PS371 Final

Addition is a Brain Disease... and It Matters
- Former director of the National Institute on Drug Abuse (NIDA), said that addiction is a brain disease and the behaviors that come may have societal responses, but the fundamental problem is in the brain.
- Addiction is not a matter of weak willpower or moral failure, but is instead a complex condition that involves changes in the brain's reward system and other brain circuits involved in decision-making, impulse control, and other cognitive processes
- Influential in shaping public policy and research on addiction, helped to shift focus from punitive approach to addiction treatment to more compassionate, science based approach that emphasizes the importance of addressing the underlying brain changes that contribute to addiction.

Evolutionary Theory of Substance Use

- Most drugs of abuse act on conserved neural mechnisms associated with positive emotions that evolved to mediate incentive behavior.
- Heroin, cocaine, alcohol, marijuana, amphetamine active mesolimbic dopamine-containing neurons and associated opioid receptors.
- Drugs of abuse create signal in the brain that falsely indicate the arrival of a huge fitness benefit
- Similar to video games, snacks high in fat, salt and sugar.
- We are vulnerable to such fitness-decreasing incentives because our brains are not designed to cope with ready access to these things.
- Reward systems are separated into components that correspond to "liking" (hedonic pleasure on receiving a reward) and "wanting" (incentive motivation and behavioral pursuit of a reward)
- Neural sensitization: Hyperresponsivity in ascending dopamine projections induced by addictive drugs: makes us susceptible to substance abuse.

Mediated by opioid forebrain systems and brain-stem systems

Mediated by ascending mesolimbic dopamine neurons

Components of Addictive Behavior

- Addiction researcher who developed a model to identify three components of addivtive behavior: Salience, mood modifcation, and withdrawal/negative affect.

Extent to which a particular behavior or substance is prominent and important to an individual; means that behavior or substance becomes primary focus of individual's attention and motivation

Changes in mood or emotional state that result from engaging in addictive behavior or consuming the substance; may use addictive behaviors or substances to achieve a desired mood state, such as relaxation or euphoria, or to alleviate negative emotions such as anxiety or depression.

Negative symptoms that arise when the individual is unable to engage in the addictive behavior or consume the substance; symptoms may include physical discomfort, anxiety, irritability, or depression; fear of experiencing these symptoms can alo drive individuals to continue engaging in the addictive behavior or consuming substance

Sex

- Interviewed people about sexual behavior, asked people if they did anything or how many times.
- Until Kinsey, most information about sexual behavior was theoretical.

Sex

- Recorded some of the first laboratory data on anatomy and physiology of human sexual response
- Direct observation of 382 women and 312 men in what they conservatively estimated to be 10,000 complete cycles of sexual response.
- Example of findings: Demonstrated that the physiology of female orgasmic response was identical whether stimulation was clitoral or vaginal.

Sex

- Known for conducting Little Albert Experiment
- Father of Behaviorism
- Research on role of conditioning and environmental factors in shaping behavior have had significant impact on subsequent research in the field of sexual behavior.

Excitatory/inhibitory Amino Acid Imbalances lead to Hyperexcitability and Seizures

Delirium Tremens (DTs): 5% of patients develop it and 35% mortality rate if untreated
- Rapid Heart Rate
- Increased Body Temperature
- Increased Blood Pressure
- Psychomotor Agitation Movement
- Confusion
- Cardiovascular Collapse and Death
- Disorientation
- Sleep Disorders
- Tremors
- Hallucinations
- Sweating
- Loss of Ability to Control Muscle
- Altered Mental Status

Dysfunctional Monoamine Systems
- Depression

1) Drug user inhales cocaine molecules in smoke
2) Cocaine enters bloodstream through lungs. Blood carries it throughout the body. Within seconds it reaches the brain.
3) Cocaine molecules act in the "pleasure pathway" - the limbic system in the middle of the brain. The effect occurs at synapses, where fibers of one nerve cell almost touches the surface of another.
4) Normally, a transmitting cell relays a signal by releasing dopamine molecules into the synaptic space. Dopamine drifts across the synapse and fits into receptors on the surface of the receiving cell, triggering an electrical signal that is relayed through the receiver. Then the dopamine molecules break away from the receptors and are recycled by the transmitter.
5) Cocaine molecules bind to the dopamine transporter, blocking the route by which dopamine would reenter the transmitter cell. Dopamine accumulating in the synpatic space keeps stimulating the receiving cell, creating the user's "high."

Effects of Caffiene:
- Used by over 90% of Americans
- Blocks Adenosine Reuptake
- Small Doses: Elevate Mood, Reduce Fatigue
- Regular Use: Tolerance, Dependence

Withdrawl Symtpoms:
- Psychological: Irritabiltiy, Unpleasant Mood
- Physiological: Drowsiness, Headaches

- Excessive yawning
- Nausea and vomiting
- Chills
- Muscle aches
- Diarrhea
- Insomnia

Withdrawal is uncommon with cannabis

Externalizing Disorder Pathway - Tension/Arousal -> Impulsive Acts -> Pleasure/Relief/Gratification - > Regret/Guilt/Self-Reproach -> Tension/Arousal

Internalizing Disorder Pathway - Anxiety/Stress -> Repetitive Behaviors - > Relief of Anxiety/Relief of Stress -> Obsessions -> Anxiety/Stress

1) What class of drug they are in?
2) How addictive they are?
3) How dangerous they are?
4) How they act on the body, and how the body removes them?

Acute Pharmacodynamics
- Indirect agonist at GABA Receptor
- Inverse agonist at NMDA receptor
- When aclohol enters the brain, it binds to GABA receptors and amplifies the hyperpolarization effect of GABA.
- Neuron activity is further diminished: Accounts for some of the sedative effects of alcohol

Chronic Pharmacodynamics
- Decreased GABA receptor function
- INcreased density of NMDA receptors
- Decreased DA function
- 5-HT dysfunction

CNS Effects of Amphetamines
- Significant agonist and reuptake blocking effects: Norepinephrine, Dopamine
- Linked with hallucinations and delusions

Similar to Heorin, binds to Heroin receptors and competes with Heroin molecules and prevents withdrawal from Heorin

- Reduced Inhibitions: Alcohol is known to reduce inhibitions, which can lead to increased sexual desire and more impulsive sexual behavior.
- Decreased Sexual Arousal: Small amounts of alcohol may increase sexual desire, larger amounts can decrease arousal and make it more difficult to achieve and maintain an erection or experience orgasm.
- Delayed Ejaculation
- Decreased Sexual Satisfaction: Alcohol can impair cognitive functioning and reduce sensitivity to physical sensations, which may decrease sexual satisfaction and make it more difficult to experience pleasure during sex.
- Increased risky behavior: Linekd to increased risk-taking behavior, including engaging in unprotected sex, having sex with multiple partners, and engaging in other sexually risky behaviors.

- Dental Clinic Study

"Beecher's Paper":
- Observed patients who underwent dental surgery
- Found that a significant number of patients experienced pain relief from a placebo injection of saline, even though they were told the injection contained no pain medication.
- Demonstrated power of place effect in treatment of pain, suggested that psychological factors such as expectation, belief, and trust can play an important role in the experience of pain relief.

Criticism: Size and representativeness of sample group, lack of control group

- Recorded some of the first laboratory data on anatomy and physiology of human sexual response.
- Direct observation of 382 women and 312 men in what they conservatively estimated to be 10,000 complete cycles of sexual response
- Example of findings: Demonstrated that the physiology of female orgasmic response was identical whether stimulation was clitoral or vaginal.

Pro-Ana Websites: Supposed to be for anorexia support but very often used for giving tips on how to "be better" at the disorder.
- Beauty standard is stringent, many models and people in media portrayed to be very thin or look a certain way which influences people intro controlling their weight through eating disorders.

- Low levels of arousal to appropriate stimuli
- Sexual problems
- Social deficits
- Early experiences: Inappropriate arousal/Fantasy
- High sex drive
- Low suppresion of urges/drive
- Reinforcement via Orgasm

- Involuntary pelvic spasms in outer third of vagina
- Fellings of ripping, burning, or tearing
- Prevalence: 6%
- Related to conservative views of sexuality

- Salivary Gland enlargement
- erosion of Dental Enamel
- Electrolyte Imbalance
- Kidney Failure
- Cardiac Arrhythmia
- Seizures
- Intestinal Problems
- Permanent Colon Damage

- Amenorrhea - Loss of Menstrual Cycle
- Dry Skin
- Brittle Hair and Nails
- Snesitivity to Cold Temps
- Lanugo - Downy hair on limbs or cheeks
- Cardiovascular problems
- Electrolyte Imbalance

Eating, in a discrete period of time (e.g. within any 2 hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.

2 of the following required within 12 months
A problematic pattern of substance use leading to clinically significant impairment or distress
1) The substance is often taken in larger amounts or over a longer period than was intended
2) There is a persistent desire or unsuccessful efforts to cut down or control substance use
3) A great deal of time is specnt in activities necessary to obstain the substance, use the substance, or recover from its effects
4) Craving, or a strong desire or urge to use substance
5) Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home
6) Continued substanced use despite having persistent or recurrent social or interpersonal problems cause or exacerbated by the effects of alcohol
7) Important social, occupational, or recreational activities are given up or reduced because of substance use
8) Recurrent substance use in situations in which it is physically hazardous
9) Substance use is continued despite knwoledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol
10) Tolerance, as defined by either of the following:
A. A need for markedly increased amounts of the substance to achieve intoxication or desired effect
B. A markedly diminshed effect with continued use of the same amount of the substance
11) Withdrawal, as manifested by either of the following:
A. The characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria set for withdrawal)
B. The substance (or a closely related substance) is taken to relieve or avoid withdrawal symptoms

Criterion A over four areas:
1) 1-4: Impaired Control
2) 5-7: Social Impairment
3) 8-9: Risky Use
4) 10-11: Pharmacological Criteria

Severity:
- Mild: presence of 2-3 symptoms
- Moderate: presence of 4-5 symptoms
- Severe: presence of 6+ symptoms

A. Persistent and recurrent maladaptive gambling behavior as indicated by five or more of the following:
1) Is preoccupied with gambling (e.g. preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble)
2) needs to gamble with increasing amounts of money in order to achieve the desired excitement
3) Has repeated unsuccessful efforts to control, cut back, or stop gambling
4) Is restless or irritable when attempting to cut down or stop gambling
5) Gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g. feelings of helplessness, guilt, anxiety, depression)
6) After losing money gambling, often returns another day to get even ("chasing" one's losses)
7) Lies to family members, therapist, or others to conceal the extent of involvement with gambling
8) Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
9) Reliess on others to provide money to relieve a desperate financial situation caused by gambling

B. The gambling behavior is not better accounted for by a Manic Episode

Male Hypoactive Sexual Desire Disorder
- Little or no interest in sexual activity
- Decreased frequency: Masturbation, Sexual Fantasies, Interourse
- Prevalence: 5%

- Similar to Male Hypoactive Sexual Desire Disorder
- Difficulty achieving and maintaining adequate lubrication
- Prevalence: 22%

Difficulty achieving and maintaining an erection

- Adequate desire and arousal
- Unable to achieve orgasm
- Rare in adult males: 8% delayed or absent
- Common complaint of adult females: 25%

- Before the man or partner wishes, 1 minute
- Most prevalent male sexual dysfunction: 21%, declines with age
- Common in younger, inexperienced males

- Marked pain during interourse
- Extreme pain during intercourse
- Adequate sexual desire, arousal, orgasm
- Must rule out medical reasons

Clinical Overview:
- Feels trapped in the body of the wrong sex
- Assumes identity of desired sex

Most distinguish from:
- Transvestic Fetishism
- Disorders of Sex Development
- Homosexual Arousal Patterns

Prevalence: Rare
- Female:Male - 1:2.3
- Rates are similar across cultures

Unwanted touching in public

Sexual attraction to nonliving objects

Practice of observing, to become aroused, an unsuspecting individual undressing or naked

Achieving sexual arousal and gratification by exposing genitals to unsuspecting strangers

Sexual arousal is strongly associated with the act of (or fantasies of) dressing in clothes of the opposite sex

Associated with inflicting pain or humiliation

Associated with suffering pain or humiliation

Sexual attraction to children

Sexual attraction to a family member

Causes
- Biological Dimensions:
- Heritability studies
- Inherited tendency to be emotionally responsive to stress, eat impulsively
- Perfectionism
- Hypothalamus: Serotonin
- Psychological Dimensions
- Low sense of personal control
- Low self-confidence
- Perfectionistic attitudes
- Distorted body image
- Preoccupation with food and appearance
- Mood intolerance

Overly successful weight loss
- 15% below expected weight
- Intense fears: Gaining weight, Losing control of eating
- Relentless pursuit of thinness
- Often begins with dieting

Subtypes: Restricting and Bing-Eating-Purging
Associated Features:
- Body image disturbance
- Pride in diet and control
- Rarely seek treatment

A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal, or, for children and adolescents, less than that minimally expected.
B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight

Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e. self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise

Bind-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e. self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Severity:
- Mild: BMI >= 17kg/m^2
- Moderate: BMI 15-16.99 kg/m^2
- Severe: BMI 15-15.99 kg/m^2
- Extreme: BMI < 15 kg/m^2

Associated psychological Disorders
- Anxiety - OCD
- Mood disorders (33-60%)
- Substance abuse - Suicide

Statistics:
- 90-95% female: Caucasian, middle to upper class
- Onset - age: 13-15
- Chronic
- Resistant to treatment

Binge Eating:
- Excessive amounts of food
- Perceives as "out of control"

Compensatory Behaviors
- Purging
- Excessive Exercise
- Fasting

Belief that popularity and self-esteem are determined by weight and body shape

Subtypes:
- Purging (most common): Ineffective
- Nonpurging (6-8%)
- Most are within 10% of normal weight

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1) Eating, in a discrete period of time (e.g. within any 2 hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
2) A sense of lack of control overeating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating)
B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months
D. Self-evaluation is undult influenced by body shape and weight
E. The disturbance does not occur exclusively during episodes of anorexia nervosa

Severity:
- Mild: An average of 1-3 episodes of inappropriate compensatory behaviors per week
- Moderate: An average of 4-7 episodes of inappropriate compensatory behaviors per week
- Severe: 8-13 episodes
- Extreme: 14 or more episodes

Associated psychological disorders
- Anxiety (75%) - Social Phobia and GAD
- Modd disorders (50-70%)
- Substance Abuse (36.8%)

Statistics:
- 90-95% female: Caucasian, middle to upper class
- Onset: Age 16-19
- Lifetime prevalence
- Females; 1.1%
- College women - 6-8%
- Chronic if untreated
- 5-10% male
- Caucasian, middle to upper class
- Gay or bisexual
- Athletes with weight regulations
- Onset: Older

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1) Eating in a discrete period of time (e.g. within any 2 hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances
2) A sense of lack of control overeating during the episode (e.g. a feeling that one cannot stop eating or control waht or how much one is eating)
B. The binge- eating episodes are associated with three or more of the following:
1) Eating much more rapidly than normal
2) Eating until feelign uncomfortably full
3) Eating large amounts of food when not feeling physically hungry
4) Eating alone because of feeling embarrassed by how much one is eating
5) Feeling disgusted with oneself, depressed, or very guilty afterward
C. Marked distress regarding binge eating is present
D. The binge eating occurs, on average, at least once a week for 3 months
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa nad does not occur exclusively during the course of bulimia nervosa or anorexia nervosa

Associated Features:
- Many are obese
- Older
- More psychopathology vs non binging obese
- Concerned about shape and weight

- Persistent cravings for and consumption of non-food substances that have no nutritional value, such as dirt, clay, chalk, paper, or ice
- Cravings often driven by strong and persistent urge to eat the substances despite the knowledge that they are not safe or appropriate to eat
- More commonly observed in children and people with developmental disabilities, but can also occur in adults with mental health conditions or nutritional deficiencies
- Exact causes are not fully understood but may be associated with psychological, environmental, cultural, and nutritional factors
- Health problems: Gastrointestinal damage, Lead poisoning, Infections, Obstructions of digestive system
- Treatments: Addressing underlying medical or nutritional issues, as well as behavioral therapies aimed at helping the person overcome their cravings and develop more appropriate eating habits.