Introduction To CAP Flashcards
ACE’s (Adverse Childhood Experiences)
- Abuse: Physical, Emotional, Sexual
- Neglect: Physical, Emotional
- Household Dysfunction: Mental illness, incarcerated relative, domestic violence, substance abuse, divorce
ACE score of 4 increases risk of:
- Chronic Lung Disease
- Hepatitis
- Depression
- Suicide Attempt
ACE’s overall increase risk of:
- SUDS, mental illness, smoking, obesity & STI’s
Prevalence of ChAdoPsychopathology
-20% = 17million
-Mental health is 47% of pediatric costs
ACE score of 2 or more leads to:
- > 2x likely to repeat a grade
- > 4x likely to bully others
- > 8x likely to have behavioral probs
from 2011-2021, Adolescents have
- Lower sexual activity
- Lower substance use
- Mostly lower bullying
- MENTAL ILLNESS IS RISING!
What rates are climbing?
- 40% increase in HS students feeling hopeless
-36% increase in HS students seriously considering a suicide attempt
What is projected to be the largest contributor to the global burden of disease?
Depression
Humoral Theory
Until mid 1880s, every sickness was explained by imbalance of the humors. Solutions were to purge, bleed, laxatives, etc (taking out the bad thing that’s inside you)
Psychiatrists used to be called
Alienists
Industrialization & John Locke
The philosophy of humane care, thought, social protection to children rather than indifference & harsh treatment
Itard’s perspective on Victor
(1775-1838) Victor was nonverbal, inattentive, & insensitive to basic sensations -> Itard proposed environmental stimulation would “humanize” Victor
Philippe Pinel
(1745-1826) Discarded demonical possession being mental illness, developed “moral treatment” & first attempts at psychotherapy
Benjamin Rush
(1746-1813) abolitionist, physician, & humanitarian:
Instituted reforms of care for the mentally ill
Dorothea Dix
(1802-1887) teacher & social reformer for mentally ill, established 32 humane mental hospitals
Infectious disease in the 1800s solutions
Eugenics and segregation to prevent the “insane” from interacting with the rest of society
Developmental Psychopathology
- Genes determine a capacity for development.
- Children interact with the environment from the moment of birth.
- Clinical implication: Some kind of reorganization within the child is required at each stage. If that stage is not successfully achieved, psychopathology can result
Psychoanalytic Theory (Freud)
- Biological roots to mental illness
- “tabula rasa”= experience & childhood shape us & our pathologies
- GAVE HOPE TO mental illness NOT being INEVITABLE
Freud’s Drive Theory
- Aggressive & sexual drives are the primary motivating forces toward pleasure
- End goal of development is sexual maturity
Drive Theory 5 stages
1.Oral Phase (Infancy, birth to 18 months)
2.Anal Phase (aka: Sadistic Phase, 18 –36 months)
3.Phallic-Oedipal Phase (3 –6 years)
4.Latency Phase (6 –12 years)
5.Puberty and Adolescence
Psychological fixations
Oral: Smoking, nail biting, gum-chewing
Anal: Orderliness, obsessiveness, rigidity
Phallic: Vanity, exhibitionism, pride
Biological drives
libido, agression: determine our behavior
Id, ego, & super-ego purpose
Mediate the struggle to satisfy drives, taking place in the unconscious, giving rise to fantasies, guilt and conflict, causing anxiety, and necessitating development of defense mechanisms to avoid painful emotions
Oedipus Conflict
(girls manifest with penis envy and boys with castration anxiety; unsuccessful resolution can result in homosexuality, pedophilia and neurosis)
Id, ego, & super-ego meaning
Id: The instinct-driven, pleasure-seeking part of the mind, focused on immediate gratification.
Ego: The rational mediator that balances the Id’s impulses with real-world constraints.
Superego: The moral conscience representing societal and parental standards, striving for ideal behavior.
Mahler’s Separation/Individuation
the psychological process by which infants develop a sense of self and autonomy, moving from a symbiotic relationship with their primary caregiver to a more independent state, through distinct phases
Mahler’s 6 stages of development lead to normal object relations, and recognition of “separateness
- Normal Autism (birth to 2 months)
- Symbiosis (2 –5 months)
- Differentiation (5 –10 months)
- Practicing Sub-Phase (10 –18 months)
5.Rapprochement (18 –24 months) - Object Constancy (2 –5 years)
Mahler Object relations theory
Primary emphasis is placed upon a drive for human relations with others (“objects”) not pleasure via libido and aggression (per Freud)
Hard Wiring
- Imitation is the primary mode of learning (re: mirror neurons)
- Infant cognitive development is orderly but sometimes different for different kids
- Normal attachment promotes cognitive development
Erikson’s Psychoanalytic Development
- Basic Trust vs. Mistrust (Birth to 1 year)
- Autonomy vs. Shame and Doubt (1 –3 years)
3.Initiative vs. Guilt (3 –5 years)
4.Industry vs. Inferiority (6 –11 years) - Identity vs. Role Diffusion (11 years –end of adolescence)
- Intimacy vs. Isolation (21 –40 years)
- Generativity vs. Stagnation (40 –65 years)
- Integrity vs. Despair (over 65 years)
Piaget Cognitive Development
- Sensorimotor Stage (birth to 2 years)–reflexes (sucking, grasping) lead to intentional movement and actions on objects, directing sequences of behavior and experimentation
- Preoperational Stage (2 to 7 years)–symbols, mental representations, causality
- Concrete Operational Stage (7 years to adolescence)–logic, classification, inference, conservation
- Formal Operational Stage (adolescence)–metacognition, reasoning, abstraction
Multifinality
Various outcomes may stem from similar beginnings.
Equifinality
Similar outcomes may follow from different early experiences.
Child Mental illness risk factors
Poverty, racism, inconsistent caregiving, parental mental illness, death of a parent, homelessness, family break up, early pregnancy, neonatal complications, etc.
Determinants of (Mental) Health
- Genetics 30% responsible
- The other 70% are environmental & social factors:
1)Good doctors & hospitals account for about 20% of our health outcomes (including good insurance, access, and health literacy)
2)Economic stability
3)Education
4)Community (civic participation, discrimination, workplace conditions, community cohesion, incarceration)
5)Neighborhood (zip code, transportation, access to healthy food and parks, safety, air & water quality, etc.
Domains of Resilience Factors
Constitutional (temperament, neurobiological)
Sociability (prosocial behavior, attachment)
Intelligence (academic, planning/decision making)
Communication skills (language, reading)
Personal attributes (self-efficacy/esteem, LOC)
Supportive families
Higher SES
School support (peers & teachers)
Supportive communityOlsson et al, 2002
Critical 9 Individual Resilience Factors
Emotional regulation: the ability to stay calm under pressure
Causal analysis: the ability to comprehensively and accurately identify the causes of a problem
Impulse control: the ability to shut out distractions and keep our behavior under control
Self-efficacy: a sense of capability and confidence in the world
Realistic optimism: the belief that things can change for the better, but within the bounds of reality
Empathy: the ability to read others to their emotional and psychological state
Reaching out: the ability to seek out new opportunities, challenges, and relationships
Ingenuity: the ability to imagine possibilities where others are confounded
Sense of purpose: the ability to make meaning of adversity and work toward a brighter future
Sex Differences: Girls
–More internalizing problems (particularly as they age):
Anxiety, depression, somatization, withdrawal
–Girls who display resilience come from households that combine risk-taking and independence with support from a female caregiver (e.g., mother, sister, grandmother, etc.)
Sex Differences: Boys
–More externalizing problems (particularly when young):
Aggression, delinquency
–Boys who display resilience come from households in which there is a positive male role model (e.g., father, older brother, grandfather, etc.) along with structure, rules, and some encouragement of emotional expression
Differences along the Sexes
- Female babies are more interested in faces and boys more interested in objects
- Female babies increase their visual interest in faces by 400% in the first 3 months of life; whereas males demonstrate no change by 3 months
- Girls’ brains mature about 20% faster than boys’ until the mid-teen years (e.g., girls tend to develop language quicker, toilet train earlier, hit puberty earlier, etc.)
The Health Paradox of Adolescence
- Adolescence (12 –26 y/o)
- ## Overall morbidity and mortality rates increase by 200-300% between late childhood (10 –14) and adolescence (15 –19)
The most common causes of death in adolescence are:
1.Accidents2.Homicide3.Suicide
Teenage Morbidity
Depression–4% prevalence in childhood–12% in early adolescence (16% in girls and 8% in boys)–Up to 17 –18% by 18 years of age
Risk Taking Behavior
Adolescence also heralds high rates of risk-taking behavior, sensation-seeking, and erratic, emotionally influenced behavior
What increases in Adolescence
–Responsibility
–Academic demands
–Negative life events
–Alone time–Friction between expected & actual life events
–Ability to abstract
–Intimate relationships
–Unsupervised time
Why Do Adolescents Take Risks
Brain maturation is not yet complete–Neurodevelopmental Imbalance
Driven by Reward–Dopamine & Sensation
Seeking
Evolutionary Advantage–Modern Society –Cave Man Brain
Hormones & Early Puberty - Testosterone (competition & social order) & Oxytocin (in vs. out)
Peer Effects-Reward & Emotional Pain
Behavioral Contributions-Sleep & SUDS
Synaptic Pruning
Infants are born with about 2,500 synapses per neuron
By 3 years of age, there are about 15,000 synapses per neuron
The early adolescent brain loses as many as 30,000 synapses per second
The frontal lobes are “closed for construction.”
Etiology
cause of disease
Nosology
classification and naming system for medical and psychological phenomena
Epidemiology
Branch of medical science concerned with the incidence, distribution, and control of diseases that affect large numbers of people
