Transcript Substance Dependence - People Server at UNCW

Abnormal Psychology
WEB
Anxiety as a Normal
and an Abnormal Response
• Some amount of anxiety is “normal” and is
associated with optimal levels of
functioning.
• Only when anxiety begins to interfere with
social or occupational functioning is it
considered “abnormal.”
The Bell Curve
Phobic Disorders
•
1.
2.
3.
Phobias
Specific phobias
Social phobia
Agoraphobia
Specific Phobias
Social Phobia
• General characteristics
Fear of being in social situations in
which one will be embarrassed or
humiliated
Panic Disorder With and
Without Agoraphobia
•
•
•
•
Panic disorder
Panic versus anxiety
Agoraphobia
Agoraphobia without panic
Panic and the Brain
Panic Disorder: The Cognitive
Theory of Panic
Treating Anxiety Disorders
• Medications
• Behavioral and
cognitive-behavioral
treatments
Generalized Anxiety Disorder
• General characteristics
• Prevalence and age of onset
• Comorbidity with other disorders
Generalized Anxiety Disorder:
Biological Causal Factors
• Genetic factors
• A functional deficiency of GABA
• Neurobiological differences between
anxiety and panic
Obsessive-Compulsive Disorder
• Obsessions- repetitive unwanted ideas that
the person recognizes are irrational
• Compulsions- repetitive, often ritualized
behavior whose behavior serves to
diminish anxiety caused by obsessions
Post-Traumatic Stress Disorder
• Critical Component
– Symptoms occurs AFTER a traumatic stressor
Symptoms Categories
• Intrusive
–
–
–
–
–
distressing recollections
dreams
flashbacks
psychological trigger reactions
physiological trigger reactions
Symptoms Categories
• Avoidance
–
–
–
–
–
–
–
avoid thoughts, feelings or discussions
avoid activities, places
memory blocks
anhedonia (without pleasure)
numb
alexithymia (emotions unknown)
feeling of doom
Symptom Categories
• Hyperarousal Symptoms
–
–
–
–
–
sleep disturbance
anger problems
concentration
startle response
“on guard” hypervigilence
Mood Disorders
• Major Depressive Disorder
• Bipolar I and Bipolar II
• Cyclothymia
– Hypomania
• Dysthymia
• Schizoaffective disorder
Categories of Personality
Disorders
• Cluster A
– Paranoid
– Schizoid
– Schizotypal
Personality Disorders
•
•
•
•
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
Histrionic personality disorder
Categories of Personality
Disorders
• Cluster B
–
–
–
–
Histrionic
Narcissistic
Antisocial
Borderline
Categories of Personality
Disorders
• Cluster C
– Avoidant
– Dependent
– Obsessive-compulsive
The Clinical Picture in
Schizophrenia
• Positive symptoms
– Delusions: fixed firm beliefs with no basis in
reality
• Most common are grandiose, persecutory
and referential
– Hallucinations: disturbances in perception
• Can occur in any of the five senses
– Most common are auditory and visual
The Clinical Picture in
Schizophrenia
• Formal Thought Disorder (a positive symptom)
– Disturbances in speech that reflect underlying
problems in cognition or thinking
• Most common forms are tangentiality and
circumstantiality
• Less common are neologisms, word salad and
clang associations
The Clinical Picture in Schizophrenia
• Negative symptoms (Nancy Andreasen)
–
–
–
–
–
Avolition
Anhedonia
Alogia
Flat Affect
Asociality
The Classic Subtypes of
Schizophrenia
•
•
•
•
Undifferentiated type
Catatonic type
Disorganized type
Paranoid type
Graph of HS drug use
Substance-Related Disorders
Methods of taking substances:




7 sec
20 sec
4 min
30 min
inhaling
IV
snort
oral
or
Intramuscular
injection
When is addiction addiction?
• What is substance use?
• What is substance abuse?
• What is substance dependence?
Where is the line???????
DSM-IV Criteria
Substance Abuse
 leads to impairment or distress
 one of these within 1 yr:
 failure to full fill role
obligations
 physically hazardous
 legal problems
 persistent social problems
Substance Dependence
 leads to impairment or distress
 3 of the following:
 tolerance
 withdrawal
 delirium tremens (DTs)
take more than intended
persistent desire
fail to control use
lots of time spent obtaining,
using, or recovering from
 use in place of activities
 continuing despite physical or
psychological problems




Solomon’s Opponent Process
Theory of Addiction
• Basic Premise- People take, abuse and
become dependent on drugs because of the
effect of these drugs
• The Clements Corollary- noone ever
becomes addicted to thorazine
– A State- the initial pleasant effect
– B State-unpleasant effects occurring as a result
of drug withdrawal
The Clinical Picture of Alcohol
Abuse and Dependence
• Alcohol’s effects on the brain
• Physical effects of chronic alcohol use
• Psychosocial effects of abuse and
dependence
Alcohol (ETOH)




Short-term effects:
absorbed from the stomach into
the blood
metabolized by the liver (1 oz/hr)
it is a drug
acts within brain to:
 stimulate GABA receptors
 reduces tension
  dopamine/serotonin levels
 pleasurable aspects of
intoxication
 inhibits glutamate receptors
 diminishes cognitive abilities
Long-term effects:
 reduced food intake
 ETOH: no nutrient value
 impairs food digestion
 results in vitamin deficiency
 B-complex
 can lead to brain damage/amnesia
 kills brain cells
 leads to loss of gray matter from
the temporal lobes
 Korsakoff’s Syndrome
 suppresses the immune system
Alcohol (ETOH)
 A “drink”:
 1 oz. Spirits = 1 glass wine = 1 beer
 DWI (Driving while intoxicated)
 takes approximately 2-4 drinks over one hour
 lighter weight, empty stomach will require less
 legal blood alcohol limit (.10%)
 DUI (Driving under the influence)
 The CAGE
Alcohol Addiction: Treatment
 Admitting the problem
 a prerequisite for therapy (video clip)
 Inpatient Hospital treatment
 expensive & does not lead to better results
 may be necessary for safe detoxification
 Aversion therapy
 Antabuse - drug that creates nausea
 uses operant conditioning principles
 Controlled drinking training
 Self-Help groups
 Alcoholics Anonymous