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DSM-IV-TR divided substance problems into 2 categories:

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Substance abuse Substance dependence

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DSM-5 Criteria for Substance Use Disorder

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Two or more symptoms within a 1 year period: -Failure to meet obligations -Repeated use in situations where it is physically dangerous -Repeated relationship problems -Continued use despite problems caused by the substance -Tolerance -Withdrawal -Substance taken for a longer time or in greater amounts than intended -Efforts to reduce or control use do not work -Much time spent trying to obtain the substance -Social, hobbies, or work activities given up or reduced -Craving to use the substance is strong

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Treatments of Substance Use Disorders

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-Detox -AA -CBT -Contingency-Management Therapy -Controlled drinking medications

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Alcohol Use & effects

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Alcoholic- dependent/heavy user Delirium Tremens (DTs) Polydrug abuse (users use multiple substances)

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addicting agent of tobacco

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nicotine

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Tobacco prevalence

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-More prevalent among White and Hispanic youth than African Americans -However African Americans less likely to quit and more likely to get lung cancer -More prevalent among men than women (Except 12- to 17)

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Cannabis prevalence

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-Greater use by men than women -More common in European- and Native Americans than in Africa, Asian, or Hispanics

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major active ingredient in marijuana

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THC

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Effects of marijuana

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-Increased blood pressure -Rapid shifts of emotion -Effects take 30 minutes to appear

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Brain effects of marijuana

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-Cannabinoid brain receptors High concentration in hippocampus -Increased blood flow to emotion regions (Amygdala and anterior cingulate) -Reduces nausea and loss of appetite caused by chemotherapy -Relieves discomfort of AIDS & chronic pain

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Opiates

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Group of addictive sedatives that in moderate doses relieve pain and induce sleep

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Effects of opiates

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-Stimulate receptors of the body's opioid system producing euphoria, drowsiness, and lack of coordination -Loss of inhibition, increased self-confidence -Severe letdown after about 4 to 6 hours Tolerance develops and withdrawal occurs Muscle soreness and twitching, tearfulness, yawning Become more severe and also include cramps, chills/sweating, increase in heart rate and blood pressure, insomnia, and vomiting Withdrawal lasts about 72 hours

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Stimulants/amphetamines & effects

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Alertness, high energy & motor activity, reduced fatigue, reduced appetite, increased heart rate, and constricts blood vessels Trigger release of and block re uptake of norepinephrine and dopamine High doses can lead to: Nervousness, agitation, irritability, confusion, paranoia, hostility Tolerance can develop after only 6 days' use

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Hallucinogens & effects

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LSD- d-lysergic acid diethylamide Flashbacks Mescaline- Active in peyote Psilocybin (Mushrooms)-psilocybe mexicana Ecstasy (MDMA)- Methylenedioxymethamphetamine Acts on serotonin Its use peaked in 2001, with 1.8 million users; may be rising again PCP- Angel dust, Animal tranquilizer Causes severe paranoia and violence

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Treatment of Drug Use Disorders

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Contingency Management Vouchers given to people who stay off drugs that can be traded for desirable goods Motivational interviewing or Motivational Enhancement therapy Reduce ambivalence Self-help residential homes

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Drug Replacement Treatments and Meds

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Heroin substitutes: Synthetic narcotics- Methadone, levomethadyl acetate, bupreophine Opiate antagonists Prevents feeling high Ex: Naltrexone, suboxone

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treatment for cocaine

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antidepressants and CBT

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Bulimia Nervosa

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an eating disorder characterized by binge eating and subsequent purging, usually by induced vomiting and/or use of laxatives

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Binge-Eating Disorder

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Recurrent episodes once a week for 3 months No compensatory behavior is present (i.e., purging) (Basically eating a whole bunch of food without pucking to purge yourself of some of it) Associated with obesity and history of dieting

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Physical changes & prognosis for Eating Disorders

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Family and twin studies support genetic link First-degree relatives of individuals with eating disorders more likely to have the disorder Higher rates for both anorexia and bulimia in identical twins Body dissatisfaction, desire for thinness, binge eating, and weight preoccupation all heritable Environmental factors (e.g., family interactions) play an even greater role in etiology Low levels of endogenous opioids Substances that reduce pain, enhance mood, and suppress appetite Released during starvation & may reinforce restricted eating of anorexia Excessive exercise increases opioids Low levels of opioids in bulimia promote craving Serotonin related to feelings of satiety (feeling full) Low levels of serotonin metabolites in anorexics and bulimics Dopamine related to feelings of pleasure and motivation Anorexics feel more positive and rewarded when viewing pictures of underweight women

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Objectification Theory

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Women defined by their bodies & looks; men defined by their accomplishments, power, and masculinity Societal objectification of women leads to "self-objectification" Women see their own bodies through the eyes of others Leads to more shame when they fall short of cultural ideals

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Normal BMI & obesity

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Normal = 20-25 Obese = >30

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Treatments of Eating Disorders

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Anorexia: 1st gain weight, then long term maintenance CBT: Family-based therapy Bulimia: Anti-depressants CBT more effective than medication Exposure and Response Prevention (ERP) Binge-Eating Disorder: CBT is effective Antidepressant medications not effective

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Sexual norms & sex differences

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culture influences beliefs about sexuality

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Gender identity

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the gender someone associates themselves with

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Gender dysphoria

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Someone who does not assosiate themselves with the gender they are born with Very rare, about 1 in 30,000 men and 1 in 100,000 women meet formal diagnosis

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Sexual response cycle

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Desire phase Excitement phase Orgasm phase Resolution phase (DEOR)

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Female sexual interest/arousal disorder

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Diminished, absent, or reduced frequency of at least three of the following: Interest in sexual activity Sexual/erotic thoughts or fantasies Initiation of sexual activity and responsiveness to partner's attempts to initiate Sexual excitement/pleasure during most sexual encounters Sexual interest/arousal elicited by any internal or external erotic cues Genital or nongenital sensations during most sexual encounters

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Male hypoactive sexual desire disorder

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Persistently deficient or absent sexual fantasies and desires, as judged by the clinician

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Erectile disorder

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-At least 1 of the following symptoms must be experienced approximately 75%-100% of occasions of sexual activity: -Marked difficulty in obtaining an erection during sexual activity -Marked difficulty maintaining an erection until the completion of sexual activity -Marked decrease in erectile rigidity

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Female orgasmic disorder

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On most occasions or almost all occasions (75%-100%) of sexual activity: • Marked delay, infrequency, or absence of orgasm • Markedly reduced intensity of orgasmic sensation

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Delayed ejaculation disorder

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Marked delay, infrequency, or absence of ejaculation on most or all occasions (75%-100%) of sexual activity

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Premature (early) ejaculation disorder

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Persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following penetration and before the individual wishes

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Genito-pelvic pain/penetration disorder

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Vaginal penetration during intercourse Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts Marked fear or anxiety about pain in anticipation of, during, or as a result of vaginal penetration Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration

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Etiology of sexual dysfunction

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Diseases of vascular system Diseases of the nervous system Low levels of testosterone or estrogen Low physiological arousal Heavy alcohol consumption before sex History of chronic alcoholism Heavy cigarette smoking Medications may cause problems Antihypertensives (used to treat high blood pressure) SSRIs

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Treatments of sexual dysfunction

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Anxiety reduction Directed masturbation CBT - change thoughts and attitudes Sexual skills and communication training Couples therapy Medications and physical treatments Squeeze technique for early ejaculation Medications for erectile dysfunction Viagra, Cialis, and Levitra

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Transvestic disorder

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(cross-dressing for sexual gratification) rarely marked by distress and rarely involves nonconsenting persons

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Paraphilic Disorders

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Recurrent sexual attraction to unusual objects or sexual activities For at least 6 months Deviation (para) in what the person is attracted to (philia) Should only be diagnosed when they cause marked distress or done with non consenting persons Transvestic behaviors

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Fetishistic disorder

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Reliance on an inanimate object or nongenital body parts for sexual arousal Occurs most often in men The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

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Pedophilic disorder

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Pedophilic Disorder Pedos = "child", philia = "attraction" Sexually arousing urges, fantasies or behaviors involving sexual contact with child (generally age 13 years or younger) Offender at least 16 years old and 5 years older than victim Often child pornography is widely used Victims usually known to pedophile Neighbors, family members, friends, clergy Most pedophilia does not involve violence other than the sexual activity Incest - subtype of pedophilic disorder with evolutionary significance

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Voyeuristic disorder

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Sexually arousing fantasies, urges, or behaviors while observing unsuspecting person who is naked or engaging in sexual activity The individual has acted on these sexual urges with a nonconsenting person, or sexual urges/fantasies cause clinically significant distress or impairment Excitement comes from knowing the victim is unaware of the voyeur; element of risk important Seldom results in physical contact Orgasm achieved by masturbation Almost always men

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Exhibitionistic disorder

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Intense desire to obtain sexual gratification by exposing one's genitals to unsuspecting persons Victims can be children Seldom results in physical contact Usually involves desire to shock or alarm victim Often comorbid with voyeuristic and frotteuristic disorders The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges/fantasies cause clinically significant distress or impairment

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Frotteuristic disorder

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Sexual arousal from touching or rubbing against a nonconsenting person The individual rubs his/her genitals against another person's body or fondles their genitals Often occurs in crowded subway or other public place Uninvited sexual touching of or rubbing against another individual may occur in up to 30% of adult males in the general population Substantially fewer females than males are diagnosed with this disorder

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Sexual sadism

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Intense and recurrent desire to obtain or increase sexual gratification by inflicting pain or psychological suffering on another person

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sexual masochism disorder

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Intense and recurrent desire to obtain or increase sexual gratification through receiving pain or humiliation

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Asphyxiophilia

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oxygen deprivation during sex

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Etiology of paraphilias

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Neurobiological factors Male hormones or androgens Almost all individuals with paraphilias are men Do not have unusual levels of testosterone Classical conditioning not supported by research Operant conditioning Poor social skills or reinforcement of unconventionality History of childhood physical and sexual abuse Alcohol and negative affect are common triggers Cognitive distortions "Because the child doesn't run away, she must want me to fondle her"

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Treatments of paraphilias

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Incarceration and court-ordered treatment are common Often difficult to interpret outcome from treatment studies Studies vary greatly Many lack control groups Dropout rates are high Enhance motivation Denial and minimization of problem often present Some blame the victim Lack of motivation for treatment Drop out of treatment Cognitive behavioral treatment Aversion therapy Covert sensitization Counter distorted thinking Often combined with social skills and empathy training Biological treatments Medications Hormonal agents to reduce androgens SSRIs to help control impulses

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Developmental psychology

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Studies disorders of childhood within context of lifespan development

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Changes from DSM-IV-TR to DSM-5

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Autism, Aspergers, Disintegrative, Persuasive developmental disorders became AUTISM SPECTRUM DISORDER Mental retardation became INTELLECTUAL DISABILITY

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Neurodevelopmental Disorders

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a disorder that stems from early brain abnormalities (Autism spectrum disorder, intellectual disabilities, learning disorder, ADHD, tic disorders)

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Externalizing disorders

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Characterized by outward-directed behaviors Noncompliance, aggressiveness, overactivity, impulsiveness (Includes ADHD, conduct disorder, and oppositional defiant disorder)

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Internalizing disorders

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Characterized by inward-focused behaviors Depression, anxiety, social withdrawal Includes childhood anxiety and mood disorders

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ADHD criteria

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- often fails to give close attention to details or makes careless mistakes in schoolwork, work, or during other activities - often has difficulty sustaining attention in tasks or play activities - often does not seem to listen when spoken to directly - often does not follow through on instructions and fails to finish school work, chores, or duties in the work place - often has difficulty organizing tasks and activities - often avoids or is reluctant to engage in tasks that require sustained mental effort - often loses things necessary for tasks or activities - is often easily distracted by extraneous stimuli - is often forgetful in daily activities

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3 subcategories of ADHD

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Predominantly inattentive type Predominantly hyperactive-impulsive type Combined type

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ADHD prevalence

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ADHD often comorbid with anxiety and depression More common in boys Symptoms persist beyond childhood 65-80% still have symptoms in adolescence and adulthood 60% of adults meet criteria for ADHD in remission

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ADHD etiology

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Genetic factors Heritability estimates as high as 70 to 80% Two dopamine genes implicated Either gene associated with increased risk when mother smokes or drinks alcohol during pregnancy Neurobiological factors Dopaminergic areas smaller in children with ADHD Poor performance on tests of frontal lobe function Prenatal factors Low birth weight (can be mitigated by later maternal warmth)

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ADHD treatment

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Medication of stimulants plus behavioral treatment Slightly better than meds alone and improved social skills Psychological treatment Parental training, behavior monitoring, and reinforcement of appropriate behaviors Supportive classroom structure Brief assignments, immediate feedback, task-focused style, breaks for exercise

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Conduct Disorder criteria

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Repetitive, persistent behavior which violates the rights of others or social norms -Aggression to people and animals, -Destruction of property -Deceitfulness or theft -Serious violation of rules

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Conduct Disorder prevalence

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Substance abuse common Comorbid with anxiety and depression Present before anxiety and depression develops Prevalence Boys: 4 to 16% Girls: 1.2 to 9%

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Conduct disorder etiology

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Genetic factors - 40-50% of antisocial behavior is heritable Genetics and environment interact Abuse as a child PLUS low MAOA activity most likely to develop Conduct Disorder Poor verbal skills; Low IQ; Lower levels of resting skin conductance and heart rate suggest lower arousal levels Psychological factors Deficient moral development, especially lack of remorse Modeling and reinforcement of aggressive behavior Abuse or Harsh and inconsistent parenting Lack of parental monitoring (neglect) Cognitive bias: Neutral acts by others perceived as hostile Sociocultural factors Poverty & Urban environment Higher rates of delinquent acts among African American males linked to living in poorer neighborhoods rather than race Peer influences associated with Conduct Disorder Rejection by peers & Affiliation with deviant peers

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Oppositional Defiant Disorder

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ODD behaviors do not meet criteria for Conduct Disorder (especially extreme physical aggressiveness) but child displays pattern of defiant behavior Argumentative Loses temper Lack of compliance Deliberately aggravates others Hostile, vindictive, spiteful, or touchy Blames others for their problems

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Treatment of Conduct Disorder

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Family interventions Family check-ups (FCU) linked with less disruptive behavior Parental Management Training (PMT) Teach parents to monitor more & reward prosocial behavior Multisystemic therapy Deliver intensive community-based services

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Depression and Anxiety children/adolescents

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Commonly co-occur with ADHD and CD Also co-occur with each other Early research suggested that depression and anxiety could be distinguished from each other: Depression - high negative affect, low positive affect Anxiety - high negative affect but not low levels of positive affect

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Depression in Children and Adolescents

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Symptoms common to children, adolescents, and adults Depressed mood Inability to experience pleasure Fatigue Problems concentrating Suicidal ideation Symptoms specific to children and adolescents Higher rates of suicide attempts and guilt Lower rates of Early morning awakening Early morning depression Loss of appetite Weight loss

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Etiology of Depression in Children and Adolescents

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Genetic factors Early adversity and negative life events Family and relationship factors A parent who is depressed Children with depression interact with their parents in negative ways (Less warmth & More hostility) Cognitive distortions and negative attributional style Stable attributional style Believe that a negative event, or the effects of it, are permanent

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Treatment of Depression in Children and Adolescents

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Medications (antidepressants) Concerns: side effects and increased risk of suicide Psychotherapy generally only modestly effective with children and adolescents Interpersonal psychotherapy (IPT) Focuses on peer pressures, transition to adulthood, and issues related to independence CBT - change thoughts & behaviors More effective for those with recurrent depression, high cognitive ability, and good coping skills

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Anxiety in Children and Adolescents

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Fears and worries common in childhood Anxiety disorder More severe and persistent worry Must interfere with functioning Most childhood fears disappear but adults with anxiety disorders report feeling anxious as children "I've always been this way" Prevalence 3-5% of children and adolescents are diagnosed with anxiety disorder

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Separation Anxiety Disorder (children)

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Worry about parental or personal safety when away from parents Typically first observed when child begins school

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Social Anxiety Disorder (children)

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Extremely shy and quiet May exhibit selective mutism Refusal to speak in unfamiliar social setting Prevalence 1% of children and adolescents Etiology Overestimation of threat Underestimation of coping ability Poor social skills

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PTSD in children

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Exposure to trauma Chronic physical or sexual abuse Community violence Natural disasters Symptom categories Flashbacks, nightmares, intrusive thoughts Avoidance Negative cognitions and moods Hyperarousal and vigilance Some symptoms may differ from adults, but mostly the same May exhibit agitation instead of fear or hopelessness

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OCD in children

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Prevalence 1 to 4% Symptoms similar to those in adults Most common obsessions: Contamination from dirt and germs Aggression Thoughts about sex and religion more common in adolescence OCD more common in boys than girls

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etiology of anxiety disorders in children

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Genetics Heritability estimates from 29 - 50% Genetics plays a strong role in separation anxiety Parenting plays a small role in anxiety disorders Emotion regulation and attachment problems also play a role Perception of lack of acceptance by peers a factor in social anxiety disorder Risk factors for PTSD include: Family stress and coping style Past experience with trauma Low social support Parent psychopathology Pre-existing psychiatric disorder Female sex

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treatment of anxiety disorders in children

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Psychoeducation CBT - Cognitive Restructuring Develop new ways to think about fears Develop coping plan Behavioral therapies Exposure to feared object Reward approach behavior Modeling Skills training and practice Relapse prevention Family involved in treatment Medications might be an option for some

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Specific Learning Disorder

answer

DSM-5 Criteria for Specific Learning Disorder: Difficulties in learning basic academic skills (reading, mathematics, or writing) inconsistent with person's age, schooling, and intelligence Significant interference with academic achievement or activities of daily living Problems listening, speaking, reading, writing, spelling, reasoning, performing math Lifelong disability - early identification can help Duration criterion of 6 months required for diagnosis Individual usually of average or above average intelligence

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Learning disabilities etiology

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Learning Disabilities caused by: Heredity Problems during pregnancy Incident after birth Genetic and biological factors Evidence from twin studies suggest common genetic factors underlie both reading and math deficits Children can have just one learning disability or several Intraparietal sulcus implicated Problems with brain areas associated with language or math

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Treatment of Learning Disabilities & Communication Disorders

answer

Special Education - individualized instruction and practice in the deficient area Multisensory instruction in listening, speaking, and writing skills Computer games and audiotapes that slow speech sounds Phonics instruction Modified teaching Speech Therapy Social skills training Therapy

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Intellectual disability

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DSM-5 criteria: Intellectual deficit of 2 or more standard deviations in IQ below the average score for a person's age and cultural group (IQ<70) Significant deficits in adaptive functioning relative to the person's age and cultural group in one or more of the following areas: Communication, social participation, work or school, independence at home or in the community, requiring the need for support at school, work, or independent life Onset before age 18 Neurodevelopmental - problems often seen shortly after birth

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Intellectual etiology

answer

Down syndrome An extra copy of chromosome 21 47 instead of 46 chromosomes Fragile-X syndrome Mutation in the FMR1 gene on the X chromosome Recessive-gene disease Phenylketonuria (PKU) Maternal infectious disease, especially during first trimester i.e., rubella, herpes simplex, HIV, syphilis Lead or mercury poisoning

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Intellectual disorder treatment

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No cure for intellectual disabilities, but can help individuals live more independently Residential treatment Small to medium-sized community residences Behavioral treatments Language, social, and motor skills training Method of successive approximation to teach basic self-care skills e.g., holding a spoon, toileting Cognitive treatments Problem-solving strategies Computer-assisted instruction

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Autism spectrum disorder

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Profound problems with the social world Rarely approach others, may look through people Problems in joint attention Pay attention to different parts of faces than do people without autism; focus on mouth, neglect eye region This neglect likely contributes to difficulties in perceiving emotion in other people Theory of mind Understanding that other people have different desires, beliefs, intentions, and emotions Crucial for understanding and successfully engaging in social interactions Typically develops between 2½ and 5 years of age Children with Autism Spectrum Disorder seem not to achieve this developmental milestone

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autism etiology

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Genetic factors Heritability estimates of around 80% Several genes implicated Neurobiological factors Brain size Although normal size at birth, brains of autistic adults and children are larger than normal Pruning of neurons may not be occurring "Overgrown" areas have been linked with language, social, and emotional functioning Abnormally sized amygdala predicted more difficulties in social behavior and communication

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autism treatment

answer

Psychological treatments more promising than drugs Earlier treatment associate with better outcomes Intensive operant conditioning Parent training and education Pivotal response treatment: Focus on increasing child's motivation and responsiveness rather than on discrete behaviors Joint attention intervention and symbolic play used to improve attention and expressive skills Medication used to treat problem behaviors Reduces aggression and stereotyped motor behavior Does not improve language and interpersonal relationships

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autism criteria

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A. Deficits in social communication and social interactions as manifested by the following: ---Deficits in nonverbal behaviors such as eye contact, facial expression, body language ---Deficit in development of peer relationships appropriate to developmental level ---Deficits in social or emotional reciprocity such as not approaching others, not having a back-and-forth conversation, reduced sharing of interests and emotions B. Restricted, repetitive behavior patterns, interests, or activities manifested by the following: ---Stereotyped or repetitive speech, motor movements, or use of objects -----Excessive adherence to routines, rituals in verbal or nonverbal behavior, or extreme resistance to ---Very restricted interests that are abnormal in focus, such as preoccupation with parts of objects -----Hyper- or hypo-reactivity to sensory input or unusual interest in sensory environment, such as fascination with lights or spinning objects C. Onset in early childhood D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning

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