Suicide Prevention & Eating Disorders
What is alcohol induced myopia?
As many as at least 70% of suicide attempts involve alcohol. Alcohol induced myopia is the tendency for those under the influence to focus on the more negative aspects of their life and personal circumstances, emotions, and thoughts; it is also thought that alcohol may reduce aversion and and inhibitions related to death.
What are the physiological and psychological effects of depressants?
Please provide some examples of these substances and what neurotransmitters they interact w/ in the brain.
Depressants are a group of drugs that decrease central nervous system activity. The primary effect is to reduce our levels of physiological arousal and help us relax. Included in this group are alcohol and sedatives, hypnotic, and anxiolytic drugs, such as those prescribed for insomnia or anxiety.
Alcohol, anxiolytics (anti-anxiety), barbituates (sedatives, hypnotics), benzodiazepines (like Valium and Xanax)
GABA
What is the difference between ego-dystonic and ego-syntonic, and what might be an example of each?
ego-dystonic = does not align with the person's perception of themselves and symptoms are seen as an unwanted problem by the person experiencing them
ego-syntonic = person aligns with symptoms/traits and they do not find them distressing
Ex: When a person experiencing the distress, loneliness, and feelings of emptiness or abandonment as a part of borderline personality disorder, this would likely be ego-dystonic.
Ex: When a person experiences their symptoms of anxiety, or perhaps rigid organizational patterning of obsessive compulsive personality disorder and necessary, motivating, and helpful, this would be ego-syntonic.
Which factors are mentioned in your text as being associated with a high risk of developing a full-blown psychotic disorder and schizophrenia?
Prodromal period (85% of patients w/ schizophrenia have had this): Period of 1 to 2 years before serious symptoms of schizophrenia occur but when less severe yet unusual behaviors start to appear. Includes magical thinking, ideas of reference, and illusions.
Risk factors for going from high risk to developing the disorder include the length of duration of symptoms before seeking help, baseline functioning, as well as the presence of negative symptoms and disorganized symptoms.
What are the central defining features of attention deficit/hyperactivity disorder?
The primary characteristics of people with attention deficit/hyperactivity disorder (ADHD) are a pattern of inattention (such as not paying attention to school- or work-related tasks), impulsivity, and/or hyperactivity.
These deficits can significantly disrupt academic efforts and social relationships. ADHD is found in about 5.2 percent of the child population across all regions of the world.
Boys are two to three times more likely to be diagnosed with ADHD than girls.
What primary risk factors for increased risk of suicide were discussed in class (name at least 3)? How do these risk factors relate to the relationship between lethality of means and gender?
Main risk factors include: Family hx of suicide, previous attempts, recent significant loss or stressful event, terminal illness, significant psychiatric conditions, recent hospitalization for psychiatric care, access to lethal methods, substance use
Due to risk of lethality being higher with firearms, and the greater likelihood that men will choose this means of suicide, men are typically identified as being at a higher risk of dying by suicide.
What are the physiological and psychological effects of stimulants?
Please provide some examples of these substances and what neurotransmitters they interact with in the brain.
Stimulants, the most commonly consumed psychoactive drugs, include caffeine (in coffee, chocolate, and many soft drinks), nicotine (in tobacco products such as cigarettes), amphetamines, and cocaine. In contrast to the depressant drugs, stimulants make us more alert and energetic.
Dopamine, norepinephrine
What are the different classes of personality disorder, and what main traits are associated with each?
DSM-5 includes 10 personality disorders that are divided into three clusters: Cluster A (odd or eccentric) includes paranoid, schizoid, and schizotypal personality disorders;
Cluster B (dramatic, emotional, or erratic) includes antisocial, borderline, histrionic, and narcissistic personality disorders;
and Cluster C (anxious or fearful) includes avoidant, dependent, and obsessive-compulsive personality disorders.
What are the distinctions among positive, negative, and disorganized symptoms of schizophrenia?
Positive symptoms are active manifestations of abnormal behavior, or an excess or distortion of normal behavior, and include delusions and hallucinations. These are extra behaviors/ thoughts/symptoms, adding to the individuals experience and usually involving perceptual or thought changes.
Negative symptoms include avolition, alogia, anhedonia, asociality, and affective flattening. These are deficits or things that are being taking away from the person's typical functioning.
Disorganized symptoms include rambling speech, erratic behavior, and inappropriate affect.
What are the major characteristics of autism spectrum disorder?
People with ASD all experience trouble progressing in language, socialization, and cognition. This is not a relatively minor problem (like specific learning disorder) but is a condition that significantly affects how individuals live and interact with others.
Autistic spectrum disorder is a childhood disorder characterized by significant impairment in social communication skills and restricted, repetitive patterns of behavior, interests, or activities.
This disorder does not have a single cause; instead, a number of biological conditions may contribute, and these, in combination with psychosocial influences, result in the unusual behaviors displayed by people with ASD.
What are the defining features of bulimia nervosa and anorexia nervosa? How can they be differentiated?
How does binge-eating disorder differ from bulimia?
There are three prevalent eating disorders. In bulimia nervosa, dieting results in out-of-control binge-eating episodes that are often followed by compensating for the intake, either through purging the food through vomiting or other means or through trying to “make up” for the intake by exercising and/or fasting.
In binge-eating disorder, a pattern of binge-eating is not followed by purging.
Anorexia nervosa, in which food intake is cut dramatically, results in substantial weight loss and sometimes dangerously low body weight.
What are the physiological and psychological effects of opiates?
Please provide some examples of these substances as well as what neurotransmitters they interact with in the body/brain.
Opiates include opium, morphine, codeine, and heroin; they have a narcotic effect—relieving pain and inducing sleep.
The broader term opioids is used to refer to the family of substances that includes these opiates and synthetic variations created by chemists (e.g., methadone) and the similarly acting substances that occur naturally in our brains (enkephalins, beta-endorphins, and dynorphins).
What were some of the concerns identified in class & in your text in response to gender, validity, and reliability of diagnoses?
Personality disorders are associated with perhaps the most stigma out of all disorders. This can lead to biases in diagnosis by clinicians and providers, problems with reliability and validity in diagnosis.
There are high levels of comorbidity between personality disorders, suggesting potential problems with the reliability and validity in assessing and diagnosing each of these disorders and separate disorder.
Gender differences indicate that men tend to show traits that are more aggressive, structured, self-assertive, and detached. Women tend to show traits that are more submissive, emotional, and insecure. These differences lead to bias in diagnosis, such as men & women displaying the same traits, but getting diagnosed with ASPD and HPD, respectively. This could be do to gender socialization OR clinician bias.
More research is needed on all personality disorders for more accurate assessment, diagnosis, and understanding of the origins of these disorders, and there is a great deal of controversy and debate in the psychiatric community about personality disorders.
What are the genetic, neurobiological, developmental, and psychosocial risk factors for schizophrenia? Name at least one of each.
General genetic vulnerability for psychotic spectrum of disorders;
Neurotransmitter imbalances (dopamine in basal ganglia & prefrontal cortex),
Structural damage to the brain caused by a prenatal viral infection or birth injury (enlarged ventricles in the brain)
Twin and adoption studies offer support for a genetic basis for schizophrenia (48% risk among identical twin w/ dx)
Psychological stressors: Relapse appears to be triggered by hostile and critical family environments characterized by double bind communication systems and high expressed emotion.
Sociocultural stress, such as poverty, homelessness, early life adversity, growing up in an urban environment, minority group position, and the stress of being in a new country
Substance use: ketamine, PCP, cannabis (in those w/ genetic vulnerability, use increases risk)
(Double bind = caregivers send out mutually contradictory signals place their children in impossible situations where they cannot act without in some way going against their caregiver's apparent wishes)
What are major prevention efforts for the neurodevelopmental disorders? Provide at least one example of a community-based or individual therapy based prevention or treatment effort.
Prevention efforts for the neurodevelopmental disorders are in their early stages. These efforts include early intervention.
Although many children can make significant progress if interventions are initiated early in life, not all children benefit significantly from such efforts.
Example: Early Start Model (Denver): in-depth, daily behavioral and social intervention program aimed and helping children identified as having signs of ASD to adapt and adjust to their environment; includes social and sensory interventions.
Prevention example: providing community based education about teratogens, threats to prenatal health and development, and early-identification efforts for children with neruo-developmental conditions (education campaigns).
Given recent advances in genetic screening and technology, it may someday be possible to detect and correct genetic and chromosomal abnormalities.
What social, psychological, and neurobiological factors might cause eating disorders? What are some main treatments that seem to be most effective?
In addition to sociocultural pressures, causal factors include possible biological and genetic vulnerabilities (the disorders tend to run in families), psychological factors (low self-esteem), social anxiety (fears of rejection), and distorted body image (relatively normal-weight individuals view themselves as fat and ugly).
Several psychosocial treatments are effective, including cognitive-behavioral approaches combined with family therapy and interpersonal psychotherapy. Drug treatments are less effective at the current time.
Eating disorder prevention programs have shown substantial reduction in the cases of eating disorders in the treatment population.
Double!
1. What are the physiological and psychological processes that lead to substance dependence?
2. What are synergistic effects and why are they dangerous?
Most psychotropic drugs seem to produce positive effects by acting directly or indirectly on the dopaminergic mesolimbic system (the pleasure pathway). In addition, psychosocial factors such as expectations, stress, and cultural practices interact with the biological factors to influence drug use. Cont'd use can result in neurological changes involved the reward pathway (over time).
Substance use can lead to tolerance and withdrawal sxs, related to increased use, related the opponent-process theory and negative reinforcement connected to use.
Also: expectancy effects (cognitive & social); media and cultural values regarding substance use; ACEs & trauma positively associated w/ substance misuse
Synergistic affects: when both alcohol and opioids are ingested by a person, this significantly raises their overdose risk and risk of death due to the manner in which both substances interact in the system, especially in terms of suppression/depression of respiration/breathing.
What is the difference between obsessive-compulsive personality disorder and obsessive-compulsive disorder?
People who have obsessive-compulsive personality disorder are characterized by a fixation on things being done “the right way.” This preoccupation with details prevents them from completing much of anything. They display a pervasive pattern of rigidity in thinking and behavior across contexts.
People who have OCD experience obsessions and compulsions, which can develop at a later age of onset than OCPD. People with OCPD do not experience obsessions and compulsions.
What are the goals of therapy for schizophrenia? What biological and psychosocial treatments for schizophrenia are available?
Successful treatment for people with schizophrenia rarely includes complete recovery.
The quality of life for these individuals can be meaningfully affected, however, by combining antipsychotic medications with psychosocial approaches, employment support, and community-based and family interventions.
Treatment typically involves antipsychotic drugs that are usually administered with a variety of psychosocial treatments, with the goal of reducing relapse and improving skills in deficits and compliance in taking the medications (token economy).
The effectiveness of treatment is limited, because schizophrenia is typically a chronic disorder.
Treatment across cultures includes using traditional healers, ancestor worship, alternative medicines, and prison sentences. Prevention efforts focus on early intervention involving parent training and treatment in the prodromal stages of the disorder.
Additional psychosocial treatments: community mobilization, psychotherapy, family psycho-education, cognitive therapy
Double!
What are the defining features of neurocognitive disorders?
What is the difference between Alzheimer’s and Dementia?
Most neurocognitive disorders develop much later in life. Two classes of neurocognitive disorders exist: delirium and mild or major neurocognitive disorder.
Delirium is a temporary state of confusion and disorientation that can be caused by brain trauma, intoxication by drugs or poisons, surgery, and a variety of other stressful conditions, especially among older adults.
Major neurocognitive disorder is a gradual deterioration of brain functioning, mild neurocognitive disorder is a condition in which there are early signs of cognitive decline.
Dementia is the condition of having a deteriorating neurocognitive disorder; Alzheimer's is disease and a form of dementia.
What are some of the main risks associated with each of the eating disorders discussed in class (bulimia nervosa, anorexia nervosa, binge-eating disorder; think medical & social)?
Purging methods can result in severe medical problems, Erosion of dental enamel, electrolyte imbalance, Kidney failure, cardiac arrhythmia, seizures, intestinal problems, permanent colon damage
Amenorrhea, Dry skin, brittle hair & nails, Sensitivity/intolerance for cold, Potential for cardio problems, low blood pressure & heart rate, Electrolyte imbalance, kidney & cardiac problems (also true for bulimia); elevated risk for suicide and cardiac arrest and organ damage
What psychological and medical treatments are available for substance-related disorders? Provide some specific examples, one for psychosocial and at least one medical.
Substance dependence is treated successfully only in a minority of those affected, and the best results reflect the motivation of the drug user and a combination of biological and psychosocial treatments.
Some examples of treatment programs (psychosocial) include both inpatient and outpatient drug tx programs, abstinence only programs, abstinence support groups (AA, NA), harm reduction techniques, motivational interviewing...
Drug/medical treatment options include: agonist substitution (similar, less harmful, and less intense drug prescribed as a substitute), antagonist (drugs that block the effect of drug of abuse; naltrexone, nalaxone), and aversive drug tx (drugs that induce aversive physical and emotional consequences for using certain drugs, such as atuabuse for alcohol use - induces nausea and vomiting upon ingestion of alcohol).
Programs aimed at preventing drug use may have the greatest chance of significantly affecting the drug problem.
What are the main differences between schizoid personality disorder, schizotypal personality disorder, and schizophrenia?
People with schizoid personality disorder show a pattern of detachment from social relationships and a limited range of emotions in interpersonal situations. They seem aloof, cold, and indifferent to other people.
People with schizotypal personality disorder are typically socially isolated and behave in ways that would seem unusual to most of us. In addition, they tend to be suspicious and have odd beliefs about the world. Schizotypal is categorized in the DSM-5 under personality disorders and schizophrenia spectrum disorders.
Those with schizophrenia will experience distinct hallucinations and delusions that are an alternate experience of reality. They do not only have perhaps magical thinking, but experience belief and participation in delusions and hallucinations that go beyond odd thinking or behavior.
How do you differentiate between each of the schizophrenia & related disorders?
Schizophrenia, schizoaffective, brief psychotic disorder, delusional disorder, schizphreniform disorder
Same sxs, less than 6 months = schizophreniform disorder
Same sxs + mood disorder sxs = schizoaffective disorder
Delusional disorder: delusion of alternate reality, absence of other sxs
Brief psychotic disorder = positive symptoms & disorganized speech, less than one month duration
What are the symptoms of and treatment for major and mild neurocognitive disorders, and how is this different from delirium?
Major neurocognitive disorder is a gradual deterioration of brain functioning that affects memory, judgment, language, and other advance cognitive processes.
Mild neurocognitive disorder is a condition in which there are early signs of cognitive decline such that it begins to interfere with activities of daily living.
To date, there is no effective treatment for the irreversible neurocognitive disorder caused by Alzheimer’s disease, Lewy bodies, vascular disease, Parkinson’s disease, Huntington’s disease, and various less common conditions that produce progressive cognitive impairment.
Treatment often focuses on helping patients cope with the continuing loss of cognitive skills and helping caregivers deal with the stress of caring for affected individuals. Other treatments focus on supportive counseling for distress associated with deterioration, compensatory behaviors to adjust to cognitive changes and decline in abilities, and cognitive stimulation.
Alzheimer's preliminary drug tx: drugs which inhibit the breakdown of the neurotransmitter acetylcholine; others attempt to target and breakdown amyloid beta (plaques).
Other efforts are primarily focused on prevention