Adult Psychopathology Midterm 2

• substance use disorder
• substance-induced disorder (intoxication and withdrawal)
• non-substance related disorders (gambling)

Almost anything could be labeled as an addiction

• In substance addiction, the substance is what leads to the physiological response
• in process addiction, the behavior is what leads to the physiological response (gambling creates an adrenaline rush)

• the same neural pathways are used
• they have the same psychological consequences

• salience
• euphoria 
• tolerance
• withdrawal
• conflict
• relapse/reinstatement

either the activity or the substance dominates the person's life

The feeling of being high

substance taken to a progressively higher level to get the same effect

stopping the substance can lead to unpleasant physiological/physical sensations

can lead to conflict with people or self

the resumption of a substance or activity after trying to stop.  usually has negative consequence (losing job, family, etc...)

a patter of use with at least 2 of the following 

• using larger amounts than intended
• unsuccessful attempts to stop or control use
• spending a great deal of time obtaining, using, or recovering from the effects of the substance 
• craving or strong urge to use the substance
• failure to fulfill major role obligations (work, home, school)
• continued use despite recurrent substance-related social or interpersonal problems
• important activities given up or reduced because of use
• use in physically hazardous situations (drunk driving)
• continued use despite substance-related physical or psychological problems
• tolerance
• withdrawal

• reversible, substance-specific syndrome due to recent ingestion or exposure to substance
• clinically significant maladaptive behavioral or psychological changes due to effect of substance developing shortly after use 
• symptoms not sue to a general medical condition
• common among those with substance use disorder

• substance-specific syndrome due to cessation of or reduction in use that has been heavy or prolonged 
• causes clinically significant impairment 
• not due to a general medical condition 
• common urge to re-administer to reduce withdrawal symptoms 
• usually, associated with a substance use disorder

• asses a person's attitude towards assessment
• ability to acknowledge a problem
• how defensive
• risk of legal problems
• emotional problems

A 4 item yes/no questionnaire with 2 yes answers meaning a possible drinking problem 

• Have you felt the need to CUT down your drinking?
• have people ANNOYED you by criticizing your drinking?
• have you ever felt GUILTY about your drinking?
• have you ever felt that you needed a drink first thing in the morning? (EYE opener)

• developed by the world health organization and has been cross culturally validated. 
• Used mostly in primary care settings
• mostly used to asses or detect harmful or hazardous use of alcohol 
• scores of 8-19 show abuse
• scores above 20 show dependence

• identity of substances used
• history of use, emergencies, and treatment
• cognitive impairment
• physiological signs neurological signs
• psychomotor agitation or retardation 
• changes in mood 
• changes in personality and defenses

• dilated eyes
• sleepiness
• etc...

if it is given in a clinical setting with confidentiality in place

getting agitiated/anxious when attempting a physical task

when a person is hardly moving or moving like a slug

• externalized blame
• minimizing usage amount
• diversion tactics (rather talk about anything other than use)
• defensive or hostile
• rationalize use

• genetics are an important factor in alcohol abuse and dependence
• almost as important for drug use
• genetics are a stronger component for men

• familial abuse and associated problems 
• level of stress

• means a person has a problem with drugs/alcohol and a mental disorder
• happens in 60% of people with dependence problems
• can use questionnaires to identify mental illness (MMPI, SCL-90, etc...)
• typically, need to deal with the substance abuse first
• all hinges on clients readiness to chance

• precontemplation 
• contemplation 
• preparation 
• action
• maintenance

• no intent on changing in the foreseeable future
• unaware of problem or under report

aware of problem ad thinking about overcoming it, but have not committed to making a change

both intent and behavior including trying to quit in the last year, but no level of effectiveness reached yet

person is actually modifying their behavior/environment to overcome their addiction for up to 6 months

person works to prevent relapse and consolidate their gains and remains free from addictive behavior for more than 6 months

behavioral:  any compulsive behavior that interferes with daily living and has significant negative consequences 

• can be almost anything 
• being addicted to an activity 
• must impair social and/or occupational functioning 

Substance:  drugs and/or alcohol

• acute crisis
• withdrawal from substance
• sequelae 
• predisposing factors

• is something life threatening
• any medical care or psychiatric care needed
• any family violence

• the substance and the withdrawals sit between the client and the therapist 
• prioritize the substance problem by dealing with the withdrawals (detox/out patient)
• establish support base (psychological/social support/services, houseing, clothing) for the recovery process

• things that have happened because of the substance abuse.  
• Effects of the person's use has to be addressed such as depression, guild, cravings, relapse, family issues
• learning to develop necessary skills (communication, exploring emotions, etc..)

family alcoholism, trauma in childhood or adolescence, sexual orientation, etc...

• admission of problem 
• detox: multiple is a bad sign
• antabuse:  must take pill, high drop out rates
• AA: free, provides sponsor, high dropout rates
• controlled drinking: non threatening, harm-reduction that does not confront denial, seeks to minimize use, not effective with high level of addiction

sees family as an ecosystem 

• family system approach 
• behavior is approached within interactions within a family 
• eventually the behavior of the family begins to adapt to the addict 
• family members begin to develop coping strategies and try to recover balance 
• system is designed to treat the family as a whole/ecosystem 

concept of homeostasis

• addict
• co-dependent/enabler 
• hero
• scapegoat
• lost child
• mascot

• substance-focused
• irresponsible
• externalized blame
• unproductive 
• abusive

• offers family sense of stability/protection
• contributes to progression of addiction
• assumes responsibility inappropriately
• common for them to become depressed and/or fatigued

• usually first born
• source of pride for the family
• usually an achiever
• job is show the family is functioning well
• alliance with or listens to problems of the enabler 
• trained to be little enablers

• someone for the family to blame
• usually second child
• mirror opposite of the first child
• gets in trouble, acts out, poor grades, etc... 
• expresses family's anger and frustration signaling there is a problem with the family

• no trouble to the family
• stays out of the way
• possible middle child or youngest 
• shy, withdrawn, fears taking risks
• usually has the best prognosis because of little contact with the family

• distracts the family from pain and sorrow with laughter and fun 
• often the youngest child
• more fragile, vulnerable, pronounced need for approval 
• defensive against feelings of anxiety and inadequacy 
• usually the worst prognosis because they distract themselves from feeling bad

• addiction to adrenaline 
• consistent and recurrent maladaptive gambling behavior 
• more common in men and often see a link between same sex parent 
• tend to be lower income 
• tend to be more extroverted
• high rates of suicide
• residential and inpatient treatment are effective

• happens across all cultures
• it is a biochemical issue
• usually appears in adolescents (12+) and post adolescents
• sometimes referred to as a thought disorder

a false belief that the person holds onto despite evidence to the contrary 

• tend to be more bizarre with schizophrenia 
• delusion disorder tend to not have bizarre delusions

sensory perception that appears to be immediately real and true 

most common are auditory hallucinations

involve an excessive amount or distortion of a person's normal functions 

increased amount of dopamine

the diminishment or loss of normal functions 

underactive dopamine

• hearing voices out loud (thought echo)
• hearing voices discussing or arguing about person
• hearing voices describing a persons activity 
• high importance or personalized significance to a  normal perception (something has special meaning)
• experience sensations outside of the person (moon is energizing my brain)
• thought being placed in head by external force (thought insertion)
• someone is taking away persons thoughts (thought withdrawal)
• believes others can hear thoughts (thought broadcasting)
• thoughts or feelings are being controlled by others
• desires and impulses are controlled by others
• motor activity is being controlled by others

• language and communication
• content of thought
• perception
• affect
• sense of self 
• volition
• relationship to the external world 
• motor behavior

• circumstanciality: person makes irrelevant detours while talking 
• poverty of speech: a lot of words being used but little is being said, overly abstract or concrete
• neologism: combine two or three words into a single word that has magical meaning 
• tangentiality: communication has no breaks
• word salads: utter incoherents
• clanging: speaking in rhymes 
• looseness of association: immediate changing of subjects with little or no connection

• sometimes voices telling them to do things that they do not want to do
• command hallucinations: person is being told what to do

usually very inappropriate, blunted, or flat (laughing while talking about a death in the family)

• impacted by lack of boundaries that are not clear
• reality testing is not in place

sense of intention, sometimes have too much or too little (avolition)

sometimes disconnected from the outer world

• catatonic
• hyper agitation

• erotomanic
• grandiose
• jealous
• persecutory
• somatic
• mixed
• unspecified

pay a lot of attention to the specifiers of these disorders, there is a lot of specificity involved

involved another person, usually of high status, that loves them

• inflated worth, power, knowledge
• a relationship to a god

sexual partner is not faithful

there is someone after me

some sort of physical problem with no evidence  (I know I have brain cancer)

more than 1 type occurring

Requires at least 1 of the following and at least one star 

• delusions ★
• hallucinations ★
• disorganized speech ★
• grossly disorganized or catatonic behavior
• duration from 1 day to 1 month

2 or more symptoms with at least 1 star 

• delusions ★
• hallucinations ★
• disorganized speech ★
• grossly disorganized or catatonic behavior
• negative symptoms
• duration from 1 month to 6 months

2 or more symptoms with at least 1 star 

• delusions ★
• hallucinations ★
• disorganized speech ★
• grossly disorganized or catatonic behavior
• negative symptoms
• duration of at least 6 months

meets the requirements for schizophrenia (primary disorder), but also has a major mood episode during the active or residual phase of schizophrenia 

specifiers 

• bipolar type if manic episode
• depressive type of major depressive episode
• with catatonia

• delusions
• hallucinations 
• during or soon after substance intoxication, withdrawal, or exposure to medication 
• substance is capable of producing such symptoms

• prominent hallucinations or delusions 
• evidence that disturbance is a direct consequence of the medical condition

• block dopamine receptors 
• high drop out rates for meds because of unpleasant side effects (dizziness, blurred vision, sexual dysfunction, etc...)

• psychodynamic 
• social skills training
• family therapy and expressed emotion reduction (EE)
• CBT

not used, research does not support

• often a component in treatment
• helps with skills that structure their world

• relapse happens when families have high levels of EE
• therapy is design to calm the patient by calming the family 
• focused on education, signs of a psychotic break, knowing meds and side effect, etc... 
• to provide hope in he family and the patient that improvement can happen
• been shown to lower relapse rate

• teaches how to recognize inappropriate affect
• how to notice signs of relapse 
• muscle relaxation 
• taught that they have an emotional vulnerability to stress 
• taught that there thinking is not always as clear as it should be 
• taught to stay on their meds