week 10 lecture - conduct disorders and SUDs

what are the externalizing psychopathology disorders?

ODD

CD

ADHD (with hyperactivity)

antisocial personality disorder

encopresis (in kids)

we are more worried when someone with hyperactive ADHD also has what disorder

CD - conduct disorder

highly comorbid with eachother

what two pairs of externalizing disorders are highly comorbid with eachother

CD and ADHD

CD and SUDs and ASPD

what do all externalizing disorders have in common?

impulsivity

what is the common trajectory of ODD/CD disorder? *hard to stop this

childhood: ODD

adolescence: CD

18+ adulthood: ASPD

we are good/bad at treating externalizing disorders

bad

not empirically valid treatments

abnormal antisocial behavior through lifespan

toddlerhood

irritable, difficult temperament

abnormal antisocial behavior through lifespan

preschool - 3 or 4 y.o.

defiant

constantly arguing

abnormal antisocial behavior through lifespan

school-age

lying, fighting, minor theft

abnormal antisocial behavior through lifespan

preadolescence (middle school)

assault, prematurely sexual

abnormal antisocial behavior through lifespan

adolescence

robbery, abusing substances

abnormal antisocial behavior through lifespan

adulthood (ASPD)

repetitive crimes

not caring about partner in relationships

domestic abuse to spouse or kid

ODD

ODD stands for what

fairly common disorder of _____

oppositional defiant disorder

common disorder of childhood

ODD

prevalence rate of ODD

2-16%

ODD

sex ratio before vs. after puberty

before puberty: M > F

after puberty: M = F

ODD

which gender is more confrontational and is more likely to have persistent symptoms?

males

ODD

ODD is the developmental precursor to what disorder where symptoms become more serious?

CD - conduct disorder

ODD

ODD definition

pattern of negativistic, hostile, and defiant behavior more time than not lasting for at least 6 months

ODD

diagnostic criteria of ODD

need at least 4+ (4/8) symptoms for at least 6 months

ODD

ODD symptoms get more normative/less normative with age

less normative

ODD

3 categories of symptoms in ODD

vindictiveness

mood symptoms - angry/irritable mood

argumentative or defiant behavior

ODD and CD

what disorder trumps the other

CD trumps ODD - CD is more worrisome

CD will be the diagnosis

ODD

what is the meaning of cross-sectional consistency that is needed for an ODD diagnosis?

ODD diagnosis needs the same acting out across many environments and contexts

ODD

is ODD likely going to send the child to jail and lead to ASPD?

no, not on its own

not unless it follows the trajectory of developing into CD and then ASPD

CD

CD definition

persistent behavior with violations of:

1. basic rights of others

2. major age-appropriate rules/norms

what disorder is the most common reason for a referral to inpatient clinics and hospitals in US

CD - conduct disorder

CD

what is the prevalence rate of CD?

*not rare which is worrying because there are no treatments

4-10%

CD

sex ratio of CD

3:1 M > F

CD

CD in boys vs. CD in girls

boys - direct PHYSICAL aggression; confrontation

girls - indirect MENTAL aggression; group affiliation

CD

what is the heritability rate of aggressive behavior?

.52 to .94

CD: diagnostic criteria

what are the categories/attributes of symptoms of CD (4)

aggression to people or animals

destruction of property

deceitfulness or theft

serious violations of the law

CD: diagnostic criteria

all symptoms of CD reflect what

antisocial actions

CD: diagnostic criteria

are psychological features criteria for CD? 

no because they are too young to have developed these traits; we wait to use these in ASPD

CD: diagnostic criteria

what is diagnostic criteria for CD

3 symptoms in the last year; at least one in last 6 months

CD: subtypes

what are the 3 subtypes of CD?

• note least serious, most serious, and most common

*not listed in DSM

group type - least serious

solitary aggressive type - most serious

undifferentiated type - most common

CD: subtypes

group type CD

conduct issues occur mainly as a group

aggressive behavior may or may not be present

usually goes away on own; just a blip in someone’s life

ex: gang/clique

CD: subtypes

solitary aggressive type CD

aggressive behavior is initiated mainly by 1 person, not as a group activity

hardest to treat

don’t even need to be provoked

CD: subtypes

undifferentiated type CD

includes mixture of clinical features that cannot be classified as group or solitary CD

CD: childhood vs. adolescent onset

what is the threshold to distinguish between childhood-onset vs. adolescent-onset CD? why?

threshold is 10 years old

determines who will come out of CD and who will go on to get ASPD

CD: childhood vs. adolescent onset

which diagnosis is more concerning and signaling to lead to ASPD (psychopathy in adulthood)

childhood onset

CD: childhood vs. adolescent onset

which onset involves obvious aggression?

childhood onset

CD: childhood vs. adolescent onset

which onset involves academic issues?

childhood onset

CD: childhood vs. adolescent onset

which onset has a lower prevalence (more severe)

childhood onset

CD: childhood vs. adolescent onset

which onset has a sex ratio that is not 1:1

childhood onset has M > F males outnumbering females

CD: childhood vs. adolescent onset

which onset has comorbidity with ADHD

childhood onset

CD: childhood vs. adolescent onset

which onset has a good prognosis

adolescent onset

CD: childhood vs. adolescent onset

does adolescent onset have any evidence prior to age 10?

no evidence prior to age 10

CD: childhood vs. adolescent onset

theory of etiology/cause of childhood onset

• more ____-based

• caused by combo of what 3 things?

more organic, brain-based

caused by combo of:

• early neurodevelopmental deficits

• bad parenting

• bad social influences

CD: childhood vs. adolescent onset

theory of etiology/cause of adolescent onset (1)

caused by peer influences during transition to adulthood

CD: etiology

possible differences in what brain area

prefrontal cortex/frontal lobe

CD: etiology

feel inactivated with lower ___ and ____ so seek out trouble

lower HR and HPA activity

CD: etiology

might have variant in genes that…

gnees that encode monoamines

varying MONOAMINES

CD

the greater the number of conduct problems, the _____ the cognitive performance (any type of cognitive performance)

more conduct problems = lower cognitive performance

CD: theories

Deviance-Amplifying Environmental Factors theory claims what 3 factors are present in CD?

1. difficult temperament in toddlerhood (poor parent relationship)

2. neuropsychological deficits (bad social)

3. peer rejection (may lead to find gang)

CD: theories

Parent-Child Interactions theory claim what 3 things lead to CD

1. lots of coercion from family (ex: if you don’t xyz, I will beat you)

2. negative reinforcement (providing reward to stop tantrum)

3. poor parental supervision/discipline

CD: theories

what is the most significant predictor of later child problems? (2)

• low parent monitoring of child behavior (know where kid is, control)

• low parent-child warmth (praise, hugs)

CD: theories

Hostile attributional biases theory believes CD boys…

CD boys misinterpret their environment and attribute negative and hostile intent to neutral situations, leading to aggression

CD: theories

Insular mothers theory claims what leads to behavioral problems?

cold mother relationship

mother is socially isolated, MDD (more likely as single mother)

mother’s stressors interfere with perceiving child and she responds to child in negative and hostile manner

often pushes child to seek family in gangs

ODD and CDD: outcomes

high risk to develop what

increased risk to develop what

high risk: other externalizing disorders such as SUDs and ASPD

increased risk: internalizing disorders

ODD and CDD: outcomes

__-__% of ODD/CD continue onto ASPD

30-40%

SUDs

how many people in US have substance abuse?

(amount equal to…)

population of Florida whole state

SUDs

is substance abuse expensive?

very expensive…lots of ER drug related visits

SUDs

#1 ER drug-related visit substance

alcohol

SUDs

modal patient of ER drug-related visits

white males

SUDs

substance use disorders involve what type of symptoms (3) and you can/cannot stop using despite knowing the substances bring problems

psychological, behavioral, cognitive symptoms

cannot stop using substances

SUDs

is gambling included in SUDs in DSM now?

why?

yes

because neurobiology are identical between substances and gambling

SUDs

SIDs (not as important)

short-lived; the immediate effect of substance

ex: drunk state while using alcohol

SUDs: diagnostic criteria

what is SUDs criteria for diagnosis?

need at least 2/11 symptoms for at least 12 months

SUDs

does DSM-5 have dimensionality for diagnosis SUDs? 

• mild = _ symptoms

• moderate = _ symptoms

• severe = _ symptoms

yes

• mild = 2-3

• moderate = 4-5

• severe = 6

SUDs

what are the most common 2 SIDs

*leave when drug leaves symptom

intoxication

withdrawal

SUDs

what are the 2 dopamine pathways associated with substance abuse?

mesolimbic

nigrostriatal

SUDs

what are the 3 main brain areas most associated with substance abuse?

prefrontal cortex

nucleus accumbens - midbrain

VTA (ventral-tegmental area) - midbrain

SUDs

why do drugs feel so good/what is happening in our brain?

dopamine is flowing in a much more significant manner when using drugs

SUDs

what substance has astronomically more dopamine release than natural causes (sex, food) and even other drugs?

methamphetamine

SUDs

what is the motivator behind maintaining heroin and opioid use in abusers

not so much for feeling of being high

they are trying to avoid and run from withdrawal/negative symptoms when they stop

NOT to chase high…but to AVOID LOWS

SUDs

_% of people who have SUDs seek treatment

~20%

SUDs

3 pharm treatment methods for SUDs

1. replace - something synthetic

2. relieve - meds to make detox bearable

3. block - condition to not use/block desired effects

SUDs

psych/non-pharm treatments for SUDs

CBT

programs (AA)

incentive programs

SUDs

Vaillant 1983 longitudinal study showed what about relapse in alcoholism?

• how many times did subject on avg go through detox

• _% died at end

• _% still abusing at end

• _% sober at end

relapse is incredibly common

• detox 2x a year

• 30% died

• 25% abusing still

• 25% sober

SUDs

Korsakoff’s syndrome/Alcoholic Korsakoff’s syndrome from alcoholism resulted in what

unique amnesia

could not make new memories and lost memories from past

SUDs: alcoholism/Korsakoff’s

etiology/caused by what?

• severe _____ deficiency especially from drinking and not eating

thiamine deficiencies

SUDS: alcoholism/Korsakoff’s

what are main symptoms of beginning (Wernickes) stage of Karsakoffs (3)

confusion

eye movements

un-coordinated motor skills

SUDS: alcoholism/Korsakoff’s

what is treatment?

• how many fully recover?

tx = large doses of thiamine

• 25% fully recover

SUDS: alcoholism/Korsakoff’s

in chronic Korsakoff stage what is main symptom

amnesia

• anterograde (no new memories)

• retrograde (no past memories)

SUDS: alcoholism/Korsakoff’s

important structure to look at in brain destruction in Korsakoffs and why

cerebellum

• atrophy occurs in history of alcoholism

SUDS: alcoholism/Korsakoff’s

neuropsychology:

do they make up stories to fill memory voids?

yes

SUDS: alcoholism/Korsakoff’s

neuropsychology:

is intellect preserved?

is there difference in IQ score and memory score?

yes intellect preserved, as smart as ever were

yes difference in these scores

SUDS: alcoholism/Korsakoff’s

like other SUDs, 2 main structural change in Korsakoffs is…

enlarged ventricles to try and fill skull

loss of brain tissue

SUDS: alcoholism/Korsakoff’s

outcomes:

• _% will not recover

• _% make a good recovery (can take 2 years of thiamine tx and rehab)

• _% recover but need to live with others/need help with life management

50% will not recover

25% make a good recovery

25% recover but need help with life management