Psychology Chapter 16 Many Hospital Patents Experience Delirium Reaction Stressors

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Chapter 16

disorders in at-risk and high school and college students

D. Substance Use Disorders

1. Some adolescents explore identity and strive for peer acceptance by

experimenting with smoking, drinking, and drug use

2. DSM-5 substance use disorder – when use of a substance has adverse

terminated, and the inability to quit (worse than substance abuse)

4. Heavy toll of substance abuse and dependence

a. Teens under influence of alcohol make risky choices including risky sex,

driving under the influence, riding with others who are drinking, fighting, and

5. Use patterns

a. Current rate of substance abuse in adolescence not as high as in the 1970s but

represents an increase since the early 1990s

b. Typical increase in use with age; exception is inhalants (e.g., glue, nail polish

remover) used more often by young teens than older teens (reason likely due

narrowing

g. Cascade model of substance abuse – transactional and multifactor model

i. Begins with child at risk due to difficult temperament

ii. Child born into an adverse family environment characterized by problems

like poverty, stress, and substance abuse

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correlation between many factors that predicted both the next step in the

model and involvement in substance abuse

ix. Research indicates that behavioral and psychological disorders do not

spring out of nowhere but grow out of accumulating effects of transactions

between an individual and parents, peers, and other aspects of the social

environment over many years

x. Model indicates that there are opportunities to intervene at each step in the

cascade model

h. Genetic factors

i. Behavioral genetics research suggests that a genetic predisposition to

drink alcohol may cause teens to associate with other peers who drink

abuse and head off problematic substance use in adulthood

E. Depression and Suicidal Behavior

1. Adolescents more vulnerable to depression than in childhood (especially females)

a. Rate in girls about 1% at age 12 but 17% at age 19

2. Factors in depression

a. Rise in risk possibly due to genetic influences related to timing of puberty

may explain greater risk to females who mature earlier

b. Interpersonal stressful adolescent events (divorce in family, breakups) result

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iii. Ruminative coping predicts future depression and binge-eating in

adolescent girls

3. Suicidality

a. Increase in depression between childhood and adolescence leads to increase in

suicidal thoughts, attempts, and actual suicides

b. Suicide third leading cause of death in teens (far behind accidents and

4. Adolescent suicide behavior is product of diathesis/stress

a. Four risk factors for suicide are youth psychological disorder, family

pathology, stressful events, and access to firearms

b. Additional suicide factors: genetic predisposition, substance abuse, anxiety

Checking Mastery

1. What does the fact that 20% or so of adolescents have diagnosable psychological

disorders say for and against the notion that adolescence is a period of storm and

stress?

➢ Answer: The 20% or more rate of significant mental health

2. How does the sociocultural environment contribute to anorexia nervosa?

➢ Answer: Anorexia nervosa is more likely to be diagnosed in

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when they become adolescents?

➢ Answer: Early contributors to illicit drug use in adolescence

include a difficult temperament; an adverse environment (poverty,

4. How do males and females differ with respect to (a) suicide attempts and (b)

completed suicides?

V The Adult

A. Stress and Disorder

1. Stressful experiences in childhood and adolescence increase a person’s chances of

2. Psychological problems emerge when a vulnerable individual faces overwhelming

stress

a. Adults typically experience the greatest amount of stress in early adulthood

b. Life strains tend to decrease from early to middle adulthood

f. Cognitive impairments (e.g., dementia) tend to increase in frequency with age

B. Depression

1. Age and sex differences

a. By age 75, 28% of Americans experience diagnosable mood disorder, but

elderly adults become less vulnerable to stress

b. Mental health in old age is likely good unless an individual develops physical

health problems that contribute to depression or experiences increasing levels

of stress

c. Reasons to be concerned about depression in old age

i. Elderly depressed most likely age group to take own life

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(especially very old women who are physically ill, poor, and/or socially

ruminate)

2. Treatment

a. Big challenge is to get depressed adults to seek treatment

b. Elderly most likely to go undiagnosed and untreated (especially if they are

members of minority groups)

C. Aging and Dementia

1. Dementia – term for senility, a progressive deterioration of neural functioning and

associated traits (memory, thinking, personality changes)

a. Senility not a normal part of aging, yet incidence of dementia increases with

2. Alzheimer’s disease or dementia of Alzheimer’s type – most common form of

dementia (70% of cases)

a. Can strike in middle age, but becomes more likely with advanced age (5% of

population at age 65, 40% at age 90)

b. Related brain changes

i. Senile plaques – masses of dying neural material with toxic protein call

iv. Effects of Alzheimer’s disease progressive and irreversible

c. Alzheimer’s symptoms

i. First symptoms involve mild cognitive impairment in learning and

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iii. Progresses to trouble recalling old information and coming up with words

during conversation; may not know where or when they are

d. Causes and contributors

i. Has a genetic basis but there is no single “Alzheimer’s gene”

ii. Early-onset form (prior to age 60) more linked to genetic factors including

a dominant gene on the 21st chromosome pair (early onset only account

for 2% of cases)

iii. Late onset type much more common than early onset type, and a number

of genes increases risk; genes account for 60% of the variation in

Alzheimer’s

e. Reserve capacity – extra brain power or cognitive capacity that people can fall

back on as aging and disease take a toll

f. People with advanced education, high intelligence, good health, and who are

socially active tend to have higher levels of reserve capacity

g. Preventions and treatments

i. Early detection the best

vi. Physical and mental exercise may delay onset and progression of dementia

h. If Alzheimer’s disease is not preventable, researchers hope to learn to slow the

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i. Much can be gained by making the disease more bearable

3. Other causes of cognitive impairment

a. Vascular dementia (multi-infarct dementia) – series of continuing strokes

i. Unpredictable pattern of development (deterioration after each stroke) that

normal

d. Some elderly who are diagnosed with dementia actually suffer from

delirium—treatable condition developing rapidly over course of the day that

may be characterized by disorientation, wandering attention, and

hallucinations

i. Many hospital patents experience delirium in reaction to stressors like

illness, surgery, drug overdoses, interactions of drugs, or malnutrition;

essential to identify this condition before patient is sent home as those who

Checking Mastery

1. In which adult age group, gender, and ethnic groups would you expect the highest

rates of major depressive disorder?

➢ Answer: Young adults have higher rates of depressive disorder than either

2. How does Alzheimer’s disease progress with regard to the timing of plaques and

tangles in the brain, cognitive deficits, diagnosable dementia, and death?

➢ Answer: Changes in the brain in people with Alzheimer’s disease appear to begin

person can be expected to die.

3. What are two approaches used to treat Alzheimer’s disease?

➢ Answer: Approaches used to treat Alzheimer’s disease include efforts to improve

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techniques, educational programs for both patients and caregivers).

4. What are two key differences between delirium and dementia?

➢ Answer: Compared to dementia, delirium emerges more rapidly than dementia,

SUGGESTIONS FOR CLASS DISCUSSIONS OR PROJECTS: To develop critical thinking skills

and enhance learning with exercises that support the course learning objectives.

1. Stress in Adolescence: Much debate has centered on Hall’s (1904) notion that adolescence is a

period of storm and stress. Entertain the possibility that adolescence is a period of storm and

2. Adolescent Egocentrism: Students generally have some personal experience with delinquent

behavior or illicit drug use. Ask them to be the “experts” and analyze why adolescents become

involved in such activities. Encourage them to consider theoretical concepts such as Erikson’s

conflict of identity versus role confusion and Elkind’s (1984) concept of adolescent egocentrism.

3. Media Portrayal of Mental Illness: Have students write a paper on how psychological

disorders are portrayed by the media. Are the portrayals stereotypical or accurate? What

television shows, commercials, or movies have the most and the least accurate portrayals? Those

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4. Resources for Treatment: For a practical and interesting activity, follow the following

suggestion also adapted from a Current Health source. This suggested activity involves having

5. Changes in the DSM: The Diagnostic and Statistical Manual of Mental Disorders-5 (2013),

published by the American Psychiatric Association, delineates that defining characteristics of

psychological disorders and is generally viewed as the standard for the field. Standards do,

however, change. A brief history of attention-deficit/hyperactivity disorder (ADHD) as described

in the DSM demonstrates how changes in the depiction of disorders reflect ongoing research

discoveries and philosophical changes in how we view the disorder.

Researchers, diagnosticians, and therapists have wrestled over whether inattention or

hyperactivity is the primary problem in ADHD. In DSM-II (1968), the label was hyperkinetic

reaction of childhood, and the main characteristic was hyperactivity. In DSM-III (1980), there

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After discussing ADHD, students might look up descriptions of disorders mentioned in the text

6. Dementia and Caregiving: There are typically students in the class who have aging relatives

with dementia (Alzheimer’s or another form). You might ask them to describe their relatives’

7. Psychopathology: The purpose of this assignment is to have students expand their knowledge

of psychopathology by exploring the topic of school phobia, a type of anxiety disorder associated

8. Silver Alert System: Most student are probably familiar with the Amber Alert system, in

which a national alert is issued in response to missing and abducted children, but far fewer may

be aware of the Silver Alert system, which is designed to issue an alert when a cognitively