Substance Related Disorders

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Substance Related Disorders
By Kelly Goodness, Ph.D.Jeff Baker, Ph.D.
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Substance Dependence

• Physical dependence
• Psychological dependence

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DSM-IV Criteria for Substance Dependence
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(1) tolerance (2) withdrawal (3) often taken in
larger amounts or longer than intended
(4) unsuccessful controlling its use (5) much
time is spent getting, using, recovering
from it (6) interferes with daily activities (7)
used despite recognition it creates
significant problems
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Substance Abuse

• Interferes with daily functioning

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Epidemiology

• Lifetime Prevalence
• Substance abuse 18 16.7
• Alcohol abuse/dependence 13.8
• Non-alcohol abuse/
• dependence 6.2

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Characteristics Associated With Higher Substance
Abuse

• Men gt Women
• Unemployed gt Employed
• Minority gt Majority
• Young gt Older
• Lower education gt Higher education
• Medical Professionals gt Non-medical

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Comorbidity

• Alcohol and another drug
• APD
• Anxiety disorders
• Major depressive disorder
• Dysthymic disorder

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Etiology

• It is adaptive and defensive
• Men may use it to mask depression

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Treatment

• Inpatient is best bet
• Prolonged treatment
• Use antabuse, methadone,
• antidepressants
• Psychotherapy

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Schizophrenia
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Epidemiology

• Lifetime prevalence - 1.5
• Men women affected about equally

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Gender Differences in Schizophrenia
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Etiology

• Diathesis-stress model

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Prodromal Symptoms of Schizophrenia
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• Usually ignored
• Somatic complaints
• Ineffective daily
• functioning
• Develop interest in
• occult, philosophy, or
• religion

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• Peculiar behavior
• Unusual speech
• Bizarre ideas
• Strange perceptual
• experiences

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DSM-IV Criteria for Schizophrenia

• 1) Delusions
• 2) Hallucinations
• 3) Disorganized speech
• 4) Grossly disorganized or catatonic
• behavior
• 5) Negative symptoms

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1) Delusions
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2) Hallucinations
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3) Disorganized speech

• a) Thought content
• b) Form of thought
• c) Thought process

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a) Thought content

• Ideas of reference
• Loss of ego boundaries
• Doubt sexual orientation or gender

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b) Form of thought

• Loose associations
• Derailment
• Incoherence
• Tangentiality

• Neologisms
• Echolalia
• Word salad
• Mutism

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c) Thought process

• Perseveration
• Overinclusion
• Flight of ideas
• Thought blocking
• Impaired attention

• Poverty of thought content
• Poor abstraction abilities

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4) Grossly disorganized or catatonic behavior

• Catatonia
• Echopraxia

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5) Negative symptoms

• Affective flattening
• Alogia
• Avolition

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B. Social/occupational dysfunction C.
Duration Persists for at least 6 months D.
Schizoaffective and Mood Disorder exclusion
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Table 13-4Features Weighting Toward Good to Poor
Prognosis in Schizophrenia
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• Good Prognosis
• Late onset
• Obvious precipitating factors
• Acute onset
• Good premorbid social, sexual, work
• histories
• Mood disorder symptoms (especially
• depressive disorders)
• Married
• Family history of mood disorders
• Good support systems
• Positive symptoms

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• Poor Prognosis
• Withdrawn, autistic behavior
• Family history of schizophrenia
• Negative symptoms
• Neurological signs and symptoms
• History of perinatal trauma
• No remissions in three years
• Many relapses
• History of assaultiveness

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Risk Factors for Suicide in Schizophrenics

• Depression
• Young
• More educated
• Greater premorbid functioning
• Relapse after improvement
• Change in illness course
• Living alone

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Other Psychotic Disorders
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• Schizophreniform
• Brief psychotic disorder
• Schizoaffective
• Delusional disorder
• Psychotic Disorder Due To
• a General Medical Condition
• Substance Induced
• Psychotic Disorder

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Atypical Psychotic Disorders

• Shared Psychotic Disorder
• Culture-Bound Psychotic
• Syndromes (Table 14.1-6)
• Bulimia
• Amok
• Koro

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Psychotic Disorder NOS

• Includes
• Postpartum Psychosis

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Delusional Disorders

• Erotomanic type
• Grandiose
• Jealous type
• Somatic
• Persecutory type
• Mixed