-More likely over 65

-Women 3x more likely than men to try, men 3x more likely to succeed

-twice as many white Americans than black Americans

1) Alcohol and drug use

2) Stressful evens and situations

3) Mood and thought changes

4) Mental disorders

5) Modeling and contagion suicides

1) Thinking of things in terms of rigid either/or forms

2) Part of mood/thought changes

Psychodynamic: themes of loss and self-directed anger

Biological: lower levels of serotonin activity

Sociocultural: egoistic, altruistic and anomic

Committed by people who do not have stable structures (family, friends, religion) to support them and give them meaning to life

1) Establishing a positive relationship

2) Understanding and clarifying the problem

3) Assessing suicidal risk

4) Assessing and mobilizing the caller's resources

5) Formulating a plan

1) Demographic

2) Pscyhosocial

3) Psychiatric

4) Physical illness

5) Psychological dimensions

-Refusal to maintain a body weight above a minimally normal weight for age and height

-Fear of gaining weight, even though underweight

-Body distortions, not able to recognize being underweight, undue influence of weight/shape on body self-evaluation, amenorhhea

-Recurrent episodes of binge eating

-Recurrent inappropriate compensatory behavior in order to prevent weight gain

-Symptoms at least 2x a week for 3 months 

-Undue influence of weight/shape on body self-evaluation

Typical ages of onset for anorexia and bulimia

Anorexia: 14-18

Bulimia: 15-21

Medical: Amenorrhea (absence of menstrual cycle), lowered body temperature, lower heart rate, low blood pressure, body swelling, reduced bone mineral density

Psychological: anxiety, mood disorders, substance abuse, OCD

Medical: Enlarged salivary glands and erosion of dental enamel, electrolyte imbalance, severe constipation and possible colon damage, calluses on fingers and back of hands

Psychological: Anxiety, mood disorders, substance abuse

-2-40 times a week

-Associated with shame

-Preceded by tension and uncontrollable desire to consume, self-blame, guilt, depression, and concern about weight gain

-Compensatory measures: vomiting, laxatives, diuretics

Anorexics: obsessive, control-focused, achievement oriented

Bulimics: concerned with pleasing others, being attractive, having relationships, and being sexually active; prone to mood swings, low impulse control

Ego deficiencies: poor sense of independence and control

Cognitive disturbances: Result of ineffective parenting, victims of eating disorders improperly label internal sensations and needs)

Minuchin: developed enmeshed family pattern. Little room for individuality and independence. Family over-involved in people's lives. Family might force kid to take on a "sick role" because the sick child needs her family.

Bruch: psychodynamic theory of eating disorders. Result of poor parenting, making the child overly concerned with what people think of them, having a lack of support from family, ineffective parents, gender roles, overcoming helplessness. 

Lateral: Produces hunger when it is activated

Ventro: Reduces hunger when it is activated

Early focus: regain lost weight, recover from malnourishment and eat normally again

Most effective treatment: combination of supportive nursing care, high-calorie diet and nutritional counseling

Main goal: no binge/purge pattern, develop good eating habits.

1) Individual insight therapy: psychotherapy involving cognitive, psychodynamic and interpersonal therapies.

2) Behavioral therapy: with cognitive, including exposure and response prevention. 

3) Antidepressant medication: Prozac, in combination with psychotherapy

4) group therapy: self-help groups, helpful in about 75% cases

Abuse: Rely on drug excessively and regularly, drug use has a negative impact on relationships, employment, etc., brings danger to self and others

Dependence: Restructures life around drug, possibly develops tolerance, may experience withdrawal symptoms when not taking it

Stimulant

Delirium Tremens (DTs): withdrawal from alcohol. confusion, clouded consciousness, terrifying hallucinations. 

Personal and social long-term effects: social/emotional danger, disruption and distress

-Types of depressants

-Barbiturates: addictive, reduce anxiety, help sleep. Affects GABA system- create sense of well-being and relaxed muscles. Slurring, poor motor control. High doses- death or coma, halt breathing, lower blood pressure.

-Benzodiazepines: reduce anxiety (Valium, Xanex), anticonvulsants, muscle relaxants, affects GABA system like alcohol

-Type of depressant. Euphoria and disrupts social function.

-Opium: made from sap of poppy

-Morphine: reduces pain

-Heroin: one of the most addictive derivatives of opium

-Endorphins: neurotransmitters that help relieve pain and reduce emotional tensions. "Body's own opioids"

-AIDS (needles)

-Easy to overdose

-Fatal if combined with other drugs

Definition: Addictive, from coco plant. Stimulant. Most powerful natural stimulant.

Statistics: 28 million have tried, 2 million currently users

Nervous System: Blocks dopamine reuptake, increases norepinephrine and serotonin activity in selective areas

Expression free-base: technique for ingesting cocaine in which pure cocaine is chemically separated from processed cocaine, vaporized by heat from a flame, and inhaled with a pipe

Crack: ready to smoke, free-base cocaine

Amphetamine: a stimulant manufactured in a lab

Methamphetamine: Powerful amphetamine. Surge in popularity in recent years has caused major health and law enforcement problems. 

In nervous system: Enhancing norepinephrine and dopamine activity. Increase vigor and elation, reduce fatigue

Varieties: Hashish and marijuana

Ingredient: THC

Why more dangerous: 4x stronger

Effects: increasingly a pattern of abuse and dependence, affecting social, occupational and academic function

Behavioral: Operant- rewarded by reduction of tension associated with using drug, negative reinforcement. Classical- important in development of associations with objects or circumstances associated with drug use

Cognitive: pattern of reward associated with constant drug use creates cognitive expectancies which promote craving

Biological View: Genetic basis for drug dependence (twin studies, molecular biology techniques), abnormal forms of dopamine-2 receptor sites

Biochemical factors: biochemistry, brain's reward center, increased dopamine activity

Reward centers: dopamine-rich pathway in the brain that produces feelings of pleasure when activated

Reward-deficiency syndrome: in some individuals, brain's reward centers not activated by usual events in their lives

For treating drug abuse and dependence

Clients repeatedly presented to unpleasant stimuli while performing undesirable behaviors like taking a drug

Often paired with alcohol abuse and dependence

Behavioral way of treating drug abuse and dependence

Patients rewarded for following rules and regulations of treatment plan, punished less for not following

Cognitive behavioral approach to treating alcohol abuse and dependence

Clients keep track of drinking behavior and apply coping strategies in situations that generally trigger excessive drinking

Approach to treating alcohol abuse similar to behavioral self-control training. 

Clients plan ahead for risky situations and reactions

Biological approach to treating drug abuse and dependency

Systematic and medically supervised withdrawal from drug

Drugs that block or change effects of addictive drugs. 

Examples: Disulfram, Antabuse

Dysfunction: persistent inability to function normally in some area of the human sexual response cycle

Paraphilias: recurrent and intense sexual urges, fantasies or behaviors involving nonhuman objects children, non-consenting adults, or experiences of suffering or humiliation

Masters and Johnson

Sexual desire, excitement, orgasm, resolution. Sexual dysfunction happens in the first 3 stages

Desire phase: urge to have sex, sexual fantasies, sexual attraction to others

2 disorders: Hypoactive sexual desire disorder (lack of interest in sex and low level of sexual activity), sexual aversion disorder (aversion to and avoidance of sexual interplay)

Biological: high levels of prolactin, low levels of testosterone, high or low levels of estrogen.

Sociocultural: situational pressures, problems in relationships, cultural standards, trauma of sexual molestation/assault

Psychological: general increase in anxiety, depression or anger

Excitement phase: changes in pelvic region, physical arousal, increases in heart rate, muscle tension, blood pressure and rate of breathing

2 dysfunctions: Female sexual arousal disorder (persistent inability to attain sexual excitement, including adequate lubrication or genital swelling during sexual activity), Male erectile disorder (repeatedly fails to attain or maintain an erection during sexual activity)

Biological: vascular problems, nocturnal penile tumescence (erection during sleep), use of certain medications, substance abuse

Psychological: depression, performance anxiety (fear of performing inadequately and a related tension experienced during sex) vs. spectator role (state of mind where you focus so much on performance during sex that performance or enjoyment are reduced)

Sociocultural: loss of job, financial stress, marital stress

Orgasm phase: Sexual pleasure peaks and sexual tension is released as muscles in the pelvic region contract rhythmically

3 dysfunctions: Rapid/premature ejaculation (man reaches orgasm and ejaculates before, on or shortly after penetration, before he wants to), male orgasmic disorder (repeated inability to reach orgasm or long delays in reaching orgasm after normal sexual excitement), female orgasmic disorder (woman rarely has an orgasm/repeatedly experiences a very delayed one)

Person experiences severe pain in the genitals during sexual activity.

Cause: injury during childbirth, scar during episiotomy, collision of penis with hymen, vaginal infections, wiry pubic hair that rubs against labia 

1) Assessment and conceptualization of problem

2) Mutual responsibility

3) Education about sexuality (guided masturbation)

4) Attitude changes

5) Elimination of performance anxiety and spectator role

6) Increasing sexual and general communication skills

7) Changing destructive lifestyles and marital interactions

8) Addressing physical and mental factors

Affectual awareness: patients visualize sexual scenes in order to discover feelings of anxiety, vulnerability, and other negative emotions they have regarding sex

Self-instructive training: help patients change negative reactions to sex

Recurrent and intense sexual urges and fantasies and behaviors that involve use of a nonliving object, often to the exclusion of all other stimuli

Transvestic: repeated and intense sexual urges, fantasies and behaviors that involve dressing in clothes of the opposite sex

Repeated sexual arousing urges or fantasies about exposing genitals to another person. May act upon urges. 

-Enduring pattern of inner experience and behavior that deviates markedly from the person's culture, with at least 2 of the following areas affected: cognition, affectivity, interpersonal functioning and impulse control

-Pattern is inflexible and pervasive across a broad range of personal and social situations

-Pattern is stable and long-lasting, onset traced back to at least adolescence or early adulthood

-Significant distress and impairment

A) odd or eccentric behavior. Paranoid, schizoid, schizotypal

B) dramatic, emotional, erratic. Antisocial, borderline, histrionic, narcissistic

C) Anxious or fearful. Avoidant, dependent, obsessive-compulsive

Cluster A. Odd, eccentric behavior. Pattern of distrust and suspiciousness, early interaction with demanding parents, genetic causes. 

Treated with object-relations therapy and cognitive behavioral therapy

Persistent avoidance of social relationships, little expression of emotion, unsatisfied need for human contact and suffer from defenses in thinking.

Treatment: Cognitive behavioral therapy.

Cluster A. Extreme discomfort in close relationships, odd forms of thinking and perceiving, and behavioral eccentricities. Similar patterns that cause schizophrenia (deficits in attention and short-term memory, high activity of dopamine, enlarged brain ventricles)

Treatment: Cognitive behavioral therapy and antipsychotic drugs.

Cluster B. General pattern of disregard for and violation of other people's rights; absence of parental love during infancy, learned through modeling or imitation, lower serotonin activity, deficient functioning in frontal lobes.

Treatment: Treatments are ineffective.

Underarousal: Cortical arousal is low, so one needs to do exciting things to get physically aroused

Fearlessness: Fail to respond to danger cues and ignore them

Cluster B. Repeated instability in interpersonal relationships, self-image and mood and by impulsive behavior, parental relationships, biological abnormalities, biosocial theory, linked to cultures that undergo rapid change.

Treatment: Dialectical behavior therapy, antidepressants, antibipolar, antianxiety and antipsychotic drugs.

Cluster B. Excessive emotionality and attention-seeking, unhealthy relationships with cold and controlling parents, lack of substance and extreme suggestibility, produced in part by social norms and expectations. 

Treatment: Seek treatment on own or through cognitive therapy.

Cluster B. Broad pattern of grandiosity, need for admiration and lack of empathy. Cold, rejecting parents. People treated too positively- "eras of narcissism" in society.

Treatment: Difficult to treat. Psychotherapists try to help people recognize and work through their basic insecurities and defenses.

Cluster C. Constant discomfort and restraint in social situations, overwhelming feelings of inadequacy, extreme sensitivity to negative evaluation. Similar causes to anxiety disorders (traumas and fears), general sense of shame, fears of being judged by others, failure to develop social skills.

Treatment: Similar to social phobia treatment. Psychotherapy, cognitive therapy, group therapy, antianxiety and antidepressant drugs.

Cluster C. Pattern of clinging and obedience, fear of separation, ongoing need to be taken care of Unresolved conflicts during oral stage, parents unintentionally reward child's clinging, maladaptive attitudes.

Treatment: Couple or family therapy, CBT, group therapy.

Cluster C. Such intense focus on orderliness, perfectionism and control that individual loses flexibility, openness, and efficiency. Anal regressive and illogical thinking processes. 

Treatment: Psychodynamic or cognitive therapy. 

1) Issues of reliability and validity make diagnosis difficult. (Some distinguishing signs of disorder cannot be observed and must be inferred, clinician has to judge difficult personality vs. disorder, psychiatric disorders vs. individual differences, distinguish disorders within or between clusters?)

2) Dimensions rather than categories (transitional DSM approach suggests an either/or approach to definition and diagnosis- an alternative would be to assess the degree to which a person exhibits particular personality dimensions, like the 5 Big Traits)

1) Extraversion

2) Agreeableness

3) Conscentiousness

4) Neuroticism/Emotional stability

5) Openness to experience

Causes: possible biological disposition and environmental deprivation, more likely a hostile, rejecting and high-conflict family environment

Treatment: Parent/child therapy, parent management training, treatment foster care, juvenile training centers, problem-solving skills training, anger management programs, stimulant drugs (Ritalin, prevention programs)

ADHD: poor focus, disorganized, distractible, hyperactivity, impulsivity, poor control, blurting out answers, etc.

Secondary problems: compromised academic performance, social isolation

-Family pattern of general psychopathology

-Association with dopamine levels

-previously, ideas of minimal brain damage

-Accumulated psychosocial factors

-Mothers who smoke during pregnancy: child 3x more likely to have ADHD.

Enuresis: Childhood disorder marked by repeated bed-wetting and wetting one's clothes. Not much treatment, may have behavioral treatment like bell and battery technique or dry-bed training.

Encopresis: Childhood disorder marked by repeated defecating in appropriate places, such as one's clothing. Training involves behavioral and medical approaches, such as laxatives, lubricants, diets, education and even family therapy

Sociocultural: research has failed to support original ideas of family relationships and stress

Psychological: perceptual or cognitive disturbances, like limited theory of mind

Biological: genetic (high rate among siblings, especially identical twins), prenatal difficulties (risks higher when mom exposed to rubella or toxins), birth complications (during labor or delivery), MMR vaccination (vaccines could cause autism in small children, but research has not confirmed a link)

Shaping and developing speech and social skills, classroom and self-help skills, early behavioral intervention appears significant.

LEAP therapy: for preschoolers with autism. integration of autistic children into classrooms

Mental retardation: Disorder marked by intellectual functioning and adaptive behavior that are well below average.

Intelligence Quotient: Score derived from intelligence tests that theoretically represents a person's overall intellectual capacity. 

Mild, moderate and profound

Mild- education, can support themselves as adults

Moderate- People can learn to care for themselves and benefit from vocational training

Profound- Need a very structured environment with close supervision

Severe- technically between moderate and profound. Require careful supervision and can learn to perform basic work in structured environment and sheltered settings)

1) Chromosomal causes- Down's Syndrome. Abnormality in 21st chromosome.

2) Trisomy 21. Third 21st chromosome.

3) Fragile X syndrome. X chromosome with genetic abnormality that leaves it prone to breakage. Intellectual dysfunction, language impairments, behavioral problems

4) Metabolic causes. PKU, Tay-Sachs disease

5) Pre-natal and birth related disorders (i.e. fetal alcohol syndrome). brain damage related to anoxia.

6) Childhood injury and exposure to toxins. Up to age 6, certain head injuries and exposures to toxins can lead to mental retardation, lead poisoning, meningitis, encephalitis  

Special education: Kids with disorder and grouped together and given a separate, specially designed education.

Mainstreaming: Placement of children with mental retardation in regular school classrooms.

Geropsychology, and why it is different from a focus on disorders of cognition?

Geropsychology: Considers mental health issues of elderly including anxiety, depression, substance abuse, etc.

Disorders of cognition: includes memory and cognitive changes that are part of the aging process, like delirium, dementia, and Alzheimers

-Increases with age, as does suicide risk

-up to 20% of people in old age

-Associated with physical, social and emotional challenges, poorer general health

-Slow recovery

Treatment: CBT, interpersonal therapy, antipsychotic medication

Challenges of this period, like physical challenges of aging, making sense of our experiences, traveling uncharted territory, likely to trigger anxiety. About 6% elderly men, 12% women. 

Treatment: Psychotherapy, CBT, anxiolytic medication (i.e. benzodiazepines).

Not as common as younger generation (about 7%) but higher prevalence in nursing homes or hospitals. 

Treatment: detoxification, Antabuse, AA, cognitive therapy.

More important substance-related issue is misuse of prescription medication.

Delusional disorders: State of confusion or rapidly developing clouding of consciousness. Person has great difficulty concentrating, focusing attention and following an orderly sequence of thought.

Treatment: addresses underlying medical condition or mismanagement of medication. Social support important. 

Severe problems in memory and at least one other function.

General deterioration in function as a result of impairment in memory, planning and abstract reasoning. Includes emotional changes (depression; delusions).

Can occur at any age, most common in elderly.

Broad cognitive impairment: memory, orientation, judgment and reasoning, poor sequencing and planning- starting with lapses in attention and difficulties with language and communication- becomes increasingly pervasive. 

Loss of interest, social isolations and agitation, depression, anxiety, hostility. 

Begins in 60s/70s, believed to affect 4 million Americans.

Neurofibrilary tangles: twisted protein fibers that form within certain brain cells as people age. In Alzheimer's, MANY of these tangles.

Senile plagues: Sphere-shaped deposits of beta-amyloid protein that forms in spaces between certain brain cells and in certain blood vessels as people age.

Genetic: genetic basis increases likelihood of excessive tangle formation and plague.

Structural and biochemical: abnormal formation of proteins, high levels of zinc, autoimmune response, viral infection. 

1) prevent certain conditions such as substance abuse that could bring on dementia

2) Stop brain damage from spreading and becoming worse

3) Help individuals and caregivers cope with advancing deterioration

Drugs that prevent the breakdown of acetylcholine, but benefits are limited and risks are high. Useful in early stages of condition. 

For prevention: estrogen and antiinflammatory drugs (Motrin, Advil, etc.)

Cognitive: Stimulate mental exercise

Behavioral: Changing everyday behaviors that are stressful- particularly for caregivers. Therapy for family and caregivers also important

Sociocultural: Day care and community support.

Kraepelin: clinical description of schizophrenia

Bleuler: term of schizophrenia, concept of "breaking of associative threads"

Positive: Paranoia, hallucinations, delusions

Negative: Loss for words, loss for expression, loss of motivation, social withdrawal

Genetics. Path of transmission is unclear 

Biochemical: high levels of dopamine, drug L-dopa, amphetamines

Abnormal brain structure. 

Psychodynamic: response to ineffective parenting

Cognitive view: efforts to understand the delusions and hallucinations can undermine rationality and encourage paranoia