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121 Cards in this Set

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Substance Abuse

- pathological substance use that involved potentially hazardous behavior or continued use despite persistent social, psychological, occupational, or health problems


-drinking and driving, coming into work under the influence, and engaging in other risky behavior will lead you into entering criteria for substance abuse

Substance Dependence

usually involves physiological need for increased drug amount to achieve same effect (tolerance)




and withdrawal symptoms: physical symptoms such as sweating, tremors upon discontinuation


-- you need the drug in your system to avoid these symptoms and withdrawals

DSM-IV: Substance Abuse definition

One or more of the following during a 12 month period:




- recurrent substance use results in failure to fulfill major obligations


-recurrent substance use in situations in which is it physically hazardous


-recurrent substance-related legal problems


-continued substance use despite persistent social problems caused by substance use

DSM-IV: Substance Dependence

3 or more of the following during a 12 month period:




-tolerance


-withdrawal


-taking larger amounts than originally intended


-persistent desire/unsuccessful efforts to cut down


-spending a lot of time to use/recover from substance


-reducing social, occupational, recreational activities because of substance


-continuing to use substance despite knowing that there is a recurrent physical/psychological problem

DSM-5: Alcohol Use Disorder

2 or more of following 11 symptoms during a 12 month period:




-alcohol taken in larger amounts than was intended


-persistent desire to cut down or control alcohol use


- a great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects


-craving, or a strong desire or urge to use alcohol


-recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home


-continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol


-important social, occupational, or recreational activities are given up or reduced because of alcohol use


-recurrent alcohol use in situations in which it is physically hazardous


-alcohol use is continued despite knowledge of having persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol


-tolerance


-withdrawal

Alcohol Dependence Stats

- lifetime prevalence (US) alcohol dependence: 9% - 13.4%


-Alcohol-dependent people die 12 years earlier, on avg


-Alcohol Abuse: 37% comorbidity, especially depression


-Gender ratio M/F: 5:1 (but increasingly common in women); one of the only disorders where men are way more affected than women


-it’s been estimated that about 250 billion dollars a year in economic costs are due to alcohol

College Students

- in 2012, 60.3% of college students age 18-22 drank alcohol in the past month compared with 51.9% of same-age peers not in college


-40.1% of college students age 18-22 engaged in binge drinking (5 or more drinks on an occasion) in the past month compared with 35% of same age peers not in college


-14.4% engaged in heavy drinking (5 or more drinks on an occasion on 5 or more occasions per month) in the past month compared with 10.7% of same age peers not in college

Consequences of College Students Drinking

-1,825 college students between the ages of 18 and 24 die from alcohol related unintentional injuries, including motor-vehicle crashes, each year




- 696,000 students between the ages of 18-24 are assaulted by another student who has been drinking




- 97,000 experiencing between the ages of 18-24 alcohol related sexual assault or date rape




-roughly 20% of college students meet the criteria for an AUD




-about 1 in 4 college students report academic consequences from drinking, such as:


-- lower grades


-- missing class


-- going out to party instead of studying




- these are all annual numbers, happening per year



Alcohol Use Disorders in the World

-happens world wide


-map of years lost due to drinking; could be from disability, ill health, etc


-russia is in the lead with the metric of the impact of drinking


-followed by Peru, Hungary, Columbia, Norway, China, Australia, UK, North America, etc



Prevalence of Alcohol Use Disorders in the US

-Colorado, Wyoming, Montana, Michigan, DC, northern california : all higher than the mean for Alcohol use


-Kentucky, Maine, Utah: among those below the mean for alcohol use


-take home message: alcohol uses prevalent


-about 7% of the us population in the past year will meet criteria for some sort of Alcohol Use Disorder

What does the degree to which alcohol affects a person depend on?

age, gender, physical condition, how much food they’ve eaten, other drugs, etc

Effects of Alcohol

-alcohol is nervous system depressant


-alcohol is first ingested into the small intestine and into the stomach, and the small intestine and stomach can only process so much alcohol; if it can’t process the rest of alcohol, results in vomiting


-alcohol is then absorbed through out the body, some goes through the lungs (this is why breathalyzers are used), some passes through the brain, some passes through the liver and then gets funneled out


-7-10 grams of alcohol can pass through the body without any significant affects (one beer, glass of wine, ounce of 90 proof liquor)


-once alcohol is in your blood stream however, it can diffuse into every biological tissue piece in your body, including the brain

At low levels of alcohol, what area of the brain is stimulated?

the pleasure area, with the following effects:


- dopamine increased


- you feel good


- your confidence increased


- you become more friendly


- your inhibitions go down a bit




part of the cycle of addiction is when these same pleasure areas in the brain are not stimulated, then cravings pursue


- one thought is that if we stop these cravings, then alcohol dependence goes down



Other effects of alcohol

- your ability to learn new things diminishes


- motor coordination becomes impaired


- less likely to feel cold or pain


- your body begins to shut down to some degree


- can't make decisions as well

Brain Effects: Chronic Drinking

- visible differences between control person and alcoholic person


- you see an overall reduction in brain size and an increase in ventricle size in people who are dependent on alcohol

Chronic Alcohol Use

- less grey matter in brain


- brain appears to be smaller


- the brain is really plastic, it can recover from this insult but it takes time


-- if someone goes back to drinking, the shrinkage occurs more quickly than it would have the first time

Memory and Alcohol

- a number of cognitive processes are effected by alcohol




- blackouts: time when intoxicated person cannot recall key details of events




- 51% of college students report blackouts


-- 40% will say they have had a blackout within the past year


-- 10% will say they've had a blackout within the past 2 weeks




- fragmentary more likely than en bloc


-- en bloc means you don't remember the entire night


-- fragmentary kind are much more prevalent




- avg 11.5 drinks before blackout


-- a little challenging to get this data because you're getting people to tell you how many drinks they had before they blacked out even though blacking out means they didm't remember anything or most things




- usually liquor is what leads to blackout (hard liquors, not beer or wine)



Physical Effects

- liver damage (cirrhosis)



Foetal Alcohol Syndrome

- small head


- flat midface


- missing groove


- small chin


- very think upper lip


- small, narrow eyes


- minor ear anomalies


- little or no bridge


- vertical fold on either side of the nose


- small and short stubby nose




other common disorders in this syndrome


- hearing impairment


- visual impairment


- behavioral and neurological problems

Alcoholism Risk: Adoption Study

looked at 3 groups:


- no alcoholic parent


- 1 alcoholic parent


- 2 alcoholic parents




separated into male and female




results showed that 2 alcoholic parents were far more detrimental to the children's substance abuse risk than just one but especially no alcoholic parent. Males were more affected by 1 or 2 alcoholic parents than females

Alcoholism Risk: Problematic Parenting?

Parental Alcoholism combined with either ineffective monitoring, stressful events, or negative affect leads to.... CHILDREN'S SUBSTANCE ABUSE

Why do people drink? Social Cognitive Factors

- expectations of popularity / social success




- tension reduction hypothesis (conger, 1956): drinking to reduce stress


-- 28 day study, 3 contacts per day


-- drinking to reduce tension actually increases tension next day

Treatment Options: Medications

Drugs


-Antabuse: triggers vomiting after drinking


-tranquilizers (e.g., valium, librium)

Naltrexone

-naltrexone caused significantly fewer amount of people to relapse compared to placebo


- lots of people are still relapsing but not as many on naltrexone

Alcohol + MDD Study

- study with patients who had a dual diagnosis of depression and alcohol dependence


- used zoloft/setraline for depression


- used nalprexone for alcohol use


- each group in the study got CBT for their depression, but there were also four conditions:


1) placebo


2) naltrexone


3) setraline


4) naltrexone and setraline


-pretty significant relapse rate for every group except for the group that used naltrexone and setraline


- so you need to treat the depression AND the alcohol dependence in order to see a decrease in relapse


- wanted to see the effects on harm reduction (episode of HEAVY drinking/binge drinking) rather than effects on patients not drinking alcohol ever again

Alcoholics Anonymous

- most popular form of treatment




-52,000 groups in US (1.2M members)




-somewhat controversial “12 sep” program




-not everyone agrees with its phiilosophy


-- also traditionally not open in participating in studies about alcoholics anonymous (which is why it’s controversial as well)




-no randomized studies have been completed, but they may have done their own studies




-established in 1935

Alcoholics Anonymous

Principles of AA (examples)


- alcoholism is a progressive, chronic illness


-alcoholics have permanently lost the ability to control drinking


-only viable alternative is total and lifelong abstinence


-acceptance and reaching out to fellow alcoholics are key steps towards improvement


-faith in a higher power is a key principle (this is sometimes a bit of a challenge for people who aren’t spiritual or religious)


- 12 steps to the program

Does AA work?

Affiliation with AA after formal treatment is associated with positive drinking outcomes


-high levels of commitment to abstinence


-higher appraisal of harm from drinking


-better self-efficacy to stop drinking; being affiliated with AA helps people that they will be able to stop drinking


-AA claims 75% success rate, but this success rate is for people that stick with AA


--so if you’re with AA for a year, 75% of those people will not relapse


--but what you really want to know is how many people continue with the program versus those who simply just attend the meeting; so what’s the success rate for anyone who simply attends a meeting


--so it’s actually only 10% success rate in terms of people who stick with AA and don’t relapse out of everyone who has ever attended

Psychological Treatment Options

Group Therapy


- generally involves people who are going through recovery




Cognitive-Behavioral Treatment


- the goal is to take a harm-reduction approach and avoid binge drinking or binge episodes of drinking rather than a total abstinence approach




Motivational Treatments


- motivational interviewing


- basic idea is that you have individuals who are often ambivalent about stopping drinking, and the goal is to really increase the client's motivation to stop drinking, increasing their internal or intrinsic motivation


- you want to move them from contemplating stopping drinking and towards an action stage of moving forward with not drinking


- the way to do this is not to coerce them but to address their ambivalence


- the best way to motivate someone is not to confront them but rather address their ambivalence by saying "well, maybe right now isn't the right time to stop drinking" and they will either agree (making them not ambivalent) or they will try to convince you and come up with other reasons as to why they should stop


- by the end of the session, they're kind of ready to move forward

Project MATCH

largest clinical trial of psychotherapies ever


-took them 8 years


-had many clinic testing sites


- took billions of dollars




Three active treatments:


- 12 step facilitation (similar to AA; same idea as AA but less emphasis on God; still had a similar higher power idea)


- cognitive-behavioral therapy: emphasis was on harm reduction and reducing drinking


- motivational enhancement therapy




the treatments were selected because they were all fairly distinct and all showed success in their own small groups




there were dramatic improvement, but all were equally effective




should have added a control group




all the groups are kind of the same in that they all need self-efficacy

Marijuana

Pot, Ganga, Weed, Grass


-plant leaves are smoked


-THC (tetrahydrocannabinol) connects to cannabinoid receptors on nerve cells


-memory and learning problems, distorted perception, and difficulty thinking and solving problems



Marijuana Effects: Regions with many cannabinoid receptors

Brain Region: Function




- cerebellum: body movement, coordination


- hippocampus: learning and memory


- cerebral cortex: higher cognitive functions


- nucleus accumbens: reward


- basal ganglia: movement

Marijuana Effects

THC binds to receptors that regulate balance, posture, coordination of movement, and reaction time


- 6-11% of fatal accident victims test positive for THC


- marijuana and alcohol are often found together in users

Marijuana: Social Effects

- heavy marijuana use impairs ability to form memories, recall events, and shift attention




- long-term heavy marijuana users' ability to recall words from a list was impaired I week following cessation of marijuana use


-- even a week after stopping MJ use, you still see some cognitive influence


-- but the brain is pretty elastic so after 4 weeks, you see the brain return to regular levels; this is seen typically in college aged youth who haven't had long-term marijuana use and are relatively healthy


-- even for those who are long term users, brain does bounce back eventually, but they operate at lower cognitive level at all times




- you perform at higher levels without MJ, even if it seems like a person is brilliant with MJ. You have to ask what they would be like without it, and the evidence suggests that they would be even more brilliant/higher performing




- measured problem-solving and emotional skills 8th and 12th grade




- students drinking alcohol plus smoking marijuana in 8th grade particularly problematic outcomes

Cocaine

Coke, Snow, Flake


-powder or dissolved in water and injected


-crack is less expensive more potent form




-interferes with reabsorption of dopamine and produces continuous high




-highs range from 5-30 minutes




- some people will go on binges of cocaine, using it repeatedly within a short period of time




-with these binges comes withdrawal


-- extreme cases see full blown psychosis


-- paranoia




Physical Reactions:


-heart attacks


-respiratory failure


-chest pain


-heart failure




- such a strong high that even when people aren't high, they have a strong craving for that high and will do anything to get another hit

Methamphetamine

speed, meth, chalk




ingested, smoked, injected and give very pleasurable high (or rush if smoked)




stimulant - sudden “rush” of pleasure or a prolonged sense of euphoria, as well as increased energy, focus, confidence, sexual prowess and feelings of desirability




could last several hours, in contrast to cocaine




used to be used for narcolepsy, obesity, and other health conditions


-now that people know the consequences of using these, no longer used as medication




the dopamine levels of release are off the charts compared to cocaine, sex, food


-meth - 1200%


-cocaine - 350%


-sex - 100%


-food - 50%




over time, the brain thinks it doesn’t need as many dopamine receptors because it is being flooded with dopamine


-but when the dopamine receptors are lost, the person feels the need for more dopamine, which leads to more meth use, which leads to more dopamine receptors lost and so on


-this eventually leads to a person not being able to feel pleasure without using meth

Prevalence of Meth

12.3 million people aged 12+ used in life




5.2 percent of the population




majority between 18-34 years of age




in 2004, 6.2% high school seniors reported lifetime use (unchanged from 2003)




decline in lifetime use of 8th grade users

Montana Meth Project

2005 Montana ranked #5 for Meth use




50% of inmates were incarcerated for meth




50% of foster-care admissions were meth related


-parents became addicted to meth and didn’t care about anything else, including their children, except getting their next fix




started a large-scale, statewide prevention campaign


-included billboards, ads, tv ads, etc in LARGE numbers (Montana is not a large state, so it really hit a lot of people)


-targeted at younger audience; “actually, doing meth won’t make it easier to hook up” example of ad


-showed the consequences of meth


-didn’t show at all what meth looks like so it didn’t give young people more information on how to get it


-showed even social consequences; “my girlfriend said she would do anything for me, so I made her sell her body"


-really targeted the 18-34 audience

Montana Meth Project Results

-montana now ranks #39 for Meth use


-teen meth use declined by 63%


-adult meth use declined by 72%


-meth related crime declined by 62%


-similar campaigns have been launched in Arizona, Colorado, Georgia, Hawaii, Illinois, and Wyoming

Heroin

Smack, H, ska, junk




effects appear and leave quickly




surge of euphoria accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities




one of the issues with heroin is that sometimes the withdrawal is so unpleasant that people may have the genuine desire to stop but they continue to use just to deal with withdrawal symptoms




withdrawal symptoms include:


-muscle aches


-diarrhea


-insomnia


-vomiting


-pains in bones


-restlessness


-extreme discomfort







Health Complications with heroin

HIV used to be an issue, partially because heroin was injected and needles passed around could lead to the spread of HIV

What system of the body does Heroin activate?

activates the opiate system in the body


- opiates can depress breathing by changing neuro-chemical activity in the brain stem, where automatic body functions are controlled


- opiates can change the limbic system, which controls emotions, to increase feelings of pleasure


- opiates can block pain messages transmitted through the spinal cord from the body

Opiate Addiction Treatment

Use of Methadone


- theory is that people switch to methadone to get them off of opiate addiction, and then slowly reduce their methadone use until they are off of it completely


-people felt that they weren’t really getting off of their heroin/drug use or they weren’t really free when they were using methadone treatment because they were still dependent on something


-vicious circle of methadone and heroin: the only way to get off of heroin is to take methadone, the only way to get off of methadone is to take heroin




Compared to other forms of treatment, methadone decreases drug use, reduces medical comorbidity, decreases transmission of HIV, reduces mortality, and improves social functioning




Methadone is a synthetic opiod


- the idea is that it will reduce a lot of the effects of withdrawal from heroin, and block some of the effects of heroin as well


-but then the question becomes, how do we get people off of methadone? Or should we be getting them off of methadone vs seeing it as a long term treatment

More Info on Methadone and its treatmetn

- methadone does not get you high but limits withdrawal symptoms




-might feel lightheaded at first, but will develop tolerance




-long term vs short term (1-2) years treatment


-- long term is many years if not lifetime


-- we do know that methadone treatment that is only 30 days has been associated with high relapse, so the short term treatment should be longer than 30 days




-short term treatment associated with greater likelihood of relapse




- you prescribe methadone for a certain amount of time, and then you taper a person off of methadone



Study done with methadone

-tapering of methadone treatment


-both conditions had psychological therapy as well


-methadone detox condition (short term) also received a lot of additional education (14 extra sessions) and six months of after care services


-the methadone maintenance group was lower than the methadone tampering group, and they begin to diverge around the time when the tapering should be done


-everyone in the groups is still using heroin though, just not as much

Opiate Addiction Treatment

compared to other forms of treatment, methadone increases treatment retention, decreases drug use, reduces medical comorbidity, decreases transmission of HIV, reduces mortality, and improves social functioning

Health Psychology: Presenting Symptoms

-sad mood


-fatigue


-weight gain


-irritability


-cold intolerance


-slow speech

Hypothyroidism

-presenting symptoms lead you to think about depression, but there’s a physiological underlying cause to the symptoms they are experiencing


-in hypothyroidism, the thyroid gland can be small or large (goiter), depending on the cause of low levels of thyroid hormone


-Atrophied thyroid


- when you treat hypothyroidism, you often treat the depression as well

Psychology and Health

- a couple different ways that psychological or biological factors can affect health




-one way is that emotions, reactions to environment (known as stress), etc, can disrupt some psychological process that benefits our health






-the other way is engaging in risky behaviors that results in some sort of physical disorder or disease, health condition, etc


-- poor eating


-- lack of exercise


-- smoking




-so psychology can have a really big impact on health

Daily Stress and Illness

-about a week or so, before the onset of symptoms, people are much more likely to experience a stressful event


- charts show number of desirable events for the ten days preceding an episode of respiratory infection vs number of undesirable events in the ten days preceding an episode of respiratory infection, with undesirable events coming out on top in number



Social Factors and Health (study with wound healing)

- you wound someone and see how long they take to recover; but is that dependent on stress and how you manage your emotions?




- chronic stress


-- caregivers for alzheimer's patient take longer for wound to heal than controls


-- take longer to heal: 48 vs 39 days


-- also have poorer immune functioning




- stress suppressed your body's ability to fight infection

Stress and Influenza experiment

- give everyone a flue virus at the hospital, and during the week of their hospital stay, they measure their mucus output




-people with high stress over the last 30 days experience worse flu symptoms than people without stress over the last 30 days

Social Support and Stress

-physically having someone present seems to be a buffer on stress, so social support and having friends/family nearby helps reduce stress


-this is true for blood pressure, for galvanic skin response (how much the skin sweats)

Cognitive Processing and Health Study

- 40 HIV+ men interviewed following loss of close friends to AIDS




- health outcomes followed for 2 years




-measured cognitive processing and discovery of meaning


-- cognitive processing: thinking about death


-- discovery of meaning: after death, did the person change their perspective or did the death have some sort of meaning for the person

Further Definition of Cognitive Processing Category from Study

Definition: deliberate, effortful, or long lasting thinking about the death




Examples:


- "I think in a spiritual way, I tried to understand it"


- "I keep thinking about what the lessons are for me, what can I learn"


_ "I've been thinking more about what I'm doing, dealing with myself and what I want to accomplish"


- "I'll think about (him), as a person, as a friend. More importantly, I think about him as a life"

Further Definition of Discovery of Meaning

Definition: Major shift in values, priorities, or perspective in response to the loss




Examples


- "In one way I suppose that his passing influenced me to believe more strongly about the quality of life and living life in a satisfying way as much as possible"


- " I certainly appreciated more the friends that I have and became much closer with them"

Study Design of HIV Study

-pretty simple: follow the men for 2 years and study their immune systems


-40% engaged in discovery of meaning


-people who didn't engage in cognitive processing (low CP) had a dropped TC count


-if you were high in cognitive processing but didn’t engage in meaning, they had a similar TC count drop


-But for those who had both high CP and meaning, they saw no change and maybe a bit of improvement





Psychological Interventions and Health

mainly correlational studies up to this point




can psychological interventions actually slow illness progression


-cancer


-HIV

Psychological Interventions and Cancer: Mortality

1 year


-no effective psychological intervention for morality at 1YR




4 YRS


- in about 670 patients, similar effects as 1YR in that there is not much difference from "no difference"


-in terms of enhancing survival, unfortunately the allegory data says that there isn't much support for enhancing survival


-no effective psychological intervention for mortality at 4 yrs


-what we do find nice effects for is quality of life

Psychological Interventions and Cancer: Quality of Life

- significantly different than zero and favors intervention


- fairly large effect; mean effect size was .91


- these interventions help with quality of life; significantly improve depression and anxiety


- so although these psychological interventions don't prolong life during cancer treatments, they do improve quality of life


-also a smaller effect and benefit for pain



Acquired Immunodeficiency Virus

Nature of AIDS




Role of Stress Reduction Program


- high stress and low social support speed AIDS progression

Cognitive-Behavioral Stress Management (CBSM)

10 Weekly meetings, 2.5 hours/week




stress management:


- change cognitive distortions, improving coping, assertiveness, anger management, and increase social support




relaxation


- muscle relaxation, meditation, breathing, and guided imagery




Study results:


-you see improvements in depression and anxiety as well as in immune system functioning over the control groups

Psychological Treatment of Physical Disorders - Biofeedback

biofeedback


- you ask the patients about how they're doing it and they can't tell you; they say they don't know, they just zone out and their blood pressure goes down.


- you can do this with blood pressure, heart rate, etc


-also starting to do near-feedback; deactivate parts of the brain




Biofeedback has shown to have good evidence for hypertension (high blood pressure), chronic head aches (reduced number)


- not good evidence for a whole lot else


-has been shown to be helpful for psychiatric conditions, but not a lot of GOOD evidence that those interventions are effective (these could be like ADHD)

Delirium Disorders

-impaired consciousness and cognition during course of several hours or days




-10-30% of emergency room cases




-often co-occurs with dementia


--can be confusing if it’s not an extreme or profound delirium because you have to ask “is this just a more severe dementia or different dementia? Or is there something new now?"




-most prevalent among the elderly


--recent changes in their medication can induce delirium




-cancer patients also report delirium




-has a fast onset, which is in contrast with dementia

Delirium Treatment

- delirium is treated typically in the short-term with an anti-psychotic


--delirium from substances treated with haloperidol or other antipsychotics




-Haloperidol also given for acute delirium




-psychosocial treatments also used


--supportive treatment


--familiar belongings


--include in treatment decisions

Dementia: Case Study

- a woman in her early 50s was admitted to a hospital because of increasingly odd behavior: her family reported that she had been showing memory problems and strong feelings of jealousy. She also had become disoriented at home and was hiding objects. During a doctor’s examination, the woman was unable to remember her husband’s name, the year, or how long she had been at the hospital. She could read but did not seem to understand what she read, and she stressed the words in an unusual way. She sometimes became agitated and seemed to have hallucinations and irrational fears




-this is Agusta D, a woman from the late 1800s (died in 1906) and is now known to have been the first person with Alzheimers




-one of the most unusual parts of the story (and a give away to her condition) is her young age, she was only in her 50s.




-Alzheimer’s is a form of dementia; there are many ways to develop dementia, and alzheimers is just one of them



Dementia

alzheimers disease major cause of dementia


-dementia “deprived of mind"


-loss of cognitive function beyond normal aging




dementia is not a specific disease


-there are different diseases that lead to dementia (ex: alzheimers)


-sometimes you can see an infection in the wrong part of the brain or brain injury leading to dementia


-rather than a specific disease, it describes collection of symptoms

Dementia effects on the brain

brain regions no longer function as they should, and the cell loss from that is beyond what you would normally expect for aging




impaired intellectual functioning; have to have the loss of at least two brain functions to be diagnosed. These can include:


- difficulty solving problems


- difficulty with emotions


- perceptual hallucinations


- delusions


- difficulty with attentional or other cognitive control


- working memory: keeping info in your mind then manipulating it


- memory




symptoms need to be present for at least six months



Dementia: statistics and population

about 7 million americans suffer from dementia


-about 2 million of the 7 suffer from severe dementia and can’t function any more




clearly associated with age


-about half of everyone over the age of 85 has some form of dementia


-there are early onset forms of dementia as well




all forms of dementia result from death of nerve cells (or loss of communication)


-cortical dementia


-subcortical dementia




progressive dementia: the gradual loss of mental functions such as the ability to think, reason, remember, and plan.

Treatment of Dementia

drugs: do not halt disease but may slow progression


-cholinesterase inhibitors (aricept)




Cognitive training


-helps with executive function, learning, working memory (possibly daily function)




Behavioral modification


-putting your keys in the same spot everyday so that you always know where to go when you forget where you put them

Alzheimer's Disease

-most common cause of dementia in 65+


-4 million people in US


-1 in 10 over 65; almost 50% over 85


-360,000 Americans diagnoses with AD/year


-50,000 die from AD each year


-most people with alzheimer’s die from their body shutting down because it isn’t working the right way


-on average, patient with AD live for 8-10 years after they are diagnosed; some live as long as 20 years


-patients with AD often die of aspiration pneumonia because lose ability to swallow; food gets stuck in their lungs and they are not able to get it out

Alzheimer's brain

- extreme shrinkage of the brain


-the hippocampus experiences a lot of shrinkage as well, which is important because this area plays a key role in forming new memories


-shrinkage of cerebral cortex


-severely enlarged ventricles

Alzheimer's Disease: More bio stuff

- protein doesn’t divide properly, so it builds up and forms these sticky plaques


-neuron loses shape, can’t transport nutrients properly, and then the neuron dies


-neurofibrillary tangles; lasting impact you see in patients with AD


-we don’t really know exactly what is going on with the neurons; what we need to know is what are the disease mechanisms leading to these end points



Treatment of Alzheimers

- cholinesterase inhibitors


-slow down breakdown of acetylcholine


-acetylcholine is neurotransmitter used formation of memories


-hippocampus and cerebral cortex, two brain regions that are affected by AD

Amnestic Disorder

-focused primarily on memory disfunction


-can include different types of memory loss


-retrograde amnesia vs anterograde amnesia


-language and cognitive control is fine, working memory is fine



Retrograde amnesia

-difficulty recalling events that happened prior to the amnestic disorder


-loss of the ability to retrieve old memories


-in contrast to anterograde amnesia



anterograde amnesia

-no longer able to learn new information because they can’t retain new memories


-all long term memories in tact

Video on Amnestic Disorder:

-roger comprehends everything, but retains almost nothing


-his condition is called global amnesia


-his memory is like a tape deck : able to retain about 1 minute of information, and then 60 seconds later, that information is gone


-it’s like a recorder that self erases constantly and consistently every 60 seconds


-his memories from 1980 and before then are completely intact


-he got amnestic disorder through a virus that ended up affecting his brain



Amnestic Disorder

another way to develop amnestic symptoms is through wernicke-korsakoff syndrome


-profound difficulty recalling information presented several minutes earlier


-caused by damage to the thalamus


-relay station for other parts of the brain


-often due vitamin B-I (thiamine) deficiency, associated with heavy alcohol use

Schizophrenia spectrum and psychotic disorders

-defined by abnormalities in one or more of the following: delusions, hallucinations, disorganized thinking/speech, disorganized behavior, and negative symptoms




involves the following disorders:


- schizophrenia


-delusional disorder


-schizoaffective disorder


-schizophreniform


-catatonia


-schizotypal personality disorder

delusional disorder

having bizarre or non bizarre delusions that are not grounded in reality


-bizarre delusions are bizarre and just not likely; ex: i'm the second coming of Jesus


-non bizarre delusions are thinking that someone is out to get you, but it can turn bizarre the more complicated it gets (government involvement). But non bizarre delusions can be probably and may have happened to others in the past, but it's still unlikely

shizoaffective disorder

similar to schizophrenia but for a shorter duration. Combined with a mood disorder.

schizophreniform

-if its the first 6 months of symptoms for schizophrenia, you will be diagnosed with schizophreniform until evidence shows that the symptoms are persisting past 6 months




-after 6 months, the diagnosis would then be schizophrenia




-however, sometimes symptoms only last for a couple months and therefore clinicians wanted to avoid giving the diagnosis for schizophrenia until it showed more stability in the symptoms

catatonia

abnormality of movement and behavior arising from a disturbed mental state (typically schizophrenia). It may involve repetitive or purposeless overactivity, or catalepsy, resistance to passive movement, and negativism.

schizotypal personality disorder

-odd views of the world


-may seem eccentric


-tend to have delusions, but those delusions are more of the non-bizarre type and are grounded in a bit more in reality; ex: able to "read" people


-often have a lot of trouble socially because of the eccentricities that make it difficult for others to relate to them


-feel like they are misunderstood by people and tend to spend a lot of their time alone

schizophrenia: DSM-5 diagnostic criteria

characteristics symptoms: 2 of 5 "for a significant portion of time" during a 1-month period

-delusions


-hallucinations


-disorganized speech (frequent derailment, incoherence)


-grossly disorganized or catatonic behavior


-negative symptoms: flat affect, alogia (not saying much), avolition (low motivation)




these symptoms must interfere with functioning (work, interpersonal relations, self care)




continuous signs of disturbance for 6 months; less than six months consider schizophreniform disorder




cannot be due to drugs or medication

schizophrenia: statistics and population

onset age


- men: 16-25


-women: 25-30




Women have a little bit later onset than men




lifetime prevalence rates: around 1/2 to 1%




lifetime prognosis


-pretty variable, but women tend to have better prognosis


-women take longer to relapse, have shorter hospital stays, etc

Types of Delusions

-persecutory


-jealousy


-guilt, sin


-grandeur


-religious


-delusions of reference


-delusions of being controlled


-delusions of mind reading


-thought broadcasting


-thought insertion


-thought withdrawal

Types of Hallucinations

Visual: seeing things that aren't there


Somatic-tactile: feelings something that isn't there (spiders crawling up your arms)


Olfactory: smelling something that isn't there


Auditory: voices commenting or conversing

Negative Symtpoms

Means there is a lack or absence of something




Affective flattening


-loss or lack of emotions




Alogia


-might grunt a single word answer


-not very descriptive in speech




Anhedonia


-lack of interest in things they used to enjoy


-they are asocial, which means they are simply not interested in people (commonly mistaken for being antisocial, but that requires more aggression)




Avoliton


-apathy


-a lack of motivation

Positive Symptoms

Means there is a presence of something




Thought Disorder


-derailment: discourse consisting of a sequence of unrelated or only remotely related ideas




-tangentiality: the tendency to speak about topics unrelated to the main topic of discussion




-incoherence: word salad; speech that is unintelligible




-illogicality: Conclusions are reached that do not follow logically (non sequiturs or faulty inductive inferences).




-circumstantiality: non-linear thought pattern and occurs when the focus of a conversation drifts, but often comes back to the point




-clanging: a mode of speech characterized by association of words based upon sound rather than concept (compulsive rhyming or alliteration without logical connection between words)




-pressure of speech: tendency to speak rapidly and frenziedly, as if motivated by an urgency not apparent to the listener; difficult to interrupt or understand




-distractible speech: During mid speech, the subject is changed in response to a stimulus



How can schizophrenia change a person over time?

in their appearance, voice, and speech

Neuropsychological findings on schizophrenia

bellack, gearon, and blanchard (2000)


-deficits in attention, memory, abstract reasoning


-deficits in ability to integrate situational context or previous experience into ongoing processes (‘executive’ functions)

Why aren't schizophrenia subtypes used anymore?

They got rid of the subtypes of schizophrenia because they found people cycle through different types and that they only serve to divide schizophrenics up further than they need to be.

Brain structural abnormalities

-enlarged lateral ventricles




-widened cortical sulci




-decreased temporal lobe volume


--speech semantics is important in temporal robe


-temporal lobe plays important role in executive functioning, longterm memory, hippocampus




-hypofrontality - decreased activity in prefrontal cortex (PC is important for decision making, personality)

Genetics

-genetic contribution to schizophrenia


-as your relationship to someone affected by schizo decreases, your risk of developing schizo also decreases


-if you have a twin who has schizophrenia, the odds of you getting it is 50/50


-the offspring of two parents with schizophrenia also highly increases your chances of developing schizophrenia

Etiology: Bad Mothering?

number of old models of schizophrenia that tried to blame the mom




Bateson (1956): Double bind hypothesis


-particular forms of conflicting communications to the child cause schizophrenia




Schizophrenogenic Mother Hypothesis


-freida fromm-reichmann (1948) inferred “toxic” parenting by mother creates schizophrenia in the child



Etiology: Critical Families

-expressed emotion: just like in bipolar disorder, EE does not CAUSE schizophrenia


-but when someone is in a household with lots of aggravating comments, people with schizophrenia are twice as likely to relapse




-relative talk about that patient in a critical, hostile, or emotionally over involved way

Etiology: Life Stress

-retrospective reports support role of life stress in onset of schizophrenia




Prospective study confirmed this:


-contact patients every 2 weeks


-life stress month before predicted onset


-in this study, half of the patients reported no life stress before the onset of symptoms, so there doesn't have to be life stressors before hand


-however there is a weak link with life stressors and onset of schizophrenia

Social Causation Hypothesis

-schizophrenia more common in lower than higher social classes (income, job status)


-fathers and brothers of schizophrenia patients are not over-represented in lower social classes


-suggests downward drift hypothesis


-this has been debunked! was popular 40/50 years ago

When was the beginning of widespread use of antipsychotic agents?

1955




it caused a decline in the number of patients in mental institutions

Drug Agonists

Drug produces an increase in the creation of the neurotransmitter




Drug helps increase the release of the neurotransmitter




All happens in the Synapse/Synaptic Vesicle and Dendrite

Drug Antagonist

Drug interferes with the release of the neurotransmitter




Drug occupies the receptors, blocking the neurotransmitter




Drug causes the neurotransmitter to leak from the synaptic vesicle

Chlorpromazine (thorazine)

- 1950s french neurosurgeon, Henri Laborit, was searching for drugs to relax patients prior to surgery




- helps to minimize the effective dopamine


- chlorpromazine is an antagonist


- locks symptoms of schizophrenia, occupies the dopamine site on the D2 receptor preventing receptor activation by dopamine



How do Amphetamines and cocaine effect the dopamine terminal and schizophrenia??

Serve as agonists and have the following effects:




-agonist: amphetamine promotes the release of dopamine and fosters symptoms of schizophrenia




- agonist: both amphetamine and cocaine block re-uptake of dopamine and foster symptoms of schizophrenia

Traditional Antipsychotics

-all symptoms respond to traditional neuroleptics (chlorpromazine (thorazine), haloperidol)


-good for treating positive symptoms (these could be hallucinations, delusions, thought disorders)


-they are okay with the negative symptoms;have some impact, but they are not as good at treating negative symptoms





What are the long-term side effects of traditional antipsychotics and what are they due to?

due to the decreased dopamine




following are the side effects:


-tardisconesia - lip smacking


-itchy muscles


-movement difficulties: could have trouble with their gait, you’ll see them shuffling instead of walking; see some tremors; similar to what you see in parkinson; muscle stiffness as well




so these drugs are rarely used over the long-term as well because of all the evidence the evidence for side effects


-building on this work, they have now developed atypical antipsychotics





Atypical Antipsychotics

target multiple receptors, and are a little more specific in the receptors they target


-still target D2 receptors, but more specific to the brain regions thought to produce some of the positive symptoms


-also bind to D3 and D4 receptors, and those are primarily in the cortex in the limbic system (the rain regions involved in emotions and function)




You don't see as many movement side effects in these drugs as the traditional ones




also target serotonin so you see less mood side effects

Atypical Antipsychotics include the following medications:

-risperidone (Risperdal)


-Olanzapine (zyprexa)


-clozapine (clozaril)

Which symptoms are reduced with atypical antipsychotics?

-reduce hallucinations, both auditory and visual


-reduces positive symptoms


-okay for negative symptoms and cognitive problems than traditional antipsychotics

Are the newer medications better? Study details

examined 12,649 patients in 52 RCTs


-compared atypical antipsychotics to conventional antipsychotics


-many people were not on an appropriate dosage of these antipsychotics




at the appropriate dosage, no differences in drop out or effectiveness


-conventional antipsychotics (at proper dosage) no different from atypicals


-however, there were fewer extrapyramidal side effects (movement)




From Beever's personal experience, these atypical antipsychotics have worked very well, even within a few days


-less hallucinations


-a challenge to get someone who is that paranoid already to take the medication



What kind of side effects does thorazine have?

-hard to make coherent speech


-powers of thought, articulation, rationalization, etc are taken from you


-throat feels like it is on fire


-muscular discoordination

Psychosocial Treatment

-medications help with positive and negative symptoms


-not as effective for improving social adjustment, obtaining employment, managing life stress (functional outcomes)

Cognitive Therapy

-therapy focuses on achievable long-term goals (e.g., independent housing, employment, relationships), intermediate goals, and short-term goals




-key impediments to reaching these goals are dysfunctional beliefs


-- "taking even a small risk is foolish because the loss is likely to be a disaster"


-- "making new friends isn't worth the energy it takes"




-special focus on negative symptoms


-use cognitive and behavioral techniques (e.g., exercises, games, role-playing, community outings)


-collaboratively devised action plans for practice outside the session


-other impediments to reaching goals such as the presence of delusions, hallucinations, and disorganized thinking were also addressed

Cognitive Therapy Study Details

-treatment was tailored to the participant's level of functioning




-Therapists made extensive use of visual aids


--whiteboards for reinforcing session material


--laminated cards to help patients remember key take-home points


--colorful signs that patients posted at home




-Deficits in attention, executive function, and social skills were targets for the therapy




-later sessions were devoted to consolidation of functional gains and relapse prevention

Cognitive Therapy Study Results

-a promising treatment


-significant improvements in positive symptoms in the CT with ST group


-CT with ST helped improve avolition-apathy and anhedonia-asociality


-ST only helped with affective flattening and alogia





Effectiveness of Family Therapy

Family treatment

-relapse: 24% family therapy vs 64% TAU


-effects seem durable (9 months - 2 years)


-lack of research testing effectiveness in community settings



Assertive Case Management (What's main goal?)

patients with schizophrenia have difficulty finding services in community




assertive case management


-assigned to multidisciplinary team (nurse, case manager, etc)


-delivers services for immediate needs


-main goal is to prevent re-hospitalization not rehabilitation



Social Skills Training

training in capabilities necessary for effective social performance




break skills into smaller components

Vocational Rehabilitation

-<20% have regular community job




-programs help find and maintain jobs




-goal is permanent placement


--do not provide specific skill training


--place the individual into job


-- unlimited support to help maintain job



Psychosocial treatments summary

-good support for family treatments


-assertive case management also effective


-social competence improves with social skills training


-vocational treatment appropriate for those who want to work


-CBT also appears to be effective