Developmental Psychopathology

what is a mental disorder?

• distressing to self or others

• dysfunctional for person or society

• deviates from social norms

• this all equals judgement of abornormality

what can classification also be called?

• nosology

what are examples of contemporary classifications?

• DSM-5

• ICD-10

what are the features of contemporary classifications?

• uses operational definitions

• criteria is research based

• atheoretical an aetiologically agnostic

what does the term “uses operational definitions” mean?

• instead of sayng “typical features of the disorder are A, B, C and D” opertaionla definitions specofy how much of A,B, C and D must be present to diagnose the disorder

what does the term “ criteria are research based” mean?

• research is reviewed in expert working groups

what does the term “ atheoretical” mean?

• classification does not rely on or endorse any specfic theory about how or why a condition develops

what does the term “aetiologically agnositic” mean?

• this means it does not make assumptions about the cause (aetiology) of the disorder

• it does not claim to know what causes the disorder

what are the criticisms of contemporary classifications? (7)

1. high rates of comorbidity

   1. questions the validity of this idea of distinct disorders

2. inconsistent with dimensionality of psychopathology

   1. criticising the idea that mental disorders are clear cut categories

   2. dsm-5 says you can be diagnosed with MDD if you have symptoms that last for 14 days which means if you have symptoms for 13 days you do not qualify for the diagnosis

   3. seems arbitrary.

3. causes and treatments often transdiagnostic

   1. CBT is the primary treatment that works well for most disorders

   2. if cases and treatments are very similar does that not mean there is maybe just one big class of disorder rather than all these individual

4. conflicts of interests

   1. 70% of members had a conflict on interest when coming up with DSM-5

   2. pharmaceutical companies were involved in the creation

5. cross-sectional “one point in time” focus

   1. ignores the longitudinal nature of mental health, including changes, remission, recurrences

   2. overlooks the developmental trajectory of mental illness

6. medicalisation - over diagnosis

   1. everyday problems or distress may be increasingly labeled as mental disorders

   2. expanding diagnostic criteria risks pathologizing normal human experiences like grief, shyness, etc

7. most research based on WEIRD samples - not representative of the world

   1. many cultural differences.

what is epidemiology?

• it is the study of how diseases or health-related conditions are distributed in populations and the factors that influence them or determine that distribution

• in simple terms

  • who gets sick?

  • how often?

  • where and when does it happen?

  • why does it happen?

  • and what can be done to prevent or control?

• looks at patterns of health and ilness across groups of people - not just individuals

• it examines risk factors, causes and protective factors

• uses data and statitiscal methods to make sense of trends and test hypotheses

what is prevalence?

• how common are mental disorder

what is point prevalence?

• proportion of indviduals in a specfied population who the disease of interest at one point in time

what is period prevalence ? (life time or last year prevalence)

• proportion of individuals in a specfied population who have the disease of interest over a specfied period of time

what did the longitudinal cohort study investigate?

• asessed 1037 people born in dunedin in new zealand repeatedly over 4 decased

• conducted clinical interviews for common mental disorders

what is the source for the dunedin study?

•  (Caspi et al., 2020)

what does this graph from the dunedin study depict?

• each person = one line

• green = absence of disorder

• yellow = indvidual met the criteria for disorder at a given assessment

• orange/brown = greater number of concurrent disorders

• gray/black = missing/death

what were the findings for proportions of participants meeting the criteria?

• already by age 11-15 a third of particpnats had a mental disorder

• by 45 years old, 86% peopple had experienced at least one mental disorder

• people who had a disorder once did not necessarily have one again

• lifetime prevalance is not unique to this cohort and matched prevalnce reported for mutliple psychitric epidemology studies around the world

what were the main findings of age of onset from the dunedin study?

• most participants received a diagnosis as. ateenaged

• virtually no participants received a diagnosis at age 45 years

what were the findings regarding comorbidity from the dunedin study?

• participants with early onset disorders subsquently met diagnostic criteria for more diverse disorder types

• among particpants ever diagnosed with an internalisng disorder, 70% also experienced externalising or thought disorders

• by age 45 years, 85% of participnats with a disorder had accumulated comomorbid diagnoses.

what are the typical findings for age of onset of mental disorders?

• most mental disorders have their diagnosable onset by ealry adulthood

• it is relatively unusual to have a first disorder onset in adulthood

• there are differences across disorders

  • schizophrenia usually onsets in early twenties unless drug induced

what are the general findings of comorbidity across disorders?

• rare for people to have just one pure single disorder

• people with thought disorders will almost never only have one disorder

• comorbidity across disorders is extensive

what does the life- course perspective on psychopathology focus on? (8)

• to what extent are mental disorders continuing or discontinuing across development?

  • why do some people have a chronic course? why do some people recover?

• homotypical and hetereotypical comorbidities

  • homo - within disorders

  • hetero - across different categories

• longer term effects of earlier experiences

  • sensitive periods

  • cumulative effects

• gene-enviroment interplay overtime

• age/period/cohort effects

  • for example , to what extent does your risk of getting a mental disorder influenced by the broader effect of the period of histiry that you’re living in

• important to look at asessment of comorbidity when asessing a person with depression you must look at them and decide if they are a person who will have depression once and then recover or have it until adult life

• the image shows that some of causes of mental disorders start prenatally

• stochastic factors/random factors - someone might get into a car accident and develop PTSD but this could interact with already pre-existing enviormental or genertic risk factors

what are externalising disorders?

• attention deficit/hyperactivity disorder

• conduct disorder

• alcohol dependence

• cannabis dependence

• other drug dependence

• tobacco dependence

what are internalising disorders?

• depression

• generalised anxiety disorders

• fears

  • social phobia

  • simple phobia

  • agoraphobia

  • panic disorder

• post traumatic stress disorder

• eating disorders

  • bulimia

  • anorexia

what are thought disorders?

• obsessive compulsive dirorder

• mania

• schizophrenia

why should we consider different developmental phases? (4)

1. prevalence of disorders may differ across age

2. differences and similarities in presentation

3. differences in assessment

4. differences in treatment

what are the reasons for age differences in prevalence?

• pragmatic reasons

  • age retsirctions

  • sample drop out

• genuine age differences

explain the age restrictions for diagnosis?

• in the DSM-5 disorders are defined as one that can only occur at a certain age

  • for example, anti social disorder can only be diagnosed in 18+ years older (even if symptoms had to be present for 15+)

  • this is because you have to know if these symptoms have been a stable and pervasive pattern

    • before age 18, people can be diagnosed with conduct disorders

explain sample dropout?

• people with disorder die earlier than the general population so are not included in older samples

• the graph shows the difference in life expectancy across patients with schizophrenia

  • majority of the shortened life expectanacy is due to age related diseased not always suicide

  • there is alos a gap in treatment for people schizophrenia

  • there is a difference in life expectancy of about 20 years in males and 15/16 years in females across europe

explain the genuine age differences?

• anti social behaviour peaks in adolescence

  • rewiring of the brain cause difficulties of brain processing

  • adolescents are less able to regulate their behaviour

  • prevalence of antisocial behvaiour follows a characteristic curve across life

  • veyr few people have antosicla behaviour that is stable

• schizophrenia usually had a peak age of onset in early adulthood

explain the differences and similarities in presentation?

• from a paper on adolescent and adult differences in major depressive symptoms profiles

• weight loss and weight gain is much more common in adolescents than in adults

  • vegetative things seems to show most variation

• insomnia is much more common in adolescents than in adults

• physical symptoms seem to vary quite a bit

what are the differences in asessment, particulary asessment in childhood ?

• observe behaviours and interactions throuugh observations and play asessments

  • interested in how they intercat with others

  • do they play well with strangers?

  • follow development carefully over 6, 12, and 24 months

  • persistence of not making eye contact with childre - something that you see on avarege in autistic childre

• rely heavily on caregiver reports

• as children get older, play asessemnt becomes more independent rather than guided

• berkley puppet interview

  • helps elicit information on whether there is domestic violence going on at home

what are the differences in asessment, particulary asessment in adulthood ?

• SCID asessment

• sometimes you can ask spouses to help understand/ recognise the problem

what are the differences in assessment, particularly assessment in old age?

• you can also rely on caregiver reports, not from parents but of whoever is looking after the old person as they may not be able to explain what is happening

what are the differences in treatment?

• important to note that old people can also get medication

what does mental health in infancy/early childhood look like?

• young children can be diagnosed with mental disorders

• however it is hard to assess especially when very young

• this is because assessment methods need to be age appropriate

• there is lots of variation in normal development

• children may catch up in development

• there can be worries about labelling a child

• wuetsions about stability of diagnoses

• stability of infant diagnoses

  • when we just focus on diagnostic criteria for autism, the largets group does not meet the criteria for any of these ages

  • if a child does not meet the criteria at 18 months, there is a chance they could meet the criteria later

what does mental health in childhood look like?

• common externalising problems: neurodevelopmental disorders, anxiety disorders

• rare/non existent in childhood : schizophrenia , bipoalr disoder, personaloty disorders

• difficulty to distinguish between normal and problemati behvaiour?,m

how to distinguish between normal and problematic behaviour/

• lots of children have temper trantrums but do not meet the criteria for diagnosis

• severity

• persistence

• pervasiveness

• type of behaviour

what did researchers come up with to help distingish? and who was it ?

• they came up with the DB-DOS

• looked at non compliace (defiance )

• temper loss domain (difficulty recovering from negative affect)

• agression domain (agression toward adult)

• within each of these three measures, they distingusiged what a normal child would show and what a atypical child would show

  • e.g - normative behaviour should be able to move on from tantrums independently but atypical behvaiour finds it hard to struggle with transitions

• Wakschlag et al. (2007)

what does mental health in adolescence look like?

• this is the key age of onset of many disorders

• adolescents face ,any developmental challenges such as integrating with peers, school, puberty, sexual experimces and relationships

• sex differences in some disorders emerge

  • however no difference before the age of 15v

what does mental health in early adulthood look like?

• simialr to adolescence - many disorders first onset here ( schizophrenia)

• face developmental challenges of leaving home, beginning college or entering the workforce, little stability/ lots of change

• use of drugs and alcohol may become more common during this time

what does mental helath in adulthood/mid - age look like?

• relatively rare for disorder to first onset at mid-age

• with age, mental disorders can become comobird with physical health problems

  • diabetes and depression

• menopause is currently receiving a lot of research attention for its potential association with new-onset or escalation of mental health problems

• drop in antisocial behaviour even in people with antisocial personality disorder

what does mental health in old age look like ?

• severe menyal disorders, esp new onset, in older age is relatively more rare than in developmental periods

• because of earlier mortality

• can be harder to identify symptoms in older people

• there may be some growing out of symptoms (but it is rare)

• mental disorders can sometimes develope secondary to other problems e.g dementai

what can be used to detect ADHD in very young children?

• the DC: 0-5 is more inclusive, offering clinicians the ability to use the nosology to characterise the clinical presentation of veyr young children

• some children under 36 months of agre present with extremes of hyperactivity or inattention and/or impulsivity

• parent reports of hyperactvity/impulsivness at age 19 months were signficantly associated with teacher reports at 72-84 months

does mental illness often run in families ?

• yes

• if both biological parents have a condition your chnaces of getting the disorder are greatly increased

• this could be explained through envrioment and genetics and how these both combine instead of one or the other

what is an example of mental illness running in families?

• the galvin family

  • based in the US and there were 12 children, 8 out of the 12 children developed schizophrenia

what is the liftime chance of getting schizophrenia and bipolar disorder?

• 1 in 100

what is the chance of getting SZ or BPD if one of your biologicla parents have the condition?

• 6 in 100

what is the chance of getting SZ or BPD if both your biological parents have the condition?

• 45 in 100 sz

• 40 in 100 bpd

what is the chance of getting SZ or BPD if your brother or sister has the condition?

• 9 in 100 sz

• 13 in 100 bpd

what is the chance of getting SZ or BPD if your identical twin has the condition

• 40-50 in 100 sz

• 40-70 in 100 bpd

what is the chance of getting SZ or BPD if your non identical twin has the condition?

• 17 in 100 sz

• 20 in 100 bpd

nature vs nurture?

• think about how they combine rather than one or the other

what are some goals of psychiatric genetic research?

• quantifying overall genetic influence

  • how much genetic influence is there on ADHD

• identifying specific genetic variants

  • is there a particular genetic variant associated with schizophrenia

  • proven to be quite tricky

• studying gene-environment interplay

  • how does genetic liability and parenting combine to influence risk of antisocial behaviour?

what are tools of psychiatric genetics?

• quantative-genetic approaches

  • inferring genetic influences

  • twins, adoptees

• molecular genetic approaches

  • measuring genetic variation directly

  • genome wide association studies (GWAS)

what are twin studies and what are the three components that make up twins?

• twin studies allow us to estimate how much a trait comes from our genes and how much of that is influenced by environment

• genetic influences, shared environments, non-shared environments

what are shared enviroments ?

• these make identical twins and non identical twins alike

• they are often thought of as family wide influences because they affect members of a family equally. e.g - SES or neigbourhood

if there was differences between identical twins what would this be due to ?

• non shared enviromental influences

what percentage of genes do twins share? identical/ non identical ?

• identical twins share 100% of their genes

• non identical twins share 50% of their genes

  • if they share some of their other characteristics then this could come from families as they are both brought up in the same enviorment

what are the statistics for genetic infleunces of different traits/behaviours/disorders?

• these estimated are based on a meta analysis and all are approximate

• important to consider that if you expose 100 people to the exact same event, not all people are going to develop PTSD

• some of these rely on the environment, if there is no alcohol in the environment, then there will be no alcohol abuse

what is a gene enviroment interaction interplay?

• where all of these people may experience the same event or they may all be exposed to alcohol at univeirtsy and some will emerge from these experiemces without any issues with alcohol but thse may have genetics that are slightly different coudl develop issues

MYTH: heritability refers to individuals . TRUE OR FALSE?

• FALSE

• refers to populations not indviduals

• 40% of differences between people in depression are due to genetic differences between them

  • not 40% of ones depressiom

MYTH: heritability is fixed, it does not change. TRUE or FALSE?

• FALSE

• heritability can change and vary across history and in different cohorts

  • in more recently born cohorts, heritability of women’s alcohol has increased which could be due to alcohol use becoming more socially acceptable

• can change across age/development

  • as children grow older heritability tends to increase for some mental health problems

  • 

• can change across environments

  • in neighborhoods where there are more alcohol outles and more opportunities for buying and presumably also consuming alcohol. there is greater heritabiloty of alcohol use

MYTH: high heritability means non malleability, i.e that a mental health problem cannot be changed - TRUE OR FALSE?

• FALSE

• there are ways of how environmental influences can modify to what extent a genetic disposition can manifest itself

• short sightedness is very highly genetically influenced yet ome can wear glasses to soften the impact

• someone who inherits a geentic risk of alcohol abuse decides to expose themsleves to alcohol

can you describe the molecular - genetic methods?

• an entire set of 23 human chromosones is called a genome

• human genome is composed of 3 billion base pairs

• variation at a single base pair is called a SNP

• there are around 10 million SNPS in the human genome which account for many of the genetic differences between you and everyone else

• some SNPS account for differences in appearances, other can affect how we develop diseases or respond to drugs

• direclty measure genomic variation

• most currect research focuses on relativley common variants

what are candidate gene studies?

• popular approach from approx 2003-2016

• selected specific genetic variants a priori ( serotonin transporter gene 5-5HTT)

• tested association between these outcomes either individually or in interaction with emvriorment

• very poorly replicable

what replaces candidate gene studies?

genome wide association studies (GWAS)

what are GWAS studies ?

• they do not just look at one particular genetic variant. they look at the whole genome

• there is no prior selection of specific variants, they test thousands of variants

• statistically much more sop

• they calculate polygenic scores across many variants

  • higher scores - higher risk

what have we learned from psychiatric genetics research?

• there is no single gene for mental disorders

  • for the most part mental disorders appear to be infleunced by many common genetic variants that each have a tiny effect

  • in other words mental disorders are polygenic not monogenic

• there is shared heritability across disorders

  • higher genetic risk for one mental disorder is often associated with higher genetic risk for other disorders too

  • could partly explain high comorbidity across disorders

• there is gene-envrioemntal interplay

what is the evidence for the gene enviorment interplay ?

• stress vulnerability model

  • idea the more stressors in ones environment increases their vulnerability

  • e.g - person may carry a genetic vulnerability for SZ but they may never develop it unless they experience significant stress such as drug use, trauma, or social isolation

what is gene-environmnet correlation? implications? examples?

• this is when environments don’t always happen to people randomly

• example- children’s peer groups, often parents say “ my child fell in with the wrong crowd”. unfortunately it does seem to be the case that children often select their peers. children who are more prone to risk taking choose peers who are the same.

• implications:

  • can be highly controversial, risk of victim blaming

  • but important tp consider when studying why mental illness develops

  • can guide us towards interventions

• examples

  • a lot of policy effeort and interest in the legalistaion of cannabis

  • idea that if teenages or young adults have more access to cannabis because its legal, more likely to get schizophrenia

  • reserach suggests that if you have a genetic risk to dveelop schizophrenia, you are more likely to smoke cannabis

what are examples of microenvironmental influences? (6)

• parenting

• maltreatment

• peer relationships

• built environments

• neighbourhoods

• socioeconomic status

what is one way you can categorise environmental influences?

• bronfrenners ecological systems

explain bronfenners ecological system?

• microsystem - immediate environment

  • families, parents, schools.

  • immediate interactions individuals has with the environment

• exosystem - friends families. neighbours, legal services

• meso system - the way in which micro system intercats with the exosystem

• macrosystem - things that are properties of country, culture and society that the individual lives in

• chronosystem - particualr point in time that someone lives in

  • for example, pandemic or war

what are the three challenges for studying effect of enviornmental influences?

• they can be difficult to measure

  • parents don’t report

  • child isn’t aware that what they are experience is abuse

• they might not have immediate effects

  • longitudinal follow up studies might be better however these are expensive and harder to do

• they cannot be easily studied using casually informative research designs

what is the hierarchy of evidence?

• how good the quality of evidence is and how high the risk of bias is

• randomised controlled trials/ systematic rviews and meta-analyses of RCTs are highest quality and lowest of bias

• editorials, experts opion are low quality and high bias

what is a problem of for mosy hypothesised risk factors randomised controlled trials?

• they are typically unethical/ impractical

  • cannot assign someone to experience maltreatment, peer victimisation, war or diseased

what 4 biasses are introduced due to a lack of casually informative designs?

1. reporting biases

2. reverse causality

3. environmental confounding

4. genetic confounding

how do you measure parenting?

• observational measures

  • unstructured tasks - play with your child for 10 mins

  • structure tasks - parents fill out form while child is playing next to them

  • home observation - wander around, see how many toys there are, focus on specfic aspects of parental behaviours and measure something like langauge development

  • voice recordings

• informant reports

  • from child

  • from parent

what do you measure when parenting?

• positive and negative parenting

what are examples of positive and negative parenting?

positive parenting

• high warmth, affection

• effective discipline

• parental monitoring

negative parenting

• dissatisfaction

• shouting,hitting

• chaotic home enviorment

what is a common measure of parent child relatinships and what is common finding from this measure ?

• Robert C. Pianta scale

• you see a skew in the questions that ask/ state “ i act warm to my child”

what are 4 challenges in interpreting association from parenting?

• reporting biases

• reverse causality

• environmental confounding

• genetic confounding

what is reporting bias in parenting?

• in this study it explains that the child behaviour was completed by the primary caregiver at each time point to assist presence of child internalising and externalising symptoms

• research suggests that mother who are depressed are more attuned to negative behaviours

  • therefore mothers with depression may rate their child’s internalising problems higher than mothers without

• if completed by the same informant for predictor and outcome

• could lead to a possible distortion by maternla depression

what is reverse causality in parenting?

• this is when instead of poor parenting leading to internalising disorders it means that internalising problems cause the parents to perform poorly or act in a neglectful way

  

• this graph shows that internalising at age 3 predicts maternal depression at age 5

• another study was done where mothers reacted more positively towards their hyperactive children when they were on medication

what are the enviormental confounds in parenting?

• the common cause could be things such as;

  • family socioeconomic status

  • antisocial father

  • neigbourhood

• these factors could have a direct impact on parenting

what are the genetic confounds in parenting (3)?

• passive gene-environment correlation

• evocative gene-environment correlation

• active gene-environment correlation

what is passive gene-enviornment correlation?

• where genetic influences in parents might affcet the envrioment they provide for their children

  • example - parent at risk for depression may pass these genes to their child (increasing risk of depression) but also parent in less warm or more negative eays whihc may impact the child

what is evocative gene-enviornment correlation?

• parent behaves differentlt toward the child based on their genetic disposition

  • example - a child with a genetic tendency toward ADHD might be more impulsive or difficulty which could cause their parent to be more harsh, frustarted or controlling

what is active gene-environemm correlation?

• young perosn’s genetics lead them to select themselves into certain environments

  • example - a teenager with a genetic risk for risk-taking might seek out peers who drink or engabge in delinquent behavior

  • therefore experienced more conflict with parents as a result

what can we do about the challenges in interpreting association of parenting?

• run RCT for parenting interventions

• quasi experiments for treatments for maternal depression

• genetically - sensitive designs, adoption design, twin differenes designs

• high quality observational data

  • longitudinal

  • multiple informants

what is the example of the twin differences deisgn?

• NASA did an expeirment where a set of twins provided lots of measurements including heart rate and various other forms of biological functions

• one brother went into space and one styaed behind

• when the brother came back, they comapred them on all the indicators

• another examples was mesuring twins with differences in parening

• the twin who revived more warm parenting from their mother dispayed fewer externlasing problems

• effects were small