Abnormal Psychology Lecture Notes

2/22/99

Professor thinks substance abuse may not be appropriate for psychopathology – better considered as a medical problem than a psychological one.

substance abuse involves medical, legal, theological, and historical issues – dealt with differently in different parts of the world (ex. capital punishment for drug trafficking in Indonesia)

1840’s – Opium Wars over whether to allow opium commerce involving China; led to downfall of Chinese monarchy and cultivation of opium, which resulted in widescale famine

Opium:

• prototype of an addicting substance
• 2 categories: 1. addicting (morphine, codeine) 2. papeverine (used in cardiovascular medicine)
• used for centuries as a medicine for fevers, pain, diarrhea, sedative, coughing
• popular in the orient because it is a sedative, alcohol brings too much embarrassment

Is there a difference between dependence and addiction? Using the DSM IV, only 3 of 7 criteria are needed for dependence diagnosis. Thus, different types of people can have the same diagnosis.

BAC .10 – effects differ whether going up or down

Recivism rate of 50-90%, with some maturing out or dying – diagnosis only provides jobs and pays for clinics; treatment generally does not work

What’s in right now? victimization, depression, alcoholism, sexual idenity disorders, anorexia

What’s out right now? schizophrenia, embezzlement, child abuse, pedophiles

comorbitity à simultaneous diagnosis; substance use is part of or associated with another psychopathology

psychoactive à substance alters psychological state

dependence (any 3 qualify for diagnosis)

1. preoccupation with substance
2. unintentional overdoses
3. tolerance
4. withdrawal
5. helplessness/desire to quit
6. social abandonment
7. harmful physical effects

abuse

1. forgoing obligations
2. endangerment
3. legal problems
4. reduction in social involvement

long term effects of alcohol à withdrawal, psychotic-like episodes, liver problems

depressants à first considered to be the only addictive substance

• opiates, alcohol, barbiturates, minor tranquilizers

stimulants à were not originially thought to be addictive

• amphetamines, cocaine, caffeine, nicotene

hallucinogens à alter perceptions

• LSD, PCP, THC

some evidence of genetic predisposition, twin studies

denial is common among the dependent and their families

2/24/99

Mood Disorders

• account for 14-15% of hospital admissions for psychological disorders; in population, about 1% occurrence
• melancholia = sadness, opposite of mania = excess of dark, black bile
• women at a higher risk; average age of onset is later than for schizophrenia
• depression is increasing throughout the world

"manic depressive psychosis" – anecdote about former student who reflected modern treatment by refusing psychosis as a mood disorder; not as serious, more accepted by mainstream that way, less stigma

euphoria

dysphoria

endogenous à unknown precipitating factor (inside or outside)

reactive/exogenous à known precipitating factor/from outside

mania

major depression à no evidence of any mania, may occur only a single time

bipolar disorder

mood disorder

cyclothemia

comorbidity

vegetative à only activity of the involuntary organs of the body

dysthemia

hypomania

affective psychosis

schizo-affective disorder

seasonal affective disorder

Video:

Patient #1

• neurovegitative symptoms
• lack of energy
• anhedonia
• insomnia, thoughts running through his mind
• excessive worry
• frowning facial expressions
• wanted to be like other people, felt he wasn’t good enough, couldn’t do things like he used to
• loss of sexual desire, erection, and performance
• trouble concentrating
• felt that he didn’t deserve to do well,
• physical complaints were almost delusional
• felt that he had a poor memory, but mental status exam showed most orientations intact
• lost all confidence in himself

Patient #2

• put his wife in a nursing home 1 ½ years ago; could no longer care for her due to a series of serious medical problems
• reports auditory and visual hallucinations of 14 people standing over him trying to decide his fate
• prior shock treatment helped some, but this episode is worse than the other ones
• loss of concentration, insomnia
• felt that he lost everything he had after wife went in nursing home
• current stay started with heart problems

Patient #3

• feels that he should not have to ask for help; strong belief in his independence
• always felt alone
• tearful
• feels it’s a shame to need help

"I control my emotions"