Psychopathology: Neurodevelopmental and Schizophrenia Spectrum Flashcards
What are the three criteria for Intellectual Developmental Disorder?
(a) deficits in intellectual functioning as determined by the results of a clinical assessment and individualized, standardized intelligence testing;
(b) deficits in adaptive functioning that cause a failure to meet developmental and socio-cultural standards for personal independence and social responsibility; and
(c) an onset of deficits during the developmental period.
What’s the intelligence testing score ordinarily found among people with an intellectual disability?
Two or more standard deviations below the population mean
What are the specifiers for intellectual disability and what are they based on?
- Mild, Moderate, Severe, Profound
- Based on adaptive functioning in conceptual, social and practical domains
- Helps determine how much support a person needs
What is the percent of ID cases with a known etiology and what are the common causes?
- 25-50% cases have known etiology
- Of those with known etiology 80-85% are due to prenatal factors (chromosomal, genetic causes: downs syndrome, fragile x, fetal alcohol syndrome), 5-10% perinatal factors (asphyxia), 5-10% postnatal factors
What is the diagnostic criteria for autism spectrum disorder (ASD)?
Symptoms must be during early developmental period
(1) deficits in social communication and social interactions across contexts. Impaired social-emotional reciprocity
** e.g. no initiation of social interaction, no sharing of emotions, difficulty processing and responding to social cues.
** Impaired nonverbal communication (atypical eye contact, facial expressions and gestures)
** impaired ability to develop, maintain and understand relationships (atypical social interests, inappropriate approaches to others that seem aggressive or disruptive)
and
(2) restrictive and repetitive patterns of behaviors, interests, activities
** stereotypes or repetitive motor movements, speech, use of objects
** insistence on sameness or inflexible adherence to routines
**restricted or fixated interests that are abnormal in intensity or focus
*hyper- or hyporeactivity to sensory input
What makes prognosis for ASD good?
- IQ over 70
- functional language skills by age five
- absence of comorbid mental health problems
What are common features of ASD?
1 - intellectual and language impairments
2 - self-injurious behaviors (e.g. head banging)
3 - motor abnormalities (e.g. clumsiness, walking on tiptoes)
4 - disruptive/challenging behaviors
5 - impaired facial and emotional recognition (likely contributes to social challenges)
** children with autism did not react differently to novel and familiar faces (as they did with objects). Children with autism had deficits recognizing basic and complex emotions (across face, voice and body expression)
Prevalence estimates for ASD in the US?
- 1-2% of the population
- 3-4x more often in males than females
Etiology, risk factors and concordance rates of ASD?
- Etiology is unknown (likely multiple genetic and non-genetic factors)
- non-genetic risk factors include male gender, birth before 26 weeks gestation, advanced parental age, exposure to some environmental toxins during prenatal development
- Concordance rates for monozygotic twins 69-95%
dizygotic twins 0-24%
ASD brain and neurotransmitter abnormalities?
- Accelerated brain growth in children with ASD from approx. 6 months and plateaus by preschool (larger than normal head circumference, increased brain volume and weight)
- Cerebellum, corpus callosum and amygdala abnormalities
- lower than normal serotonin in the brain but lower levels in the blood (blood serotonin enters the fetal brain during the early stages of development before the blood-brain barrier is fully mature, which causes reduced development of or damage to serotonergic neurons in the brain)
*dopamine, GABA, glutamate, acetylcholine
What are the primary goals of ASD treatment?
- Minimize core symptoms
- maximize independence by promoting acquisition of functional skills and reduce or eliminate behaviors that interfere
Treatment modalities of ASD?
- Early Intensive Behavioral Intervention (EIBI) uses ABA (applied behavior analysis)
** at least 40 hours per week of behavioral interventions (shaping, discrimination, teaching nonspeaking children to communicate verbally)
** greatest impact on intelligence and language acquisition - smaller impact on adaptive skills, social functioning and severity - No medications only prescribed for co-ocurring psychiatric conditions
methylphenidate and other psychostimulants are used to alleviate symptoms of ADHD;
SSRIs are used to treat depression and anxiety
atypical antipsychotics (especially risperidone and aripiprazole) are used to reduce irritability and aggressive, self-injurious, and other disruptive behaviors
Diagnostic criteria for ADHD?
- Pattern of inattention and/or hyperactivity-impulsivity that has persisted for at least 6 months
- onset before age 12
- present in at least two setting
- interferes with social, academic or occupational functioning
- At least 6 symptoms of inattention and/or at least 6 symptoms of hyperactivity or impulsivity (at least 5 symptoms for 17y/o or older)
Inattention symptoms:
- Doesn’t listen when spoken to
- fails to pay close attention to details
- doesn’t follow through on instructions
- easily distracted by extraneous stimuli
- often forgetful in daily activities
Hyperactivity/Impulsivity symptoms:
- unable to engage in play or leisure activities quietly
- often runs or climbs in inappropriate situations
- talks excessively
- has trouble waiting their turn
- interrupts or intrudes others
Gender ratios of ADHD
two times more common in males than females in childhood
gender differences decreases somewhat in adulthood 1.6 males: 1 female
Changes in ADHD from childhood to adulthood
- evidence estimates that core symptoms persist into adulthood
- symptoms may change in adulthood:
1 - excessive motor activity decreases replaced with inability to relax, sit still, impatience, restlessness
2 - impulsivity decreases slightly and changes to driving recklessly, abruptly quitting jobs, ending relationships, overspending
3 - inattention continues and manifests as inability to meet deadlines, careless mistakes, procrastination (esp. for boring/tedious tasks
What is adhd commonly comorbid with among children?
- Oppositional Defiant Disorder (most common)
- Conduct Disorder
- Anxiety Disorder
- Depressive Disorder
Brain abnormalities of ADHD?
(a) Impaired response inhibition, working memory, sustained attention, and other aspects of executive functioning are associated with abnormalities in the prefrontal cortex, striatum (caudate nucleus and putamen), and thalamus;
(b) impaired temporal information processing (e.g., inability to perceive and organize sequences of events and anticipate when future events will occur) is associated with abnormalities in the prefrontal cortex and cerebellum; and
(c) emotion dysregulation is associated with abnormalities in the prefrontal cortex and amygdala
** reduced total brain volume with smaller-than-normal volumes in the prefrontal cortex, striatum, corpus callosum, and cerebellum, as well as reduced activity in these regions
Neurotransmitters associated to ADHD?
- low levels of dopamine and norepinephrine have most consistently been identified as contributors to the cognitive and behavioral symptoms of ADHD (e.g., Brune, 2016).
For example, low levels of these neurotransmitters in the prefrontal cortex have been linked to impairments in impulse control, attention, and executive functioning.
Concordance rates of ADHD?
- one of the most heritable psychiatric disorders, with the mean heritability estimate across twin studies being 76%
- monozygotic and dizygotic twins vary somewhat from study to study, but the average is about 71% for monozygotic twins and 41% for dizygotic twins
- ADHD has also been linked to low birth weight, premature birth, and maternal smoking or alcohol use during pregnancy.
Best treatments of ADHD for children and adolescents?
(a) Parent- and teacher-administered behavioral interventions are the treatment-of-choice for preschool children, with evidence-based parent training in behavioral management (PTBM) being the primary recommended intervention. Included in this category are the positive parenting program and parent-child interaction therapy (PCIT). Medication is prescribed only when behavioral interventions do not produce adequate improvement.
(b) For elementary and middle-school children, the recommended treatment is a combination of medication and behavioral interventions at home and at school.
(c) For adolescents, the recommendation is to prescribe medication with the adolescent’s assent and to combine medication with behavioral and instructional interventions when they are available. There is evidence that adolescents may benefit, for example, from behavioral therapy, motivational interviewing, mindfulness-based training, and classroom training
Best treatment for adults with ADHD?
- First line treatment is medication
- Psychosocial interventions such as cognitive behavior therapy
Are psychostimulants in childhood associated with increased risk of substance use among children and adolescents with ADHD?
the research suggests this link is not due to treatment with a psychostimulant in childhood
children with ADHD who do and do not receive a psychostimulant drug are comparable in terms of rates of future substance-related problems.
treatment of ADHD during childhood with a psychostimulant neither decreases nor increases the risk for later substance use disorders.
What is the definition of a tic according to the DSM-5?
a “sudden, rapid, recurrent, nonrhythmic motor movement or vocalization” (p. 93). Motor tics include eye blinking, facial grimacing, shoulder shrugging, and echopraxia, while vocal tics include throat clearing, barking, and echolalia.
