SMU PSYC 2351 Exam 3

Pica

- compulsive eating of nonnutritive substances (such as clay or ice) for at least one month

- The eating of non-nutritive substances is inappropriate to the developmental level of the individual

- not culturally supported or socially normal

- severe enough to warrant independent clinical attention

- most commonly seen in kids

Pica Causes

- iron, zinc, or other nutrient deficiencies (common in pregnancy)

- comorbidities like OCD or schizophrenia

- to ease hunger in individuals with anorexia

- cultural factors (clay is believed to increase fertility in Turkey, Australia, and Africa)

- social factors (parent neglect, food deprivation)

- associated with developmental problems (autism, intellectual disability, other developmental problems)

Effects of Pica

lead poisoning, intestinal blockage, parasites, choking, malnutrition, infection, death

Pica Treatment

iron supplements, psychotherapy, medication for OCD tendencies, removing certain substances from surroundings

Avoidant/Restrictive Food Intake Disorder (ARFID)

- persistent failure to meet appropriate nutritional and/or energy needs associated with 1+: significant loss of weight, significant nutritional deficiency, dependance on enteral feeding or oral nutritional supplements, marked interference with psychosocial functioning

- not explained by lack of available food or by cultural practices

- does not occur exclusively during anorexia or bulimia

- not attributed to a medical or mental condition

- common in autism spectrum, ADHD, intellectual disabilities, anxiety disorders

ARFID Treatment

CBT, exposure therapy, speech therapy, physical therapy, dietitians

Binge Eating Disorder

- characterized by both: eating, within a 2 hour period, an amount of food that is definitely larger than most people would eat during the same period AND lack of control over eating during episodes

- binge is associated with 3+: eating more rapidly than normal, eating until uncomfortably full, eating large amounts when not hungry, eating alone bc of embarrassment, feeling disgusted/depressed/guilty after

- once a week for 3 months

- not another eating disorder

Binge Eating Treatment

- reinforce healthy body image

- decrease dieting frequency

- CBT - individual, group, or family

- Vyvanse

- nutrition counseling

Anorexia

A. restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health

B. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even at a significantly low weight

C. disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Anorexia Types

restricting and binge eating/purging

Bulimia

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by BOTH of the following: 1. Eating in a discrete amount of time (ex. within a 2 hour period) an amount of food that is definitely larger than what most individuals would 2. sense of lack of control over eating during an episode

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months

D. Self-evaluation is unduly influenced by body shape and weight

E. The disturbance does not occur exclusively during episodes of anorexia nervosa

Risk and Causal Factors in Eating Disorders

Genetics: heritable

Brain region: hypothalamus

Set point disruption

Neurotransmitter: serotonin

Socio-cultural factors: thinness ideal

Schizophrenia criteria

2+ symptoms, present for a significant portion of time during a 1-month period

Delusions

Hallucinations

Disorganized speech

Disorganized behavior

Negative symptoms

Dysfunction in work, interpersonal relationships, or self-care

Signs of disturbance for at least 6 months

Delusions

- erroneous belief that is fixed and firmly held despite evidence

- common delusions: persecutory, external control, thought insertion, thought removal, delusions of reference, bodily delusions, reincarnation

Hallucinations

- sensory experiences that occur in the absence of external stimuli

- types: auditory (75%), visual, olfactory, tactile, gustatory

Disorganized Speech

- failure to make sense

- seem to conform to semantic and syntactic rules

- neologisms - new, made up words

Disorganized Behavior

- impaired goal-directed activity

- daily functioning: hygiene, safety, health, silliness, clothing

- catatonia: disturbed movement (repetitive, blunted)

- catatonia stupor: no voluntary movement

Positive and Negative Symptoms

positive: excess or distortion in normal behavior (delusions and hallucinations)

negative: absent or deficient in normal behavior (flat affect- blunted emotion, alogia- little speech, avolition- inability to initiate/persist goal-directed activity, asociality)

Schizophreniform Disorder

schizophrenia criteria for 1-6 months

Schizoffective Disorder

- schizophrenia and mood disorder (mania or depression)

- full major mood episode that occurs >50% of the time

- prognosis depends on whether psychosis or mood symptoms are primary

Delusional Disorder

Delusions, otherwise behave normally / not significantly impaired

Brief Psychotic Disorder

- sudden onset of psychotic, disorganized, or catatonic symptoms

- only lasts a few days

- often triggers by stress

Differential Diagnosis

- depression with psychotic features (delusions occur with depressive episode)

- schizoaffective disorder (mood disorder more than 50%, can have psychotic symptoms outside of mood disorder)

- schizophreniform disorder (1-6 months)

- schizophrenia (>6 months)

Genetics

- STRONG genetic component

- many genes working together (chromosomes 22, 6, 8, and 1, 108 different loci)

- but not 100%!

Prenatal Factors

- babies born between Jan-Mar (flu during 2nd trimester)

- birth complications (breeched, prolonged labor, cord around neck --> reduced oxygen flow)

- maternal stress in 1st or early 2nd trimester

Neurodevelopmental Factors

- developmental precursors: motor abnormalities in childhood, more negative facial emotion, lower social competence

Neurocognitive Factors

cognitive impairments: lower IQ, processing speed deficit, visual and auditory processing deficits, impaired attention, social cognitive deficits, difficulty recognizing emotions

Neuroanatomical Factors

- frontal and temporal lobe = reduced volume (reduced activity during cognitive tasks)

- white matter = reduced volume, structural abnormalities (important for connectivity)

- missing inhibitory interneurons (less agility to regulate overactivity in brain)

Family and Living Factors

- family: expressed emotion- criticism, hostility, over-involvement, triggers onset and relapse

- urban living: infancy/toddlerhood in urban setting

Recovery

- no cure for psychosis, chronic

- 12% long-term treatment or institutionalization

- therapy + medication (38% "reasonable" recovery

Medication

- 1st-gen antipsychoticsis (Haldol): block dopamine, work on + sxs, most significant side effect: tardive dyskinesia (repetitive movements in face)

- 2nd-gen antipsychoticsis (Clozapine, Risperdone, Abilify): fewer motor side effects, work on both + and - sxs, most significant side effects: diabetes and lactation

Sleep

- state of unconsciousness in which the brain is relatively more responsive to internal than external stimuli

- functions: restorative, homeostatic function

Dyssomnias

disorders of quantity and timing

Parasomnias

abnormal behaviors during sleep or the transition between sleep and wakefulness

Sleep Disorders Causes

aging, mental or physical illness, night shift work, blindness, genetics, stress, diet (caffeine, alcohol, smoking), medication (anti-depressants)

Primary Insomnia

- difficultly initiating or maintaining sleep

- persistent (at least 3 days a wk for 1 month)

- more common in females

Secondary Insomnia

- transient insomnia: occurs at times of stress

- short term insomnia: occurs with personal problems, like grief/relationship strain/illness

Primary Hypersomnia

- excessive amounts of sleep, excessive daytime sleepiness, or both for at least 1 month

Insomnia and Hypersomnia Treatment

sleep hygiene, cognitive therapy, stimulus control therapy, progressive muscle relaxation, medication (stimulant for hyper, sleeping pills for insomnia)

Narcolepsy

- episodes of irresistible sleepiness leading to 10-20 minute sleep (usually rapid onset of REM sleep, commonly occurs with sudden loss of muscle tone = cataplexy)

- occurs at inappropriate times

- treatment: regular daytime routine, planned naps, avoid fatigue, medications

Parasomnias

nightmares, sleep walking, teeth grinding, night terror

Nightmares

- awakening from REM sleep to full consciousness with detailed dream recall

- at least 1/wk

- causes: anxiety, PTSD, fever, psychiatric medications

Sleep-walking

- automatic movements that occur during non-REM sleep

- usually in early part of night

- few seconds to minutes

- causes in children: brain areas developing at different speeds

- treatment: relaxation techniques, sleep hygiene, medication

attention-deficit/hyperactivity disorder (ADHD)

- DSM-5 ADHD = ADD

- persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development

- sxs for at least 6 months, present prior to the age of 12, present in two or more settings

DSM-5 ADHD Symptoms (5+)

inattention: little attention to detail, difficulty sustaining attention, not listening when spoken to directly, not following through instructions, not finishing tasks, difficulty organizing, reluctant to do effortful tasks, losing things, easily distracted, forgetful

hyperactivity: fidgets, taps hands/feet, squirms, leaving seat, running or climbing at inappropriate times, does not engage quietly, excessive talking, blurting answers, difficulty waiting turn, interrupts others

ADHD

- inattentive, hyperactive, or combined type

- causes: brain not filtering out unnecessary stimuli

- risk factors: genes, maternal alcohol and drug use during pregnancy, premature birth

- treatments: stimulants, executive functioning therapy

Autism Spectrum Disorder (Criterion A)

- deficits in social communication and social interaction across multiple contexts

- social-emotional reciprocity: failure of normal back-and-forth conversation, reduced sharing interests, emotions, or affect, failure to initiate or respond to social interactions

- nonverbal communication: abnormalities in eye contact and body language, deficits in understanding and use of gestures, lack of facial expressions and nonverbal communication

- developing, maintaining, and understanding relationships: difficultly adjusting behavior to suit various social contexts, difficulties in sharing imaginative play or in making friends, absence of interests in peers

Autism Spectrum Disorder (Criterion B) (2+)

- repetitive motor movements, use of objects, or activities: motor stereotypies, lining up toys or flipping objects, echolalia (repetition of words) or idiosyncratic sentences

- insistance on sameness, routines, or ritualized patterns: extreme distress at small changes, difficulties with transitions, rigid thinking patterns or greeting rituals, need to take same route or eat same food

- highly restricted, fixated interests that are abnormal in intensity or focus

- hyper- or hypo-reactivity to sensory input: apparent indifference to pain/temperature, adverse response to sound/texture, excessive smelling/touching objects, visual fascination with lights or movements

Autism Treatment

applied behavioral analysis, social skills training, occupational therapy, speech therapy, physical therapy, specialized education

Dyslexia

reading, word recognition and spelling, comprehension

Dysgraphia

writing, handwriting, copying writing

Dyscalculia

difficulty with math reasoning

Oppositional Defiant Disorder (ODD)

- recurrent pattern of angry, argumentative, defiant, or vindictive behaviors

- at least 6 months (not towards a sibling)

- 4+ symptoms: angry (loses temper, easily annoyed, angry and resentful), argumentative/defiant behavior (argues with authority, actively defies or refuses to comply with authority, deliberately annoys others, blames others for misbehaviors), vindictiveness (spiteful or vindictive behavior)

- behavior not associated with personal distress

Conduct Disorder

- persistent, repetitive violation of the rights of others age-appropriate social norms

- at least 1 year

- 3+ sxs: aggression (bullies, threatens, intimidates, initiates physical fights, using a weapon, physically cruel to people/animals, confrontational stealing, forced another into sexual activity), destruction of property (fire setting, destruction of property), deceitfulness (lies to obtain goods/favor/avoid punishment, non confrontational stealing of nontrivial good (shoplifting, forgery)), serious rule violations (disregard of parental rules, running away multiple times, truancy, very early sexual activity)

Conduct Disorder Specifier - With Limited Prosocial Emotions

- additional 2+ over 1 year

- lack of remorse or guilt (lack of concern over negative consequences, punishment is not aversive)

- callous lack of empathy (disregard, unconcerned with others feelings of others)

- unconcerned about performance (no concern/no effort to perform well)

- shallow or defiant affect (does not express emotion unless for personal gain)

Illness Anxiety Disorder

- formally hypochondriasis

- high anxiety about potentially having or developing a serious illness for at least 6 months

- no somatic symptoms

- performance of excessive behaviors to prevent illness

Somatic Symptom Disorder

- one or more somatic symptoms that are distressing or result in significant disruption of daily life

- excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: disproportionate and persistent thoughts about the seriousness of ones symptoms, persistently high levels of anxiety about health or symptoms, excessive time and energy devoted to these symptoms or health concerns

- although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months)

Conversion Disorder

A. one or more sxs of altered voluntary motor or sensory function

B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medial conditions

C. the sx of deficit is not better explained by another medial disorder

D. clinically significant distress or impairment

- neurological sxs in ABSENSE of neurological diagnosis

- sxs affect: sensor- blindness, deafness, motor- partial paralysis, seizures?- quasi-seizures, shaking (no EEG abnormalities)

Factitious Disorder

- falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception

- the individual presents themselves to others as ill, impaired, or injured

- deceptive behavior is evident even without obvious reward

- intentionally producing psychological or physical sxs

- AKA Munchausen's syndrome

- Muchausen's by proxy