Childhood Disorders

Prevalence of childhood disorders

1. Alot of Stressors
2. Highly resilient
3. One stable competant healthy adult is enough for resilience
4. Alot develope who don’t have stressors
5. Temperament -> worse temperament leads to worse environment
6. Developmental psychopathology
   1. Need to be considered within development of children
   2. Echolalia -> repeating words, normal, not a symptom

ADHD

1. Its annoying so it gets more attention (squeeky wheel)
2. Socialization/Normal development (delayed response)
3. 6 or more for 6 months
   1. Inattention -> trouble with details, or playing a game, inattentive symptoms, trouble organizing activies, loses things, easily distracted
   2. Hyperactivity -> figiting, scwerming, trouble with leasure activities, excessive talking
   3. Impulsivity -> blurting out answers, interrupting, trouble waiting your turn
4. In two or more settings
5. Three subtypes
   1. Combined -> areas go together (most common)
   2. Predominant Inattentive
   3. Predominately H-Im
6. Poor peer relationships
7. Popularity
   1. Media (actual prevelance 1-7%)
   2. Cross cultural, but US gives out the most (with other countries on the rise)
   3. Gender differences (3:1, boys)
   4. Girls tend to have inattentive subtype
   5. Comorbidity
   6. Inaddtentive more tolerated in Girls, but impulsivity tolerated less
   7. Male brains develope slower
8. Prognosis
   1. Tend to grow out of
   2. Tend to lead to antisocial, substance abuse, marital problems, legal problems, traffic tickets
9. Causal Factors
   1. Brain damage? probably not (people with tend not to have damage, and people damaged tend not to have adhd)
   2. Can’t just look at the brain and figure it out
   3. However, tend to have differences in frontal lobe, basel ganglia and corpus column
   4. Immaturity Hypothesis -> Immaturity of the brain
      1. Adult adhd is contraversial
   5. Prenatal -> oxigen to brain, mothers who drink, smoke or do drugs
   6. Diet? Probably not
   7. Genetics (tend to run in families)
   8. Also common in families with big disruption -> move, divorce, death in family, etc
10. Treatment
    1. 70-80% respond well to stimulants (don’t help with academics), but gains short term
    2. Alot of kids on drugs don’t meet symptoms
    3. Most drugs given out by family doctors, not psychiatrists

Conduct Disorder

1. Bully?
2. Chronic lack of concern for rights of others
3. Diagnostic criteria (3 or more)
   1. Aggression to people and animals (serious aggression, tying animals legs together), including mugging and rape
   2. Distruction of property
   3. Deceitfulness of theft (con games)
   4. Serious violation of rules (like runing away)
4. Generally start early
5. Prognosis
   1. If it starts young -> not so good
   2. If in adolecence -> tend to grow out of it
   3. Tends to lead to antisocial and borderline

ODD

1. Less sevear than CD
2.  You don’t do what people tell you todo
3. Criteria
   1. 6 months of negative, hostile, defiant behavior
4. Early Childhood -> in infancy
5. Comorbid with adhd and CD
6. Higher in boys (3:1), is this really the case? underdiagnosed in girls (mean girls the movie)

Review

Rogers

1. Real self vs Ideal-self
2. Conditions of worth, seperate the two
3. The incongruence causes anxiaty

Pain Disorder vs Somatization (Somatization has certian requirements)

Schizophrenia-> second work on negative side effects

Delusions are beliefs, hallucination are sensory experiences

Hypocondriasis -> you believe you’re suffering from
PHA -> Sympathetic nervous system arousal -> fight or flight all the time
People with low negative affect are ok

If you have high negative affect and…

high positive -> tend to be fine unless you have PHA

Low positive -> depression, also anxiety in PHA

Fear of Fear -> classical conditioning of body sensation with panic attacks (you fear things that happen durring panic attacks)

Stroop study: colored words (pause on bad words) GAD, chronically attuned to thread (works even if flashed too fast to read

GAD -> tend to think the worring is good, leads to hyper vigilance

Expressed emotion -> hostility, criticism, predicts onset of schizophrenia, lower in non-industrialized (schizo happens less)
Balimia -> electrolyte inballance, treat by helping with Coping with emotions (inability to cope leads to binging and purging)

Theories of OCD -> disfunction in acting on impulses, normally acting causes impulse to go away, but OCD has disregulations (its only temporarily reduced)
Negative symptoms are the real problem with schizophrenia, not delusions/hallucinations

Treatment for DID -> either ignore and treat comorbid, or integrate

Schitzoaffective disorder -> trashcan disorder, low reliability

Common treatment for Conversion disorder -> its caused by a stressor, so remove that

Somatic Hallucination -> seeing your fingers falling off

Tardie Disconesia -> Parkensens like side effect of first gen schizophrenia drugs

Marijauna -> increases risk for schitzophrenia, only before 15, (Twice as likely)

Adaptive fear is in proportion to threat, and disapates when threat is gone -> maladaptive is out of proportion and lasts longer
Non-purging balimia -> binge and then starve yourself, or exercise

cytoarchitecture  -> interruption of migration of neurons (by virus or toxin)

Psychosis con’t

Schizophrenia

1. Diagnosis
   1. Atleast two of the following: Delusions, hallucinations, disorganized speech, grossly disorganized behavior, negative symptoms
   2. Impairment in functioning
   3. Atleast six months of symptoms, but acute symptoms for atleast one month
2. Additional Diagnositic issues
   1. Prodromal phase (before): Eccentric, bizzar, but not schizophrenic
   2. Residual symptoms (after): odd, eccentricity, none of the acute symptoms
3. Schizophreniform -> more than one month, less than six
4. Brief psychotic disorder -> more than a day, less than a month
5. Schizoaffective disorder -> schizophrenia and a mood disorder (take your pick)
   1. Meet criteria for mood disorder
   2. Psychotic symptoms in absence of mood symptoms
6. Prognosis -> not great (repeat hospitalizations), after 5-6 years symptoms decrease
7. Role of genes
   1. Diathesis stress model
   2. Communication deviance -> vague, uninterpratable, fragmented
   3. Expressed emotion
8. Statistics
   1. With one parent: 13%
   2. 63% with have no relatives who have had
9. Dopamine Hypothesis
   1. Initial Clues
      1. Thorazine -> reduces dop, reduce acute symptoms
      2. Amphetamines -> increase dop, cause symptoms
      3. Increasing dopamine for parkinson’s -> can cause pyschosis
   2. Explanation of link
      1. Dopamine seems to regulate your ability to pay attention
      2. too much causes Aberrent salience
   3. Where does it come from?
      1. Over production
      2. too little reuptake
      3. not enough deactivation
      4. increased sensitivity
   4. Did spinal tap to find evidence for excess dopamine, which there wasn’t
   5. Back to sensitivity -> presence of D2 receptor (110% more than non-schizophrenic patients)
      1. Could be due to medication use though…
   6. BRAIN SCANS
      1. No evidence for increased sensitivity
   7. Glutamate
      1. PCP blocks Glutamate receptors and causes psychosis, connection?
      2. ketamine -> same thing, but no psychosis in kids, only adults
      3. Reduced functioning of NDMA receptors? (which are sensitive to glutamate)
      4. Reduced functioning also causes Brain Damage (possibly explaining negative symptoms)
   8. Link?
      1. Dopamine inhibits the release of Glutamate (which is why increase causes psychotic symptoms, but schizophrenics don’t have extra dopamine
10. History
    1. 1st generation neuroleptics -> thorazine, haldal
       1. Not great
       2. Akinesia
       3. Akathesis
    2. 2nd generation -> closopene
       1. fewer side effects
       2. wider than just d2 receptors
       3. help with some negative symptoms
       4. still have fatal side effects

Somatoform and Dissociative Disorders

1. Case study: Vertigo
   1. Attacks of dizzieness -> with slight nausia
   2. Every day at 4pm
   3. Husband -> tyrant
   4. Dreaded his arrival
   5. But she’s not faking it
2. Somatoform is a real physiological symptom, with psychological origin
3. Psychosomatic: psychological factors contribute
4. Malingering: deliberate faking to avoid unpleasantness
5. Factitious: deliberately faking to get medical attention (munchausen’s)
6. Somatoform
   1. Symptoms are real
   2. How do you know?
   3. Conversion Disorder -> loss of function in part of body
      1. Testing for conversion paralysis
         1. Drop hand on face (won’t catch with other hand if paralized)
         2. Muscil atrophy (won’t atrophy with with somatoform)
         3. Pin prick (won’t move, but heart rate will increase with somatoform, but not paralysis)
         4. Blindness (eye will follow mirror)
         5. Aphonia (somatoform will cough, if they really have it they won’t, same for crying)
         6. Symptoms will often breifly disapear as you wake up
      2. Treatment
         1. Find what’s causing them stress
   4. Somatization Disorder
      1. Symptoms
         1. Pain (4 areas)
         2. 2 GastroIntestinal
         3. 1 sexual disorder (medical)
         4. 1 neurological
      2. Cultural Differences (schizophrenia is better in non-industrialized, but Somatization is worse)
         1. We’re more open about saying things like stressed out
      3. Grand parents are more likely to somatizise
         1. Less able to express emoations
      4. Family influences -> runs in families, but not genetic
         1. Parents who somatizise neglect children
         2. causes children to model their behavior as attention seeking
   5. Hypochondriasis
      1. Worrying about having a serious disease
      2. Tend to seek help immediately
      3. Dr. Shopping
      4. Tend to focus on one area of body
      5. Disfunctional beliefs about illness (thinking its more common than it is)
   6. Dissociation
      1. Active consciousness: plans, desires, voluntary
      2. Receptive consciousness: hidden observer

Anxiaty

Generalized Anxiety Disorder

1. Anxious all the time in all situations
2. More days than not for atleast 6 months
3. A number of events/activities
4. Restlessness, Fitgue -> from muscle tension
5. More common in women 5% (as opposed to 3% in men)
6. OCD
   1. Obession (Persistant and uncontrolible) -> images, ideas or impulses
   2. Compulsion -> behavioral or mental act
   3. Anxiety -> caused by obession or prevented from doing compulsion
   4. Psychotic? no
   5. Common for: Dirty things, Aggression
   6. Compullsions get rid of obession normally
   7. Magical Thinking
7. Cognative theories -> GAD
   1. Worry as effective motivator
   2. Leads to hyper-vigalence
   3. happens on a subconcious level
   4. Use CBT
      1. Challenge thoughts
      2. confront worry
8. Humanists -> Rogers
   1. We all have Organismic Self (true self)
   2. We also have Ideal-self (self-concept)
   3. Conditions of worth seperate True from Ideal
   4. or we have Existential Anxiety
      1. Basic conflict: coming into contact with the givens of existence
      2. Death
      3. Freedom/Responsibility
      4. Existential Isolation
      5. Meaninglessness
      6. Can be empowering
   5. k

Myths

Szasz’ take

Are there such things as mental illness?

1. Reification -> making something not concrete into concrete (which mental illness isn’t)
   1. Mental disorders are problems in living
2. Mental vs Physical Illness
3. Mental symptoms
   1. Really are attempts to communicate
   2. just unusual
4. Psychiatry is the denial that life sucks
   1. esspecially social relationships
   2. Symptoms are not clear cut (in the eye of the beholder)
5. Choice and Responcibility
   1. People use mental illness to excuse behavior
6. A convenient myth
   1. A conveniant way to explain away social disharmony

Mood Disorders

1. Neurochemical Approaches
   1. too much or too little of neurotransmitter between synapse
   2. Possibly reasons
      1. Possibly a problem with reuptake
      2. Possibly degradation (too much enzyme breaking down neurotransmitter)
      3. Possibly too much or too little synthesis (making new neurons)
   3. Monoamine theories
      1. Neurotransmitters
         1. Seritonine
         2. Dopamine
         3. Norepinepherine
      2. Neurochemical treatment
         1. Tricyclics
            1. 50-60% effective, which is good (placebo is 40%, aerobic exercise is 50%)
            2. 4-8 weeks to kick in, which is bad
            3. side effects, also bad
            4. overdose is only 3 doses, REALLY BAD
         2. MAOI (monoamine oxidase inhibitors)
            1. inhibits break down of neurotransmitters
            2. if taken with certain foods you die (like aged cheeses, or dried weat, or pastromy)
         3. SSRIs (selective seritonine reuptake inhibitor) and SSNRIs (selective seritonine and norepinepherine inhibitor)
            1. prozac and zolft
            2. still 50%, but in two weeks
         4. Bupropion (acts on norepinepherine)
            1. also effects dopamine
            2. helps with the slow down aspect of despression
            3. fewer sexual side effects
            4. less weight loss
         5. For bipolar
            1. Lithium -> hard to get right dosage, fatal dose not much more than useful dose (only for the manic part)
            2. Anticonvulsants
            3. Antipsychotics (acts on dopamine)
            4. Calcium Channel Blockers
      3. What about the brain -> fmri, catscan
         1. Depression
            1. Decreased activity on the left side of prefrontal cortex (decision making, goals, social)
            2. also in Anterior cingulate (autonomic responses, and others)
            3. also Hippocampus (memory, and fear learning) -> never seems to get better
            4. Amygdala is enlarged (directs your attention to emotionally charged stimula)
         2. ECT
            1. Inducing a brain seizure (usually target left side)
            2. only in cronically suicidal
            3. Used to be used to punish
            4. can cause amnesia (also going forword)
         3. rTMS (repetitive transcranial magnetic stimulation)
            1. side effect: headache (alot better)
         4. Vagus nerve stimulation
            1. sends pulses through vagus nerve to amigdula and hypothalamus
            2. surgically implanted
            3. can cause seizures
      4. What about Genes
         1. polygenic (more than one gene)
         2. only a predisposition
         3. often misunderstood
         4. the odds: (at best 90%)
         5. Family history studies (increased risk, two to three times as family), both gene and enviornment
         6. Twin studies
         7. Serotonin transporter gene (seems to put you at increased risk)
   4. k
2. end

Depression con’t.

Subtypes and Specifiers

1. With melancholic features -> slowed down, eat less
2. With psychotic features -> delusions and halucinations (connected)
3. With catatonic features -> can’t move, hard time comunicating
4. With atypicial features -> weight gain, heavyness, sensitive to interpersonal rejection
5. With postpartum onset -> rare
6. SAD -> Seasonal Anxiaty Disorder, rare, 2 years in a row, get better when winter is over
7. MDD -> single episode
   1. single MDE
   2. Never manic
   3. Never some other disorder
8. MDD -> recurrent
   1. 2 or more (at least 2 months apart)
9. Dysthymic Disorder
   1. Majority of days, most of day, 2 years or more
   2. Never without for 2 months
10. Gender Difference (not just self report)
    1. Power, status, and trauma
       1. More likely to experience things like, spouce abuse, rape, sexual harassment
    2. Chronic strains -> fewer options in life
    3. Hormones?
       1. Prior to puberty hormones are the same (where the difference spikes)
       2. But no biological evidence
    4. Body image (a puberty women become less thin and men become stronger)
    5. Postpartum -> too small a difference between postpartum and not to explain the difference
    6. PMS -> 5-10% actually have pms, 70+% think they have
    7. Menopause -> completely wrong, even if you take hrt
    8. HPA theories -> Hypothalamus, Patuitary, Adrenal
       1. Early trauma causes deregulation in this system
    9. Self-Concept -> inconsistant
    10. Interpersonal orientation -> approach to relationships
        1. Putting others before yourself
        2. Less likely to get benefits
        3. more likely to lose from ending the relationship
    11. Attachment style
        1. High maintenance
        2. Fishing for compliments
        3. Tends to cause hostility (making the attachment person depressed)
    12. Coping style
        1. Women cope via rumination
        2. less effective than active coping
    13. Integrative Model -> a little from column A, a little from column B

Bipolar Disorder

1. Used to be manic depression
2. Manic part
   1. Unrealisticly positive view of self
   2. Racing thoughts
   3. Pressured speech
   4. Both Euphoria and Irriation
   5. Impulsivity (shopping, gambling, sex)
   6. Big plans
3. Bipolar I
   1. Atleast one manic
   2. followed by major depressive
4. Bipolar II
   1. Major despressive
   2. hypomanic episoid
   3. Hypomania: less intense, tends not to interfere with daily functions (where as manic does)
5. Cyclothymia
   1. Less severe and more chronic
   2. Hypomania and moderate depression
6. Bipolar and Creativity
   1. Mania helps creativity and charisma -> likely
   2. Benefits of depression? maybe
   3. Family study -> creative families have bipolar more than others
7. Avoid romanticizing

Suicide

1. Death seekers -> clearly want to die
   1. Unlikely to fail
   2. plan alot
   3. long time coming
2. Death initiators
   1. Terminally ill
3. Death ignorers
   1. Don’t think death will kill them
   2. Drinking koolaid
   3. Suicide bomber
4. Death darers
   1. Ambilvilant
   2. fail alot
5. Subintentional deaths
   1. Chronically doing things that increase your chances of death
6. If you think someone might kill themselves: ASK THEM
   1. This is not a joke, ask them if you think they might
7. If they try, 50% go on to have a serious attempt

Depression

pseudoscience con’t.

1. Recovered memory therapy, day care sex abuse, MPD (full of shit)
2. What happens to those who stand up? (shunned)
   1. A study showed that sexually abused kids turn out ok
   2. Congress passed resolution against the study
3. Keep an open-mind, but question them too

Despression

1. What good is feeling bad?
2. Why is pain painful?
3. Benefits of jealousy (cuckoldry)
4. Benefits of anxiety (pass up things with immediate reward)
5. Benefits of sadness
6. Is nature overly sensitive? We’re not monkeys anymore
7. we’re not ment to be happy, we’re designed to be alive

Mood Disorders and Etiology

1.  Despression
   1. 60% at some point in their lives
   2. most common in 15-24
   3. Why rare among older adults?
      1. more stable, more coping skills, become less self focus
      2. depressed people are more likely to die before they get old
      3. possibly gets harder to diagnose because you aquire more medical problems
   4. Presentation
      1. Tearfulness
      2. rhumination
      3. aches and pains
      4. Anhedonia (can’t feel happy)
      5. worthlessness/guilt
      6. biased interpretations
      7. Cultural differences?
      8. psychotic symptoms (thinking you’re responsible for all the word’s pain)
      9. Insomnia (more common)/hypersomnia
      10. Appetite changes
      11. Psychomoter changes

Criticism of the DSM

First 15 minutes missed (get notes from Jay)

1. 81 Words. In DSM 2, there were 81 words which defined homosexuality as a mental disorder
2. Because it was a mental disorder, homosexuals were stopped from holding government jobs, security clearences, teaching, or even practicing psychiatry
3. Continued to linger after DSM3

Other Criticisms

1. Reliability vs. Validity
2. Comorbidity and ambiguity
3. Deconstructionist critiques
4. Not scientific
   1. Arbitrariness (line between normal and non-normal)
   2. Author bias (If you look at the people on the committee work for drug companies in their area)
   3. Conflict of interest
5. Intentionally ambigious so that therapists can give diagnoses for insurance reasons
6. Claims to Label disorders not people (which is a huge lie)
7. Acts of Power (not in DSM)
   1. Drapetomania (the mental illness which caused slaves to want to run away -> medical treatment is whipping)
   2. Dysaethesia Aethiopica (the mental illness which causes slaves to not want to work for masters…)
8. Effects on behavior -> self fulfilling prophecy
9. Stigma

On Being Sane in Insane Places

Rosenhan’s Study

1. Do these disorders exist? or are they only in the minds of psychaitrists
2. Had people commited claiming to experience conditions
3. They took notes
4. The patience all figured it out
5. They’re all released with schizophrenia in remission
6. Then he tells them that he’s sending more in (but doesn’t)
7. They finger some people who are currently in
8. Medical false positives
9. Staff behavior
   1. patients powerless
   2. depersonalized (abuse, talked about them like they weren’t there, case history out, no eye contact)

Spitzer’s Critique

1. “detecting the sanity of a pseudopatient”
   1. 3 possible meanings
   2. Recognition that patient no longer showing signs of disturbance?
      1. In remission (their way of saying its fake)
      2. Were they really behaving normally? (wouldn’t they want out?)
   1. Spotting fakers
      1. Malingering
      2. Psychaitrists are not trained to recognize faker
      3. Schizophrenia is the closest to what they presented
      4. Don’t know what they said in interview
   1. Recognition of feigning after admission
      1. Mental illness doesn’t last forever (so thats what sending them home means)

Rosenhan’s Reply

1. People don’t like to hear bad things with no solution
2. The effect of context
   1. Diagnoses weren’t reliable (which because they’re all the same they were)
   2. Term sanity used in context
3. Schizophrenia is incorrect (thus you shouldn’t diagnose)
4. Difference between in remission and sane

The DSM System

1. Multiaxis system (you get a classification for each axis)
2. Axis 1: Major mental disorders, developmental disorders and learning disablities
3. Axis 2: Underlying pervasive or personality conditions (disorders), + mental retardation
4. Axis 3: any nonpsychiatric medical condition
5. Axis 4: psychosocial / environmental problems (family, education, occupation, housing, economic, legal, etc)
6. Axis 5: Global Assessment of Functioning

Pseudoscience

1. Technically Clinical Psychologists are supposed to be Scientist-practitioner
   1. consume and conduct research
2. What we have is: The Gap
   1. We have scientists here and practitioners there
   2. possible reasons: psyD programs (instead of phd), you become a therapist not a scientist
3. Accusation
   1. What does a phd get you?
   2. Syndromophilia

History of Psychopathology

Mind Body Dicotemy: Descarte

Supernatural Tradition

1. Battle between good and evil
2. Witchcraft, exorcism
3. Charles VI
   1. Fucking nuts
   2. they cut holes in his head
   3. might have had: DI psychophrenia, inseflitious, porfuria
4. Moon and Stars
5. Mass Hysteria

Biological Tradition

1. Hippocrates and Galen
   1. Treat like any other
   2. comes from brain
   3. humoral theory
   4. hysteria -> if you’re not making babies
2. Syphilis -> Malarial treatment
3. John Grey -> insanity due to a physical causes
4. New biological treatments
   1. insulin, ECT
   2. Neuroleptics, benzodiazapines
5. Kraepelin
   1. Dementia Praecox -> psychophrenia

Psychological Tradition

1. Moral Therapy
   1. Pinel, Tuke, Rush
2. Decline of moral theorapy
   1. Dorthea Dix -> mental hygiene
3. Early psychoanalytic
   1. Mesmerism
   2. Charcot, Freud, Breuer
      1. People talked about troubles while under hypnosis
      2. Catharsis
      3. unconcious -> dream analysis and free association
4. Deinstitutionalization
   1. Medications
   2. Need for humanitarian treatment
   3. Civil rights
   4. Financial concerns
5. Managed Care
6. Recent developments
   1. Biopsychosocial model

Diagnosis and Labeling

1. Classical/pure categorical approach
   1. tangible underlying issue
   2. each disorder is unique
2. Dimensional approach
3. Prototypical approach

Reliability and Validity of Diagnosis

1. Reliability: Degree to which measurement is consistant and can be reproduced
2. Validity: Does it measure what it’s supposed to measure