeating or smoking or alcohol addiction is that they have no given up that tendency to seek oral pleasure - oral-dependant personality - traced to fixation in the oral stage of psychosexual development

Answer 107

- Both cultural and subcultural (eg. religion) - Eg. Catholic church taking communion with wine - some use intoxicants for religious and spiritual rituals - others have prohibitions against it - Use of alcohol and drugs often occurs within a group or social setting. - Drinking is determined in part by where we live, with whom we worship, and the social or cultural norms that regulate our behaviour. - Peer pressure and peer drug use play an important role in use for adolescents.

Answer 108

- Prochaska and DiClemente (1983) - the steps ppl will take when making a life change - *Transtheoretical* in nature. - not only one-theory oriented - Has utility in most areas of psychotherapy, not just addictions. - Weight loss - Motivation - Exercise - CBT goals - Has been operationalized in the URICA Scale - University of Rhode Island Change Assessment Scale - provides a key of where they are on this cycle below 1. - Pre-Contemplation - no intention of changing behaviour - If they did do some corrective behaviour, they may enter pre-contemplation and contemplation stage - is an upward spiral because they learn from each relapse and with subsequent attempts to get back on the horse, their chances of success increase 2.Contemplation - aware a problem exists but with no commitment to action. 3. Preparation: intent on taking action to address the problem - asking sb what therapist they used - research 4. Action - active modification of behaviour 5. Maintenance - sustained change; new behaviour replaces old - if action does not change, but continues and is maintained. 6. Relapse Process - fall back into old patterns of behaviour - not just one break - fall into old patterns of behaviour associated with their substance use - may stay there for a long period of time or engage in some sort of corrective behaviour --> then cycle may repeat

Answer 109

- Detoxification - often carried out in a hospital setting to provide the support needed to help the person withdraw safely from the addictive substance -> benzodiazipines may be used to block more severe withdrawal symptoms such as seizures and delirium tremens. - Disulfiram (Antabuse) - gives you a nasty reaction when you drink alcohol → makes you violently ill if you drink - break out in sweat, muscle tension, muscle cramping, nausea - positive punishment - Antidepressants - reduces impulsivity - when sb is drinking to reduce anxiety or depression, this can reduce those feelings that cause sb to drink - Nicotine Replacement Therapy - nicotine released into blood on regular basis - reduces withdrawal symptoms without the person resorting to smoking - >so the negative reinforcement effects do not kick in - Methadone Maintenance Programs - Methadone - satisfies cravings of heroin user with same levels of intoxication - Naloxene and Naltrexone - Block the high from opiates - get ppl to take in lower doses at regular basis → so they don’t experience a high when they take the drug next → so they don’t get that high - >don’t get positive reinforcement → may stop wanting to inject - Poor long-term compliance

Answer 110

- Detoxification - often carried out in a hospital setting to provide the support needed to help the person withdraw safely from the addictive substance -> benzodiazipines may be used to block more severe withdrawal symptoms such as seizures and delirium tremens. - Detox from alcohol takes about a week.

Answer 111

**Nonprofessional Support Groups** - Al-Anon Residential Approaches - Multi-faceted - Make it difficult to obtain substances - providing lifestyle management things: social skills training, nutrition, exercise Psychodynamic Approaches - Not very effective with this population - may be effective for ppl who are really motivated to overcome their substance abuse

Answer 112

- Self-Control Strategies - Harm-reduction - safe sites if you’re going to use - Controlled drinking - idea is that if you’re going to drink → limit the amount you drink → eg. buy a 6 pack instead of a 24-pack - problem is that the subtext is its okay to drink and we are only controlling the amount - Aversive Conditioning - eg. antabuse/disulfiram - bc of stimulus relevance they’re not really effective - Bc brain is unlikely to form a connection/association between electric shock and alcohol - biological things like food intake and alcohol intake will not pair with an electrical shock stimulus bc it is not readily paired with it irl - Social Skills Training - fear of being rejected from the group can keep you abusing substances

Answer 113

Disulfiram (antabuse) - discourages alcohol consumption because the combination of the two produces a strong aversive reaction consisting of nausea, sweating, flushing, rapid heart rate, reduced blood pressure, vomiting. - Shortcomings: in some cases, drinking alcohol while taking disulfiram can lead to such a dramatic drop in blood pressure that the individual goes into shock and may even die. -> limited effectiveness bc many patients who want to continue drinking simply stop using the drug. - Strengths: with each dose the patient reaffirms their committment to remain abstinent. -> also patients are no longer tormented by an internal dialogue pulling them in both directions as to whether or not they should consume. -> since ingesting alcohol is no longer an option, it permits them to implement coping strategies.

Answer 114

- Whether a lapse becomes a relapse depends on the person's interpretation of the lapse. - participants in these programs are encouraged to think of lapses as temporary setbacks that provide opportunities to learn what kinds of situations lead to temptation and how they can avoid or cope with such situations. - also may include social supports REVIEW NOTES ON PROCESS

Answer 115

tendency in people trying to maintain abstinence from a substance, such as alcohol or cigarettes, to overreact to a lapse with feelings of guilt and a sense of resignation that then may trigger a full-blown relapse.

Answer 116

- Whereas most interventions aim to reduce or eliminate substance use entirely, the Harm Reduction approach attempts to mitigate the harmful consequences. - Needle exchange programs - may be using drugs problematically but at least aren’t passing on aids or diseases - Methadone programs - habit forming - does produce a certain level of intoxication but not same as heroin - Designated drivers - is there one of you who is good at not drinking → at least don’t have injuries or intoxication charges - Restrict use to weekends or other non-work days - could you control yourself to the point of only having it on certain nights

Answer 117

**Viable Option of Big Mistake?** - Can people with alcoholism be taught to engage in controlled social drinking? Original research done in the 70s. - Not encouraging - idea was that there was a subset of people who struggled with drinking and wouldn’t participate in a program without alcohol - Improper control procedures however - did not work very well - The contention that people with alcoholism can learn to drink moderately remains controversial. - Self-fulfilling prophecies - getting ppl to complete abstinence is the best thing bc moderate drinking is a matter of degree - ppl really enjoy it: the environment, the taste, the social aspect → overpowering - Controlled drinking programs may represent one pathway to abstinence for people who would not otherwise enter abstinence-only treatment programs.

Answer 118

- *Schizophrenia* (Gr. *split* *mind*) refers to loosening of connections between the various psychic functions (eg. ideas, perceptions, emotions, behaviours) (left) - Schizophrenia → doesn’t mean that there are multiple psychic functions associated with different entities - totality and unity of their identity and perceptual expereinces are singular but different from each other in the cracks of the mirror - DID involves the formation of separate, but (at least partly) integrated personality structures (right). - aka *alters* - if we had actual separation to the point of mini mirrors → have sth like this → separate identities after that crack

Answer 119

- A. Disruption of identity characterized by 2 or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity (sth starts at one point and ends at another → psychological disocontinuity) in sense of self and sense of agency (what they’re in control of), accompanied by related alterations in affect, behaviour, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others (eg. change in vocal pitch, occular prescription) or reported by the individual. - eg. one alter is athletic and one is not - internal part is observed by the person themselves - B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. - don’t remember what happened the other day: eg. went out with sb but doesn’t remember it - can also forget date of birth, SIN, favourite band - confabulated → memory has been filled in with sth else - C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. - D. The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play. - E. The symptoms are not attributable to the physiological effects of a substance (eg. blackouts or chaotic behaviour during alcohol intoxication) or another medical condition (eg. complex partial seizures)

Answer 120

Factitious Disorder (Meunchausen's Syndrome) - The essential feature of factitious disorder is the falsification of medical or psychological signs and symptoms (producing a physical illness which is measurable by medical professions) in oneself or others that are associated with the identified deception. - literally is **producing/creating** the medical or psychological signs and symptoms → or subjecting themselves to an actual procedure like a surgery - Individuals with factitiuous disorder can also seek treatment for themselves or another* following induction of injury or disease. - Eg. ppl with it may inject themselves with saliva to create an infection - *Factitious Disorder By* *Proxy*. - producing it in sb else - eg. a mother inducing it in her child - a number of them tend to be healthcare professionals themselves and are women - they are loving, concerned parents → there everyday looking after their child, brings in stuff for the staff - Unifying factor whether they are doing it themselves or to others seems to be they are motivated by being the centre of medical attention

Answer 121

sense of self, sense of continuity, sense of agency Eg. DSM-5 Criteria: - A. Disruption of identity characterized by 2 or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity (sth starts at one point and ends at another → psychological disocontinuity) in sense of self and sense of agency (what they’re in control of), accompanied by related alterations in affect, behaviour, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others (eg. change in vocal pitch, occular prescription) or reported by the individual. - eg. one alter is athletic and one is not - internal part is observed by the person themselves - B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. - don’t remember what happened the other day: eg. went out with sb but doesn’t remember it - can also forget date of birth, SIN, favourite band - confabulated → memory has been filled in with sth else - C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. - D. The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play. - E. The symptoms are not attributable to the physiological effects of a substance (eg. blackouts or chaotic behaviour during alcohol intoxication) or another medical condition (eg. complex partial seizures)

Answer 122

Disorders in which people complain of physical (somatic) problems although no physical abnormality can be found.

Answer 123

- A. Disruption of identity characterized by 2 or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity (sth starts at one point and ends at another → psychological disocontinuity) in sense of self and sense of agency (what they’re in control of), accompanied by related alterations in affect, behaviour, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others (eg. change in vocal pitch, occular prescription) or reported by the individual. - eg. one alter is athletic and one is not - internal part is observed by the person themselves - B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. - don’t remember what happened the other day: eg. went out with sb but doesn’t remember it - can also forget date of birth, SIN, favourite band - confabulated → memory has been filled in with sth else - C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. - D. The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play. - E. The symptoms are not attributable to the physiological effects of a substance (eg. blackouts or chaotic behaviour during alcohol intoxication) or another medical condition (eg. complex partial seizures)

Answer 124

- *Schizophrenia* (Gr. *split* *mind*) refers to loosening of connections between the various psychic functions (eg. ideas, perceptions, emotions, behaviours) (left) - Schizophrenia → doesn’t mean that there are multiple psychic functions associated with different entities - for schizophrenia: there may be little agreement between thoughts and emotions or between the individual's perception of reality and what is truly happening. -> may become giddy when told of disturbing events or may experience hallucinations or delusions. - totality and unity of their identity and perceptual experiences are singular but different from each other in the cracks of the mirror - DID involves the formation of separate, but (at least partly) integrated personality structures (right). - aka *alters* - if we had actual separation to the point of mini mirrors → have sth like this → separate identities after that crack - each alter usually shows more integrated functioning on cognitive, emotional and behavioural levels than is true of people with schizophrenia.

Answer 125

- A lot of clinicians and researchers are highly skeptical about this disorder. - About 21% of Board certified psychiatrists felt there was strong evidence for the condition - 58% voiced skepticism and/or thought it should be removed from DSM - Fallacy of medical report → malingering → reporting symptoms that they do not have/know aren’t accurate - Piper and Merskey (2004) - Not proof that it results from childhood trauma as broadly believed - Very low base rate - not sth we see in a high rate → like depression or anxiety - Numbers of *alters* appears to be increasing with time - Seems to correspond to more movie portrayals - eg. ppl reported 2500 - *Types* of alters being reported is absurd. - Nick Spanos (2001) research - Almost unheard of outside North America → reinforces idea that it might be heavily influenced by media exposure and cultural factors - Appearance in highly influenced by cultural factors - A form of role-playing inadvertently cued by interviewers? - Eventually becomes habitual→ through being reinforced by interviewers - Emphasizes the importance of careful interviewing. - so do not lead them on → do not give them facial input of interest

Answer 126

- **Kenneth Bianchi, the so-called Hillside strangler**. - Abducted and sexually assaulted and murdered a number of girls and women. - Did the police psychiatrist who interviewed Bianchi suggest to him that the could role-play a person with multiple personalities? - the psychologist’s interest → leaning in, “so tell me more about” - Bogus typemind → you tell them you think they’re suffering from dissociative identity disorder → but you only have 2, there should be 4 → then he pulls out 4 → you got him - Nick Spanos (2001) research - Almost unheard of outside North America → reinforces idea that it might be heavily influenced by media exposure and cultural factors - Appearance in highly influenced by cultural factors - A form of role-playing inadvertently cued by interviewers? - Eventually becomes habitual→ through being reinforced by interviewers - Emphasizes the importance of careful interviewing. - so do not lead them on → do not give them facial input of interest

Answer 127

- *lters* may or may not be aware of each other. - “Co-conscious” (aware of each other and talk to each other) or may communicate indirectly through other people or leaving notes. - don’t communicate directly - At other times may be in apparent conflict - will not communicate bc they don’t want to talk to each other

Answer 128

- Nick Spanos (2001) research - Almost unheard of outside North America → reinforces idea that it might be heavily influenced by media exposure and cultural factors - Appearance in highly influenced by cultural factors - A form of role-playing inadvertently cued by interviewers? - Eventually becomes habitual→ through being reinforced by interviewers - Emphasizes the importance of careful interviewing. - so do not lead them on → do not give them facial input of interest - What’s It Like To Live With Dissociative Identity Disorder (DID) - 11 Alters (5 co-conscious) - “Minnie” is a 3 year old girl - speech change, tone change, temperament change - “Devyn” is Minnie’s 26 year old caregiver - “Encina” (→ her whole conscious) says we all start off like with multiple alters - Are these just different behaviours under the control of different stimuli?

Answer 129

- Therapeutic goal has traditionally been “reintegration” - idea → group therapy with a bunch of alters that live within one person - number of people with dissociative identity disorder may say “we reject that” → coping strategy or think is meant to be/it is a part of them

Answer 130

- A type of dissociative disorder in which a person experiences memory losses *in* *the* *absence* *of* *any* *identifiable* *organic* *cause.* - eg. not hypoxia, head trauma, intoxication - Would be *retrograde* (going backwards) except general knowledge, habits, personal tastes, and skills are usually retained. - eg. if they are piano players they can still play piano - Forgotten material is usually related to trauma. - May be *localized*, *selective* or *generalized*. - generalized → whole bunch - localized → particular point in time or geographical location - selective → more topical - Different from DID in that: -> no alters -> not 2 or more distinct personality states

Answer 131

- Faking illness so as to avoid or escape work or other duties, or to obtain benefits. - Faking amnesia is quite common. Usually an attempt to escape criminal or other responsibility. -> not easily verifiable. - bc the dissociative identities may be reinforced -> positive and negative reinforcement: receiving attention from others and evading accountability for unacceptable behaviour. - one of the tests of suggestiblilty is whether or not they will respond to hypnotic suggestions - look for inconsistencies?

Answer 132

retrograde amnesia -> inability to remember events, information or experiences that happened before the onset of the amnesia

Answer 133

localized → amnesia of a events that happened during a particular point in time or geographical location - eg. a person can't recall events for a number of hours or days after a stressful or traumatic incident like war

Answer 134

In selective amnesia, people forget only the disturbing particulars that take place during a specific time period eg. the time period where they conducted an extramarital affair but not the guilt-arousing affair itself selective → more topical

Answer 135

In generalized amnesia, people forget their entire lives--who they are, what they do, where they live, and with whom they live with. generalized → whole bunch

Answer 136

- specifier for dissociative amnesia - Specifier: 300. 13 With dissociative fugue: Apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information. - Type of dissociative disorder in which one suddenly flies from one’s life situation, travels to a new location, assumes a new identity, and has amnesia for past personal material. - The person usually retains skills and other abilities and may appear to others in the new environment to be leading a normal life. - person takes off, sometimes with different name, but is not clear if they have taken on a different identity - may or may not come out of this

Answer 137

Faking an illness to avoid or escape work or other duties, or to obtain benefits. - Not a dissociative disorder. - Faking amnesia is quite common. Usually an attempt to escape criminal or other responsibility.

Answer 138

type of psychological disorder where individuals fake or manufacture physical or psychological symptoms but without really any apparent motive. - The essential feature of factitious disorder is the falsification of medical or psychological signs and symptoms (producing a physical illness which is measurable by medical professions) in oneself or others that are associated with the identified deception. - literally is **producing/creating** the medical or psychological signs and symptoms → or subjecting themselves to an actual procedure like a surgery - Individuals with factitiuous disorder can also seek treatment for themselves or another* following induction of injury or disease. - Eg. ppl with it may inject themselves with saliva to create an infection - *Factitious Disorder By* *Proxy*. - producing it in sb else - eg. a mother inducing it in her child - a number of them tend to be healthcare professionals themselves and are women - they are loving, concerned parents → there everyday looking after their child, brings in stuff for the staff - Unifying factor whether they are doing it themselves or to others seems to be they are motivated by being the centre of medical attention

Answer 139

For Dissociative Identity Disorder - Function of Repression - defense mechanism of shutting sth out of consciousness - idea is if there is sth in that person’s consciousness that is so stressful to them → they will shuck it out of awareness → separate it from themselves → trying to escape sth by adopting the mental identity of sb else who is not struggling with those same issues. - “splitting off” + retreat to an alternate personality. For Factitious/Munchaunsen's Disorder -Primary gains: in psychodynamic theory, the relief from anxiety obtained through the development of a neurotic symptom. - eg. relief from the anxiety itself - resolution from the psychological conflict is always the primary gain - Secondary Gains: side benefits associated with neuroses or other disorders, such as expressions of sympathy and increased attention form others and release from ordinary responsibilities. - probably what we focus on more - eg. ppl feeling sorry for you, increased attention from others - eg. “oh my god, this migraine is so bad” → psychological conflict stops, ppl in the family might stop arguing

Answer 140

- If a memory is repressed in someway is it possible that it can be reinforced in some way to come back? - An ancillary issue: Claim that some traumatic memories may be repressed but lead to depression, anxiety, and other psychological symptoms. - Through the use of hypnosis or psychotherapy these can supposedly be recovered. - There is much controversy around this. → can make ppl think they have a memory of sth that never happened to them. - Repressed memories may or may not be a real phenomenon, but false memories are a reality and can be “induced” in most people. - Are Recovered Memories Believable? - R. v. Francois - an individual who presented in therapy with some big complaints -> feel unsettled, depressed, poor self-esteem - therapist said they often hear reports of this from ppl that have been abused → you can’t remember it bc your mind found it way too difficult to deal with it and repressed them → if we talk about it enough you might remember → comitting the same error poice investigators are making → person is actually responsding to the signs of interest on the expert’s face → genuinely beleives sth happened to them - Francois charged with raping a girl → charged with rape on just her murky account → therapist suggested her account could be given if they asked her about the event. - Hundred of people have been charged for crimes they never committed on the basis of “recovered memories.” - Suggestibility and Probing - False memories can be produced in experiments - 26% Porter et al (1999) - group of bright undergrads → 26% of them could be induced in a short amount of tie and ensured with a high degreee of confidence that things happened to them that actually didn’t - True vs. False Memories - *Constructivist* nature of normal memory. - you have a collection of random memories that can be put together to form a whole - eg. eyewitness testimony → show them video or have actors go through scenario that is objectively verifiable → what occurred ? → even if they grossly agree what narratively happened, they can all have different details about what happened → why ppl can’t be convicted based on heresay.

Answer 141

- Learning: “not thinking” plus neg Rf - Avoiding conscious consideration of unpleasant matter - when you engage in any kind of mental behaviour that results in a reduction anxiety → negative reinforcer takes place - thinking is you can change your brain through a process of reinforcement to not think about things that are unpleasant - net result with psychodynamic is same thing except one is defense mechanism and one if learning process - Spanos: Role playing via observational learning - usually cues from people around them that can encourage the probability of those behaviours → eg. telling a joke → ppl laugh → positive reinforcement - eg. solve a difficult math equation → pleasure you take from it is intrinsic

Answer 142

- Psychoanalysis - Uncovering early childhood traumas - get ppl to develop neurosis → see the problem → get them to unpack it and deal with it - *Hysteria* (Greek) = uterus - Freud: Less common among married women. - Bias built into his sample → more women came to him for help - Rx’d marriage for “hysterical” women → masturbation

Answer 143

- Removal of secondary gains (coaching family) - or whoever that person lives with - want ppl to be constructively supportive but not inadvertently positively reinforcing that person - Teach alternative means of coping with stress/anxiety - if you are experiencing headaches bc of squabbling with family members → family therapy → will constructively reduce the severity and frequencies of the conflict - Early, but promising results - close to behavioural

Answer 144

- A. One or more somatic symptoms (bodily) that are distressing or result in significant disruption of daily life. - B. Excessive thoughts, feelings or behaviours related to the somatic symptoms or associated health concerns as manifested by at least one of the following: 1. Disproportionate and persistent thoughts about the seriousness or one’s symptoms. 2. Persistently high level of anxiety about health or symptoms. 3. Excessive time and energy devoted to these symptoms or health concerns. C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months) - will complain about sth for usually over 6 months Specifiers: With predominant pain: Persistent (>6 months); mild / moderate / severe

Answer 145

- used to be called hypocondria - The preoccupation with the idea that one is sick (or is about to get sick) is accompanied by substantial anxiety about health and disease. Individuals with illness anxiety disorder are easily alarmed about illness, such as by hearing about someone else falling ill or reading a health-related news story. - Their concerns about undiagnosed disease do not respond to appropriate medical reassurance, negative diagnostic tests, or benign course. - They characteristically assume their physician is lying, holding sth back, etc.

Answer 146

- La Belle Indifference: French term describing the lack of concern over one’s symptoms displayed by some people with conversion disorder but also by people with real physical disorders. - Means you’re converting a deep psychological conflict into a physical one that is more manageable It appears in Conversion Disorder. -> bc they may be converting a psychological conflict into a physical one that is more manageable -> also in Dissociative Amnesia-> show a remarkable indifference to their symptoms -> Evidence shows that many people cope with real physical disorders by denying their pain or concern, which provides the semblance of indifference and relieves anxieties--at least temporarily.

Answer 147

- A. One or more symptoms of altered voluntary motor or sensory function. - eg. being able to open one’s eyes, being able to speak - B. Clinical findings provide evidence of incompatibility between the symptoms and recognized neurological or medical conditions. - C. The symptom or deficit is not better explained by another medical or mental disorder. - D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation. - Symptom Specifiers: With weakness or paralysis; with abnormal movement; with swallowing symptoms (e.g globus hystericus → clenching of esophagus muscles feel like a tumour → can interfere with swallowing); with speech symptom (eg. dysphonia, slurred speech); with attacks or seizures; with anaesthesia (loss of feeling) or sensory loss; with special sensory symptom (eg. visual, olfactory, or hearing disturbance); with mixed symptoms - With / without psychological stress - Acute/persistent - episodic or acute and persistent

Answer 148

Factitious Disorder (Munchausen’s Syndrome) - The essential feature of factitious disorder is the falsification of medical or psychological signs and symptoms (producing a physical illness which is measurable by medical professions) in oneself or others that are associated with the identified deception. - literally is **producing/creating** the medical or psychological signs and symptoms → or subjecting themselves to an actual procedure like a surgery - Individuals with factitiuous disorder can also seek treatment for themselves or another* following induction of injury or disease. - Eg. ppl with it may inject themselves with saliva to create an infection - *Factitious Disorder By* *Proxy*. - producing it in sb else - eg. a mother inducing it in her child - a number of them tend to be healthcare professionals themselves and are women - they are loving, concerned parents → there everyday looking after their child, brings in stuff for the staff - Unifying factor whether they are doing it themselves or to others seems to be they are motivated by being the centre of medical attention

Answer 149

- Closest DSM category is Illness Anxiety Disorder. - does not respond to legitimate medical reassurance - *Koro* *Syndrome* - Supposedly fatal condition in which the genitals shrink, or retract unto the body. - Primarily among young Asian males - May try to mechanically prevent retraction. - attaching strings and weights to the penis - Can occur in epidemics - if ppl are talking about it → preoccupation - Based in acceptance of Koro folk tales - cautionary tales - Most prevalent among less educated, geographically isolated individuals. - limited source of information - Typically responds well to reassurance and education. - when they get enough reassurance and education

Answer 150

- Primary gains: in psychodynamic theory, the relief from anxiety obtained through the development of a neurotic symptom. - eg. relief from the anxiety itself - resolution from the psychological conflict is always the primary gain - primary gains consist of allowing the individual to keep internal conflicts repressed

Answer 151

- Secondary Gains: side benefits associated with neuroses or other disorders, such as expressions of sympathy and increased attention form others and release from ordinary responsibilities. - probably what we focus on more - eg. ppl feeling sorry for you, increased attention from others - eg. “oh my god, this migraine is so bad” → psychological conflict stops, ppl in the family might stop arguing - Secondary gains may allow the individual to avoid burdensome responsibilities and to gain the support--rather than the condemnation--of those around them.

Answer 152

- Benefits of secondary gains make it hard to quit bc they are positively reinforcing. - Secondary Gains: side benefits associated with neuroses or other disorders, such as expressions of sympathy and increased attention form others and release from ordinary responsibilities. - probably what we focus on more - eg. ppl feeling sorry for you, increased attention from others - eg. “oh my god, this migraine is so bad” → psychological conflict stops, ppl in the family might stop arguing - Removal of secondary gains (coaching family) - or whoever that person lives with - want ppl to be constructively supportive but not inadvertently positively reinforcing that person - Teach alternative means of coping with stress/anxiety - if you are experiencing headaches bc of squabbling with family members → family therapy → will constructively reduce the severity and frequencies of the conflict

Answer 153

Culture-Bound Dissociative Conditions - Closest DSM category is Illness Anxiety Disorder. - does not respond to legitimate medical reassurance - *Koro* *Syndrome* - Supposedly fatal condition in which the genitals shrink, or retract unto the body. - Primarily among young Asian males - May try to mechanically prevent retraction. - attaching strings and weights to the penis - Can occur in epidemics - if ppl are talking about it → preoccupation - Based in acceptance of Koro folk tales - cautionary tales - Most prevalent among less educated, geographically isolated individuals. - limited source of information - Typically responds well to reassurance and education. - when they get enough reassurance and education FOCUS ON DIVERSITY - *Dhat* *Syndrome* - India, young men - Dhat = “Elixir of life” (semen) - Intense fear that ejaculation will rob the body of vital energy. - Primarily through nocturnal emissions, but also during voiding.

Answer 154

1. Draw the person out. - Don’t let them isolate → draw them out → do sth that is socially involved 2. Be sympathetic - empathetic would be better - don’t tell them to toughen up or that they’re overmagnifying stressors in their life, what to give them a belief that there are solutions other than dying 3. Suggest that means other than suicide can be discovered to work out their problems. - ppl will be impacted by your passing whether you realize it or not 4. Inquire as to how the person expects to commit suicide - if they made attempts in the pass, there is a high likelihood they could do it again - eg. tylenol or bleach → do you have it in the house? and if they do get together with the person and take them to emergency room or therapist now → You deserve help, I care about you 5. Propose that the person accompany you to see a professional right now. 6. Don’t degrade the individual (You’re talking crazy…”)

PSYCH 239 Lectures 4-6 Flashcards

(180 cards)