Reproductive Psychiatry and Human Development Flashcards
What is the difference between gender and sex?
Gender is what culture or society expects for a male or a female
Sex is based on biology
What is the difference between organizational and activational effects of gonadal hormone?
Organizational effects of gonadal hormones occur early in development (in utero or early postnatal) and are considered to be permanent
Activational effects of gonadal hormones occur late in development and are transient and superimpose themselves on organizational effects.
What psychiatric disorders exhibit a gender bias?
Women > men: typically affective disorders
- Major depression disorder
- Panic disorder
- Generalized anxiety disorder
- PTSD
- Borderline personality disorder
- Seasonal affective disorder
Men > women
- Autism
- Schizophrenia
- Alcoholism
- Drug addiction
- Antisocial behavior
- ADD
- Tourette’s syndrome
What medical conditions exhibit a gender bias?
Women > men: typically autoimmune
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Osteoporosis
- Cushing disease
- Hashimoto’s thyroiditis
- Grave’s disease
- MS
- Scleroderma
- Alzheimers
Men > women
- Hepatocellular carcinoma
- Kidney disease
- Ankylosing spondylitis
- Goodpasture’s syndrome
- Heart disease
- Parkinson’s disease
Describe the effects of estrogen in the brain.
Describe the effects of progesterone on the brain.
Describe the effects of oxytocin on the brain.
Oxytocin is largely responsible for milk let down and uterine contractions. It impacts affiliate behavior and has an anti-glucocorticoid effect to minimize stress. It also modulates neural circuitry for social recognition and fear (reduced amygdala activation in response to threatening faces or scenes). Oxytocin levels are increased by partner intimacy and are linked to lower BP and HR.
What causes masculinization of the brain?
Androgen exposure in utero results in a masculine brain. Decreased androgen exposure defaults to feminization of the brain.
What is prementrual dysphoric disorder?
Criteria: irritability, depressed mood, affective lability, anxiety, or tension that markedly interfere with work, school, or usual activities or relationships. Other symptoms include decreased interest, lack of energy, change in sleep, physical symptoms, feeling out of control, change in appetite, and difficulty concentrating. They must not be an exacerbation of another disorder and must be confirmed before two menstrual cycles.
PMDD is responsive to treatment with SSRI’s regularly or during the luteal phase alone.
Relevance: hormones are important in modulating mood, cognition, and behavior
What is the importance of social attachment?
Social attachment is the foundation for healthy personality and functioning in society. It influences cognitive abilities, development of conscience, coping skills, relationship development, ability to handle perceived threats, and ability to handle negative emotions.
What types of attachment are biologically relevant?
Attachment is bidirectional
- Infant attachment: clinging, suckling, cooing, separation response
- Parent behavior: maternal-infant (nursing, retrieval, nest building, grooming defense) and paternal-infant (retrieval, nest building, grooming, defense, feeding)
- Pair bond formation: cohabitation, partner preference, mate guarding, separation response
What is attachment behavior?
Behavior that promotes proximity to or contact with the persons to whom an individual is attached. It is discriminating, specific, and reciprocal.
What hormones, neurotransmitters, and neural circuits are important in attachment?
Dopamine and oxytocin are involved in rat pup attachment to mother (olfactory bulbs, locus ceruleus, amygdala). Maternal behavior is mediated by oxytocin and estrogen, which regulates the number of oxytocin receptors in the CNS, as well as dopamine.
Oxytocin binding in the prelimbic cortex and nucleus accumbens mediate maternal behavior and pair bonding in prarie voles.
What was the long term impact of wire surrogate mothers on monkey development?
What are the necessary conditions for the development of attachment? How does attachment develop?
In order to develop attachment, the infant must have sufficient interaction with the caretaker, be able to distinguish the caretaker from others, be able to engage in a reciprocal cycle of interaction, and be able to recognize the caretaker’s permanent and independent existence.
Attachment develops with the infant has a need and reacts leading to the caregiver supplying the need. This permits gratification, relief, and building of trust.
What is the first phase of attachment and its corresponding behaviors?
Phase 1: indiscriminate sociability (0-2 months)
- Infant behaves the same toward anyone who interacts in caregiver role
- Reciprocal interactions minimize crying
- Smiling, crying, vocalization, visual tracking, clinging, sucking
Phase 2: attachments in the making (2-7 months)
- Infant begins differentiating familiar caregivers
- Differential crying and smiling, climbing, vocalizations, greeting response
Phase 3: clear cut attachments (7-24 months)
Phase 4: goal-coordinated partnership with linguistic involvement (>2 years)
What is the second phase of attachment and its corresponding behaviors?
Phase 2: attachments in the making (2-7 months)
- Infant begins differentiating familiar caregivers
- Differential crying and smiling, climbing, vocalizations, greeting response
What is the third phase of attachment and its corresponding behaviors?
Phase 3: clear cut attachments (7-24 months)
- Infant consolidates attachment
- More complex motor, cognitive, and communicative changes
- Intentional control over attachment behavior
- Develops person permanence
- Differential response to people and new situations
- “Still face experiment”–abnormal response if the mother has not been emotionally available
- Stranger anxiety: 6-8 months
- Separation anxiety: 10-18 months
What is the fourth phase of attachment and its corresponding behaviors?
Phase 4: goal-coordinated partnership with linguistic involvement (>2 years)
- Can alter attachment behavior
- Can negotiate a shared plan for proximity
- Can understand objectively the causal relations between caregiver’s goals and behavior
What are the precursors to strong and healthy attachments?
What are the phases of response to separation? What are the outcomes in response to loss?
Phases of response:
- Protest: child cries and searches for lost parent
- Despair: child seems to lose hope, becomes passive and withdraws
- Detachment: child is seemingly indifferent to parent’s absence
Outcomes
- Depression: non-responsiveness, social withdrawal, immobility, poor sleep
- Reorganization: new attachments form to other caregivers
- Emotional blunting: limited ability to form new affectionate relationships
What are the potential consequences of faulty attachment? What are some risk factors for attachment disorders?
- Failure to thrive syndromes
- Anaclitic depression
- Separation anxiety disorder
- PTSD
- Personality disorders
What is reactive attachment disorder?
Clinical syndrome manifested by difficulty in forming long-lasting intimate relationships due to characteristic absence of the ability to be genuinely affectionate towards others. Begins before the age of five and is associated with grossly pathogenic care.
Inhibited RAD: child appears fearful and restricted in interest in caregivers
Disinhibited RAD: indiscriminate in interest in caregivers, shallow relationships
What are the long term consequences of attachment disorders?
Psychological: poor mental and emotional health, cognitive difficulties, social difficulties, alcoholism, and substance abuse
Behavioral: delinquency, low academic achievement, teen pregnancy, abusive behaviors
What are the different types of milestones? In what direction are they achieved?
Describe the major characteristics of an infant up to one month of age.
- No head or neck control
- Lots of flexor tone, hands fisted
- Recognizes parental voice
- Fixes gaze at 8-12 inches (myopic)
- Prefers contrasting images
- Primitive reflexes due to incomplete myelination: root/suck, moro/startle, grasp, asymmetric tonic reflex
Describe the major characteristics of a two month old.
Describe the major characteristics of a four month old.
- Rolls over, sits with support
- Asymmetric tonic reflex and startle reflex extinguished
- Grab intentionally
- Babble conversationally
- Recognizes familiar people
Describe the major characteristic of a six month old.
- Grabbing
- Sits alone and crawls
- Transfers objects between hands
- Feeds self
- Strings consonants
- Laughs
- Shows preference for primary caregiver
Describe the major characteristics of a nine month old.
- Chew on everything
- Upper core trunk control
- Pulls to stand and cruises (not independently)
- Pincer grasp and bangs objects together (ulnar to radial transition)
- “Dada, Mama” jargon
- Stranger anxiety
Describe the major characteristics of a twelve month old.
- Independent walking, climb stairs, exploring environment
- Drink from cup, dump things out
- Single words, points, waves, shakes head
- Imitates, wants to do what you do, shy with strangers
- Very receptive
Describe the characteristics of an 18-21 month old.
- Climb, run, dance (gross motor)
- Stack blocks, play with dolls/cars/trains, wash hands (fine motor)
- More words, some phrases
- The idea of “mine,” prefers playing alone next to someone instead of sharing
Describe the characteristics of a two year old.
- Love to play
- Climbs, kick balls, run, jumps, up and down stairs holding rail
- Scribbles
- Two word phrases, language is 50% understandable, follows simple instructions
- Play by self mostly, short attention span
- Defiance
Describe the major characteristics of a three year old.
- More communicative
- Language and social, emotional ability
- Interactive cooperative play
- Rides tricycle, runs well, marches, alternates feet climbing stairs
- Turns pages well, colors (outside lines), feeds self well
- 4-5 word sentences (75% understandable)
- Imagination with blurred boundaries, vivid and realistic
- Beginning transitions from parallel play to interactive play
Describe the major characteristics of a four year old.
- Lots of sharing and stories
- Rides bike with training wheels, hops, kicks, throws ball
- Cuts with scissors, draws stick people
- Tells stories, dramatic, lots of questions
- Almost completely understandable
- Cooperates and plays with friends
Describe the major characteristics of a five year old.
- Able to do things like dress on their own
- Somersaults, skips
- Prints, exhibits handedness, uses fork and spoon
- Recognizes numbers, letters, and colors
- Distinguishes between imaginary and reality (lying)
- Acknowledges consequences
- Follows basic rules and takes turns, interacts well with others
What are some of the cultural influences on adolescence?
Economy, educational system, media images, youth culture
Erik Erickson’s stage: identity versus identity diffusion, individuation and separation from family
What are some of the developmental tasks of adolescence?
- Emotional independence from parents
- Ability to negotiate between the pressure to achieve and the need for acceptance from peers
- Experiment with behaviors, attitudes, and activities to prepare for adulthood
- Understand pubertal changes
- Search for self definition
- Search for a personal set of values
- Gain competencies to assume social roles
- Acquire social interaction skills
What are some of the effects of puberty on adolescents?
- Sense of body image
- Cognitive development and health
- Changing peer and family relationships
- Sexualtiy and romance
- Emotional conflict
- Sensation seeking, risk taking, reckless behavior
- Sensitivity to social status
What are the three developmental routes through adolescence?
Continuous growth (40%): smooth continuous change
- Self assurance, steady increase in confidence and maturity
- Solid families without major stresses
- Good coping skills and relationships
- Acceptance of cultural values and norms
- Connected to family members
Surgent growth (40%): development spurts and uneven change with periods of emotional conflict and turmoil as well as periods of steady progress
- Mixed families with more stress
- Not as confident of dealing with crises
- Conflict with parents
- Self doubt, more vulnerable
Tumultuous growth (20%): turmoil and conflict, identity crises, intense emotional outbursts and misbehavior
- More troubled families
- Much personal insecurity
- Dependent on peer acceptance
- More likely to develop clinical symptoms
What are some of the anatomical changes that take place in the brain during adolescence?
Linear increases in white matter in all four lobes
Inverted U shape changes in gray matter with differential peaks of change in different lobes–increases with arborization and establishing more connections, decreases reflect process of pruning where certain connections are eliminated
Maturation of frontal lobes is last (planning, thinking through consequences, inhibition, decision making)
Greater whole brain connectivity (white matter growth)
What are the general changes in adolescent thinking?
- From concrete to abstract
- From uni- to multidimensional
- From absolute to relativistic
- From reactive to self-reflective, self-aware
- Egocentric tendencies: self-focused, heightened self consciousness, myth of invulnerability, trying on different identities
What are the leading causes of death in adolescents?
- Unintentional injury (45%): cars and alcohol related accidents
- Homicide (14%): access to weapons
- Suicide (10%): access to weapons
- All of these are more common than cancer and diseases of the heart in adolescents
What is the relevance of locus of control?
Those with an internal locus of control believe that they can change what will happen to them. Others have a fatalistic view or an external locus of control where they believe that whatever is going to happen will happen no matter what they do.
How does risk taking behavior change in adolescence?
Risk taking increases between childhood and adolescence and then declines between adolescence and adulthood. Risk taking increases with friends or when they know when someone is watching. Peers increase risk taking behavior by enhancing activity in the brain’s reward circuitry (dopamine).
Describe adolescent behavior and risk taking with respect to alcohol.
Half of adolescents who died accidentally had alcohol in their system
25% of seniors, 20% of sophomores, and 5% of 8th graders engage in binge drinking
About 25% of adolescents admit to getting in the car with a driver who they know to have been drinking.
Peak initiation age: 18 years
Describe adolescent behavior and risk taking with respect to sexual activity.
About 25% of seniors have had four or more sexual partners
About 45% of sophomores have had sexual intercourse
Females are more likely to report having used alcohol or drugs at the time of their last sexual intercourse
Male sexual partners average three years older than teen women
Risks: age difference between partners, sexual abuse, excessive number of partners, sexually transmitted diseases, unwanted pregnancies
Describe the patterns of sexual abuse, STD’s, and pregnancy in adolescents.
15% of girls and 6% of boys have been sexually assaulted before 16 years old
Almost 3/4 of teen women having sex before 14 report having intercourse involuntarily
25% of sexually active adolescents will acquire an STD before high school graduation
25% of teenage girls are currently infected with an STD
20% of Americans with AIDS were infected during adolescence
About 10% of women between 15-19 years of age become pregnant.
