Chapter 8 Substance-Related and Addictive Disorders Delirium Tremens, or DTs

- heavy users of Alcohol withdrawal

The classification of substance use disorders in the DSM - dramatically lower their intake of alcohol after many
system years of heavy drinking. DTs involve intense
- is not based on whether a drug is legal or not, but autonomic hyperactivity
rather on how the use of a drug impairs the person’s - profuse sweating and tachycardia
physiological and psychological functioning. DSM-5 Delirium
classifies substance-related disorders in terms of two - mental confusion characterized by incoherent
major types: substance-induced disorders and speech, disorientation, and extreme restlessness
substance use disorders. - Terrifying hallucinations frequently of creepy,
crawling animals—may also be present
Substance-induced disorders
Withdrawal syndrome
- are patterns of abnormal behavior induced by use of
- cluster of psychological and physical symptoms
psychoactive substances
following abrupt cessation of use of the substance.
Korsakoff’s syndrome Psychoactive Substances lead to Withdrawal Syndromes:
- a substance-induced disorder that leads to alcohol, opioids (opiate drugs), stimulants such as
irreversible memory loss after years of chronic cocaine and amphetamine, sedatives and sleep-inducing
alcohol abuse. drugs (hypnotics), marijuana, and tobacco (which
Two of the major types of Substance-induced disorders: contains the stimulant nicotine)
1. Substance intoxication
- a pattern of repeated episodes of intoxication, which Hallucinogens such as LSD and phencyclidine (PCP) and
is a state of drunkenness or being “high,” brought inhalants (e.g., glues or aerosols)
about by the use of a particular drug - do not produce clinically significant withdrawal
features of intoxication depend on which drug is effects, they are not recognized as producing
- ingested, the dose, the user’s biological reactivity, identifiable withdrawal syndromes (APA, 2013)
and—to some degree—the user’s expectations Substance use disorders
Signs of intoxication - patterns of maladaptive use of psychoactive
- confusion, belligerence, impaired judgment, substances that lead to significant levels of impaired
inattention, and impaired motor and spatial skills functioning or personal distress
2. Substance withdrawal - general diagnostic classification
- cluster of symptoms that occur when a person - requires two or more specific features or symptoms
abruptly stops using a particular substance following - psychoactive substances: including alcohol, opioids
a period of prolonged and heavy use (opiates such as heroin and morphine), sedatives
and sleep-inducing or hypnotic drugs, stimulants
Repeated use of a substance may alter the body’s such as cocaine and amphetamines, and tobacco.
physiological reactions, leading to the development of Alcohol use disorder
physiological effects such as Tolerance - particular substance associated with problematic use
Ex. Using alcohol in situations that pose a risk to the person’s
Tolerance safety or the safety of others, such as repeatedly drinking and
- state of physical habituation to a drug, resulting driving
from frequent use, such that higher doses are
needed to achieve the same effect The previous version of the DSM distinguished between two
Withdrawal syndrome- a.k.a “Abstinence syndrome” types of substance use disorders:

- People who experience withdrawal syndrome often 1. substance abuse disorder

return to using the substance to relieve the - milder
discomfort associated with withdrawal, which thus 2. substance dependence disorder
serves to maintain the addictive pattern. - more severe
Symptoms of Alcohol Withdrawal The DSM-5 allows clinicians
- Sweating or rapid pulse, tremors of the hand, - to designate the severity of the disorder by
fleeting hallucinations or illusions, insomnia, nausea specifying whether it is mild, moderate, or severe
or vomiting, agitated behavior, anxiety, and possible Caffeine
seizures - most widely used psychoactive drug, caffeine (the
Caffeine withdrawal mild stimulant found in coffee, tea, colas, and even
- milder and may include headache, significant chocolate
drowsiness, depressed mood, problems with Alcohol
concentration, flu-like symptoms, nausea, and - most widely used substance
muscle stiffness or pain
 - Compulsive use of a drug accompanied by signs of
✔ Not all nor even most of the associated features or
physical dependence. Addiction involves a loss of
symptoms of a substance use disorder need to be control over use of a drug despite knowledge of the
present for a diagnosis to be made. harmful consequences it causes
✔ Not all persons with the same diagnosis fit the same Substance use disorder for diagnostic purposes
symptom profile - rather than addictive disorder, substance use
disorder is less stigmatizing and pejorative than the
For example, Henry may show clear signs of withdrawal term addiction.
syndrome and persistent difficulty curtailing the use of Psychological Dependence
alcohol despite multiple attempts. But Jessica’s drinking may - You cannot become psychologically dependent on a
lead to recurrent problems at work or school and continue drug without also becoming physically dependent on
despite knowledge of these harmful consequences, even it
though she shows no evidence of tolerance or of withdrawal - psychologically dependent use a drug compulsively
symptoms when she goes without alcohol for a time. to meet their psychological needs, such as relying on
a drug to combat daily stress or anxiety
Alcohol and Tobacco We can think of people who feel compelled to use marijuana
- commonly associated with drug dependence are (or caffeine or other drugs) to cope with the stresses of daily
legally available substances life but do not require larger amounts of the substance to get
high or experience distressing withdrawal symptoms when
Nonchemical Addictions and Other Forms they cease using it.
of Compulsive Behavior
Pathways to Addiction
The DSM-5 introduced a new diagnostic category, Substance Addiction- Although no one sets out to
Use and Addictive Disorders, that includes both Substance become addicted to drugs, routine drug
use disorders: use can lead to addiction when users feel
powerless to control their use of drugs
1. gambling disorder/pathological gambling
- a nonchemical form of addiction 1. Experimentation
withdrawal symptoms are typically psychological - or occasional use, the drug temporarily makes users
(e.g., anxiety, irritability, feel good, even euphoric. Users feel in control and
or restlessness) rather than physiological (e.g., believe they can stop at any time.
tremors, shaking hands, nausea) in nature.
- Pathological or compulsive gambling was previously 2. Routine Use
classified in the DSM-IV in a diagnostic category - people begin to structure their lives around the
called Impulse Control Disorders: pursuit and use of drugs.
Kleptomania- compulsive stealing - Denial plays a major role at this stage, as users mask
Pyromania- compulsive fire setting the negative consequences of their behavior to
themselves and others
- Values change. What had formerly been important,
Features of Drug Addiction or Dependence such as family and work, comes to matter less than
- Compulsive gambling, compulsive shopping, and the drugs.
even compulsive Internet use 3. Addiction or dependence
Compulsive shopping and compulsive Internet - feel powerless to resist drugs, either because they
use as recognized disorders: want to experience their effects
- category of proposed disorder requiring further or to avoid the consequences of withdrawal
study. Drugs of Abuse
Physical Dependence ✔ Drugs of abuse are generally classified within three
- also called chemical dependence or physiological
major groupings: (a) depressants, such
Dependence
as alcohol and opioids; (b) stimulants, such as
- refer to a pattern of drug-use behavior in which a
amphetamines and cocaine; and (c) hallucinogens.
person’s body has changed as a result of regular use
Depressant
of the drug, such that the person now requires larger
- is a drug that slows down or curbs the activity of the
amounts of the drug to achieve the same effects
central nervous system.
(tolerance) or has troubling withdrawal symptoms
- reduces feelings of tension and anxiety, slows
upon cutting back or stopping use of the drug (a
movement, and impairs cognitive processes.
withdrawal syndrome).
In high doses, depressants can arrest vital functions and
Addiction
cause death.
Alcohol
 - most widely used depressant, can cause death
✔ African Americans are more likely to encounter the
when taken in large amounts because
- has biochemical effects similar to those of a stresses of unemployment and economic hardship,
class of antianxiety agents or minor tranquilizers, the and stress may compound the damage to the body
benzodiazepines, which includes the well-known caused by heavy alcohol consumption
drugs diazepam (Valium) and chlordiazepoxide Korsakoff’s syndrome
(Librium) - connected with vitamin B deficiency, which is
- is an over-the-counter tranquilizer characterized by glaring confusion, disorientation,
Alcohol-related motor vehicle accidents and memory loss for recent event
- are the leading cause of death among teenagers and fetal alcohol syndrome
young adults - (FAS), a syndrome characterized by facial features
Alcohol Dependence such as a flattened nose, widely spaced eyes, and an
- refer to a pattern of impaired control over the use of underdeveloped upper jaw, as well as mental
alcohol in someone who has become physiologically retardation and social skills deficits
dependent on the drug. - affects from 1 to 3 of every 1,000 live birth
Disease Model
- the belief that alcoholism is a medical illness or Gambling Disorder
disease. - type of addictive disorder
- this perspective, once a person with alcoholism - excessive wagering on horse races or in card games
takes a drink, the biochemical effects of the drug on and casinos, to extravagant betting on sporting
the brain create an irresistible physical craving for events, to chancy stock picks
more - Many compulsive gamblers seek treatment only
- This model holds that alcoholism is a chronic, during a financial or emotional crisis, such as a
permanent condition bankruptcy or divorce
Alcohol
- BDOC= big drug on campus
- not cocaine or other drugs, is the drug of choice
among young people today and the leading drug of Compulsive or Pathological Gamblers
abuse - experienced a big win, or a series of
winnings, early in their gambling careers

Risk Factors for Alcoholism

Chapter 9: EATING DISORDER & SLEEP-WAKE
1. Gender
Eating Disorder
- Men are more than twice as likely as women to
- involve disordered eating behaviors and maladaptive
develop alcoholism
ways of controlling body weight.
2. Age Bulimia
- great majority of cases of alcohol dependence - Recurrent episodes of binge eating followed by
develop in young adulthood, typically between the purging.
ages 20 and 40 - Weight is usually maintained within a normal range.
3. Antisocial personality disorder - Overconcern about body shape and weight • 
- Antisocial behavior in adolescence or adulthood Binge/purge episodes may result in serious medical
increases the risk of later alcoholism complications.
- Typically affects young European American women
4. Family History
- best predictor of problem drinking in adulthood
Anorexia Nervosa (“without desire for [food)
appears to be a family history of alcohol abuse.
- Excessive fears of gaining weight or becoming fat,
Family members who drink may act as models
despite being abnormally thin.
(“set a poor example
- No compensatory behavior: no self-induced
- biological relatives of people with alcohol
vomiting, excessive laxative use or exercise.
dependence may also inherit a predisposition that
- Failure to recognize the risks posed by maintaining
makes them more likely to develop problems with
body weight at abnormally low levels
alcohol
5. Sociodemographic factors. - 2 types of Anorexia Nervosa:
- Alcohol dependence is generally more common - Binge eating/purging type - frequent episodes
among people of lower income and educational during the prior three-month period of binge eating
levels, as well as among people living alone or purging (such as by self-induced vomiting or
Socioeconomic factors overuse of laxatives, diuretics, or enemas)
 - Sleep typically runs in cycles of about 90 minutes
- Restricting Type - does not have bingeing or each that progress in stages from light sleep to deep
purging episodes. (involve substance abuse or sleep and then to REM sleep, when most dreams
stealing.) occur.
- The word “parasomnia” literally means “around
- Actually, the rate of suicide attempts in young sleep” and signifies that abnormal behaviors
women with anorexia nervosa is much higher than involving partial or incomplete arousals occur
that of young women in the general population around the boundary between wakefulness and
sleep.
Binge Eating Disorder
- Recurrent binge eating without compensatory Sleep terrors
purging. - repeated episodes of terror induced arousals that
•  Individuals with BED are frequently described as usually begin with a panicky scream.
compulsive overeaters - Arousal typically begins with a loud, piercing cry or
•  Typically affects obese women who are older scream in the night.
than those affected by anorexia or bulimia Sleepwalking
- repeated episodes in which they walk about the
house while remaining asleep.
Insomnia Disorder - partially awake and can perform complex motor
- Persistent difficulty falling asleep, remaining asleep, responses, such as getting out of bed and walking to
or getting enough restful sleep. another room.
- at least three months and that it occurs at least - most common in children.
three nights per week.
Nightmare disorder
Hypersomnolence Disorder (sleep drunkenness) - recurrent episodes of very disturbing and well-
- Persistent pattern of excessive daytime sleepiness. remembered nightmares during REM sleep.
- may sleep 9 or more hours a night but still not feel - associated with traumatic experiences and generally
refreshed upon awakening occur when the individual is under stress.

Narcolepsy C10: Disorder Involving Gender and Sexuality

- Sudden attacks of sleep during the day.
- experience an irresistible need to sleep or sudden Transgender identity
sleep attacks or naps without warning and remain - have the psychological sense of belonging to one
asleep for about 15 minutes. gender while possessing the sexual organs of the
Cataplexy - loss of muscle tone ranging from mild other.
weakness in the legs to complete loss of muscle
control, causing the person to collapse. Paraphilia
-
Breathing-Related Sleep Disorders Gender Identity
- Sleep repeatedly interrupted due to difficulties - psychological sense of being male or female. For
breathing. most people, gender identity is consistent with their
physical or genetic sex.
Circadian Rhythm Sleep-Wake Disorder
- Disruption of the internal sleep-wake cycle due to Gender dysphoria
time changes in sleep patterns. - previously called gender identity disorder.
- applies to people who experience significant
Obstructive sleep apnea hypopnea syndrome personal distress or impaired functioning as a result
- (obstructive sleep apnea) of a conflict between their anatomic sex and their
- breath, pauses of breath, or abnormally shallow gender identity—their sense of maleness or
breathing. femaleness,
- Hypopnea - refers to shallow or reduced breathing
that is not as severe as full apnea. Accompanied by [Gender identity should not be confused with sexual
loud snoring. orientation. Gay males and lesbians have erotic interest in
- People with sleep apnea may gasp for breath members of their own gender, but their gender identity is
hundreds of times during the night without realizing consistent with their anatomic sex.]
it.
Sex Reassignment Surgery
Parasomnias - gender dysphoria
 - People who undergo sex reassignment surgery can - Men have a higher risk of developing schizo.
participate in sexual activity and even reach orgasm,
but they cannot conceive or bear children because Period of Gradual Deterioration:
they lack the internal reproductive organs of their Prodromal phase
newly reconstructed sex. - Prodrome
- Characterized by subtle symptoms involving unusual
OVERVIEW OF SXUAL DYSFUNCTION thoughts or abnormal perceptions.
[ difficulty meeting responsibilities of daily living, and
Male Hypoactive Sexual Desire Disorder impaired cognitive functioning involving problems with
- Deficiency or lack of sexual interest or desire for memory..]
sexual activity.
Acute phase
Female Sexual Interest/Arousal Disorder - Behavior becomes more bizarre—such as hoarding
- Deficiency or lack of sexual interest or drive and food, collecting garbage, or talking to oneself on the
problems achieving or sustaining sexual arousal. street.

Erectile Disorder Residual phase (chronic phase)

- Difficulty achieving or maintaining erection during - Behavior returns to the level of the prodromal
sexual activity. phase.
- Difficulty maintaining an erection to the completion - Impaired by significant cognitive, social, and
of sexual activity, or have erections that lack the emotional deficits, such as a deep sense of apathy
rigidity needed to perform effectively. and difficulties in thinking.
- Disturbances of volition are most often seen.
Disorders Involving Impaired Orgasmic Response:
Female Orgasmic Disorder
- Difficulty achieving orgasm in females. GROUPING FEATURE OF SCHIZO:

Delayed Ejaculation Positive Symptoms

- Difficulty achieving orgasm or ejaculation in male. - break with reality, as represented by the appearance
of hallucinations and delusional thinking.
Premature (Early) Ejaculation
- Climaxing (ejaculating) too early in males. Negative Symptoms
- a person's ability to function in daily life and include
Genito-Pelvic Pain/Penetration Disorder such features as lack of emotions, loss of motivation,
- Pain during intercourse or attempts at penetration, loss of pleasure, social withdrawal, alogia.
or fear of pain associated with intercourse or
penetration, or tensing or tightening of the pelvic SPEECH INCOHERENT AND INCOMPREHENSIBLE
muscles, making penetration difficult or painful.
Neologisms
Female orgasmic disorder and delayed ejaculation - made-up words that have little or no meaning to
- marked delay in reaching orgasm (in women) or others.
ejaculation (in men), or an infrequency or absence of
orgasm or ejaculation. Preservation
- inappropriate but persistent repetition of the same
Vaginismus words or train og thought.
- the muscles surrounding the vagina involuntarily
contract whenever vaginal penetration is attempted, Clanging
making sexual intercourse painful or impossible. - stringing together of words or sounds on the basis of
rhyming such as “I know who I am but I don’t know
Sam”
CHAPTER 11: Schizophrenia Spectrum Disorders
Blocking
Schizophrenia - Involuntary abrupt interruption of speech or
- (present for 6 months - active at least 1 month) thought.
- chronic, debilitating disorder that touches every —---------------------------------------------
facet of the affected person’s life.
- Disengage from society. Hypervigilant
- Delusions, hallucinations, illogical thinking, - acutely sensitive to extraneous sounds.
incoherent speech, and bizarre behavior.
Auditory
- Most common type of hallucinations
- 2nd is the Visual.

Catatonia
- Waxy Flexibility.
- severely impaired cognitive and motor functioning.
- Unaware of the environment and maintaining a fixed
or rigid posture, bizarre positions for the house as
the limbs become stiff or swollen.

Brief psychotic disorder

- lasts from a day to a month
- delusions, hallucinations, disorganized speech, or
grossly disorganized or catatonic behavior.

Schizophreniform disorder
- at least one month but less than six months.

Delusional disorder
- applies to people who hold persistent, clearly
delusional beliefs, often involving paranoid themes
(grandeur, reference, jealous type, erotomania…)

Chapter 11: Personality Disorders and Impulse-Control

Disorder

Cluster A:
- People who are perceived as odd or eccentric.
- Paranoid, schizoid, and schizotypal personality
disorders.

Cluster B:
- People whose behavior is overly dramatic,
emotional, or erratic.
- Antisocial, borderline, histrionic, and narcissistic
personality disorders.

Cluster C:
- People who often appear anxious or fearful.
- Avoidant, dependent, and obsessive–compulsive
personality disorders.