PSYC DISORDERS FINAL

Neurodevelopmental Disorders

Neurologically based disorders that are revealed in a clinically significant way during a child’s developing years

ADHD

• Persistent pattern of inattention and/or hyperactivity-impulsivity interfering w/ functioning or development

• At least 6 symptoms are required for either inattention or hyperactivity/impulsivity

• Subtypes = Combined, predominantly inattentive, and predominantly hyperactive/impulsive

Biological Causes of ADHD (3)

• Genetics = Runs in families, multiple genes related to dopamine are different in people w/ ADHD

• Brain structure + function = Smaller brain volume, inactivity or abnormal brain function of frontal cortex or lobe, poor inhibitory control (endophenotype)

• Toxins = Maternal smoking and food additives

Psychosocial Causes of ADHD (2)

• ADHD children are often viewed negatively by others

• Frequent negative feedback from peers and adults leads to social isolation and low self-esteem

Biological Treatment for ADHD (2)

• Stimulant medications = Improve compliance and decrease negative behaviors

• Non-stimulant medications = More limited efficacy

Psychosocial Treatment for ADHD (2)

• Behavioral reinforcement = Increase appropriate behaviors and decrease inappropriate behaviors

• Parent training

Specific Learning Disorder

• Difficulty learning and using academic skills, w/ presence of symptoms for at least 6 months

• Subtypes = Impairment w/ reading, written expression, or mathematics

Biological Causes of Specific Learning Disorders (2)

• Disorders run in families, but subtypes do not

• Subtle neurological difficulties (decreased functioning of areas responsible for word recognition)

Psychosocial Causes of Specific Learning Disorders

Specific languages may pose more challenges than others

Treatment for Specific Learning Disorders (3)

• Specific skills instruction = Vocabulary, finding main idea

• Strategy instruction = Decision-making, critical thinking

• Direction instruction = Systematic w/ scripted lessons plans or teaching mastery by staying on topic to make sure child understands

Autism Spectrum Disorder (ASD)

• Persistent deficits on social communication and interaction such social-emotional reciprocity, nonverbal communicative behaviors, and developing/maintaining relationships

• Restricted repetitive patterns of behavior, interests, or activities (sameness)

Genetic Causes of ASD

• Significant influence

• Familial component = One child having it, chance of second child having it is 20%

• Older biological parents associated w/ increased risk

Neurobiological Causes of ASD (2-3)

• Larger amygdala = Elevated cortisol, anxiety, and fear

• Oxytocin = Lower levels

• Mercury in vaccines DO NOT increase risk, not supported

Psychosocial & Social Causes of ASD (2, Not Currently Supported)

• Failed parenting (cold and perfectionistic)

• Lack of self-awareness

Psychosocial/Behavioral Treatments of ASD (6)

• Skill building

• Reduce problem behaviors

• Communication and language training

• Increase socialization

• Naturalistic teaching strategies

• Early intervention

Biological Treatment of ASD

• Typically ineffective

• Drugs such as tranquilizers and SSRIs

Intellectual Developmental Disorder

• Deficits in intellectual functions (reasoning, problem solving, planning, abstract thinking, etc.)

• Deficits in adaptive functioning resulting in failure to meet developmental and sociocultural standards for personal independence and social responsibility

• Onset of deficits during developmental period

Biological Causes of Intellectual Developmental Disorders (2)

• Genetic = Lesch-Nyham syndrome, intellectual disability w/ symptoms of cerebral palsy and self-injurious behavior

• Chromosomal = Down syndrome (extra 21st chromosome), most common cause of intellectual disability; Fragile X syndrome

Treatment of Intellectual Developmental Disorders (2)

• Task analysis

• Augmentative communication strategies

Prevention of Intellectual Developmental Disorders (2)

• Early interventions such as Head Start

• Prenatal interventions such as gene therapy

Psychological Disorder

Psychological dysfunction that is

• Significantly distressing or impairing

• Not typical or culturally expected

• Including cognitive, behavioral, and emotional elements

Historical Conceptions (3)

Supernatural (demonic possessions), biological (physical illness), and psychological (Freud’s id, ego, superego; person-centered therapy; hierarchy of needs

1-Dimensional vs. Multi-Dimensional Models

o   1-dimensional = Single cause that ignores information from other areas (OCD = Family history)

o   Multi-dimensional = “System”/multiple of influences drawn upon from several sources

Diathesis-Stress Model

Biological vulnerability + environmental stressors = Increased likelihood of disorder.

Stigma’s Impact

Limits the degree to which people express mental health and seek treatment

Equifinality

Many paths to 1 outcome

Multifinality

Many outcomes come from 1 source

Assessment vs. Diagnosis

A= Evaluation and measurement of multi-dimensional factors

D = How symptoms fit diagnostic criteria (interpretation)

Mental Status Exam

Measure appearance (clothing and hygiene), behavior, thought processes, mood/affect (happy, blunt, sad), intellectual function, and sensorium (know what year it is) of patient

Psychological Testing (3)

• Projective = Analyzing unconscious processes and projecting personality aspects onto ambiguous test stimuli

• Personality = Objective tests such as the MMPI (567 items with true/false questions that discern people with or without psychological disorders)

• Intelligence = School performance and intellectual functioning/IQ (ex. Deviation IQ)

DSM vs. ICD

• DSM published and updated by American Psychiatric Association (APA)

• ICD published by WHO covering medical conditions

Dates of DSM Editions (3)

• DSM-III = 1980

• DSM-IV = 1994

• DSM-5 = 2013

Generalized Anxiety Disorder

Excessive anxiety and worry occurring for numerous events, not just extremely stressful ones

Panic Disorder

• Recurrent unexpected panic attacks w/ intense fear/discomfort, sweating, heart palpitations, chest pain, dizziness, etc.

• Persistent concern or worry of future panic attacks, and maladaptive change to behavior to avoid them

Agoraphobia

• Fear or anxiety of particular places or situations (transport, open spaces, outside of the home alone)

• Individual fears or avoids situations

• Fear/anxiety out of proportion to actual danger

• Fears avoided and endured w/ stress

Specific Phobia

• Fear or anxiety about a specific object or situation (ex. Flying, heights, animals, injections, blood)

• Phobic object/situation provokes immediate fear or anxiety

• Fear/anxiety out of proportion to actual danger

Social Anxiety Disorder

• Fear or anxiety about 1 or more social situations in which individual is exposed to possible scrutiny from others (social interactions, performing)

• Fears avoided and endured w/ stress

• Fear/anxiety out of proportion to actual danger

PTSD

• Person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence

• Traumatic event is persistently re-experienced through nightmares, flashbacks, emotional reactivity, and distress

• Avoidance of trauma-related stimuli after the trauma

Adjustment Disorder

Anxious or depressive reactions to life stressors such as moving, new job, divorce, etc.

OCD

• Obsessions = Recurrent, persistent, intrusive, and unwanted thoughts causing anxiety and stress and thus attempts to ignore them by other thoughts and/or actions

• Compulsions = Repetitive mental thoughts or behaviors performed to curb obsession and prevent anxiety and stress

Body Dysmorphic Disorder

Preoccupation with some imagined defect in appearance—even if there is an actual defect, it appears slight to others

Hoarding

Excessively collecting and keeping items with minimal value, leading to cluttering and disruption of living space

Trichotillomania

• Urge to pull out one’s own hair from anywhere on the body

• Leads to noticeable hair loss on scalp, eyebrows, arms, pubic region, etc.

Excoriation

• Repetitive and compulsive picking of the skin, leading to tissue damage

• Face is common target

Major Depressive Episode

• Depressed mood and diminished interest or pleasure in activities

• Most of the day, nearly every day, for at least 2 weeks

Manic Episode

• Inflated self-esteem (grandiosity), more talkative, and/or flight/racing of ideas

• At least 1 per week

Hypomanic Episode

• Shorter, less severe version of manic episodes

• Last at least 4 days

Major Depressive Disorder

• 1 or more major depressive episodes w/ periods of remission for at least 2 weeks

• Never had a manic or hypomanic episode

Persistent Depressive Disorder

• Depressed mood for most of the day, for more days than not, for at least 2 years

• Never been w/out symptoms for more than 2 months at a time in 2-year period

• Never been a manic or hypomanic episode, along w/ never meeting criteria for cyclothymic disorder

• Other possible symptoms = Poor appetite/overeating, low self-esteem, and feelings of hopelessness

Diagnostic Specifiers

• Additional diagnostic label for clinicians to convey extra symptom information

• Not mandatory—only assigned when appropriate

Bipolar I Disorder

Alternations between major depressive and manic (2 week) episodes

Cyclothymic Disorder

• Alternating between less severe depressive and hypomanic symptoms

• No criteria met for major depressive, manic, or hypomanic episodes

• “Mild” version of bipolar II

Bipolar Specifier: Rapid Cycling

• Moving quickly in and out of mania and depression

• Associated w/ greater severity

Gender Differences w/ Suicide

• Males complete more suicides

• Females attempt suicide more

• Disparity due to males using more lethal methods

Prevention of Suicide (Professional and Non-Professional)

• Professional = Risk assessment (ideation, plans, intent, means, etc.), develop safety plan (who to call, coping strategies), and sign no-suicide contract

• Non-Professional = Talk to them and ensure they’re getting support; remove lethal methods

Biological Causes for Mood Disorders & Suicide (2)

• Genetics play a strong contribution

• Neurobiological = Serotonin regulates norepinephrine and dopamine, and mood disorders are related to low levels of serotonin

Psychological Causes for Mood Disorders & Suicide (3)

• Learned helplessness = Lack of perceived control over life events leads to decreased attempts to improve own situation

• Attributional Style = Internal (my fault), stable (future ones are my fault), global (everything is bad)

• Cognitive errors = Arbitrary inference (more negative aspects) and overgeneralization

Social/Cultural Causes for Mood Disorders & Suicide

Lack of social support predicts late onset of depression

Treatment of Mood Disorders: Antidepressants (4) and Mood Stabilizers (1)

• Only 50% benefit

• SSRI’s = Block reuptake of serotonin

• Tricyclic antidepressants = Block reuptake of norepinephrine

• Monoamine oxidase inhibitors = Block monoamine oxidase

• Mixed reuptake inhibitors = Block reuptake of serotonin and norepinephrine

• Lithium = Mood stabilizer for depressive and manic symptoms of bipolar

Treatment of Mood Disorders: ECT + TMS

• Electroconvulsive Therapy = Brief electrical current applies to brain that creates temporary seizures

• Transcranial Magnetic Stimulation = Magnets to generate precise localized electromagnetic pulse, less effective than ECT

Treatment of Mood Disorders: Psychosocial

CBT = Cognitive errors of thinking

Tolerance

Needing more of a substance to get the same/reduced effects from the same amount

Withdrawal

Physical symptom reaction when substance is discontinued after regular use

Major Classes of Substances (4)

• Depressants = Alcohol effects, delirium tremens, dementia, and Wernicke-Korsakoff disorder (confusion, lack of coordination, impaired speech)

• Stimulants = Increased alertness and energy

• Opioids = Narcotic effects

• Hallucinogens = Altered sensory perceptions w/ delusions and paranoia

Biological Causes of Substance-Related Disorders

• Multiple genes

• Genetic differences in alcohol metabolism impact which drugs are most effective for treating disorders

Psychological Causes of Substance-Related Disorders

Opponent-process theory = Drugs are easiest way to alleviate feelings of withdrawal (good, then bad, cycle continues)

Cognitive Causes of Substance-Related Disorders (2)

• Expectancy effects = Use drugs when anticipating positive effects

• Cravings = Triggered cues like mood, environment, availability of drug

Biological Treatment for Substance Abuse (3)

• Agonist = Use similar drug to abused drug

• Antagonistic = Block or counteract positive effects

• Aversive = Makes use of substance extremely unpleasant

Psychosocial Treatment for Substance Abuse: Community Support Programs

• Treating addiction as a disease

• Goal of abstinence

• Social support

Non-Substance Disorders Related to Addiction

• Some disorders exist (gambling, explosive, pyromania, etc.)

• Follow addictive, compulsive patterns regarding a behavior rather than substance

Somatic Symptom Disorder

• 1+ somatic symptoms (excessive/maladaptive response to health concerns) that are distressing and/or result in significant disruption of daily life

• Excessive thoughts, feelings, and behaviors related to it

Illness Anxiety Disorder

• Fears of having/acquiring illness

• Somatic symptoms not present; or if present, only mild in intensity

• Excessive health-related behaviors (checking for signs) or maladaptive avoidance of Dr.’s or hospitals

Causes of Somatic Symptom/Illness Anxiety (2)

• Heightened attention to physical sensations

• Benefits of attention and sympathy

Treatment of Somatic Symptom/Illness Anxiety

• CBT - Especially for Illness Anxiety

• Reduce secondary gains

Conversion Disorder (Functional Neurological Symptom Disorder)

• 1+ symptoms of altered voluntary motor or sensory function

• Incompatibility between symptom and recognized neurological or medical conditions

Treatment for Functional Neurological Symptom Disorder (3)

• Process trauma or treat posttraumatic symptoms

• Remove sources of secondary gain

Factitious Disorders

• Purposely faking physical symptoms to be in “sick role”

• Munchausen syndrome = Factitious disorder imposed by proxy (ex. Caregiver inducing symptoms on child)

Depersonalization-Derealization Disorder

• Persistent or recurrent experiences of unreality or detachment from self (depersonalization) and surroundings (derealization)

• Reality testing remains intact

Dissociative Amnesia

Not able to recall memories of self (localized to specific event/events or generalized w/ identity and life history)

Dissociative Identity Disorder

• Disruption of identity by 2+ personality states w/ different affects, behaviors, memories, perception, etc.

• Recurrent gaps in recall of everyday events, personal info, and/or traumatic events

• Not normal part of broadly accepted cultural or religious practice

• Cause = Childhood trauma/abuse

Bulimia Nervosa

• Recurrent episodes of binge eating for a discrete (2-hour) period

• Lack of control overeating during episode

Anorexia Nervosa

• Restriction of eating/energy intake leading to significantly low body weight

• Intense fear of gaining weight or becoming fat

• Disturbance of how one’s body weight or shape is evaluated

Binge-Eating Disorder

• Recurrent episodes of binge eating large amounts of food and finding loss of control

• Episodes related to eating faster, feeling uncomfortably full, not feeling hungry, eating alone, and feelings of disgusted

• Disturbance not occurring during episodes of anorexia and w/out bulimia nervosa

Causes of Eating Disorders (3-4)

• Social = Media attributing thinness w/ success, dietary restraint, family who is heigh achieving and cautious of external appearances

• Biological = Genetic component

• Psychological = Sense of control

• Perfectionism

Treatments for Eating Disorders

• Antidepressants (not for anorexia)

• Family treatment (anorexia only)

Insomnia

• Difficulties initiating and maintaining sleep

• Early-morning awakening and not being able to go back to sleep

• At least 3 nights per week and/or for at least 3 months

Treatment for Insomnia

• CBT for insomnia, including psychoeducation, changing beliefs about sleep, and keeping up with a sleep diary

• Relaxation and stress reduction, modifying unrealistic expectations about sleep

• Sleep hygiene - Make bedroom a place for sleep

Hypersomnolence

• Excessive sleepiness (sleeping during the day or more than 9 hours) despite sleeping 7 hours

• Difficulty being fully awake

• At least 3 times per week for at least 3 months

Narcolepsy

• Recurrent periods of irrepressible need to sleep, passing into sleep, or napping occurring within the same day

• 3 times per week for the past 3 months

Circadian Rhythm Sleep

• Affects melatonin production and sense of night and day

• Causes = Shift in work type (irregular hours), familial type/history, and delayed/advanced sleep phase (biological clock “set” earlier or later than normal bedtime)

Nightmare Disorder

• Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that involve avoiding threats to survival, security, or physical integrity

• Occur during second half of major sleep episode

• On awakening, person rapidly becomes oriented and alert

REM Sleep Behavior Disorder

• Repeated episodes of arousal during sleep associated w/ vocalization and/or complex motor behaviors

• Upon awakening, individual is completely awake, alert, and not confused or disoriented

Psychological Causes of Dysfunctions (2)

• Anxiety and negative thoughts about encounters

• Avoid awareness of cues

Social and Cultural Causes of Dysfunctions (3)

• Unpleasant or traumatic experiences

• Poor interpersonal relationships

• Lack of communication

Treatment of Dysfunctions

• Psychoeducation alone can be surprisingly effective

• Sensate focus + nondemand pleasuring = Focus on sensations w/out trying to achieve orgasm to decrease performance anxiety

Paraphilic Disorders

• Misplaced attraction and arousal to inappropriate people/objects

• Includes: Fetishistic, voyeuristic, exhibitionistic, frotteuristic, transvestic, sexual sadism, sexual masochism, and pedophilic

Gender Dysphoria and Causes

• Marked incongruence between one’s experienced/expressed gender and assigned gender (trapped in the wrong body)

• Genetic component

• Prenatal = Exposure to certain hormones in womb (higher levels of testosterone may masculinize female fetus)

Personality Disorders

Persistent pattern of emotions, cognitions, and behavior leading to emotional distress to person affected and/or others causing difficult work and relationships

Cluster A and Disorders (3)

• Odd/eccentric

• Paranoid (unreasonable suspicion and mistrust of others), schizoid (cold, aloof, distant), and schizotypal (magical and unusual thinking and dress)

Cluster B and Disorders (4)

• Dramatic/erratic

• Antisocial (do not comply w/ social norms and rights of others, impulsive, deceitful, lacking empathy), borderline (personality disorder w/ mood disorder), histrionic (overly sensational and sexual, center of attention), and narcissistic (exaggerated and unreasonable sense of self-important)