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L2 Neuro/Clinical S2 > childhood and adolescent psychological problems 2 > Flashcards

childhood and adolescent psychological problems 2 Flashcards

1
Q

when did conduct disorder enter the DSM?

A
  • DSM 4 TR
  • 2000
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2
Q

what was conduct disorder previously known as?

A
  • externalising disorders
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3
Q

example of behaviours in conduct disorder

A
  • bullying
  • arson
  • shoplifting
  • fighting
  • property destruction
    etc…
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4
Q

different names for conduct disorder

A
  • childhood CD before age 10
  • adolescent CD after age 10
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5
Q

oppositional defiant disorder

A
  • Angry and irritable mood:
    –> often and easily loses temper
    –> is frequently touchy and easily annoyed by others
    –> is often angry and resentful
  • Argumentative and defiant behavior:
    –> often argues with adults or people in authority
    –> often actively defies or refuses to comply with adults’ requests or rules
    –> often deliberately annoys or upsets people
    –> often blames others for his or her mistakes or misbehavior
  • Vindictiveness:
    –> is often spiteful or vindictive
    –> has shown spiteful or vindictive behavior at least twice in the past six months
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6
Q

examples of callous and unemotional traits

A
  • persistent pattern of behaviour
  • disregard for others
  • lack of empathy
  • problems in emotional and behavioural regulation
  • different to other antisocial youth
  • similar to adult psychopathy
  • less sensitive to punishment cues
    –> especially when they are keen to a reward
  • positively related to intellectual skills in the verbal realm
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7
Q

is bad behaviour always a psychological disorder?

A
  • no
  • NHS accused of medicalising bad behaviour
  • 1 in 18 pre-school kids have been said to have psychological problems
  • experts doubt if oppositional defiance disorder in toddlers is real as it is only characterised by bad behaviour
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8
Q

quality of life and conduct disorder

A
  • if untreated, CD can lead to:
    –> criminal behaviours
    –> violence
    –> gangs
    –> depression and anxiety
    –> substance abuse
    –> premature mortality
    –> Antisocial Personality Disorder
    –> unemployment
    –> homelessness
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9
Q

incidence and heritability of conduct disorder

A
  • incidence:
    –> 1-2% to 2-2.5% worldwide
  • heritability
    –> between 5% and 74%
  • most extensive studies show a heritability of 40-50%
  • those with callous and unemotional traits tend to have a heritability of 45-67%
  • often comorbid with ADHD
  • 32, 000 symptom profiles could give rise to diagnosis
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10
Q

environmental factors for conduct disorder

A
  • in utero:
    –> smoking
    –> alcohol
    –> drugs
    –> stress
  • birth:
    –> birth complications
    –> maternal/paternal psychopathology
    –> malnutrition
  • familial
    –> harsh & inconsistent discipline
    –> parent-child conflict
    –> maltreatment
    –> low socio-economic status and poverty
  • extra-familial
    –> community violence
    –> association with deviant peers
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11
Q

genetic/dispositional risk factor for conduct disorder

A
  • autonomic
  • neurocognitive
  • social information processing
  • temperament
  • personality traits
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12
Q

passive gene-environment correlation

A
  • inherit a genetic predisposition to smoke or drink alcohol
  • passively in the environment we see parents smoking and drinking
  • we have the genetic predisposition and the environment already matches it
    –> we don’t do anything to change the environment so we’re passive
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13
Q

active gene-environment correlation

A
  • genes make us actively change our environment
  • we make the changes to account for our genetic predisposition
  • e.g. having the genetic component for CD and then seeking out an antisocial peer group
  • we ACTIVELY make our genetic disposition match our environment
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14
Q

evocative gene-environment correlation

A
  • we have a genetic predisposition and then people evoke this or change environment to trigger this genetic predisposition
  • multiplier effect
  • genotype evocatively interacts with the environment
  • positive feedback loop
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15
Q

what is a genome-wide association study?

A
  • an observational study of a genome-wide set of genetic variants in different individuals to see if any variant is associated with a trait
  • GWAs typically focus on associations between single-nucleotide polymorphisms (SNPs) and traits like major human diseases, but can equally be applied to any other genetic variants and any other organisms
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16
Q

GWAs and human data

A
  • GWA studies compare the DNA of participants having varying phenotypes for a particular trait or disease
  • compare cases with controls
  • this approach is known as phenotype-first, in which the participants are classified first by their clinical manifestation(s), as opposed to genotype-first
  • if one type of the variant (one allele) is more frequent in people with the disease, the variant is said to be associated with the disease
  • associated SNPs are then considered to mark a region of the human genome that may influence the risk of disease
17
Q

what is a single-nucleotide polymorphism (SNP)?

A
  • basically an allele
  • the upper DNA molecule differs from the lower DNA molecule at a single base-pair location (a C/A polymorphism)
  • a single letter in the gene has changed
18
Q

issues with genome wide association studies in psychology

A
  • when we do GWAs in psychology and psychiatry, we might find a gene which we don’t understand yet
    –> e.g. RBFOX1
    –> this is then hard to apply
19
Q

single genes associated with conduct disorder

A
  • RBFOX1 = development
  • GABRA2 = gaba, inhibitory
  • SLAC6A4 = serotonin receptor
  • Oxytocin receptor OXTR
  • C1QTNF7 = glucose metabolism and insulin signaling
20
Q

mono amine oxidase (MAO)

A
  • mono-amine oxidase (MAO) is an enzyme that breaks down mono-amine neurotransmitters
  • an enzyme is a protein
    –> proteins are made by genes
  • there are different forms of the MAO gene: –> MAO – L (low form) is less active
21
Q

genetic influences on conduct disorder (gene x environment interaction)

A
  • the low form of MAO is associated with higher conduct disorder rates
  • no maltreatment is associated with lower conduct disorder rates
  • severe maltreatment AND low form of MAO associated with the highest rates of conduct disorder
22
Q

neurocognitive symptoms of conduct disorder

A
  • deficits in:
    –> verbal IQ
    –> working memory
    –> executive functions
    –> emotion recognition
  • they are often less sensitive to punishment cues, particularly when they are already keen for a reward
  • overly sensitive to reward
    OR
  • overly sensitive to punishment cues
  • insensitive to reward
23
Q

brain areas and their basic function

A
  • frontal lobe = executive functions, decision making, learning and some emotion regulation
  • amygdala = emotional regulation and threat response
  • striatum = reward
  • all disrupted in conduct disorder
24
Q

genetic influences on conduct disorder (brain function)

A
  • people with low forms of MAO have higher amygdala activation
    –> over activation of amygdala
    –> involved in emotion regulation and threat response
25
Q

the cognitive / hostile attributional bias

A

tendency of individuals to interpret not only ambiguous cues as signaling hostility, but also many cues that are generated with benign intentions

26
Q

management of conduct disorder without comorbid disorders

A
  • different management techniques with and without LPE
  • LPE = limited prosocial emotions
  • use psychosocial interventions first
  • if psychosocial interventions don’t work, then can move towards pharmacological treatment
27
Q

management of conduct disorder with comorbid disorders

A
  • different psychosocial interventions based on the type of comorbidity:
    –> internalising comorbidity = depression, anxiety
    –> externalising = like ADHD or OCD
    –> comorbid developmental disorders = like language disorders
  • use psychosocial interventions first
  • then can use disorder-specific interventions for comorbid disorders
28
Q

pharmacological therapies for conduct disorder

A
  • stimulants (e.g. Ritalin)
  • Antipsychotics
29
Q

other therapies for conduct disorder

A
  • boot camp
    –> more intense
    –> very strict and disciplined
  • parent based / family based psychosocial interventions

L2 Neuro/Clinical S2 (9 decks)

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