Substance Abuse and Addiction: Understanding the Effects and Risks, Exams of Psychiatry

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KP 231 Final Exam

acute -

• Rapid onset
• Short course
• Caused by pathogen chronic -
• Slow progression
• Long duration
• Lifestyle behaviours are key number of types of headaches - 14 Teratogen - environmental agent that causes harm to embryo or fetus congential abnormalities -
• Present at birth
• Causes inappropriate changes to tissue (During embryonic development and Multifactorial) cleft palate and cleft lip -
• can occur on one or both sides
• Because lip and palate develop separately, and infant can be born with cleft lip, cleft palate, or both
• Genetic and environmental (maternal hypoxia - lack of O2) cleft palate - an opening in the roof of the mouth in which the two sides of the palate did not fuse

cleft lip -

• separation of the two sides of the lip
• the separation often includes the bones of the upper jaw and/or upper gum genetic conditions abnormal number of chromosomes -
• inherited or formed
• often related to the sex chromosomes genetic conditions inherited -
• transmitted from one or both parents at conception
• mutation of normal genetic material abnormal number of chromosome disorders - chromosomal disorders, down syndrome, klinefelters syndrome, turners syndrome chromosomal disorders -
• During meiosis problems can occur
• Pair of chromosomes does not separate
• Union with normal cell → 47 chromosomes down syndrome - 21st chromosome has 3 not 2 chromosomes Outcomes: Mental disabilities (IQ b/t 20 and 60) Walking delayed for 1+ years Hypotonia klinefelter syndrome -
• Y sex chromosome from father combines with two X chromosomes from mother
• born with, but usually presents at puberty

• risk factor: advanced maternal age features of klinefelter syndrome - tall, lanky build, depression, infertility, intellectual difficulties turners syndrome -
  • cause: complete or partial absence of one of the two X chromosomes
• appears to occur at random turner's syndrome characteristics -
  • short stature
• lack of ovarian development
• webbed neck
• CV, kidney and thyroid problems
• skeletal disorders
• hearing/vision disorders degenerative disorders - cardiovascular diseases, alzheimers disease, multiple sclerosis, parkinson's disease, freezing of gait alzheimers disease - Plaques and neurofibrulary tangles on cortex of brain multiple sclerosis -
  • Changes in white matter of nerve fibers = brain and spinal cord
• Slowly progressing disease that may result in total incapacitation freezing of gait -
  • Often occurs in confined spaces - ie. doorways, closets etc. or when turning
• Cause = Muscle co- contraction, Impaired timing, Perceptual link

Parkinson's disease - progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement Parkinson's disease treatments -

• Drugs = Levadopa + Carbadopa (Most effective in treating bradykinesia and rigidity)
• Surgery = Stimulation Surgery (Deep Brain Stimulation - Implantation of electrode into basal ganglia to inactivate region) psychosocial health dimensions - Mental, Emotional, Social, and Spiritual Dimensions of Health People Who Are Psychosocially Healthy -
• Feel good about themselves
• Feel comfortable with other people
• Control tension and anxiety
• Meet the demands of life
• Choose a positive outlook
• Enrich the lives of others
• Value diversity
• Appreciate and respect nature psychosocial health is the ability to -
• Perceive things realistically
• Interpret and evaluate situations appropriately
• Enjoy life, move forward, take personal responsibility Emotional health - the "feeling" part of psychosocial health; the "feeling" reactions to life.

intensified feelings or complex patterns of feelings we experience 4 components of emotional health - Physiological arousal Feelings Cognitive process Behavioural reactions emotional health subjective feelings and reactions to life -

• Love, hate, joy, fear, and anxiety
• Poor emotional health = poor social health (prejudice and bias) emotional health basic emotions -
• Harm, loss, and threats
• Benefits and rewards
• Borderline emotions
• Complex emotions social health is the ability to -
• Interact with others individually or in groups
• Use and provide social support
• Adapt to a variety of social situations social health: physical and mental health -
• Strong social bonds
• Key social supports Social bond - degree and nature of interpersonal contacts
• generally provide six major functions: -Intimacy -Feelings of belonging/integration to a group,

-Opportunities for giving or receiving care , -Reassurance of your worth, -Assistance and guidance -Advice) Social support - structural and expressive aspects of social interactions, can be emotional or structural prejudice - a negative evaluation of an entire group of people usually based on unfavourable and often mistaken ideas about the group spiritual health -

• Meaning, connectedness, energy, and transcendence
• Human uniqueness of experience (non-material)
• Connected to other dimensions of health
• Enhancing spiritual health: time and effort spirituality - most often defined as a search for meaning, connectedness, energy, and transcendence, rather than simply a connection to a particular religion interconnectedness - a web of connections, including your relationship to yourself, to others, and to a larger meaning or purpose in life enhancing psychosocial health -
• developing and maintaining self-esteem and self-efficacy
• forming realistic expectations
• getting adequate sleep (6-9 hours)
• understanding the mind-body connection (tell jokes) external influences on psychosocial health -

factors that you do not control, such as who raised you, the physical environment in which you live, and timelines imposed upon you by your professors influences on psychosocial health - external, family, environment, internal learned helplessness - an attitude of giving up and not trying because of past failures learned optimism - pattern of responding that focuses on the positive, because you choose to view each situation positively and with a sense of hope Personality - unique mix of characteristics that distinguishes you from others influenced by: Hereditary, environmental, cultural, and experiential factors influence how you develop this psychosocially healthy traits - Extroversion Agreeableness Openness to experience Emotional stability Conscientiousness enhancing psychosocial health - develop a support group, being a support, completing tasks, making time for you, maintaining physical health, examining problems, eating fruits and veggies, getting adequate sleep sleep 2 biological purposes - conservation of energy, restoration

risiliency - those traits or characteristics that protect you and your community from threat or harm mood disorders - mental illnesses, depression, anxiety disorders mental illness -

• Disorders: disrupt thinking, feeling, moods, and behaviours
• Cause impaired functioning in daily life endogenous depression - biochemical origin exogenous depression - cause by external event treating depression -
• Lifestyle modification
• Psychotherapeutic therapies: cognitive, interpersonal
• Attending a support group
• Taking medication
• increased risk in females seasonal affective disorder - SAD): a type of depression that occurs in the winter months, when sunlight levels are low anxiety disorder -
• Affects behaviour, thoughts, emotions, and physical health
• Intense prolonged feelings of fright, distress disorders within anxiety disorders -

• Obsessive-Compulsive disorders (obsessive thoughts, habitual behaviours)
• Phobias (deep and persistent fear)
• Panic disorders (sudden onset of disabling terror)
• Post-traumatic stress disorder (serious after-effects of a traumatic event) obsessive-compulsive disorder - an anxiety disorder characterized by obsessive thoughts or habitual behaviours, repetitive compulsions schizophrenia alterations of sense -
• Early stages can look like: Depression, Mood Swings, Increased Anxiety, Suspiciousness
• Later stages may include Hallucinations and/or Delusions, inability to sort incoming stimuli
• Altered sense of self, radical behaviour changes schizophrenia treatment - Hospitalization, medication, and psychotherapy phobias - a deep and persistent fear of a specific object, activity, or situation that results in a compelling desire to avoid the source of the fear panic attack - the sudden, rapid onset of disabling terror post-traumatic stress disorder - a disorder characterized by terrifying flashbacks, detachment, and anxiety following a severe traumatic event psychiatrist - licensed physician who specializes in treating mental and emotional disorders gender and depression in psychosocial health -

• Gender differences: women twice as likely than men
• Multiple life stressors for women
• Mechanisms for coping: women more vulnerable psychoanalyst - a psychiatrist or psychologist with special training in psychoanalysis psychologist - a person with a PhD and training in clinical or counselling psychology counsellor - a person with a variety of academic and experiential training who deals with the treatment of emotional problems warning signs of suicide -
• Making a plan or increased risk taking
• Talking, writing, or drawing about suicide
• Mood swings, feelings of hopelessness
• Giving away possessions
• Withdrawal from friends and family
• Increased use of alcohol or drug taking action to prevent suicide -
• Monitor the warning signals
• Find a safe place to talk
• Take any threat seriously
• Do not belittle the person's feelings
• Let the person know you care
• Listen Taking Action to Prevent Suicide: Ask directly, "Are you thinking of suicide?" -

• Help think of alternatives
• Make a safety plan with the person
• Discuss who else you can include besides friends, family, counsellors
• Never promise secrecy Circumstances for Seeking Professional Help -
• Think you need help
• Experience wild mood swings
• Problem is interfering with daily life
• Fears or guilt is distracting
• Withdraw from others
• Feeling worthless
• Emotional responses are inappropriate
• Life becomes a repeated crisis
• cannot get your act together
• You are considering suicide
• Drugs or alcohol
• Feel out of control types of mental health professionals -
• Psychiatrist
• Psychoanalyst
• Psychologist
• Clinical/Certified/Psychiatric Social Worker
• Counsellor
• Psychiatric Nurse - Specialist What to Expect When You Begin Therapy -
• Explain your needs
• Provide a personal history
• Be honest and trust your therapist

• Not to expect therapist to give answers
• Set own goals and timetables
• Change therapist, if not good fit Choosing a Therapist -
  • Do they have qualities of a friend?
• Do they act professionally?
• Do they work with you to set goals?
• Are they willing to be interviewed? addiction - physiological and psychological dependence withdrawal - symptoms experienced when substance or behaviour is stopped addictive behaviour - Addictive behaviours are habits that are out of control, resulting in a negative impact on a person's health addictive exercisers - Use exercise compulsively to meet needs of intimacy, nurturance, self-esteem, and self- competency consequences of exercise addiction -
  • alienation of family and friends
• injuries from overdoing it
• craving for more muscle dysmorphia (bigarexia) - A pathological preoccupation with being larger and more muscular

addictive behaviour examples - -gambling (consequences = relationships, work responsibilities, financial) -shopping (consequences = impaired relationships, financial), -eating - food addiction (consequences = weight gain, relationship difficulties) factors that contribute to addiction -

• Genetic predisposition
• personality traits, attitudes & beliefs
• Interpersonal skills addictive personalities -
• genetic influences (Heritabilities for most addictive disorders are moderate to high) - environmental contributions (Availability and exposure to a substance)
• personality traits (High neuroticism and low conscientiousness more prone to addiction) external influences -
• immediate environment (home, family, school, peer)
• larger society (youth subculture, modelling and advertising, technological advances) Prevalence of Addictions -
• Having an addiction ↑ likelihood of having other addictions
• Reciprocity - give up one addiction, take on another signs of addiction -

1. compulsion
2. loss of control
3. negative consequences
4. denial addiction based on 3 criteria -
5. The presence of an abstinence syndrome/ withdrawal

2. An associated pattern of pathologic behaviours (deterioration in work or academic performance, relationships and social interaction, and other personal circumstances)
3. Relapse: the tendency to use or re-engage in the addictive behaviour or drug after not using common addictive behaviours - Compulsive gambling Shopping Exercise Use of technology addiction intervention - a planned process of confrontation by significant others to break down denial compassionately so that an individual can see the destructive nature of his or her addiction treating addictions -
   • self help groups

• medications
• counseling and education
• avoiding addiction treatment of addiction -
  • Abstinence is refraining from the addictive behavior
• detoxification is adjustment physically and cognitively to being free from the influence of addiction intervention of addiction - planned process of confrontation by people who are important to the addict strategies for addiction treatment -
  • cognitive-behavioral therapy
• motivational psychology
• 12-step programs

drug use - Taking a drug as it was intended drug misuse -

• Not following proper directions
• Off label drug use drug abuse - Excessive use of a drug drug response -
• individual responses to drugs - highly variable
• Set: total internal environment when drug is taken (physical, emotional factors) physical, emotional factors
• Setting: total external environment (physical and social factors) prescription drug use -
• opioids morphine, codeine, oxycodone, percocet, fentanyl
• CNS depressants - decrease HR, respiration, BP
• highly addictive 6 categories of drugs - Prescription drugs Recreational drugs Over the counter drugs (OTC) Herbal preparations Illicit drugs Commercial drugs tolerance -

phenomenon in which a progressively larger dose of a drug or more intense involvement in a particular behaviour is needed to produce the desired euphoric effects Abuse of prescription drugs can lead to - tolerance, withdrawal physiology of addiction - Drug use and chronic stress can alter these receptor sites and cause the production and breakdown of neurotransmitters eg. Mood-altering chemicals, fill up the receptor sites for the body's natural "feel-good" neurotransmitters (endorphins) so that nerve cells are fooled into believing they have enough neurotransmitters and therefore shut down production of these substances temporarily withdrawal - experienced by individuals addicted to a drug or behaviour when the drug is not consumed or behaviour not engaged in. generally, the withdrawal symptom experiences are directly opposite to the effects experienced when engaging in the substance or behaviour marijuana effects -

• Increased HR, BP and respiration, red eyes, dry mouth, appetite
• Decreased coordination, decreased reaction time
• Euphoria, calmness, anxiety, or paranoia
• Altered perceptions, cognitive impairment marijuana risks of chronic use -
• damage to tissues of the respiratory system
• ↓ testosterone, sperm count, fetal abnormalities
• ↑ risk of cardiac arrest
• Dependence
• impaired cognitive function mental illness in relation to marijuana -

Psychiatric disorders more common in those that initiate use at a young age - also amount and genetic vulnerability important illicit drugs -

• illegal to posses, produce or sell
• cocaine
• methamphetamines
• heroine
• psychedelics / hallucinogens
• anabolic steroids
• inhalants
• overdose deaths opiates - Narcotics: drugs that induce sleep and relieve pain; primarily the opiates Opium: the parent drug of the opiates; made from the milky juice of the opium poppy Morphine: a derivative of opium; sometimes used by medical practitioners to relieve pain Codeine: a drug derived from morphine; used in cough syrups and some painkillers harm reduction solution - A controversial form of harm reduction regarding illicit drug use is supervised injection sites controversy exists because drug users inject illicit drugs under the direct supervision of a nurse or other health-care provider cocaine -
• CNS stimulant
• white powder derived from leaves of coco shrub
• snorted, injected, smoked
• highly addictive cocaine effects -
• within minutes rush of euphoria → energetic, alert, excited

• effects mood, judgment, coordination, vision cocaine results - respiratory damage, irritability, aggression, ↑ risk MI, stroke, ↑ risk of miscarriage, congenital defects Methamphetamines -
  • snorted, smoked, injected, oral ingestion
• severe dependence, irritability, aggression, severe cognitive impairment, weight loss, ↑ risk MI, stroke Methamphetamines effects -
  • within minutes rush of euphoria → excitation → agitation, anxiety Amphetamines -
  • CNS stimulants (increased release of neurotransmitters)
• small doses improve alertness, elevate mood
• chronic use → physiological & psychological dependence heroin -
  • opioid, CNS depressant injected (intravenous), smoked, snorted
• highly addictive
• rapid withdrawal (restlessness, muscle tremors, GI disturbance, hot & cold flashes) heroin effects -
  • within minutes produces "dreamy" feeling, drowsiness
• ↑ infections, risk of miscarriage, fatal overdose Heroin Assisted Treatment -

• Long term users required to visit specialized clinics to receive injections
• Evidence suggest decreased illicit drug use and overall criminal activities in those receiving treatmentHAT requires shift in public thought regarding addiction other illict drugs -
• psychedelics, hallucinogens, deliriants LSD (acid), magic mushrooms, PCP, ecstasy psychoactive drugs - effect brain functioning
• alter feelings, perceptions, and thoughts
• interfere with sensory signals - "synesthesia"
• some produce auditory or visual hallucinations tackling drug abuse -
• Reduce supply and demand for illicit drugs combating production and distribution operations
• Prevention programs education & awareness, efforts to minimize impact
• Treatment and rehabilitation programs prescription drugs - drugs that can be obtained only with a written prescription from a licensed physician Recreational drugs - drugs that people use to relax or socialize during their recreational time Psychoactive drugs - drugs that have the potential to alter mood or behaviours Illicit drugs - drugs whose use, possession, cultivation, manufacture, and/or sale are illegal Over-the-counter drugs (OTC) - drugs that can be purchased without a physician's prescription eg advil, tylenol commercial preparations -

commonly used chemical substances with a drug action, such as cosmetics, household cleaning products, and industrial by-products Synergism - an interaction of two or more drugs in which the effects of the individual drugs are magnified beyond what is expected of their individual contribution inhibition - a type of interaction in which the effects of one drug are eliminated or reduced by the presence of another drug at the receptor site alcohol use -

• common
• associates with some health benefits
• alcohol abuse - significant public health issue
• associates with significant morbidity & mortality Cross-tolerance - the development of a tolerance to one drug that carries over to another similar drug intolerance - a type of interaction in which two or more drugs taken together produce extremely uncomfortable reactions analgesic drugs - pain relievers Cold, Cough, Allergy, and Asthma Relievers - Likely the most popular OTC drugs are those intended to provide relief of the symptoms of coughs, colds, allergies, and asthma Expectorants - these drugs are formulated to loosen phlegm, allowing the user to cough and clear congested respiratory passages Antitussives - these drugs are designed to calm or curtail the cough reflex

Antihistamines - these drugs are central nervous system depressants that dry runny noses, clear postnasal drip and sinus congestion, and reduce tears Anticholinergics - these drugs are often added to cold preparations to reduce nasal secretions and tears stimulants - Non-prescription that are sometimes used by students in college or university in the last- minute panic to complete assignments antagonism - a type of interaction in which one drug blocks the action of another at the receptor site dieting aids - Laxatives: drugs used to soften stool and relieve constipation Diuretics: drugs that increase the excretion of urine from the body alcohol in the body -

• modifies body functions (ethyl)
• alcohol quickly absorbed in stomach, small intestine broken down by alcohol dehydrogenase
• absorption and metabolism Blood alcohol level (BAC) -
• concentration of alcohol in the blood - determined by = breathalyzer, urinalysis, blood tests
• drinking & driving = less than 0.05%, 0.08% criminal offense, 0 to new drivers short-term effects of alcohol -
• CNS depressant - ↓ HR, BP, respiration
• ↑ risk of accidents, risky behaviour, violence
• alcohol poisoning - ↓ respiration, coma → death
• diuretic effect = increased urine output

• relaxation, altered mood, loss of judgment reduced alertness, concentration, memory slurred speech, motor impairment, vision reduced inhibitions long-term effects of alcohol -
  • heart healthy
• relaxation, stress relief
• liver disease
• cirrhosis, fatty liver, alcoholic hepatitis
• elevated blood pressure, cardiac arrhythmias
• CVD risk↑ risk of several cancers
• damage to CNS, chronic inflammation, impaired immunity, bone loss Fetal Alcohol Spectrum Disorders -
  • Binge drinking = 2.2%
• Frequent drinking = 3.3%1 drink/day associated with growth impairment
• No safe amount FAS Cluster of birth defects resulting from prenatal alcohol exposure -
  • Growth deficiencies
• CNS dysfunctions
• Craniofacial anomalies Alcohol and Breastfeeding -
  • Failure to clearly associate any motor development deficit with alcohol intake while nursing
• should be avoided for 2 hours before signs of Alcoholism -
  • drink alone, secretive life interference, "black out" periods
• chronic, often progressive disease becoming more common in women causes of alcoholism -

• family history
• environment
• genetic
• psychological
• social and environmental factors signs of alcohol withdrawal -
• headache, N & V, - mood swings confusion, delusion, agitation, hallucination, tremors
• " delirium tremens " alcoholism treatment programs -
• Residential care facilities, outpatient care
• Crisis centres, helplines, AA Intellectual health - The "thinking" part of psychosocial health includes values, attitudes, and beliefs someone who is this type of healthy enjoys life, the environment, and the people in it respiratory disorders - Allergy: hypersensitive reaction to a specific antigen or allergen in the environment in which the body produces excessive antibodies Histamines: chemical substances that dilate blood vessels, increase mucous secretions, and produce other allergy-like symptoms hay fever - a chronic respiratory disorder most prevalent when ragweed and flowers bloom Usually considered a seasonally related disease risk factors of asthma - Family history Significant exposure to airborne allergens

Exposure to second-hand smoke, including utero Frequent respiratory infections early in life Low birth weight and respiratory distress syndrome asthma - a chronic respiratory disease characterized by attacks of wheezing, shortness of breath, and coughing spasms Emphysema - a respiratory disease in which the alveoli become distended or ruptured and no longer functional struggles to take in a fresh supply of air before the air held in the lungs has been expended uncertain cause chronic bronchitis - a serious respiratory disorder in which the bronchial tubes become inflamed and swollen such that respiratory function is compromised -cigarette smoking major risk factor tension headaches - Generally caused by muscle contractions or tension in the neck or head Tension might be caused by actual strain placed on the neck or head muscles due to overuse, static positions held for long periods of time, or tension triggered by stress migraine headaches - a condition characterized by localized headaches that result from alternating dilation and constriction of blood vessels Pulsating pain on one side of the head with dizzy spells, nausea, and intolerance for light and noise -Can last for minutes, hours, or even days and also experience some temporary visual impairment psychological headaches - "all in your head" Can stem from anxiety, depression and other emotional factors Particularly depression

No blood vessels appear to be involved thereby making relaxation and painkillers ineffective as treatment epilepsy - a neurological disorder caused by abnormal electrical brain activity; often accompanied by altered consciousness or convulsions 4 types of seizure disorders -

1. Grand mal, or major motor seizure
2. Petit mal, or minor seizure
3. Psychomotor seizure
4. Jacksonian seizure Grand mal (major motor seizure) - Often preceded by a shrill cry or a seizure aura Convulsions and loss of consciousness generally occur and can last from 30 seconds to several minutes or more Petit mal (minor seizure) - Do not involve convulsions Minor loss of consciousness that may go unnoticed Minor twitching of muscles may take place Psychomotor seizure - Involve mental processes and muscular activity Mental confusion and listless state characterized by activities such as lip smacking, chewing, and repetitive movements Jacksonian seizure - Progressive seizure that often begins in one part of the body, such as the fingers, and moves to other parts, such as the hand or arm Usually only one side of the body is affected