FINAL EXAM- Michelle Giustini

Chapters 9,10,12 & 17

Chapter 9: MOOD DISORDERS

Unipolar Depression:
o type of depression consisting of depressive symptoms but without manic
episodes

The Diagnosis of Unipolar Depressive Disorders

Two categories under unipolar depressive disorder:

o Major Depression
 Person must experience either depressed mood OR loss of interest
in usual actives PLUS at least four other symptoms of depression
for at least 2 weeks
o Dysthymic Disorder- less severe
 Person must experience depressed mood PLUS two other
symptoms of depression for more than a 2 month period

Subtypes of Major Depression

1) Depression with melancholic features: (physiological symptoms) Ex. Inability to

experience pleasure, distinct depressed mood, depression regularly worse in
morning, early morning awakening…
2) Depression with Atypical features: Odd assortment of symptoms- Ex. Positive
mood reactions to some events, significant weight gain or increase in appetite,
hypersomnia
3) Depression with Catatonic features: strange behaviours- Ex. catalepsy,
excessive motor activity, severe disturbances in speech
4) Depression with psychotic features: presence of depressing delusions or
hallucinations
5) Depression with Postpartum onset: Onset of major depressive episode with 4
weeks of delivery of child
6) Depression with Seasonal pattern: aka seasonal affective disorder (SAD)- history
of at least 2 years in which major depressive episodes occur during one season
of the year (usually Winter) and remit when the season is over

Prevalence and Course of Depression

 o 15-24 years old are most likely to have had a major depressive episode in the
past month
o Lower rates among 45-54 years old even lower rates In people 55- 70 years of
age with only 2% diagnosable with major depression
o Rates go up among the “old-old” 85 years of age
o Old adults may be less likely than young adults to report symptoms of
depression- because they grow up in a society less accepting of the disorder
o Depressive symptoms in the elderly often occur in the context of serious medical
illness which can interfere with making an appropriate diagnosis
o Older peple are more likely than younger people to have mild to severe cognitive
impairment, and it is often difficult to distinguish between a depressive disorder
and the early stages of a cognitive disorder
o People w/ a history of depression may be more likely to die before they reach old
age
o As people age they may develop more adaptive coping skills and a
psychologically healthier outlook on life, which may lead them to experience
fewer episodes of depression
o Women are about twice as likely as men to experience both mild depressive
symptoms and severe depressive disorders
o Gender difference has been found in many countries
o Become smaller with advancing age, with increasingly higher rates for man who
never married ad they age

Depression in Childhood and Adolescence

o Less common among children than adults

o 2.5 of children and 8.3 % of adolescents can be diagnosed with major depression
o 1.7 children and 8.9 adolescents diagnosed with dysthymic disorder
o Girls rates of depression escalate dramatically over the course of puberty boys
do not
o girls appear to value the physical changes that accompany puberty much
less than boys do
 girls dislike weight gain in fat and their loos of long, lithe look that is
idealized in modern fashions
 boys like the increase in muscle mass and other pubertal changes
their bodies undergo

Bipolar Mood Disorder:

o disorder marked by cycles between manic episodes and depressive episodes;
also called manic-depression
Symptoms of mania:

o diagnosis of mania requires that a person show an elevated, expansive, or

irritable mood for at least 1 week, plus at least three of the other symptoms:
o elevated, expansive or irritable mood, inflated self esteem or grandiosity,
decreased need for sleep, more talkative than usual, a pressure to keep
talking, flight of ideas or sense that your thoughts are racing, distractibility,
increase in activity directed at achieving goals, excessive involvement in
potentially dangerous activities

Diagnosis of Mania:

Bipolar I: form of bipolar disorder in which the full symptoms of mania are experienced;
depressive aspects may be more infrequent or mild

Bipolar II: only hypo manic episodes are experienced and the depressive component is
more pronounced

o hypermania: state in which an individual shows mild symptoms of mania

Cyclothymic disorder: more chronic form of bipolar disorder

o a person alternated between episodes of hypmania and moderate

depression chronically over at least 2 years
o during the periods of hypomania, the person may be able to function
reasonably well in daily life HOWEVER the periods of depression
significantly interfere with daily functioning, although these periods are not
as severe as those qualifying for major depressive episodes

Prevalence and course of Bipolar Disorder

o less common than unipolar depression

o overall life time prevalence rate of 1.7 per 100 people
o men and women equally likely to develop, no consistent difference between
ethnic groups
o developed late adolescents or early adulthood

THEORIES

Biological Theories

Genetic Theory: disordered genes predispose to depression or bipolar disorder

 o risk of developing bipolar disorder decreased as the genetic similarity between
an individual and a relative with bipolar disorder decreases

Neurotransmitter theories: dysregulation of neurotransmitters and their receptors cause

depression and mania. The monoamine neurotransmitters- norepinephrine, serotonin
and dopamine- have been most researched

Neurophysiologic abnormalities: abnormalities in the structure and functioning of the

prefrontal cortex, hippocampus, anteririor cingulated cortex, and amygdale

Neuroeodoctrine abnormalities: depressed people show chronic hyperactivity in the

hypothalamic- pituitary- adrenal axis and slow return to baseline after a stressor, which
affects the functioning of neurotransmitters

Psychological Theories

Behavioural theories:

o suggests that life stresses leads to depression b/c it reduces the positive
reinforces in a persons life

Lewinsohn’s theory: depressed people experience a reduction in positive reinforces

and an increase in aversive events, which leads to depression

Learned Helplessness theory: depressed people lack control, which leads to the belief
that they are helpless, which leads to depressive symptoms

Cognitive Theories

Aarons Beck’s Theory: Depressed people have a negative cognitive triad of beliefs
about the self, the world and the future, which is maintained by distorted thinking

o People with depression then commit many types of errors in thinking – such as
jumping to negative conclusions on the basis of little evidence, ignoring good
events, focusing only on negative events that support their negative cognitive
triad.

Reformulated learned/ helplessness theory: Depressed people have the tendency to

attribute events to internal stable, ad global factors which contribute to depression

o Focuses on people casual attributions: Is an explanation of why an event

happened

Ruminative response styles theory: depressed people tend to ruminate about their
symptoms and problems
 o Focuses more on the process of thinking, rather than the content of thinking, as a
contributor to depression(Nolen- Hoekesma)
o Reumination: focusing on one’s personal concerns and feelings of distress
receptively and passively

Psychodynamic theory: depressed people have unconsciously punishing themselves

because they feel abandoned by another person but cannot punish that person;
dependency and perfectionism are risk factors for depression

o Interjected hostility: Freud’s theory explaining how depressive people,

being too frightened to express their rage of their rejection outwardly, turn
their anger inward on parts of their own egos; their self-blame, and
punishment is actually blame punishment intended for others who have
abandoned them

Interpersonal theories: Depressed people have poor relationships with others

o Concerns with peoples close relationships and their role in those relationships
o Disturbances in these roles are thought to be the main source of depression
o Contingencies of self worth: “if-then” rules concerning self-worth, such
as “I’m nothing if a person I care about doesn’t love me”
o Excessive reassurance seeking: constantly looking for assurance from
others that they are accepted and loved

Social Theories

The Cohort Effect: people born in one historical period are at different risk for disorder
than people born in another historical period

o More recent generations are at risk for depression b/c of the rapid
changes in social values that began in the 1960’s

Social Status: people who have lower status is society generally tend to show more
depression

o Higher rates of depression in groups who have lower social status, such
as Aboriginal Canadians

Cross- Cultural Differences: the prevalence of major depression is lower among less
industrialized and less modern countries than among industrialized and more modern
countries

o May be that the fast paced lifestyles of people in modern, industrialized

societies, with their lack of stable social support or community
TREATMENTS

For Depression:

Biological Treatments

Trycyclic Antidepressants: help reduce the symptoms of depression by preventing the

reuptake of norepinephrine and serotonin in the synapses or by changing the
responsiveness of the receptors for these neurotransmitters

o Reasonably effective, leading to the relief of acute symptoms of depression

about 60% of people with depression
o Most proscribed: imrpramine, amitriptylene and desipramine
o SIDE EFFECTS: most common: dry mouth, excessive perspiration, blurring of
vision, constipation, urinary retention, and sexual dysfunction

Monoamine Oxidase Inhibitors: decrease the action of MAO and thus bring about
increases in the levels of the neurotransmitters in the synapse

o As effective as trycyclic, but physicians are more cautious in prescribing MAO’s

b/c their side effects are dangerous
o People taking MAO’s ingest food rich in an amino acid called tryamine,
they can experience a rise in blood pressure fatal

SSRIs: similar in structure to trycyclic, but they work more directly to affect serotonin

o Have become extremely popular for treatment in depression

o Not more effective than antidepressants- about the same % of people respond to
an SSRI as respond to a trycyclic or an MAOI
o Several advantages:
o People experience relief from their depression after a couple of weeks of
using drugs
o Side effects are less severe
o Drugs do not tend to be fatal in overdose and thus are safer
o Appear to be helpful in a wide range of symptoms in addition to
depression
o Most common side effect: increased agitation or nervousness
 People report feeling “jittery” or “hyper”

Other Bio Therapies:

ECT Therapy: consists of series of treatments in which a brain seizure is induced by
passing electrical currents through the brain

o Patients first given muscle relaxants so they are not conscious when they have
the seizure and so their muscles do not jerk violently during the seizure
o Metal electrodes are taped to the head and a current of 70-130 volts is passed
through one side of the brain for about one half of a second
o Full treatment consists of 6-12 sessions
o **Relieves depression in 50-60% of people who have not responded to drug
therapies

Repetitive Trancranial Magnetic Stimulation (rTMS): exposes patients to repeated

high intensity magnetic pulses focused on particular brain structures such as the left
prefrontal cortex

o Patients who are given rTMS daily for at least a week tend to experience relief
from their symptoms

Vagus Nerve Stimulation (VNS): the vagus nerve is stimulated by a small electronic
device much like a cardiac pacemaker which is surgically implanted under a
patient’s skin in the left chest wall

Light Therapy: may help reduce seasonal affective disorder by resetting circadian
rhythms, natural cycles of biological activities that occur ever 24 hours

Drug Treatments for Bipolar disorder:

Lithium: most common treatment for bipolar disorder

o Seems to stabilize a number of neurotransmitter systems, including serotonin,

dopamine and glutamate
o More effective in reducing the symptoms of mania than of depression

Three other classes of drugs: anticonvulsants, antipsychotic drugs, calcium channel

blockers

Psychological Treatments:

Behavioural therapies: Increase positive reinforces and decreased aversive events by

teaching the person new skills for managing interpersonal situations and the
environment engaging in pleasant activates

Cognitive- Behavioural therapy: Challenges distorted thinking and helped the person
learn more adaptive ways of thinking and new behavioural skills
Steps in CBT:

o Help clients discover the negative, automatic thoughts they habitually

have and to understand the link between those thoughts and their
depression
o Help clients challenge their negative thoughts
o Help clients recognize the deeper, basic beliefs or assumptions they hold
that are feeding their depression

Interpersonal therapy: Helps the person change dysfunctional relationship patterns

Psychodynamic therapies: Helps the person gain insight into the unconscious hostility
and fears abandonment to facilitate change in self0 concept and behaviours

Chapter 10: SUICIDE

Types of Suicide: In Lecture notes

Suicide Rates:

Gender Differences:

o Women 3X’s more likely to attempt suicide

o Men 4x’s more likely to complete suicide
o Canada has the highest gender suicide mortality gap of any country in the world,
with a ratio of 5.2 males suicides for each female suicide
o Males are more likely to use irreversible methods where there is less
opportunity to prevent death, such as hanging, firearms
o Women most likely use drugs, poison gases where they is better chance
of preventing death

Ethnic and Cross-cultural Differences:

o Immigrants much less likely than Canadian born to commit suicide

o 1995-97- 535 suicides were committed by immigrants, 3328 by Canadian born
o People born in Europe and Oceania (Australia, New Zealand) have relatively
higher suicides rates than people from Africa and Asia
o Suicide among Aboriginal peoples is a serious problem
 o Overall, the suicide rate for Aboriginal people is 3X’s that of the general
Canadian population

Suicide in Children and Adolescents:

o Relatively rate in young children, but it is not impossible

o Girls are much more likely to attempt suicide, but boys are more likely to
complete it
o Adolescents –young adults: males are 6x’s more likely than females to commit
suicide

Social Perspective on Suicide:

Economic Hardship: people who are chronically impoverished or who recently have lost
a job are at increased risk for suicide

Serious illness: people with serious illness are at an increased risk for suicide

Loss and Abuse: people who have experienced loss or abuse in the distant or recent
past are at increased risk for suicide

Durkheim’s Theory: in lecture notes *

Suicide Cognition: in Lecture notes*

o Suicide cluster: When two or more suicides or attempts are non-

randomaly bunched in space or time such as a serious of suicide attempts
in the same high school in response to the suicide of a celebrity

Psychological Theories of Suicide

All in Lecture notes:

o Psychodynamic, mental disorder, impulsivity, cognitive theories, and

biological theories

(Textbook: pg 349...)

TREATED AND PREVENTING SUICIDAL TENDENCIES

Crisis intervention: aims to reduce the risk for an imminent suicide attempt by providing
suicidal persons someone to talk with, someone who understands their feelings and
problems

o Some done over the phone- suicide hotlines

DRUG TREATMENTS

o Medication most consistently shown to reduce the risk for suicide is Lithium
o Those not treated with lithium were 13xs more likely to commit suicide or
attempt suicide
o Many people have difficulty taking lithium because of its side effects and
toxicity
o SSRI’s: such as celexa, Prozac, Luvox, Zoloft and Paxil
o These drugs can reduce impulsive and violent behaviours in general, and
suicidal behaviours specifically
o Some studies suggest that these drugs can increase risk for suicide in
some people
 Patients must be closely monitored when using these drugs

PSYCHOLOGICAL TREATMENTS

Dialectical behaviour therapy: refers to this constant tension between conflicting images
or emotions in people with borderline personality disorder

o Somewhat like CBT- but focuses on difficulties in managing negative emotions

and in controlling impulsive behaviours

SOCIAL APPROACHES AND PREVENTIONS

Guns and Suicides: in Lecture Notes *

The Controversy of Assisted Suicides:

o Mercy killing or euthanasia: killing another person as an act of mercy

o Assisted suicide has been prohibited by parliament since the adoption of
Canada’s first criminal code

Chapter 12: PERSONALITY DISORDERS

Cluster A: Odd Eccentric Personality Disorders

o People with these disorders have symptoms similar to those of people with
schizophrenia, involving inappropriate or flat affect, off thought and speech
patterns, and paranoia
o People with these disorders maintain their grasp on reality however

Cluster B: Dramatic Erratic Personality Disorders

 o People with these disorders tend to be manipulative, volatile and uncaring in
social relationships
o They are prone to impulsive, sometimes violent behaviours that show little regard
for their own safety or the safety needs of others

Cluster C: Anxious Fearful Personality Disorders

o People with these disorders are extremely concerned about being criticized or
abandoned by others and thus have dysfunctional relationships with others

Problems with the DSM Categories:

o Treats disorders as categories

o Each disorder is describes as if it represents something qualitatively
different from a “normal” personality
o DSM axis II disorders can be represented by a restricted list of normal
personality traits that overlap between Axis II disorders is due to common
underlying traits

Gender and Ethnic Biases in Construction and Application

o Paula Kaplan argued that the diagnoses of histrionic, dependent and

borderline personality disorders which are characterized by flamboyant
behaviour, emotionality and dependence on others are simply extreme versions
of negative stereotypes of women’s personalities
o also argued that the diagnostic criteria for anti-social, paranoid, and obsessive-
compulsive personality disorders which are characterised by violent hostile and
controlling types of men

Cluster A: Odd- Eccentric Personality Disorders

o behave in ways that are similar to the behaviours of people with schizophrenia or
paranoid psychotic disorders, but they retain their grasp on reality to a greater
degree than do people who are psychotic

1) Paranoid Personality Disorder

o Persuasive and unwarranted mistrust of others
o People with this disorder deeply believe that other people are chronically trying to
deceive them or to exploit them and are preoccupied with concerns about the
loyalty and trust worthiness of others
o Tend to misinterpret or over interpret situations in line with their suspicions
Prevalence and prognosis of PPD

- 0.5% and 5.6% of people in the general population can be diagnosed with PPD
- Among people treated for personality disorders, males outnumber female 3:1
ratio
- People diagnosed with the disorder appear to be @ increased risk for a # of
acute psychological problems including: major depression, anxiety disorders,
substance abuse and psychotic episodes

Theories and Treatment of PPD

- Paranoid personality disorder is somewhat more common in the families of

people with schizophrenia than in families of healthy control subjects
- People diagnosed with paranoid personality disorder usually come into contact
with clinicians only when they are in a crisis
- Therapists attempts to challenge their paranoid thinking which is likely to be
misinterpreted in line with their paranoid belief system
- In order to gain trust of client the therapist must be calm, respectful and
extremely straightforward

1) Schizoid Personality Disorder

o Lack the desire to form interpersonal relationships and are emotionally cold in
interactions with others
o Other people describe them as aloof, reclusive, and detached or as dull,
uninteresting and humourless

Prevalence of SPD

- Quite rare with about 0.4% and 1.7% of adults manifesting the disorder at
sometime in their life
- Males outnumber females about 3:1 ratio
- They can function in society, particularly in occupations that not require
interpersonal interactions

Theories and Treatment of SPD

- Slightly increased rate of schizoid personality disorder in the relatives of person

with schizophrenia but the link between the two disorders is not clear
- Low sociability, low warmth may be partially inherited
- Psychosocial treatments of SPD focus on increasing the persons social skills,
social contacts and awareness of his or her own feelings
 - Therapists may model the expression of feelings for the client and help the client
identify and express his or her own feelings
- Social skills training- role playing

2) Schizotyal Personality Disorder

o Tend to be socially isolated to have a restricted range of emotions and to be
uncomfortable in interpersonal interactions
o People are passive, socially unengaged, and hypersensitive to criticism

Oddities in Cognition- 4 categories:

1) Paranoia or suspiciousness: perceive that other people as deceitful and hostile,

and much of their social anxiety emerges from this paranoia
2) Ideas of reference: tend to believe that random events or circumstances are
related to them
3) Odd beliefs and magical thinking: They may believe that others know what they
are thinking
4) Illusions: just short of hallucinations- they may think they see people in the
patterns of wallpaper

Prevalence of STPD

- 0.6 and 5.2 % of people will be diagnosed with this personality disorder in their
lives
- Twice as commonly diagnosed in males as in females
- Are at increased risk for depression and for schizophrenia or isolated psychotic
episodes
- People of colour are more often diagnosed with schizophrenic-like disorders such
as STPD than are whites because of White clinicians often misinterprets
culturally bound beliefs as evidence of STPD

Theories and Treatment of STPD

- Many more studies of the genetics of STPD have been conducted than studies of
other odd eccentric disorders
- Psychotic like traits are highly inheritable
- STPD is much more common in the first degree relatives of people with
schizophrenia than in the relatives of either psychiatric patients or healthy control
groups
 - People diagnosed show problems in the ability to sustain attention on cognitive
tasks as well as deficits in memory similar to those seen in people with
schizophrenia
- Tend to show dysregulation of the neurotransmitter dopamine in the brain
- Have abnormally high levels of dopamine in some areas of the brain
- Treated with the same drugs used to treat schizophrenia: neuroleptics
(haloperidol and thiothixene), and atypical antipsychotics (olanzapine)
- Psychotherapy: important to establish good relationships with clients because
they typically have few close relationships
o Help clients increase social contacts and learn socially appropriate
behaviours through social skills training
o Objective evidence in environment for their thoughts and to disregard
bizarre thoughts

Cluster B: Dramatic- Erratic Personality Disorder

- Engage in behaviours that are dramatic and impulsive

- They often show little regard to their own safety of the safety of others
- They may engage in suicidal behaviours or self damaging acts, such as self-
cutting
- May also act in hostile of or even violent ways against others

1) Antisocial Personality Disorder

- Moral insanity: little self control and no concern for the rights of others
- Psychopathic- to anyone who had a severely maladaptive personality
- Today psychopath is not part of the DSM-IV-IR, instead people with chronic
antisocial behaviours is people with APD

APD=

o * the impairment in the ability to form positive relationships with other and
a tendency to engage in behaviours that violate basic social norms and
values
o deceitful
o Poor control of one’s impulses
o easily bored, restless
o 50-80% of men in jail may be diagnosable with APD

Prevalence of APD
 - Most common personality disorder
- Out of 3258 household residents--3.7% of population met the criteria for
antisocial personality disorder
- Men are substantially more likely than women to be diagnosed with this disorder
- More likely to see antisocial in African-Americans than in Caucasians
- People diagnosed are likely to have low levels of education
- 80% of people with APD abuse substances such as alcohol or illicit drugs
o Alcohol and other substances may reduce any inhibitions they do have,
making it more likely they will lash out violently at others

Theories of APD

1) Genetic factors contribute to antisocial behaviour

- Twin studies find that the concordance rate for such behaviours is near 50% in
MZ twins, compared with 20% or lower in DZ twins
- Criminal records of adopted sons are more similar to records of their biological
fathers than those of their adoptive fathers
2) Testosterone:
- aggressiveness is associated with high levels of testosterone; alternatively, high
levels of testosterone present in utero affect the development of the fetal brain in
ways that promote aggressiveness
3) Serotonin:
- Low levels of serotonin contribute to impulsive and aggressive behaviours
4) Attention- deficit/ hyperactive disorder:
- Children with attention-deficit/hyperactivity disorder develop antisocial behaviour
in response to social rejection and punishment
5) Executive functions:
- People with APD have deficits in the parts of the brain that are involved in
executive functions (planful behaviour and self-monitoring)
6) Arousability:
- Low levels of arousability lead to fearlessness in dangerous situations and or
stimulation-seeking behaviour, which contributes to antisocial monitoring
7) Social Cognitive factors:
- Children with antisocial tendencies have parents who are harsh and neglectful
and the children interpret interpersonal situation in ways that promote aggression

Treatments for APD

- Ppl with APD tend to believe they do not need treatment

 - Psychotherapy focus on helping the person with antisocial personality disorder
to gain control over his/her anger and impulsive behaviours by recognizing
triggers ad developing alternative coping strategies
- Lithium and atypical antipsychotics
o Used successfully to control impulsive/aggressive behaviours in people
with antisocial personality disorder

2) Borderline Personality Disorder

- Instability is a key feature
- Unstable mood with bouts of severe depression, anxiety or anger seeming to
arise frequently and often without good reason
- Self- concept is unstable with period of extreme self doubt and periods of
grandiose self importance
- Interpersonal relationships are unstable- can switch from idealizing others to
despising them without provocation

Prevalence of BPD

- 1-2% of population will develop BPD in their lives

- Much more often diagnosed in women than in men
- Common amongst people of colour than in whites and in people in lower
socioeconomic classes ex Hispanics
- People with disorder are high users of outpatient mental health services
o 50% had used some form of mental health services

Theories of BPD

- Genetic predisposition
- Functional magnetic resonance imaging (fMRI)- ppl with BPD have greater
activation of the amygdala in response to pictures of emotional faces, as do
people with mood and anxiety disorders, which may contribute to their difficulties
in regulating their moods
- Low levels of serotonin
- Ppl with disorder have more early relationships with caregivers
o Caregivers may have encouraged the children’s dependence on them
- Linehan theory: people with BPD have histories of significant others
discounting and criticizing their emotional experiences
 o Such experiences make it even harder for them to learn to learn
appropriate emotion-regulation skills and to understand and accept
their emotional reactions to events
o People with this disorder come to rely on others to help cope with
difficult situations but do not have enough self confidence to ask for
help from others in mature ways

Treatments for BPD

- Dialectical Behaviour Therapy: Linehan and colleagues developed a

therapy blending cognitive-behavioural techniques with interpersonal and
psychodynamic techniques for the treatment of people with BPD
o focuses on helping clients gain a more realistic and positive sense of
self, learn adaptive skills for solving problems and regulating
emotions and correct their dichotomous thinking
o teach clients to monitor their self- disparaging thoughts and
evaluations, learn appropriate assertiveness skills
- drug therapy: focus on reducing the symptoms of anxiety and depression
through antianxiety drugs and antidepressants and SSRIs
o drugs results have been mixed
o combination therapies not significant

3) Histrionic Personality Disorder

- Shares features with BPD including rapidly shifting emotions and intense,
unstable relationships
- Usually want to be the center of attention

Prevalence of Histrionic Personality Disorder

- 1.3 and 2.2% of the population will experience this disorder at sometime in their
lives
- Vast majority are women
- Ppl with this disorder are more likely to be separated or divorced than married
Theories and Treatments of HPD

- Psychodynamic treatments:
o Focus on uncovering repressed emotions and need and helping people
with histrionic personality disorder express these emotions and needs in
more socially appropriate ways
- Cognitive Therapy: focuses on identifying these patients assumptions that they
cannot function on their own and helping them formulate goals and plans for their
lives that do not rely on approval of others

4) Narcissistic Personality Disorder

- Rely on own self evaluations ad see dependency on others as weak and
dangerous
- Ppl with disorder often over react to criticism by becoming very angry and
ashamed

Prevalence of NPD

- Rare less than 1% in lifetime

- Diagnosed in men more

Theories and Treatment:

- Freud: phase that all children pass through before transferring their love for
themselves to significant others
o if they experience caregivers as untrustworthy and decide that they can
rely only on themselves or if they have parents who indulge them and instil
in them a grandiose sense of their abilities and worth
- Cognitive Theorists: some ppl develop assumptions about their self worth that
are unrealistically positive as the result of indulgence and overvaluation by
significant others during childhood

Cluster C: Anxious Fearful Personality Disorders

- Chronic sense of anxiety or fearfulness and behaviours intended to ward off

feared situations
- In each of the disorders, people fear something different, but they are all nervous
and not very happy

1) Avoidant Personality Disorder

 - Has been studied more than the other 2 anxious- fearful personality disorders
- Ppl with this disorder are extremely anxious about being criticized by others so
they avoid interactions with others
o When they must interact with others they are restrained, nervous and
hypersensitive to signs of being evaluated or criticized

Prevalence of APD

- 1-7% of people can be diagnosed with avoidant personality disorder

- No strong gender differences
- Ppl with disorder or prone to chronic dysthymic disorder and to bouts of major
depression and severe anxiety
- Overlap between APD and social phobia
o Want to connect with other people but avoid social interaction due to fear
or humiliation

Theories and Treatment for APD

- More common in first degree relatives of people with disorder

o Temperament or level of emotional arousal and reactivity may be
transmitted
- Some people may be born with shy, fearful temperament which causes them to
avoid people
- Cognitive theorists believe suggest that people with avoidant personality disorder
develop dysfunctional beliefs about being worthless as a result of rejection by
important others earlier in life
o They assume they will be rejected by others, as they are rejected by their
parents and thus avoid interactions with others
- CBT
o Proven helpful for people with APD
o Therapists have included graduated exposure to social settings, social
skills training and challenges to negative automatic thoughts about social
situations

2) Dependent Personality Disorder

- Anxious about interpersonal interactions, but their anxiety stems from a deep
need to be cared for by others
- Cannot make decisions for themselves and do not initiate new activities, except
In an effort to please others
- Can function only when in a relationship
 - Fear rejection and abandonment and may allow themselves to be exploited and
abused rather than los relationships

Prevalence of DPD

- 1.6-6.7% if people will develop DPD

- Higher rates of this disorder are when self report research methods are used
- More women than men are diagnosed

Theories and Treatment for PDP

- Runs in families, but is unclear whether this is due to genetics or to family

environments
- Children with anxiety about separation from their parents or of chronic physical
illness are more prone to develop DPD
- Cognitive theories argue that people with DPD have beliefs such as “I am needy
and weak”, which drive their dependent behaviours

- Ppl with DPD seek treatment

o No treatment has been tested for their effectiveness
- Psychodynamic treatment focuses on helping clients gain insight into the early
experiences with caregivers that led to their dependent behaviours through the
use of free association, dream interpretation and interpretation of transference
- CBT- includes behavioural techniques designed to increase assertive
behaviours and to decrease anxiety, as well as cognitive techniques designed to
challenge assumptions about the need to reply on others
o They may along with the therapist develop a hierarchy of increasingly
difficult independent actions that the clients gradually attempt on their own

3) Obsessive-Compulsive Personality Disorder

- Shares features with obsessive compulsive disorder but OCPD represents a
more generalized way of interacting with the world than does OCD
o Often involves only specific and constrained obsessional thoughts and
compulsive behaviours
- Workaholics and see little need for leisure activities or friendships
- Other people view them as: stubborn, stingy, possessive, moralistic, and officious

Prevalence of OCPD:

- 1.7and 7.7% of population can be diagnosed with OCPD

- More common in men than women
 - Ppl with disorder or prone to depression and anxiety but not to the same extent
as people with avoidant or dependent personality disorder

Theories and Treatment for OCPD

- No family history twin or adoption studies focusing on OCPD

- Psychodynamic theory: fixation at the anal stage of development because the
patients parents were overly strict and punitive during toilet training
- Cognitive theory: people with this disorder harbour beliefs such as “flaws,
defects, or mistakes are intolerable”
- Behavioural therapies- can be used to decrease their compulsive behaviours
o Ex. Client may be taught relaxation techniques to overcome the
anxiety created by alterations in their “perfect schedules”

Chapter 17: SUBSTANCE-RELATED DISORDERS

Definitions of Substance Related Disorders:

Substance Abuse: when a person’s recurrent use of substance results in significant

harmful consequences

- 4 categories of harmful consequences:

o Person fails to fulfill important obligations
o Person repeatedly uses the substances in situations in which it is
physically hazardous
o Person reputedly has legal problems as result of substance use
o Person continues to use the substance, even though he/she has
repeatedly had social or legal problems as a result of the use
- Must show at least 1 of these categories within a 12 month period to qualify for a
diagnosis of substance abuse

Substance Dependence: the closest to what people often refer to as a drug addiction

- A person is psychologically dependent on a substance when he or she shows

either tolerance or withdrawal.
o Tolerance: present when a person experiences less and less effect from
the same dose of a substance and needs greater and greater doses of a
substance in order to achieve intoxication
- People who are physiologically dependent on substances often show severe
withdrawal symptoms when they stop using substances
 o Symptoms may be so severe that the substances must be withdrawn
gradually in order to prevent symptoms from becoming overwhelming or
dangerous

Substance intoxication: is a set of behavioural and psychological changes that occur as

a direct result of psychological effects of a substance on the central nervous system

Substance Withdrawal: involves a set of physiological and behavioural symptoms that

result when people who have been using substances heavily prolonged periods of time
stop using the substances or greatly reduce their use

Stimulants

Caffeine: by far the most heavily used stimulant drug

- 75% of caffeine is ingested through coffee

- Caffeine stimulates the central nervous system, increasing levels of dopamine,
norepinephrine, and serotonin
- It causes metabolism, body temperature and blood pressure to increase
- 2 or three cups of coffee, caffeine can cause a number of unpleasant symptoms:
restlessness, nervousness and hand tremors
- Diagnoses should only be given if a person experiences significant distress or
impairment in functioning as a result of these symptoms

Nicotine: is an alkaloid found in tobacco

- Cigarettes are the most popular nicotine delivery device

o they deliver nicotine to the brain within a few seconds after a person
begins smoking
- nicotine operates on both the central and peripheral nervous systems
o it releases several biochemical’s that may direct reinforcing effects on the
brain, including dopamine, norepinphrine and serotonin and endogenous
opioids
- over 70% of smokers say they wish they could quit

Cocaine: a white powder extracted from the coca plant and one of the most highly
addictive substances known

- Cocaine activates the ventral tegmental area and the nucleus accumbens, the
areas of the brain that register reward and pleasure
 - Produces a sudden rush of intense euphoria, followed by great self-esteem,
alertness and energy a general feeling of competence, creativity, and social
acceptability
- Some medical complications:
o Disturbances in the heart rhythm
o heart attacks
o Chest pains and respiratory failure
o Neurological effect: strokes, seizure, and headaches
- Physical symptoms:
o Chest pains
o Blurred vision
o Fever, muscle spasms, convulsions and coma

Amphetamines: Dexedrine and Benzedrine

- these drugs are most often swallowed as pills but can be injected
- many people use them to combat depression or chronic fatigue from
overwork or simply boost their self-confidence and energy
- causes the release of the neurotransmitters dopamine and norepinephrine
and by blocking the reuptake of these neurotransmitters
- Symptoms similar to cocaine: euphoria, self-confidence. Alertness,
agitation and paranoia
- Can cause medical problems:
o Cardiovascular problems: rapid irregular heartbeat, increased blood
pressure, and irreversible stroke-producing damage to small blood
vessels in the brain

Depressants

Alcohol – a classic nervous system depressant, but its effects on the brain occur in two
distinct phases

- 1) In low doses, alcohol causes many people to feel more self-confident, more
relaxed, and perhaps slightly euphoric
- 2) at increasing doses, alcohol induces many of the symptoms of depression,
including fatigue and lethargy, decreased motivation, sleep disturbances,
depressed mood and confusion

Inhalants: volatile substances that produce chemical vapours, which can be inhaled
and which depress the central nervous system
 - Users may inhale vapours directly from cans or bottles containing the substances
or soak rags with the substances and then hold the rags to their mouths or noses
- Chronic users may have a variety of respiratory irritations and rashes due to the
inhalants
- Inhalants can cause permanent damage to the central nervous system, including
degeneration and lesions of the brain leading to cognitive deficits including
dementia
-
 Cannabis, opiates, hallucinogens and club drugs in Lecuture notes *

Theories of Substance Use, Abuse and Dependence

Biological Theories:

Genetic Factors: genetics play a role

- Relatives of people with substance-related disorders are 8X more likely to also

have a substance disorder than the relatives with no substance related disorder
- more then 3000 male twins found concordance rates for alcohol dependence
among MZ twins

Alcohol Reactivity:

- when given moderate doses of alcohol, the sons of alcoholics, who are
presumably at increased risk for alcoholism, experience less impairment,
subjectively in their cognitive and motor performance than do non-alcoholics
- at high doses, the sons of alcoholics are just as intoxicated, by both subjective or
objective measures, as are the sons of non-alcoholics
- low reactivity levels are more prone to becoming alcoholics

Psychological Theories:

- Behavioural theory: children may learn substance use behaviours from the
modeling of their parents and important others in their culture
- Cognitive Theory: focus on people’s expectations of the effects of alcohol and
their beliefs about appropriateness of using alcohol to cope with stress

Sociocultural Theories:
 - Higher rates of substance abuse and dependence among people facing chronic,
severe stress, people living in poverty, women in abusive relationships, and
adolescents whose parents fight frequently and violently
- Chronic stress combined with an environment that supports and even promotes
the use of substances as an escape is a recipe for widespread substance abuse
and dependence

Treatment for Substance-Related Disorders

Behavioural treatments:

- Aversive classical conditioning- used to treat dependency and abuse, either

alone or in combination with biological or other psychological treatments
- Convert sensitization therapy: people who are alcohol dependent use imagery to
create associations between thoughts of alcohol use and thoughts of highly
unpleasant consequences
- Cue exposure and response prevention: used to extinguish this conditioned
response to cues associated with alcohol intake

Cognitive Treatments:

- Interventions based on cognitive models of alcohol abuse and dependency help

clients identify the situations in which they are most likely to drink and to lose
control over their drinking and their expectations that alcohol will help them cope
better with those situations