HLD: final exam

developmental psychopathology (who and what)

Alan Soufre

1) studies abnormal behavior from a developmental perspective

2) studies origins and course of maladaptive behavior

3) how expression of a disorder develops and changes over time

psychopathology is the outcome of a developmental process NOT a medical model of a disease

neurodevelopmental disorders

disorders that result from typical and atypical pathways of brain development as influenced by positive and negative experiences

Developmental considerations of psychopathology

nature vs. nurture

continuity vs. discontinuity

universality vs. context specificity

nature vs nurture: genetics (nature) vs. environmental factors in relationship to the development of mental disorders

continuity vs. discontinuity: gradual changes that occur over time vs. abrupt changes and transitions

universality vs. context specific: universal biologically determined factors vs. cultural, environmental, context specific factors

Diathesis stress model of psychopathology

psychopathology results from the interaction over time of a predisposition or vulnerability to psychological disorder and the experience of stress

ancient theories of abnormal behavior:

demonological model and treatment

spirits/gods controlled much of the environment including individuals’ behaviors

Treatment: trephination (hole in skull to release spirits), incantations, exorcism

history of abnormal behavior: Greek and roman views

1) Hippocrates

2) Galen

Hippocrates: 1st to identify psychological symptoms of hallucinations, delusions, melancholia, hysteria, and mania

• emphasized environmental and physical factors (4 body humors)

• early medical model of mental illness

Galen: psychological rather than physiological causes for mental disorders

history of abnormal behavior: Middle Ages through renaissance

roman catholic church

abnormal behavior is the influence of the devil

witchcraft: a theory of abnormal behavior, beliefs

mass hysteria: emotional contagion

Enlightenment (John Weyer)

parcelsus

John Weyer: first physician specialized in treating mental illness

parcelsus: importance of hereditary and psychological origins of physical illnesses

history of abnormal behavior: nineteenth century “moral treatment model”

1) moved patients from insane asylums to specialized facilities devoted to care and treatment

2) advocated for more humane treatment (respect, kindness, religion, vocational training)

3) key founders and components: Phillipe Pinel, William Tuke, Benjmain Rush, Dorothea Dix, Emil Kraepelin

Criteria that make development abnormal

1) statistical deviance

2) maladaptiveness

3) personal distress

Infant: autism spectrum disorder

lifelong disorder, diagnosed typically by age 3

characteristics:

• difficulty forming social relationships and responding to social cues

• restricted and repetitive interest and behaviors

History of ASD: Hans Asperger

describes autistic psychopathy (Asperger syndrome)

“High functioning autism”

• above average intelligence

• good verbal skills

• desire for social relationships

• deficient social cognitive and communication skills

History of ASD: Michael Rutter

focused on language deficits

beginning of the neurobiology approach

Characteristics of ASD in early development

• lack of normal interest and responsiveness to stimuli

• failure to orient to someone calling their name

• preference to non-human stimuli

• failure to make eye contact

ASD is more common in ______

boys

Causes of ASD (suspected)

• refrigerator mother theory: lack of maternal warmth (discredited)

• abnormal brain growth and connections:

  • over proliferation during prenatal and early infancy in frontal lobes

  • underconnectivity in areas involved in social cognition

• genetics

• Environemtal influences/epigenetics

Treatment of ASD

Behavioral: Applied Behavioral Analysis

• specific behaviors vs. operant conditioning

Developmental: Early start Denver model program

• 18-30 months old trained 40 hrs./week for 2 yrs

• improvement of IQ and response to facial cues

Social Cognitive Development “Theory of Mind”

some theorists think autism is failure to develop the theory of mind (one aspect of social cognition):

• thinking of perceptions, thoughts, emotions, behaviors of oneself and others and social systems as a whole

• ability to understand human psychology, describe others, and adopt other perspectives

• understand that people have mental states that guide their behaviors

Developing Theory of Mind: False Belief Task assesses what?

understanding that people can hold incorrect beliefs and that even if incorrect can guide an individual’s behavior

“mind blindness”

social deficits that ASD individuals may experience because they lack theory of mind

• related to social/interpersonal/affective knowledge and skills

Early steps in developing theory of mind: 6 months

understand intentions of others

Early steps in developing theory of mind: 9 months

joint attention

Early steps in developing theory of mind: 1-2 years

pretend play

Early steps in developing theory of mind: during 1st year

imitation

Early steps in developing theory of mind: 2nd year

emotional understand of self and others

Early steps in developing theory of mind: 1-2years

implicit theory of mind (sensitivity to others mental states without needing to consciously reflect on them)

Early steps in developing theory of mind: by age 4

explicit theory of mind: deliberate consideration of others mental states (judgment)

true or false: social cognitive skills continue to improve after adolescence

true

True or false: elderly continue to display sophisticated social cognitive skills

true

when elderly adults do show declines in cognitive skills it is most likely due to

declines in fluid intelligence, executive control process, information processing speed loss, and memory inefficiencies

Blanchard fields theory

social cognitive skills hold up better than nonsocial cognitive skills

• cortical areas supporting social cognition and emotional understanding age slower

Grossman

focuses on differences in individualist vs. collectivist cultures in relation to adult social cognition

individualist: prioritize individual over group (USA)

collectivist: prioritize needs and goals of the group over the individual (Japan, Latin America, Asian)

children with externalizing problems experience

lack of self-control, violate social expectations, disobedient, aggressive

more common in boys

more common in individualistic cultures

children with internalizing problems experience

anxiety disorders, phobias, shyness, depression

more common in girls

more common in collectivist cultures

ADHD: Child characteristics

inattentiveness, hyperactivity, impulsivity

reflect deficits in executive functioning

usually diagnosed in early elementary school

suspected causes of ADHD

biological (genetics) (difference in cortex and cerebellum in studies)

environmental factors (gestational/birth factors)

ADHD treatment: biological

stimulants cause a slow reuptake of dopamine and norepi (methylphenidate)

ADHD treatment: psychological

behavioral methods (classroom modification, parent training)

collaborative multi-model treatment: (behavioral and medication)

cognitive behavioral therapy

adolescence characterized by

risk taking and externalizing behavior

Depression: infant

major depressive disorder is not diagnosable in infancy

symptoms: most likely in infants who are abused, neglected, lack secure attachment to caregiver

zero to three project

guidelines for psychological disorders including depression in infants and toddlers

• tearfulness

• lack of joy

• irritability

depression: child

same criteria for children and adults

treatment: psychotherapy, psychopharmacology (less affective in children)

girls most likely to show _____ in signs of depression

ruminative coping (thinking over and over again, rumination)

most common psychiatric disorder worldwide

depression

higher rates of depression found in

male Caucasians

suspected causes of depression disorders: biological

underusing neurotransmitters (nervous system unaroused)

response due to seasonal changes

suspected causes of depression: psychological

psychodynamic (Freud): anger turned inward due to object loss

attachment (Bowlby): response to maternal separation

behavioral (B.F. skinner): loss of positive reinforcers

learned helplessness (Martin Seligman): uncontrolled external and internal factors result in dysphoria

CBT (Aaron Beck): negative cognitive schemas lead to anhedonia (inability to experience pleasure) which leads to self-fulfilling prophecies for failure

treatment for depression: biological

1st gen antidepressant: tricyclic antidepressants and monoamine oxidase inhibitors

2nd gen antidepressant: SSRIs and SNRIs (norepi reuptake inhibitors)

electroconvulsive

light therapy

TMS (enhances response to antidepressants)

deep brain stimulation

treatment for depression: psychological

psychodynamic therapies: find the unconscious basis for object loss

CBT: develop skills to change negative thought patterns

interpersonal psychotherapy & Social rhythm therapy: promote daily routines

behavioral activation: increased contact with positive reinforcers for healthy behaviors

depression: elderly

often misdiagnosed due to the belief that depression symptoms are effects of aging

most often approach for treatment of depression in the elderly

psychotropics and psychotherapy

Suicide is the ___ leading cause of death for _____

2nd for 15- to 24-year-olds

men or women more likely to commit suicide?

men

anorexia definition

restriction of energy intake relative to needed energy needs that results in significantly low body weight in relation to developmental stage

emaciation

severely underweight

two types of anorexia

restricting: weight loss from dieting, fasting, exercise

binge eating/purging: recurrent binge eating and purging

clinical features of anorexia

experience weight or shape as large even when emaciated

place undue importance on body weight and shape

lack of recognition of seriousness of low body weight

amennorhea

depression and anxiety

slow heart rate, low blood pressure, reduced bone density, GI problems, low body temp

5 components of anorexia according to DSM5

denial of illness

restriction of binge eating/ purging

perception of body weight and size distorted

weight and shape as evaluation of self

intense fear of gaining weight

least common eating disorder

anorexia nervosa

mental disorder with highest mortality rate

anorexia nervosa

risk factors for anorexia

populations with emphasis on body shape and weight

personality traits such as perfectionism, obsession, neuroticism, low self-esteem

80% of people with anorexia nervosa suffer from

major depression

bulimia

recurrent episodes of binge eating with recurrent inappropriate compensatory behavior to undo effects of the binge or to prevent weight gain

clinical features of bulimia

“Invisible eating disorder”: usually no changes in weight

lack control over binge eating

inappropriate compensatory behaviors to undo effects of binge

at least one binge eating episode on average per week for three months

culture bound eating disorders

bulimia and anorexia

binge eating disorder

recurrent binge eating with no behavior to eliminate

overweight and obese individuals

new diagnostic category in DSM5

Albert Stunkard

in 1959 found binge eating disorder as subcategory in obese individuals

average duration with binge eating disorder

14.4 years

predictors of eating disorders in childhood

mothers body dissatisfaction, internalization of thin body ideal, maternal and paternal BMI

what increases risk for bulimia nervosa

early menarche (higher body fat, and being more developmentally mature)

suspected causes of eating disorders

hypothalamus (regulates metabolism, influences appetite and weight control)

ventromedial hypothalamus (regulates overeating)

lateral hypothalamus (regulates appetite)

serotonin and dopamine (influence feeding initiation, satiety, craving, appetite)

addiction model of binge eating

neurological system associated with addiction play a role in binge eating

• PET scans find that obese individuals with BED release more dopamine upon exposure to food

what eating disorders run in families

anorexia, bulimia, and BED

psychological causes of eating disorder

psychodynamic: anorexia as an attempt to defend against anxiety associated with emerging adulthood and interpersonal relationship issues

patterns of family dysfunction

cognitive behavioral theories: distorted views of body shape, weight, eating and personal control

sociocultural theories: women (western preoccupation with thin ideal and exposure to media images

• men: emphasis on lean and muscularity

Salvador Minuchins four patterns of family dysfunction

• enmeshment: emotional overinvolvement, poor boundaries

• rigidity: difficulty adapting to changing needs

• overprotectiveness

• poor conflict resolution

biological treatments for eating disorders

pharmacological: no med identified as fully affective, fluoxetine is only FDA approved medication (reduces symptoms of bulimia nervosa)

nutritional counseling

psychological treatment for eating disorders

CBT: helps change thinking patterns, addresses faulty cognition, self-monitoring and learning to change beliefs

DBT: controls emotional dysregulation when under stress

family based therapy: salvador minuchin and maudsley method of family based therapy

Maudsley method of family-based therapy

focuses on parental control and empowers parents to take an active role

body project

educational program for at risk females to reduce adherence to the thin ideal

dementia

progressive deterioration neural functioning associated with cognitive cline that is not part of normal aging

major or mild neurocognitive disorder due to Alzheimer’s disease

most common subtype of Dementia

disease process of alzheimers

plaques containing beta amyloid protein (dying neural tissue accumulates)….neurofibrillary tangles containing the tau protein….inreased inflammation….results in death of neurons

early warning signs of alzheimer’s

getting lost in familiar surroundings

trouble managing moneys, paying bills, difficulty with routines related to short- and long-term memory

suspected causes of alzheimer’s

APOE 4 gene carries 15x more likely to develop Alzheimer’s (60% of risk for developing Alzheimer’s is genetically linked)

treatment/prevention of alzheimers

memory care

drugs:

• aricept (improves eurotrasmitter function)

• galantamine/exelon (improve cognitive functioning by poreventing breakdown of acetylcholine and acetylcholinase

• namenda (slow progression of plaque buildup)

• lequembi (targets amyloid protein and reduce plaques)

According to Harvard Medical School: what is death?

biological death: total brain death

irreversible loss of functioning in entire brain

• higher centers involving conscious awareness

• lower centers controlling basic life processes

to be judged dead you must meet this criteria

total unresponsiveness to stimuli

fail to move for 1 hr, fail to breathe for 3 min, after removal of ventilator

no reflexes

no electrical brain activity

euthanasia

actively or passively hastening death of someone suffering from an incurable disease

types of euthanasia

active: taking action that results in death (mercy killing)

passive: withholding treatment or other life sustaining actions that allow natural processes that lead to death to occur

average life expectancy in 1900 in US

47

average life expectancy now in US for men and women (longest and shortest)

men: 76

women: 81

longest: Hispanics (females)

shortest: African American (males)

leading cause of death: preschool and elementary school

unintentional injuries: gun violence, car accidents

leading cause of death: adolescence and early adulthood

accidents, homicide, suicide

leading cause of death 45-64

cancer

leading cause of death: 65 and older

heart disease

Program theory of aging

aging is determined by predictable genetic timeline

Hayflick limit: maximum lifespan determined by number of times cells can divide

• telomeres: DNA that forms tips of chromosomes and shorten with each cell division

epigenetic aging clock: DNA methylation that influences gene activation or expression

Damage theory of aging

haphazard processes cause damage, errors in cells accumulate, leading to organ system malfunctions

free radicals

toxic and chemically unstable metabolic by products or normal chemical reactions in cells

DABDA perspective on dying: Elisabeth Kubler Ross

Denial, anger, bargaining, depression, acceptance