All Notes for Test 3

3/12 Notes (V) Obsessive Compulsive Disorder An obsession is a thought or an image that keeps intruding into a person?s consciousness. The person tries to reduce the thought but it keeps returning Try not to think of a white bear! A compulsion is an act that a person feels compelled to repeat again and again, in a stereotyped fashion, though he or she has no conscious desire to do so. Mild OCD is common Song playing in our heads Locked the door? Fed the cat? Cognitive Maps Our imaginal representation of the world is referred to as cognitive maps New York City and Chicago Seattle is to the north of Montreal Chicago and Rome are on the same latitude Pathological obsessions, however, do not pass They frequently involve contamination, violence, sex or religious transgressions Compulsions are responses to obsessions aimed at warding off the danger posed by the obsession Recognition of the obsessions or compulsions are excessive and unreasonable The thoughts, impulses, or behaviors causes marked distress, consume more than an hour a day, or significantly interfere with a person?s normal functioning or relationships The important thing is that, the person believes that their thoughts and actions reduce stress or prevent a dreaded event Obsessions typically pertain to: Contamination Aggressive impulses Sexual content Somatic concerns Need for symmetry It is unusual NOT to have a strange or bizarre thought occasionally Causes: Anxiety and not panic attacks Most compulsions fall under 2 categories: Cleaning rituals Checking rituals Statistics 2%-3% worldwide No sex difference Divorced, separated, or unemployed People with OCD equate thought with specific actions to reactivity represented by the thought This is called thought-action fusion Leads to feelings of excessive responsibility and guilt Ex: one patient believed that thinking about abortion was the moral equivalent to having one Median onset age is 23 years Usually first occurs after a stressful event such as the death of a family member of pregnancy Cultural factors: Saudi Arabia and Egypt- religious practices, cleanliness India- contamination themes Treatment: read pgs 165-166 (VI) Post Traumatic Stress Disorder (PTSD) PTSD occurs due to exposure to a traumatic event during which one feels fear, helplessness, or horror Afterwards the victims re-experience the event through memories or nightmares (through flashback) The traumatic event is re-experienced through 5 different ways: Reoccurring images, thoughts, and perceptions Reoccurring distressing dreams of the event A sense that the traumatic event is reoccurring, including illusions, delusions, and hallucinations Illusions are normal errors in perception whereas delusions and hallucinations are signs of abnormality The Muller-Lyer illusion ?--------------------------------?-----------------------------?? A B the Horizontal Vertical illusion the St. Louis Arch the Ponzo illusion Intense psychological distress when exposed to cues of the event Physiological reactions Symptoms: Persistent avoidance of the stimuli associated with the trauma Difficulty sleeping, irritability, hyper vigilance (very alert) Impairment in social, occupational, or other areas of functioning Duration of the disturbance should be at least 1 month PTSD occurring within 1 month after the trauma is called acute stress disorder Amnesia is possible When PTSD lasts longer than 3 months, it?s considered chronic (chronic PTSD) In PTSD with delayed onset, the person may show very few (if any) symptoms for several years The likelihood of developing chronic or delayed onset PTSD is great, for people who have an acute stress disorder Read pgs 157-161 statistics, causes and treatment 3/24 Notes (I) Schizophrenia: Symptoms, Subtypes, and Treatment Higher incidence among males, about 1 ½ times more, typically onset in early 20?s The later the onset, the less severe it is In females, onset is in late 20?s (Estrogen is protective against schizophrenia, why the onset is later) Schizophrenia is a descriptive term for a group of psychotic disorders, characterized by gross distortions of reality, and the disorganization and fragmentation of perception, thought, and emotion In psychotic disorders, reality contact is radically impaired (main feature of psychotic disorders) Schizophrenia is primarily a disturbance of thought Emil Kraepelin (1896) was the first to describe the disorder Dementia Praecox (term he used for schizophrenia) Changed to schizophrenia by a Swiss psychiatrist named Bleuler (1911) (II) The Symptoms of Schizophrenia Positive Symptoms (the presence of the symptom indicate abnormality) Delusions: a persistent, irrational belief a person holds onto, very difficult to change (7 different delusions, don?t have to have all but may have several) Delusions of persecution Delusions of control- the belief that other people, forces, or perhaps extraterrestrial beings are controlling one?s thoughts, feelings, and actions, often by means of electronic devices that send signals directly to the brain Delusions of sin and guilt- the belief that one has committed an ?unpardonable sin?- killing their own children (not true) Delusions of reference- the belief that one is being referred to by things or events those have nothing to do with one. For example, schizophrenics may thing that their lives are being depicted on TV or in the newspapers Delusions of grandeur- the belief that one is extremely powerful and famous Hypochondrical delusions- the unfounded belief that one is suffering from a hideous physical disease (they make up something ex: mold in the brain) Recognized diseases vs. bizarre affliction reports Nihilistic delusions- the belief that one or others or the whole world has ceased to exist These particular delusions seem to be highly specific to schizophrenia Loosening of Associations Normal speech follows a single train of thought with logical connection between ideas Schizophrenics- incoherent speech (the content of the speech doesn?t make sense, but can still make words) The editing process breaks down But does not mean schizophrenics cannot give a straight answer to a direct question The Cohen experiment Two disks Different colors (red and purple) [normals and schizophrenics replied alike] Same color (red and redder) Normal- ?My God this is hard. They are both about the same except one might be a little redder.? Schizophrenic- ?this is the stupid color of a shit ass bowl of salmon. Mix it with mayonnaise.? What is it that pushes schizophrenics off the track? Many experts believe that once schizophrenics make a given association, they can?t let go of it and search for a more appropriate association, like normal people can do Once the schizophrenic made the first association (to salmon), he got ?stuck? on it, and the remainder of the response did not have any relevance to the topic at hand They went off on trains of private associations on the first thought Poverty of Content Schizophrenic language may convey very little even though the person may use grammatically correct language They may say much but the content lacks a unifying principle (i.e. it is hard to figure out the point) Neologisms (means new words) It is a peculiarity of schizophrenic language, resulting from the inability to retrieve commonly agreed-upon verbal symbols Belly bad luck Goodship Clanging Pairing of words that have no relation to one another beyond the fact that they rhyme or sound alike Clanging speech is often close to nonsense verse than to rational communication Word Salad Complete breakdown of associational processes Words and phrases are completely disorganized No effort to communicate The association between phrases are not even remotely connected Disorders of Perception Body odor (they think they have) The breakdown of selective attention Focused attention The Broadbent Filter Model- the first scientific model of attention Hallucinations- see something that?s not there and there?s no rational basis for their perception auditory hallucinations are the most common among schizophrenics (70%) next are visual hallucinations Disorders of Motor Behavior Stereotypy- the act of engaging in purposeless behaviors over long periods of time Catatonic stupor- stay in one pointless pose for many hours Echopraxia- imitating someone else?s motor movement Echolalia- repeating whatever someone else is saying Negative Symptoms (the absence of something indicates abnormality) Avolition Apathy or the inability to initiate or persist in important activities Alogia Deficiency in the amount or content of speech, a disturbance often seen in people with schizophrenia Anhedonia The inability to experience pleasure, an indifference to activities that would typically be considered pleasurable, such as eating, social interactions and sexual relations Flat affect Apparently emotionless demeanor (including toneless speech and a vacant gaze) when a reaction would be expected (III) Diagnostic Criteria and Phases: If a person has shown 2 or more symptoms (positive or negative) for at least 6 months, then the diagnosis is schizophrenia Less than 1 month- brief psychotic disorder 1 month to 6 months- schizophreniform disorder The Course of Schizophrenia: Typically, schizophrenia involves 3 phases: 1) The Prodromal Phase In some cases, the onset of schizophrenia is very sudden- in a matter of few days, a reasonably well-adjusted individual could become a hallucinating psychotic Typically functioning deteriorates gradually before any clearly psychotic symptoms appear Generally withdrawn Socially isolated Performance in school/work becomes sloppy 2) The Active Phase The symptoms become prominent the various symptoms I told you about, describe the active phase of schizophrenia 3) The Residual Phase just as onset can occur almost overnight, so can recovery in most patients, the active phase is followed by the residual phase flat affect tendency to ramble poor hygiene dissipation of delusions and hallucinations difficulty in holding down a job in some cases the residual phase ends with complete remission (i.e. a return to perfectly normal functioning) the usual outcome is impairment to at least some degree fluctuation between the residual and active phases 10% active phase only 65% fluctuate between active and residual phases 25% complete recovery the life-expectancy for schizophrenics is 10 years less than the norm (IV) Causes of Schizophrenia High vs. Low-risk children Home life Instability Mothers likely to be irresponsible or antisocial Early separation and institutionalization Separated from their mothers during the first year of life and spent many years in institutions School problems and criminal behavior Males- domineering, aggressive, and unmanageable Females- lonely, passive, nervous, and sensitive to criticism Attention problems Birth complications II) Genetic Factors Contribute enormously, beyond any reasonable doubt General population- 1% 1 parent schizophrenic, 13% for offspring both parents schizophrenic, 46% for offspring DZ (dizygotic) twins, 17% MZ (monozygotic) twins, 48% Adoption studies, 16 % (both parents but adopted to normal) Brain imaging studies have shown that schizophrenics have smaller sized brains and larger ventricles Schizophrenics typically have 6 times the number of receptor sites for dopamine, compared to normal people Parkinson?s disease- motor disorder (V) Groups at Risk for Schizophrenia Typically among people of lower IQ Unemployed Unmarried City-dwellers In the US, African Americans have a higher rate than Euro Americans, but this could be due to diagnostic bias Men- early 20?s Women- late 20?s, it is thought that the sex hormone estrogen delays the onset in women Men- negative symptoms Women- positive symptoms Finally, schizophrenic men are less likely than schizophrenic women to have a family history of schizophrenia However, birth complications and brain abnormalities are more prevalent among make schizophrenics 3/31/2009 (VI) The Subtypes of Schizophrenia Since the days of Kraeplin and Bleuler, schizophrenia has been divided into 3 major subtypes, plus 2 extra subtypes The 3 major subtypes: Paranoid schizophrenia (delusions of grandeur or persecution) Delusions and or hallucinations of a consistent nature Typically centered around persecution and grandeur The delusions can range from vague suspicions to an exquisitely worked-out system of imagined conspiracies Often, delusions are accompanied by auditory hallucinations Paranoid schizophrenia is by far the most common of the 3 subtypes (approximately 50%) They are also, in the main, more ?normal? than other schizophrenics They perform well on cognitive tests They have better records of premorbid adjustment, are more likely to be married, have a later onset, and show better long-term outcomes compared to other kinds of schizophrenics The active phase of paranoid schizophrenia typically appears only after age 25, but is preceded by years of fear and suspicion- leading to tense and fragile interpersonal relationships Disorganized or Hebephrenic Schizophrenia (silly and immature emotionality) Of all the varieties of the psychologically disturbed, the disorganized schizophrenic is the one who fits the popular stereotype of a ?crazy? person 3 symptoms are characteristic of disorganized schizophrenia Pronounced incoherence in speech Affect- some display a flat affect whereas others act silly- giggling, making faces, and so on Lack of goal-orientation- a refusal to bathe or dress Delusions and hallucinations- although confused and fragmented- unlike the more coherent imaginings of a paranoid schizophrenic They are severely withdrawn, utterly caught up in their own private worlds, and at times almost impervious to whatever is happening around them Onset- gradual and early (late teens) Withdrawal into a realm of bizarre and childlike fantasies Catatonic schizophrenia (alternate immobility and excited agitation) May be dangerous Marked disturbance in motor behavior Catatonic stupor- complete immobility Mutism The patient may remain in this state for weeks Sometimes catatonics assume extremely bizarre postures during their stupors Waxy flexibility- a condition in which their limbs- like those of a rubber doll- can be arranged Catatonic negativism- doing the opposite (or something different) from what was asked Many catatonics alternate between periods of immobility and periods of frenzied motor activity, which may include violent behavior Excited- high risk of injury Immobile- could starve to death Immobility is NOT passivity Extraordinary expenditure of energy Some patients show waxy flexibility whereas others show catatonic rigidity Catatonic schizophrenia often involves medical emergencies The 2 extra subtypes: The Undifferentiated Type- people who do not neatly fit into one of the 3 major subtypes The Residual Type- is for patients who have passes beyond the active phase [4/2/2009] (VII) The dimensions of Schizophrenia The subtypes we just discussed are a classic way of looking at schizophrenia Subtypes are useful but have problems: Mere categorization Categorization does not imply validity Important for validity- different causes, different treatments and so forth Circularity of reasoning Today, researchers are looking for other ways to organize information about schizophrenia Today, discussions of schizophrenia are generally framed according to dimensions, and not subtypes Continuous variables With dimensions, patients are never ?in? or ?out? but fall somewhere on each dimension Three different dimensions: Process- reactive The cases in which the one onset is gradual are called process schizophrenia The cases in which the onset is sudden is called reactive schizophrenia Looking at time Process schizophrenia Long history of inadequate social, sexual, and occupational adjustment Socially withdrawn No regular dating in adjustment High school Jobs- 2 years Unmarried Abnormal physiological process Reactive schizophrenia Good premorbid adjustment Apparently normal history Environment stressor Symptoms are sudden and spectacular Process schizophrenia- poor premorbid adjustment Reactive schizophrenia- good premorbid adjustment Clinical researchers view the process-reactive dimension as a continuum rater than as a dichotomy They prefer to speak of a good poor premorbid dimension- that is some how well the patient was functioning before the onset of the active phase The process (poor premorbid)- reactive (good premorbid) dimensions has been useful in predicting which patients will recover and which will not The process (poor premorbid) patients are more likely to have long hospitalizations and when discharged to require re-hospitalization- that reactive (good premorbid) patients Positive-negative Of all of the dimensions of schizophrenia, this one has attracted the most research attention in recent years Positive symptoms are the presence of something that is absent in normals (ex. Hallucinations) Negative symptoms are the absence of something that is normally present Flat affect There may be two biologically distinct types of schizophrenia Type (I) Positive Schizophrenia Type (II) Negative Schizophrenia Differences between type 1 and type 2: Symptoms Type 1- positive Type 2- negative Premorbid adjustment Type 1- good Type 2- poor Onset Type 1- later Type 2- earlier Prognosis Type 1- relatively good Type 2- relatively bad Structural brain abnormalities Type 1- absent Type 2- maybe absent Drug response Type 1- good Type 2- poor Gender distribution Type 1- more likely to be in women Type 2- more likely to be in men Paranoid- non-paranoid Paranoid schizophrenia- the presence of delusions and grandeur and persecution Non-paranoid schizophrenia- the absence of the 2 delusions mentioned above Some studies have found the paranoid- non-paranoid dimension to be related to the process-reactive dimension Paranoid schizophrenics tend to have better premorbid adjustment, later onset and better outcomes They also resemble reactive schizophrenics in being more impact intellectually Conclusions regarding dimensions: all 3 dimensions have prognostic value and may aid in the development of theories as to the causes of schizophrenia (VIII) Is schizophrenia an infectious disease? is schizophrenia caused (at least in part) due to an infection? Certainly not in the way a common cold is, or the virus would have been discovered long ago Some research findings show that in some people, schizophrenia is due to viral infection- at least to a degree The viral hypothesis states that if an infection is involved in schizophrenia, it cannot be the sole cause, but must interact with other causes such as brain abnormalities Furthermore it must be a slow acting virus and not a fast acting one (like those causing measles or chicken pox) Slow viruses are known to be involved in several mental disorders, such as Jakob Creutzfeldt disease, which involves progressive mental deterioration what is the evidence for the viral hypothesis? People with schizophrenia are more likely than others to be born in the winter months Many viral infections show a peak in winter and spring months So it is possible that the higher evidence of schizophrenia in people who were winter babies is due to the fact that they are more likely to have been exposed to a virus in the late prenatal period (winter) or shortly before birth (spring) the relationship between schizophrenia and epidemics Finland- influenza epidemic in the 50?s Those babies who were exposed in the 2nd trimester were significantly more likely to develop schizophrenia In another study, mothers of schizophrenic patients were asked about infections during the child?s gestation The women reported more infections during the 2nd trimester than the 1st and 3rd combined There is also some evidence for association between enlarged ventricles in the schizophrenic and exposure to influenza in the 2nd trimester All of the evidence for the viral hypothesis is circumstantial If a virus is involved in schizophrenics, it has not yet been identified (IX) Therapy Cognitive therapy Still at the early stage Cognitive rehabilitation- giving patients a task calling upon cognitive skills- memory, attention, and social perception- and to build those up by instructions, training, prompting, and even monetary rewards Behavioral therapy Family systems therapy Drug therapy 4/7/2009 Therapy Cognitive therapy (attention, perception) Behavioral therapy (Principles of Operant conditioning) Family systems therapy Drug therapy None of these treatments cure schizophrenia They prevent relapse and help the patients to make some adjustments in the community Released patients require many kinds of assistance from many different professionals Mid 1950?s (drug therapy) major breakthroughs with schizophrenia Cognitive therapy: Still at the early stage Cognitive rehabilitation- giving patients tasks calling upon defective cognitive skills (memory, attention, social perception) and to build up those skills by instruction, training, prompting, and monetary rewards Object-sorting tasks: to improve attention and conceptual understanding (Wisconsin card sorting task) Pile of cards, provided to a subject and instructed to sort the cards according to categories Measures how rapidly and correctly subject can complete task (difficulty level per task ranges) Improves concept of categorizing To develop social perception, they were shown slides of people engaged in various activities Activity of characters in the slides Emotional tone of characters in the slides Methods to treat the contents of schizophrenic?s thinking- delusions and hallucinations The therapist leads the patient into a questioning of the thought Suggest coping methods Behavioral therapy Principles of Operant Conditioning (also called Instrumental Conditioning) Skinner Operant conditioning- action, favorable consequence, repeat action Re-inforcers should be tangible Contingencies behavior contract should be well defined Primary reinforcers- those that are important for survival and reinforcing property is not learned Shelter/oxygen Food/water Sex Secondary reinforcers- reinforcing property is learned (similar to a conditioned stimulus) Money Good grades In a token economy, patients are given tokens, points or some other secondary reinforcement in exchange for performing certain target behaviors Personal grooming Cleaning their rooms Academic and vocational training tasks Social skills training Teaching appropriate behaviors Holistic therapy Mind and body are related Family systems therapy A hostile atmosphere seems to permeate the homes of many children who develop schizophrenia What members of the family say to each other- attitudes toward patients Families of hospitalized schizophrenics have been rated on Expressed Emotions (EE) ? a lower EE is favorable- the higher the scores, the higher the rate of relapse for schizophrenic EE rating was based on 2 factors Level of criticism- how critical the family is of the patient Level of emotion over-involvement Family EE is the single best predictor of relapse Hold patient responsible Higher EE, greater chance of relapse High vs. low EE 3-4 times higher chance of relapse with families with high EE scores compared to families with lower EE scores Treatment plan for families- high EE families are counseled on how to make their interactions with the patient calmer and less negative 1 in 18- Group A- test efficacy of family systems therapy (combining therapy plans) Relapse from residual to active phase in 1 in 18 schizophrenics Proves that family members should be included in treatment plan 8 in 18- Group B- control condition, almost 50% relapse Family therapy lowers the risk of relapse Drug treatment Antipsychotic drugs (also called neuroleptics) Phenothiazines- one type of neuroleptic Ex: Thorazine first drug to treat schizophrenic ins 1950?s, Prolixin, Mellaril Effectiveness- 40% of schizophrenics, drug treatment not very effective Dangerous side effects- nausea, dry mouth, ?zombie state? Limits what medication can accomplish Substance use disorders The nature of substance abuse and dependence (abuse transforms into dependence) Psychoactive drug alters a person?s psychological state Drug use that alters the body chemistry to a point where the ?normal? state is the drugged state is called addiction (physiological) Is the abuser center his or her life on the drug, then it is called psychological dependence (psychological) Substance dependence (7 Criteria) Preoccupation with the drug Unintentional overuse Tolerance Withdrawal Persistent efforts to control drug use The abandonment of important social, recreational, or occupational activities for the sake of drug use Continued drug use despite serious problems Substance abuse The difference between dependence and abuse is a matter of degrees- lower threshold Recurrent drug- related failure to fulfill related obligations Recurrent drug use in physically dangerous situations (drinking and driving) Drug-related legal problems Continued drug use despite social or interpersonal problems Alcohol dependence Most widely used of all psychoactive drugs 52% aged 12 and older 16% binge drinking (5+ drinks) The social costs of alcohol problems $125 billion 40% of beds in US hospitals (alcohol related problems) 4/9/2009 Alcohol dependence Fetal alcohol syndrome- a pattern of damage involving bodily malformations, mental retardation, and delayed development The amount of alcohol in relation to a specified volume of blood is known as the blood alcohol level Women have less bodily fluid (but more fat) per pound of body weight. Therefore if a 150 pound woman and a 150 lb man each have drinks, she will have a higher blood alcohol level and consequently will be more intoxicated Blood alcohol level-physiological and psychological effects: .05 lowered alertness .10 less caution, impaired motor function .35 equivalent to surgical anesthesia .40 probable lethal dose The immediate effects of alcohol Pharmacologically, alcohol is a depressant It slows down and interferes with the transmission of electrical impulses in the higher brain centers The initial effect of alcohol is to stimulate rather than to depress 2 changes occur: mood and social behavior With more drinks the depressant affects of alcohol start to take effect Physiological effects? Expectancies are important Short term effects are called acute effects Long term effects of alcohol Behavioral effects- memory, judgment, and the power to concentrate are all diminished Physiological effects- stomach ulcers, hypertension, heart failure, cancer, brain damage, and cirrhosis of the liver Malnutrition Ksorsakoff?s psychosis- mainly caused by vitamin D deficiency Delirium tremens- which can last from 3-6 days is a terrifying complication of chronic alcohol dependence The Morris water tasks Rats as subjects They have to find a platform, which is slightly submerged under cloudy water Rats with hippocampal damage Rats with chronic alcohol condition Groups at risk for alcohol use Income and education: College degree 70% High school diploma 40% On the other hand, less educated Americans, twice as likely to drink to excess Substance dependence vs. substance abuse Gender Abuse Men 60% Women 42% Dependence Men 32% Women 11% Women usually begin drinking later First intoxication later Develop dependence later Go to facilities with shorter history of drinking problems Drink alone or in the company of someone close to them Women are more likely than men to combine alcohol with other substances- tranquilizers, barbiturates, amphetamines, hypnotics, and antidepressants Gender differences- social or biological? Ethnicity and religion Euro Americans (whites) have a higher rate of alcohol abuse compared to Hispanics and African Americans The pattern varies by ethnicities White teenagers and young adults are more likely to have alcohol-related problems However between the age of 30 and 40, alcohol abuse among African American men rises rapidly and surpasses the incidence of abuse among whites African American women are far more likely to abstain from alcohol than white women Income and gender and not ethnicity are the 2 most important predictors of dependence and abuse Men of Irish extraction are more likely than those of Italian origin to have dependence and abuse-related issues Another cultural correlate of alcohol abuse is religion Protestants have a noticeably high rate of abstainers Orthodox Jews- like Protestants Catholics have the highest percentage of alcohol abuse Treatment for alcohol dependence Detoxification Can take place at home but usually in a hospital Serax (oxazepam) for a week or so, to prevent seizures Behavioral changes are also necessary Multimodal treatments In the best multimodal treatment programs, patients are provided with occupational therapy, relaxation training, group, and individual training Sometimes hospital treatment programs include an additional deterrent in the form of Antabuse Support groups Alcoholics Anonymous AA started in the 1930?s Once an alcoholic, always an alcoholic An alcoholic can never go back to ?normal? drinking Sponsor 12 step program to recovery How successful as AA been? High drop-out rate Less than 10% who attend an AA meeting stay abstinent for more than a year However, for those who stay with AA, the program does seem to work Outpatient and brief treatments Many alcoholics do not have to be hospitalized around the clock Outpatient and day-hospital program have been expanding in recent years Several studies have found no difference between the outpatient and inpatient programs Most insurance companies are reluctant to pay for full hospitalization except when the patient has clear medical and psychiatric problems that extend beyond alcohol dependence 4/14/2009 The motivational interview is a question and answer method aimed at increasing the patient?s motivation to change Substance-dependent people are ambivalent Motivational interviewing follows 5 principles: Show compassion for the patient Help them see the ways in which their life is not going well Avoid arguing with them For the time being let them hold on to whatever mechanisms they favor (like rationalization) Help them develop confidence that they can change FRAMES (achronym for the 5 stages) Feedback Responsibility Advise Menu Empathy Self-efficacy Relapse prevention The relapse prevention movement received its greatest boost from the cognitive-behavioral approach to therapy The model states that the risk for relapse begins with any high-risk situation in which the individual feels a loss of control The Abstinence Violation Hypothesis (AVE)- they can?t stop drinking, even after 1 drink ?One drink does not make a drunk? Nicotine Dependence Introduction Fewer people smoke than drink but many more smokers develop dependence It is the least destructive psychologically The term nicotine dependence refers primarily to those who want to stop smoking but cannot Nicotine has paradoxical effects on the nervous system. On the one hand it elevates blood pressure, but on the other hand, it has a calming effect Around 400,000 Americans die prematurely from tobacco-induced diseases 45% (1954) to less than 20% (2008) Many adolescents believe that smokeless tobacco (snuff, chewing tobacco) is safe, but it?s not Nicotine Dependence: Theory Behavior theorists view nicotine dependence as a learned habit maintained by a number of reinforcers- the stimulant effects of nicotine, tension-reduction in social situations, and so on However, these reinforcers do not seem sufficient to account for why people maintain the habit Could smoking be a physiological addiction? For many years, experts doubted this because the evidence for tolerance is weak And the withdrawal symptoms are mild compared to those for other psychoactive drugs (like alcohol) Schacter and colleagues have found that smoking does not calm smokers or elevate their mood On the other hand, NOT consuming an adequate amount of nicotine causes smokers to show withdrawal symptoms Schacter concluded that smokers get nothing out of smoking other than the avoidance of the disruptive effects of withdrawal And it is for that reason- avoidance of withdrawal- that they smoke In one experiment, smokers increased their cigarette intake when low-nicotine cigarettes were substituted for their regular high-nicotine brands In another experiment, a group of smokers was given Vitamin C, and they smoked more cigarettes than they usually did Vitamin C lowers the nicotine level in the bloodstream, by acidifying the urine and increasing the rate at which nicotine is excreted Therapy High relapse rates One 10%-20% stay abstinent after 1 year Relapse rate is higher for people who attend treatment programs, compared to those who attempt quitting on their own Nicotine patches, gum, and nasal sprays have been developed for introducing nicotine in the bloodstream, without tobacco use Zyban- for the next 48 hours the person can?t smoke or they?ll have severe nausea Motivational, cognitive, and social factors play a major role in predicting who is likely to stay quit