Lecture 11: Psychopathology in Children and the Elderly Flashcards
bullying
- some are more traumatized by this than others
- bullies tend to: display antisocial behaviors, perform poorly in school, drop out of school, bring weapons to school ,drink alcohol, smoke, and use drugs
effects of bullying
depression, suicide, anxiety, low self-esteem, sleep problems, somatic symptoms, substance use and abuse, school problems, phobias and antisocial behavior
cyberbullying
taken place through e-mail, text messages, websites, apps, instant messaging, chat rooms or posted videos and photos
- girls are at least 50% more likely than boys to be cyberbullied
child abuse
non-accidental use of excessive physical or psychological factors forced by an adult on a child, often with the intention of hurting or destroying the child
- abusers are usually the child’s parents
- victims suffer both immediate and long-term psychological effects
childhood anxiety disorders
often different from adult anxiety disorders. behavioral symptoms and somatic symptoms are more prevalent and they tend to focus on specific objects and events rather than broad concepts
- treatment: cognitive behavioral therapy, anti-anxiety and antidepressant drugs, play therapy = revealing conflicts and feelings during play
seperation anxiety
enormous difficulty being away from their major attachment figures, may refuse to go to school
selective mutism
children consistently fail to speak in certain social situations but can speak in other situations. may be an early version of social anxiety disorder
MDD during childhood
- young children: depression can be triggered by negative life events, major changes, rejection, or ongoing abuse. features irritability, headaches, stomach pain, and a disinterest in toys and games
- teenagers: clinical depression is much more common than among young children
- treatments: cognitive behavioral therapy, antidepressants
disruptive mood dysregulation disorder
for at least a year, patterns of severe rage and temper outbursts that occur in at least two settings, diagnosed between 6 and 18 years of age
oppositional defiant disorder
children with this disorder are repeatedly argumentative and defiant, angry and irritable, and sometimes vindictive. they may argue repeatedly with adults, ignore adult rules and requests, deliberately annoy other people, and feel much anger and resentment
conduct disorder
more severe problem in which children repeatedly violate others basic rights and display aggression. they may be physically cruel to people or animals, deliberately destroy other people’s property, steal or lie, skip school, or run away from home
- begins between ages 7-15
overt-destructive pattern
individuals display openly aggressive and confrontational behaviors
overt-non-destructive pattern
dominated by openly offensive but non-confrontational behaviors
covert-destructive pattern
individuals secretly commit non-destructive behaviors
relational aggression
individuals are socially isolated and primarily display social misdeeds such as spreading rumors and manipulating friendships
causes of conduct disorder
- genetic, drug abuse, poverty, traumatic events, and exposure to violent peers
- often tied to troubled parent-child relationships, inadequate parenting, family conflict, marital conflict, and family hostility
- interactions between genetic and environmental factors
treatment of conduct disorder
- most effective with ages younger than 13
- sociocultural treatments:
- combination of family and cognitive behavioral interventions: parents management training
- residential treatment
- school programs
- child focused treatments;
- cognitive behavioral interventions: problems-solving skills training + coping power program
- prevention programs
elimination disorders
characterized by repeatedly urinating or passing feces in clothes, bed or floors. at an age which they are expected to control these functions. not caused by physical illness
enuresis
repeated involuntary bed-wetting or wetting of one’s clothes at night or day, triggered by stress
encopresis
soiling, defecation into clothing, usually involuntary and mostly during the day
- more common in boys
neurodevelopmental disorders
a group of disabilities in the functioning of the brain that emerges at birth or during early childhood and affects the individual’s behavior, memory, concentration, and ability to learn
- ADHD
- autism spectrum disorder
attention-deficit/hyperactivity disorder (ADHD)
difficulty attending tasks, behaving over-reactively and impulsively, or both
causes of ADHD
- biological: abnormal dopamine activity and abnormalities in frontal-striatal regions of the brain
- high level of stress
- family dysfunctioning
treatment of ADHD
- drug therapy: methylphenidate (Ritalin) = stimulant drug to focus better
- behavioral therapy: operant conditioning
autism spectrum disorder (ASD)
pattern marked by extreme unresponsiveness to others, severe communication and relationship deficits, lack of responsiveness and social reciprocity, highly repetitive and rigid behaviors, interests, and activities, and inflexible demand for the same routines, and over- or under-reactions to sensory input from the environment
- more common in boys
communication and language problems of ASD
- echolalia: exact echoing of phrases spoken by others
- pronominal reversal: confusion of pronouns
causes of ASD
- sociocultural: high degree of family dysfunction, social and environmental stress; no support
- psychological: central perceptual or cognitive disturbance, fail to develop theory of mind, deficiencies in joint attention
- biological: suggested genetic factor, abnormalities in cerebellum - still researching. not linked to vaccines
treatment of ASD
- can help to adapt better to the environment
- cognitive behavioral therapy: teach new appropriate behaviors, reducing negative behavior
- communication training: half remain speechless + argumentative communication system = teaching to point to pictures, symbols on communication board
- parent training
- community integration: teach self-help self-management, living, social and work skills
- psychotropic drugs and vitamins; are sometimes helpful
intellectual disability
displaying general intellectual functioning that is well below average (<70), in combination with poor adaptive behavior. learning slowly, difficulty in attention, short-term memory, planning and language
- symptoms appear before 18
assessing intelligence
- intelligence tests to measure intellectual functioning, including a variety of questions and tasks that rely on different aspects of intelligence
- difficulty in one or two does not mean low intelligence
- intellectual quotient (IQ): general intellectual ability
- tests appear to be socioculturally biased, so IQ is baised
assessing adaptive functioning
several scales: Vineland and AAMR Adaptive Behavior Scales
- proper diagnosis: clinician observe the functioning of individuals in everyday environments, taking both background and community standards into account
mild level of intellectual disability
- IQ 50-70 (most common, 80-85% of cases)
- intellectual performance improves with age
- sociocultural and psychological causes;
- poor and unstimulating environment
- inadequate parent-child interactions
- insufficient early learning experiences
- malnourishment during early years may be a factor
moderate level of intellectual disability
- IQ 35-49 (10% of cases)
- can care for themselves, benefit from vocational training and can work in unskilled or semiskilled jobs
severe level of intellectual disability
- IQ 20-34
- careful supervision and perform only basic work tasks
profound level of intellectual disability
- IQ below 20
- with training they learn/improve basic skills and need a structured environment
causes of intellectual disability
- chromosomal causes: down syndrome = trisomy 21, fragile X syndrome
- metabolic causes;
- body’s breakdown or production of chemicals is disturbed and caused by the pairing of two defective recessive genes
- Phenylketonuria (PKU) + tay-Sachs disease
- prenatal and birth-related causes;
- low iodine - cretinism
- alcohol uses - fetal alcohol syndrome
- maternal infections
prolonged period without oxygen during or after deliver (anoxia) - childhood problems;
- certian injuries and accidents
- infections
- family and social environment
treatment of intellectual disability
- intervention programs: providing comfortable and stimulating residence, social and economic opportunities and proper education
- proper residence: small institutions that teach self-sufficiency, more time for patient care, following normalization (principle that living in residences should be similar to the rest of society)
- special education vs. mainstream classrooms (neither is consistently superior)
- individual or group therapy for emotional and behavioral problems
- psychotropic medications
how can opportunities for growth for people with intellectual disabilities be increased?
- if communities allow them to grow and make their own choice they feel effective and competent
- socialising, sex and marriage are difficult but with proper training and practice they learn to use contraceptives and carry out responsible family planning
- adults need the financial security and personal satisfaction that come from holding a job
- working in sheltered workshops
- additional programs are needed
geropsychology
field of psychology concerned with the mental health of elderly (65 years or older)
psychological problems in elderly persons are divided in to two groups
disorders that may be common in people of all ages but are connected to the process of aging:
- depressive, anxiety, and substance use disorders
disorders of cognition that result from brain abnormalities:
- delirium, mild neurocognitive disorders, and major neurocognitive disorder
depression in later life
- more prevalent among aged people who live in nursing homes than those who live in the community
- raises the risk of developing medical problems, slows down recovery, and is linked to higher death rate
- elderly people are more likely to die from suicide
anxiety disorders later in life
- prevalence increases with age: higher among those 85 or older, compared to those between 65 and 84 years of age
- symptoms may be misinterpreted as medical conditions
- may be caused by declining health
substance misuse in later life
- prevalence declines after age 65
- main problem: misuse of prescription drugs, often unintentional
- increasing problem: misuse of powerful medications at nursing homes
disorders of cognition in later life
- cognitive mishaps are a common and quite normal feature of stress and aging. as people move through middle age, these memory difficulties and lapses of attention increase. sometimes, memory and cognitive changes are more extensive and problematic
- cognitive problems often have organic roots
delirium
rapidly developing, acute disturbance in attention and orientation that makes it very difficult to concentrate and think in a clear and organized manner. leads to misinterpretations, illusions, and hallucinations
- occurs over a short period of time (hours or days)
- most common in elderly
- fever, certain disease, poor nutrition, head injuries, strokes, stress and intoxication by certain substances may all cause delirium
neurocognitive disorder
experiencing a significant decline in at least one area of cognitive functioning and may also experience changes in personality and behavior
- experience of neurocognitive disorder is closely related to age:
- 65 years old: 1-2% prevalence
- > 85 years old: 50% prevalence
major neurocognitive disorder
neurocognitive disorder in which a decline in cognitive functioning is substantial and interferes with the person’s ability to be independent
mild neurocognitive disorder
neurocognitive disorder in which decline in cognitive functioning is modest and does not interfere with a person’s ability to be independent
alzheimer’s disease
most common neurocognitive disorder, marked by memory impairment
- gradually worsens and eventually they become dependent on other people
- time between onset and death is typically 8-10 years
- can only diagnosed with certainty after death, when structural changes in the brain can be fully examined. these changes are a normal part of aging but are excessive in this disease
senile plaques
sphere-shaped deposits of beta-amyloid protein that form in the spaces between neurons in the hippocampus, cerebral cortex, and certain other brain regions and blood vessels
- disrupts inter-neuron communication
neurofibrillary tangles
twisted protein fibers found within the neurons of the hippocampus and certain other brain structures. caused by abnormal activity of tau protein
- distrupts transport of molecules within neurons
cause of Alzheimer’s
the plaques formed by beta-amyloid proteins may cause tau protein within neurons to start breaking down, leading to the formation of tangles and to neuronal death
alzheimer’s as an early onset disease
- younger than 65 years of age, very rare
- mutation in particular genes increases the production of beta-APP and presenilin proteins, increasing the likelihood of plaque and tangle formations
- some families appear to transmit mutations
alzheimer’s as a late onset disease
- older than 65, does not typically run in families
- result from a combination of genetic, environmental and lifestyle factors
- different genetic factors than those with early-onset
- those who inherit the ApoE-4 gene may be more vulnerable to the development of Alzheimer’s disease: this gene promotes the excessive formation of beta-amyloid proteins, thereby triggering the formation of plaques and tangles
- there may also be gene forms that more directly promote tau protein abnormalities and tangle formations
brain structure as a cause of alzheimer’s
- two memory systems:
- short-term: consolidation = short term transformed into long-term
- long-term: retrieval = remembering information
- brain structures in memory
- prefrontal lobes: hold information
- temporal lobes and diencephalon: transform STM to LTM
- dementia involves damage to or improper functioning of one or more of these areas
biochemical changes as a cause of alzheimer’s
- several chemicals are responsible to the production of proteins in key cells when new information is acquired and stored
- if the activity of chemicals is disturbed, proper production of proteins is prevented, and the formation of memories is interrupted
- abnormal activity by chemicals may contribute to alzheimer’s
environmental toxin as a cause of alzheimer’s
certain substances found in nature, may produce brain toxicity, which may contribute to the development of disease
autoimmune theory
changes in aging brain cells may trigger an autoimmune response (= mistaken attack by the immune system against itself) leading to disease
viral theory
because Alzehimer’s disease resembles Creutzfeldt-Jakob disease (a form of dementia caused by virus), some researchers propose that a similar virus may cause Alzheimer’s. to date, no virus detected in the brains of Alzheimer’s victims
predicting Alzheimer’s
- assessing and predicting Alzheimer’s disease is difficult
- biomarkers (biochemical, molecular, genetic or structural characteristics that usually accompany a disease) are used to assess and predict Alzheimer’s
- most effective interventions are those that help prevent problems or are applied early
vascular neurocognitive disorder
result of cerebrovascular accident or stroke during which blood flow to specific areas of the brain was cut off, with resultant damage, and progressive disorder; cognitive functioning may remain normal in unaffected brain areas
Pick’s disease
frontotemporal neurocognitive disorder, similar to Alzheimer’s disease
Creutzfeldt-Jakob disease
neurocognitive disorder due to prion disease, caused by a slow-acting virus, and symptoms include spasms of the body
Huntington’s disease
inherited progressive disease in which memory problems worsen over time, along with personality changes, mood difficulities and movement problems
Parkinson’s disease
slowly progressive neurological disorder marked by tremors, rigidity and unsteadiness that can cause dementia
Lewy body disease
buildup of clumps of protein deposits within many neurons
treatment of alzheimer’s disease
treatments for the cognitive features of Alzheimer’s disease have been at best modestly helpful
drug therapy
acetycholine and glutamate - neurotransmitters known to play an important role in memory
- benefits of drugs are limited and the risk of harmful side effects is sometimes high
- taking vitamin E seems to help or prevent or slow down further cognitive decline
- certain substances may reduce the risk of Alzheimer’s disease
cognitive behavioral strategies
- focus primarily on behaviors rather than cognition, useful in preventing and managing the disease
- physical exercise is often part of the treatment program
- improve specific symptoms displayed by patients with Alzheimer’s disease
support for caregivers
caring for someone with Alzheimer’s can take a have toll. many caregivers experience anger depression and a decline in mental health
sociocultural approaches
day-care and assisted-living facilities may slow down cognitive decline and enhance enjoyment of life
mental health of elderly: 3 issues
- problems faced by elderly members of racial and ethnic minority groups
- inadequacies of long-term care: quality of care varies widely, many older people worry about being “put away” and about costs
- need for health maintenance approach to medical care in aging world
medical scientists
- the current generation of young adults should take the health-maintenance approach to their own aging processes
- growing belief that older adults will adapt more readily to changes and negative events if their physical and psychological health is good
