Abnormal PSYC EXAM 2

PTSD: Defining Features

-Trauma and Response

-Reexperiencing

-Avoidance

-Emotional numbing problems

(Many trauma survivors do not develop PTSD

PTSD Diagnosis

Reaction persists > one month

Events that typically elicit PTSD

Combat and sexual assault most common

Events in life that tend to trigger vulnerabilities in life

-Invalidation

-Trivialization

-Loss of control

Acute Stress Disorder: Onset

Immediate

-0 to 28 days after the trauma

Acute Stress Disorder: Duration

Three days and four weeks

Acute Stress Disorder: Symptoms

Depersonalization

Depersonalization

When we feel disconnected from our body/person

Derealization

Feeling detached from reality- time person space (sensorium; orientation times 3)

Acute Stress Disorder: Treatment

Short term psychotherapy and antidepressant medication

Post Traumatic Stress Disorder: Onset

At least one months after the trauma occurs

Post Traumatic Stress Disorder: Duration

Lasts at least one month and can persist for several years

Post Traumatic Stress Disorder: Symptoms

Avoidance, heightened awareness and changes in mood or cognition

Post Traumatic Stress Disorder: Treatment

Long term psychotherapy, medication, and EMDR therapy

Acute PTSD

Diagnosis 1-3 months post trauma

Chronic PTSD

Diagnosis > 3 months post trauma

Delayed onset PTSD

Onset 6+ months post trauma

-May not see symptoms until 6+ months

PTSD: Causes

-Intensity of trauma
-Learned alarms (direct conditioning; observational learning)
-Biological vulnerability
-Uncontrollability and unpredictability
-Social support post trauma reduces risk

PTSD vs. c-PTSD: Both

-Reexperiencing
-Avoidance
-Sense of threat

c-PTSD

-Reexperiencing
-Avoidance
-Sense of threat
-Affect dysregulation
-Negative self concept
-Interpersonal disturbances

Silent PTSD/c-PTSD

-High sensitivity
-Hidden mistrust
-Dissociation/maladaptive daydreaming
-Over thinking
-Chronic worry
-Mood swings
-Hyper vigilance and fawn response

Fawn Response

long term nervous system response; response to stress and make sure that other people are okay

Trauma: Attachment Disorder

-Disturbed and developmentally inappropriate behaviors in children
-Unable or unwilling to form normal attachment relationships with caregiving adults
-Result of inadequate or neglectful care in early childhood
(RAD/DSED)

RAD: Reactive Attachment Disorder

-Abnormally withdrawn and inhibited behavior

-Less receptive to support from caregivers

DSED: Disinhibited Social Engagement Disorder

-Overly friendly with unknown adults
-Children might wander off often, approach strangers with no hesitation; hug or touch
-Treat adults as parents just for attention

Non-Organic Failure to Thrive

-Infancy
-Malnourished
-Even if the infant is fed, etc. they still die

Psychosocial Dwarfism

Toddler—>preschool

-Even if toddler/preschooler is fed, etc. they still die

Trauma can involve

-Loss of self
-Impediment of intimate relationships
-Shame
-Emotional Distance from self and others
(Can retire our nervous system; become reactive)

Trauma and Irrational Brain: Three Brains

3-Neocortex Brain
2-Limbic Brain
1-Reptilian Brain

Neocortex Brain

-Metaphorical

-Rational/thinking

Limbic Brain

-Social/emotional
-Feeling
-Amygdala

Reptilian Brain

-Basic life support

-Fight/Flight/Freeze

Amygdala vs. PreFrontal Lobe

Low road vs. High road
-Emotional brain takes control, may lead to impulsive and irrational actions
Vs.
-When taking in stimuli (misinterpretation, impulse control, irrational actions outside of person's control), helps with interpretation and impulse control

Trauma changes the Nervous System

-Highly reactive

-Emotional numbness

Highly reactive

Energy dedicated to suppressing inner chaos

Emotional numbness

-When trauma is ongoing and/or inescapable; next level is DVC
-Autonomic Nervous System regulates the vagus nerves; connects the brain to major systems in the body supporting

DVC: Dorsal Vagal Complex

Dissociation

Polyvagal Chart

Down—>Up

-Ventral Vagal
-Fight Flight
-Freeze

Ventral Vagal

Safe

-Parasympathetic Nervous System
(Calm, grounded, settled)

Fight Flight

-Sympathetic Nervous System

(Denver, hyperarousal, rage, panic, anger, fear)

Freeze

-Dorsal Vagal

(Hyperarousal, collapse, immobility, dissociation, numbness)

Child Abuse and Domestic Violence

-Affiliation Motivation
-Learned helplessness (freeze; dorsal Vagal)
-Reduced executive function (reptilian Brain and Limbic system, stuck in FFF)
-fMRI (Broca's area limited during acute and/or flashbacks)

Stuck in Freeze/Fight/Flight

-Oversensitivity; faulty alarm system
-Mirror neurons + faulty alarms system = popsicle misinterpretation
(Detachment, anxiety, rage, impulse control)
-"Out of Sync"
-Ignore gut feelings
-Alexithymia

Oversensitivity: Faulty alarm system

-Stuck in survival mode

-Energy for social bonds, attention, learning, strategic thinking

Alexithymia

Inability to feel and describe emotions

Flashbacks and living in the past

Flashbacks don't have a 'story' (beginning, middle, end)
-Brief images, no conclusion/closure
-Broca's area reduced
-Visual cortex highly activated
-Left hemisphere Uc activity reduced
-Right hemisphere highly activated

Broca's area

Responsible for speech articulation
-When experiencing flashbacks, it is vivid
-Body responds as if they are back in that scnario

Left hemisphere vs. right hemisphere

Speech (Activity Reduced) vs. Image processing (Highly Activated)

-Brain believed and responds as if still in event

Insight Therapies

Don't work
-Brain organization (reptilian, Limbic, cortex)
-Few issues result of defects in understanding and identification: no amount of insight can overrule older parts of brain
(They know something is going on with them)
-Understanding≠control

Attention Deficit Hyperactivity Disorder (ADHD)

Associated with numerous impairment

• Behavioral

• Cognitive

• Social and Academic problems

ADHD: Cognitive

Less goal directed behavior

• Harder to get on/start task

• Overwhelmed with all -arts, they freeze

• Inability to filter irrelevant stimuli (attend to everything)

• Poor working memory

• Difficulty with delayed gratification

• Appear 2-3 years younger than their peers

DSM-5 Symptom Types

• Predominantly inattentive

• Hyperactive/impulsivity

Inattentive + Hyperactive/Impulsivity Combined

• Diminished regulations of emotions

• Substance use

• Delinquency

• Interrupting others

ADHD: Facts and statistics

Approx. 11% of school aged children

S/S ~3-4 years

Similar s/s childhood, adulthood

ADHD: Gender Differences (Boys:Girls)

3:1

ADHD: Cultural Factors

Most commonly diagnosed in US; prevalence fairly worldwide

ADHD Causes: Genetic Contributions

• Heritability

• DAT-DA transport gene implication

• Dopamine (how it’s being used)

ADHD Causes: Neurobiological correlations

• Smaller brain volume

• Inactivity of Frontal Cortex and Basal Ganglia

• Abnormal frontal lobe development and functioning

  • Maybe the baby didn’t grow enough; correlation

Reduced function in the Prefrontal Cortex

More impulsive and focus and rational thinking is harder

Reduced function of Basal Ganglia

Hyperactivity

ADHD Causes: Biological Contributions

Role of toxins

• Food additives (altered gut microbiota)

• Maternal smoking

• Imbalance of Omega 3 and 6

• Need good prebiotic and probiotic diet

Imbalance of Omega 3

(too) Calming

Imbalance of Omega 6

Chronic inflammation

ADHD Causes: Psychosocial Contributions

• Kids tend to be popular during early elementary but viewed negatively later school years

• Low self esteem

• Peer rejection results in social isolation

  • RSD - Rejection Sensitivity Dysphoria

ADHD Causes: Trauma

Trauma more common than previously thought

• Doesn’t cause but there is an association

• Lots of misdiagnosis of Trauma and ADHD

Biological Treatment of ADHD: Goal

Reduce impulsivity and hyperactivity

• Improve attention

Biological Treatment of ADHD: Stimulant Medications

Approx. 4 million American children

• Low doses improve focusing abilities

• Ritalin, Dexedrine, Adderall

Problem: May increase risk for later substance use

Biological Treatment of ADHD: Genes affect response to meds

Trial and Error

Autism Spectrum Disorder

Problems in language, socialization, cognition (to some degree)

• Pervasive

Autism: Defining feature

Self centered thinking (focused inward)

• Cognitive energy directed inward; it can be challenging to notice social cues

Autism: Main areas of impairment (Communication)

Communication and social interaction

• About 25% don’t acquire effective speech

• Mute or extremely limited

Autism: Main areas of impairment (Behavior)

Restricted, repetitive patterns of behavior, interests, or activities

• Need to maintain “sameness”

  • High level of consistency in activities or experiences (routine)

Autism Starts

Infancy and toddlerhood

Autism in infancy and toddlerhood

• Don’t interact with caregivers

• Maintain eye contact

• Collections of things

• Designs

• No physical touch (cuddling)

• Solitary play

Savant

Meet criteria of autism but is a genius in a specific area

• Not very common

New label in DSM-5TR

Encompasses previously classified “pervasive developmental disorders”

• Autistic disorder

• Asperger’s disorder

• Childhood disintegrative disorder

• Rhett syndrome

Only about 30% on the spectrum have severely noticeable s/s

Spectrum

• Pragmatic Language

• Social akwardness

• Monotropic Mindset

• Information Processing

• Sensory Processing

• Repetitive Behavior

• Neuro-motor Differences

Autism Spectrum Disorder: Most common

• Deficits in social interaction and communication

• Restrictive Repetitive Patterns of Interests

Restrictive in Social Interaction and Communication

Learn everything about it, until get into another thing

• Drawing to sowing to yellowstone

Sign and Symptom: Masking

Mimicking

• Identity crisis

• When they mask in a conversation, they don’t usually know what the other person is saying in conversations

• Particularly women

• Exhausting

Sign and Symptom: High sensitivity to environment

Lights, noises, scents

Sign and Symptom: Eye contact

May look different than expected

Sign and Symptom: Splitting

Looking at things dichotomously (either good or bad)

Sign and Symptom: Emotional dysregulation

Rage, sadness, etc.

BDP

Sign and Symptom: Alexithymia

Inability to identify and describe feelings

Comorbidity with

ADHD/Anxiety/Depression

• Distinct but can be comorbid with ADHD

Psychological and Social Dimensions: Historical views

• Failed parenting

• High SES

• High IQ

• Lack of self awareness

• Behavioral correlates (echolalia, self injury)

Best predictors of Autism

• IQ

• Amount of language development by age 6

• A larger head and brain size by age 6

Biological Dimensions

Significant genetic component

• Polygenic

• Oxytocin lessened

• Older parents (fathers)

Polygenic

Numerous genes on several chromosomes

Oxytocin

Bonding hormone

• Lessened: not wanting to bond with others

Neurobiological Influences

• Amygdala

• Oxytocin

Neurobiological Influences: Amygdala

Larger size at birth - higher anxiety, fear

• Elevated cortisol

• Neuronal damage: results from high stress, which may affect processing of social situations

Causes of Autism Spectrum Disorder: Biological

Neurobiological influences

• Vaccines do not increase risk of autism

• See autism ages 2-3

Treatments of Autism Spectrum Disorder: Psychosocial Treatment

Behavioral approaches

• Skill building

• Reduce problem behaviors

• Communication and language training

• Increase socialization

• Naturalistic teaching strategies

Early intervention critical

Treatments of Autism Spectrum Disorder: Biological Treatments

Medical interventions has little positive impact on core dysfunction

• Except highly agitated, repetitive behavior

• Some drugs decrease agitation

• Tranquilizers, SSRIs

Indicators of good prognosis: High IQ, good language ability,

Learning Disorders

• Reading Impairment (Dyslexia)

• Impairment in written expression (Dysgraphia)

• Impairment in numbers of mathematical reasoning (Dyscalculia)

Schizophrenia

Ability to function is impaired by severely distorted beliefs, emotions, perception, and thought processes

• 1 in 10 people develop this (24 million worldwide)

• Pervasive type of diagnosis

Schizophrenia: Myths

• Split personality (don’t have this)

• Dissociative state

• Violence (more likely victims)

Psychosis

Descriptor (not a diagnosis)

• Hallucinations and Delusions