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PSYC 301 > Dysfunction associated with psychiatric disorders (BPD + ADHD) > Flashcards

Dysfunction associated with psychiatric disorders (BPD + ADHD) Flashcards

1
Q

DSM-5 Criteria: Major Depressive Episode

A
  • Depressed mood
  • Loss of interest or pleasure in almost all activities
  • Weight or appetite changes
  • Sleep changes
  • Psychomotor changes (agitated or slowed)
  • Tiredness, fatigue, low energy
  • Sense of worthlessness or guilt
  • Impaired ability to think
  • Recurrent thoughts of death, suicidal ideation, or suicide attempts
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2
Q

DSM-5 Criteria: Hypomania

A

A. Abnormal, persistent elevated, expansive, or irritable mood and increased goal-directed activity or energy, most of the time, for at least 4 days

B. Some of the following:
* increased energy and activity
* persistent mild elevation of mood
* marked feelings of well-being and both physical and mental efficiency
* increased sociability and talkativeness (or increased irritability in some)
* increased sexual energy
* decreased need for sleep

  • BUT: none to the extent that they lead to severe disruption of work or result in social rejection, and no hallucinations or delusions (i.e., psychosis)
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3
Q

DSM-5 Criteria: Manic Episode

A

A. Abnormal, persistent elevated or expansive mood and increased goal-directed activity or energy, most of the time, for at least 1 week

B. 3+ of the following to a significant degree:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual or pressure to keep talking
- Flight of ideas or subjective experience that thoughts are racing
- Distractibility
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in activities that have a high potential for painful consequences
- The mood disturbance causes marked impairment in social or work life, necessitates hospitalization, or includes psychosis (hallucinations and/or delusions)

The mood disturbance causes marked impairment in social or work life, necessitates hospitalization, or includes psychosis (hallucinations and/or delusions)

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4
Q

Bipolar I and II: similarities and difference

A

Both share experiences of:
* Depression
* Hypomania

BP I: INCLUDES MANIC EPISODES

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5
Q

Commonality of bipolar I and II

A
  • 0.6% bipolar I
  • 0.4% bipolar II
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6
Q

Reward hypersensitivity model of BD

A

In this model, being hypersensitive to reward is a trait that predisposes someone to developing BD

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7
Q

Reward hypersensitivity model of BD - positive side

A
  • Hypomanic/manic pathway
  • Goal attainment can lead to excessive reward states and ultimately (hypo)mania
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8
Q

Reward hypersensitivity model of BD - negative side

A
  • Depressive pathway
  • Goal non-attainment can lead to excessive reward deactivation and a depressive state
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9
Q

Euthymic (period of normal mood) individuals with BD…

Evidence for the Reward Hypersensitivity Model

A
  • Still show excessive activity in reward areas: frontal-striatal reward-related areas in response to reward-I related cues (EX: gambling reward cues)
  • Make more risky choices than controls (e.g., on gambling tasks)
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10
Q

Prodromal (not currently diagnosed, but show minor symptoms) features…

Evidence for the Reward Hypersensitivity Model

A
  • before hypomania and mania: show excessive goal setting and increased success expectancies
  • before depressive episodes: decreased motivation and goal setting and low self-confidence
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11
Q

Teenagers (14-19) who score high on reward sensitivity are more likely to…

Evidence for the Reward Hypersensitivity Model

A

…develop bipolar disorder in a prospective study (Alloy et al., 2012)

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12
Q

Functional changes in euthymic BD patients - increased responsiveness…

A

Increased responsiveness in limbic and para-limbic areas (in red)

  • Amygdala
  • VLPFC
  • Ventral ACC
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13
Q

Functional changes in euthymic BD patients - Decreased responsiveness…

A

…in areas associated with cognitive control (in blue)

  • Dorsal ACC
  • DMPFC
  • DLPFC
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14
Q

Structural changes in BPD

A
  • Structural reductions in gray matter (similar areas to functional – PFC, limbic…)
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15
Q

What are structural changes in BPD driven by?

A
  • Driven particularly by time spent in manic episodes, which are associated with neuroinflammation, stress hormones
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16
Q

Treatments:

A

Treatment of BD
* Mood stabilizers: Lithium, (valproate, lamotrigine…); Alone or combined with..
* Atypical antipsychotics: (quetiapine, aripiprazole, asenapine, lurasidone, cariprazine…)

Psychotherapy – CBT, health education, family-focused treatments all have some evidence

Antidepressants alone are not recommended
>50% of patients do not adhere to treatment

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17
Q

ADHD: Executive Function - Regions involved:

A

Prefrontal cortex and/or associated projections

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18
Q

Executive Function

A

Cognitive control of behaviour

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19
Q

Executive Function - Items in a mental status exam (5)

A
  • Judgment tests
  • Verbal fluency
  • Luria’s 3 step test
  • Trail-making or drawing patterns
  • Clock drawing “10 past 11”
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20
Q

Researchers define 3 core executive functions

A
  1. Working memory: Holding and mental working with information “in mind”
  2. Inhibitory control: Resisting temptations, not acting impulsively or prematurely, over-riding automatic behaviour
  3. Cognitive flexibility: Fluidly changing perspectives or approaches to solving a problem, adjusting to new demands, switching between priorities or tasks
21
Q

Testing working memory

A
  • Digit or pointing span
  • How many can you remember? (LIKE SPOT IT)
22
Q

Testing inhibitory control

A
  • Stroop - differing colors and texts
  • Flanker - looking at reaction times
  • Wisconsin card sort - must adapt to changing rules (Measuring to see how the participant regards old instructions and engages in new ones)
23
Q

Higher order “executive functions”

A
  • Planning
  • Organizing
  • Multi-tasking
  • Self-awareness
  • Regulating emotions
  • Inhibiting inappropriate behaviour
  • Motivation
  • Concentrating
24
Q

Severe and extensive frontal lobe damage (i.e. stroke, brain injury…) can result in:

A

Abulia – lack of drive

  • Sit - won’t seek out anything, like going to the bathroom, social interactions
  • Return of primitive reflexes (“frontal release signs”)
  • Utilization behaviour
  • Knows what to do with objects given - due to the inability to inhibit this
  • EX: putting on pants, licking an envelope to seal it
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Orbitofrontal circuit dysfunction ## Footnote Specific circuits in the prefrontal cortex
* Impulsive * Socially inappropriate * Poor safety judgment * Difficulty evaluating anticipated rewards and punishments * Don’t “learn from mistakes” due to diminished guilt and regret
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Dorsolateral circuit dysfunction ## Footnote Specific circuits in the prefrontal cortex
* Distractible * Disorganized * Perseverative * Difficulty multitasking * Poor time management and prioritization
27
Attention deficit hyperactivity disorder (ADHD) - Key symptoms (3):
extreme inattention, hyperactivity, impulsivity
28
Attention deficit hyperactivity disorder (ADHD) - Diagnosis intersects with societal norms:
* Younger children within a classroom more likely to be diagnosed * Rapid (!) rise in adult diagnoses * Presentations vary with gender – underdiagnosis of hyperactivity in girls?
29
Neurobiology of ADHD
* **Reduced activity and volume of PFC** * Slower maturation of PFC (normal cortical thinning is slower; this is correlated with hyperactivity/impulsivity)
30
A dual-pathway model of ADHD
* **Executive** circuit (dysfunction: **inattention**): dlPFC and caudate * **Reward** circuit (dysfunction: **lack of motivation**) * OFC, ACC and nucleus accumbens Evidence of a hypoactive dopamine system
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Major treatment for ADHD
**medications that act upon dopamine** and norepinephrine systems in PFC and subcortical structures
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ADHD SPECIFIC LECTURE
33
Stigma is…
a sign of social unacceptability involving negative attitudes, beliefs, and/or behaviours about or towards an individual or group of people based on a characteristic or their situation in life.
34
Different types of stigma (3):
1. **Public Stigma** (Societal) - i.e. discrimination, stereotypes 2. **Systemic Stigma** (Institutional) - Embedded in workplaces, schools, healthcare system 3. **Self-Stigma** (Internalized)
35
Stigma involves (5)
1. Negative judgements 2. Stereotypes 3. Discrimination 4. Labeling 5. Othering (i.e., “us” vs “them”)
36
What can stigma result in?
Can result in people engaging in "masking" - covering up our "otherness"
37
Stigma and ADHD
* Disorders that are highly visible, perceived as controllable & misunderstood are more likely to be stigmatized * Stigma can be a barrier to care & social support * Negative bias towards individuals with ADHD contributes to increased social difficulties & social rejection * Perceived stigma can lead to social isolation, less self-compassion & lower self-esteem
38
Individuals with ADHD are more likely to experience...
negative events and stressors, often as a consequence of their condition, which can contribute to individuals with ADHD having poorer mental health and being at a higher risk for depression
39
Differential diagnosis rates between genders
* Childhood: 3:1 boys to girls * Adulthood: 1:1 men to women * Lack of data on gender diverse individuals * Differential prevalence of subtype diagnoses (ADHD-I (inattentive) vs ADHD-HI (hyperactivity or impulsivity with subthreshold inattention)) * Impact of societal values & gender norms * Girls tend to be older when diagnosed & struggle socially more * Women with ADHD experience greater severity of impairment & presence of comorbid disorders * Falls under the umbrella term of Neurodiversity
40
Gender and ADHD - **factors contributing to under- and misdiagnosis of women:**
* Lack of knowledge of gender differences in ADHD * Gender bias in research (e.g., diagnostic criteria) * Higher rates of comorbidities in women with ADHD * Symptom and result * Individuals with externalizing symptoms (vs internalizing) more likely to be recognized/referred * Higher threshold for symptom severity in women for referral & diagnosis
41
Insights into late diagnosis of ADHD - two main types of self-responding we tend to engage in during times of struggle or hardship:
1. UNCOMPASSIONATE SELF-RESPONDING 2. COMPASSIONATE SELF-RESPONDING
42
UNCOMPASSIONATE SELF-RESPONDING
Responding to oneself in a way that involves: * Self-judgement & criticism * Over-Identification with negative thoughts, emotions & experiences * Feelings of isolation in suffering
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COMPASSIONATE SELF-RESPONDING
Responding to oneself in a way that involves: * Self-kindness & understanding * Mindfulness (mindful awareness of the experience without over-identifying with negative thoughts & emotions) * Acknowledging the common humanity in suffering
44
Self-compassion is...
the practice of being kind to oneself in times of suffering such as experiencing failure or personal difficulty.
45
Self-compassion involves 3 main elements:
* How we **pay attention** to our suffering (mindfulness vs over-identification) * How we **cognitively understand** our suffering (common humanity vs isolation) * How we **emotionally respond** to our suffering (self-kindness vs self-judgement)
46
Self-Compassion and ADHD
* Higher levels of ADHD traits are associated with more uncompassionate self-responding (UCS) & emotional regulation difficulties * High levels of UCS in people with ADHD contributes to more emotion regulation difficulties & greater mental health challenges * Internalizing others’ negative feedback & criticism can make individuals with ADHD more self-critical
47
Positive outcomes associated with self-compassion for individuals with ADHD including:
* IMPROVED RESILIENCE, SELF-EFFICACY & HEALTHY COPING * IMPROVED PSYCHOSOCIAL WELLBEING & EMOTIONAL REGULATION * REDUCED COMORBID SYMPTOMS, NEGATIVE THINKING & STRESS
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PSYC 301 (14 decks)

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