PSYC241: Midterm 2 Flashcards
1
Q
Many clinicians believe that somatic symptom and related disorders happen because…
A
Of maladaptive ways of coping with extreme stress but a lot of debate over this
More systematic research in recent years is shedding light on nature/cause of these disorders
2
Q
How are dissociative and somatic symptom/related disorders classified in DSM-5?
A
Two separate diagnostic categories (but strongly linked and have common features)
Used to be classified together under anxiety disorders
3
Q
What caused the change in classification of dissociative and somatic symptom/related disorders?
A
In the DSM 3, classification changed from an emphasis on etiology to observable behaviour
This caused them to be given their own categories outside of anxiety disorders as they had different observable symptoms
4
Q
Historical theories on dissociative disorders/somatic symptom disorders
A
- hysteria caused by “wandering womb” (Plato)
- supernatural explanations like possession
- breakdown of mental processes
- resulting from trauma of a sexual nature
- Freud thought trauma was made up in their minds, decided it was protection against sexual desires + conversion to anxiety (physical symptoms) relieve pressure from dealing directly with mental problems
5
Q
Secondary gain (dissociative / somatic symptom disorders)
A
Refers to benefits that a person may consciously or subconsciously seek by adopting the sick role (hysterical symptoms=benefits=reinforcers)
6
Q
Primary gain (dissociative / somatic symptom disorder)
A
Avoidance of dealing with unconscious psychological conflicts by translating it into physical symptoms
7
Q
How are dissociative disorders characterized?
A
Severe maladaptive disruptions or changes in identity, memory and consciousness that are experienced as being beyond one’s control
Defining symptom= dissociation
8
Q
What is a common dissociative experience, and what would make it pathological?
A
Becoming so absorbed in a book or movie that you forget about your surroundings or the passage of time = normal
Pathological when it’s uncontrollable or you can’t snap out of it and it makes it hard to function normally
9
Q
What personality trait is dissociation related to?
A
Easily hypnotized
10
Q
Categories of dissociative experiences
A
1- mild, non pathological forms like absorption and imaginative involvement
2- severe pathological types of experiences like amnesia, derealization, depersonalization and identity alteration
11
Q
Causal factors of dissociative disorder
A
Psychological trauma
Emotional distress
12
Q
Dissociative amnesia
A
Not able to recall personal information but can recall general info
Includes dissociative fugue, a rare condition where people randomly leave their home and can end up in another city with no memory of their past
Usually happens after a traumatic event
Includes five patterns of memory loss
13
Q
Dissociative identity disorder
A
Presence of two or more personalities (usually 13-16)
Used to be called multiple personality disorder
Person can be aware or not of the personalities
Changing personalities is called “switching” (happens due to stressful situation)
More commonly diagnosed in women and between ages 29-35
Common to have self-destructive behaviour
14
Q
Depersonalization/derealization
A
Feeling of being detached from oneself and one’s physical and social environment
If experienced for a short time=normal
Have less reactivity to stressful stimuli and interruptions in attention/perceptual processes possibility caused by brain abnormalities in perceptual pathways
15
Q
Are repressed memories brought up by psychotherapy true or false?
A
No objective way to tell but there is a lot of evidence that hypnosis can implant highly detailed but untied memories
16
Q
People affected by dissociative disorder
A
More inpatient psychiatric patients than the general population
Same amount for women and men
Slightly more common in younger adults compared to older
High rates of comorbidity with other psych disorders like anxiety, bipolar, etc
17
Q
Five patterns of memory loss associated with dissociative amnesia
A
1- localized amnesia (failure to recall info from a specific time period)
2- selective amnesia (only some parts of trauma are forgotten, other parts remembered)
3- generalized amnesia (forgets all personal info from their past)
4- continuous amnesia (individual forgets info from specific date until present)
5- systemized amnesia (individual only forgets certain categories of info, like certain places or people)
***first two are the most common
18
Q
Depersonalization vs derealization
A
Depersonalization: detached from yourself
Derealization: detached from your surroundings (visual distortions, seeing other people or objects as foggy/dreamlike/etc)
19
Q
What is the third most commonly reported psychotic symptom after depression and anxiety?
A
Depersonalization
20
Q
Describe somatic symptom and related disorders
A
Includes conditions that involve bodily symptoms associated with distress and impairment
21
Q
Two models of etiology of DID
A
1- trauma model (diathesis-stress formulation which means person has predisposed personality traits that make them susceptible and therefore can be triggered by stress; says that DID=result of childhood trauma)
2- socio cognitive model (don’t accept DID as a legit disorder, believes it is form of role playing where people construe themselves as if they have multiple selves and begin to act in ways consistent with their own or their therapists conception of the disorder, iatrogenic=caused by treatment)
22
Q
What does attachment have to do with DID?
A
Lack of sensitive responding from parents
Develop insecure attachment called disorganized pattern (inconsistent, contradictory behaviours when faced with stress including stereotypical movements/postures, freezing and trance like states similar to dissociation)
23
Q
Psychotherapy for dissociative disorders
A
Psychotherapy
-focus on resolving emotional distress associated with past trauma and learning better ways of dealing with stress
Five step treatment for DID
1- establishing safe enviro to talk about past trauma
2- help patients develop coping skills to use in discussions
3- remembering/grieving
4- after developing more effective coping strategies and acceptance of past, last step of integrating personalities
Goal: one personality or group of alters that are conscious of each other and can work together
2/3 show improvement, 1/3 achieve integration
SLIDES SHOW 3 STAGES
1- building therapeutic alliance
2- develop coping skills and tools to deal with past trauma
3- integration of personalities
24
Q
Hypnosis for DID
A
Used to confirm diagnosis, contact alters and retrieve memories
Critique: false memories
25
Medication for dissociative disorders
```
Not very useful for dissociative disorders themselves, but good for comorbid disorders like depression and anxiety
Truth serum (sodium Amytal) which is a barbiturate that causes drowsiness used to help person recall memories or identify alters (doesn't always work and sometimes person doesn't remember what they say)
```
26
Describe somatic symptom and related disorders
Soma=body in Greek
Group of disorders where individuals present physical symptoms that suggest medical illnesses + psychological distress/ functioning impairment
Physical symptoms can take diff forms (serious=substantial impairment of sensory or muscular system; other disorders=worrying that person has a disease and become disabled by their worry anxiety and excessive time and energy devoted to their health concerns)
More likely to seek help from Doctor than psychologist
27
How somatic symptom and related disorders have changed with the DSM
- Used to be called somatoform disorders
- important criteria=no physiological basis or medical explanation
- assumption that symptoms were caused by psych factors due to early traumatic experiences and unresolved emotional distress
- because patients didn't feel good about their symptoms being called fake, DSM-5 changed it so that it's not such a central part of diagnosis (so patient could actually have medical problem and still be diagnosed with this)
- key point now=excessive worry/stress cause onset or make symptoms worse
28
Somatic symptom disorder
1+ somatic symptoms (ex: chronic pain, fatigue) that cause distress or disruption of daily life
Overdramatic concerns about seriousness
Anxiety
Excessive time and energy devoted to health probs
May or may not have actual diagnosed medical problem
29
Illness anxiety disorder
Anxiety and worry about having or acquiring a serious illness without somatic symptoms and despite not being able to find any serious medical condition
30
Conversion disorder
Symptoms affecting voluntary motor or sensory functions (blindness, paralysis, loss of feeling etc) which don't go with recognized neurological or medical conditions
Can have seizures/convulsions
Possibly due to conflict or stress
Usually have other psychological disorders like depression or anxiety
31
Psychological factors affecting other medical conditions
Individual has a medical condition (ex: asthma, diabetes, etc) that is affected by psychological or behavioural factors (ex: anxiety making asthma symptoms worse or stressful work environment causing high blood pressure)
32
Factitious disorder
Faking or inducing symptoms of illness to gain sympathy, medical care and attention
33
How to identify if symptoms are medical or not in conversion disorder
-electroencephalographic recordings can show if patient's seizures are consistent with brainwave
34
Glove anaesthesia (conversion disorder)
Loss of all sensation in the hand with the loss sharply demarcated at the wrist, rather than following a pattern consistent with sensory inner cation of the hand and forearm
35
La belle indifference (conversion disorder)
Lack of concern about the nature and implication of one's symptoms
Only in some cases and not a good defining factor
36
Brain activity involved with conversion disorder
Symptoms result from dynamic reorganization of the brain circuits that link volition, movement and perception, leading to inhibition of normal cortical activity
You don't see this in people actively faking symptoms
37
What were conversion and dissociative disorders originally grouped under?
Hysteria
38
Argument for conversion disorder being a dissociative disorder
Process of dissociation where there's a lack of integration between conscious awareness and sensory processes or voluntary control over physical symptoms
Tend to have high scores on measures of dissociative experiences and hypnotizability
Frequently have history of childhood trauma
***still grouped until somatoform disorders tho
39
Somatic symptom disorder
New diagnosis for DSM 5 (used to be somatization disorder or hypochondriasis)
Have multiple, reoccurring somatic symptoms
May or may not be diagnosed as a medical condition
Distressing to individual/disruption of daily life
Lots of anxiety and time spent worrying
Prone to periods of anxiety and depression that they can't properly cope with
Excessive sensitivity to bodily symptoms
Important to understand culture to diagnose it (burning hands/feet and bugs crawling on you=symptoms in Asia and Africa)
40
Similarity and difference between panic disorder and somatic symptom disorder
Similarity: both involve sensitivity to bodily symptoms that seem relevant to their fears
Difference: panic disorder focuses on short term symptom related disasters whereas somatic symptom disorder focuses on the long term process of illness and disease
41
Somatic symptom disorder with predominant pain
Used to have its own diagnosis as pain disorder but now under category of somatic symptom disorder
Must have pain in 1+ body sites that is severe enough to cause distress/interrupt daily life
Excessive thoughts/behaviours/feelings related to the pain such as exaggerated concerns about its seriousness or lots of energy and time dealing with it
Risk of becoming dependant on prescription meds
Associated with comorbid depression, anxiety and sleep disturbances
42
Cause of somatic pain
Once thought to be unconscious conflicts in individuals with certain dysfunctional personality traits (now bad because suggest that pain is fake and only imagination)
Now it is recognized that experiencing pain is complex synthesis of thoughts and feelings and sensory input
43
Illness anxiety disorder
New diagnosis in DSM 5 (used to be hypochondriasis)
Preoccupied with fear that they may have a serious medical disease despite medical exams showing nothing wrong with them
Highly anxious about their health and easily alarmed about illness-related events (hearing that a friend is sick or seeing illness on tv)
Examine themselves frequently and check internet for answers
Illness part of their identity
Seek doctors not psychologists
Illness preoccupation must be present for at least 6 months but illness can change
44
Difference between illness anxiety disorder and somatic symptom disorder
People with illness anxiety disorder don't have significant bodily symptoms and are mostly worrying about the idea that they are sick, whereas those with somatic symptom disorder have significant symptoms and might be diagnosed with a real medical illness
45
Factitious disorder
Also called Münchausen syndrome
Deliberately fake or generate the symptoms of an illness or injury to gain medical attention
Involves physical symptoms and psychiatric symptoms like hallucinations or delusions
To be diagnosed, must not be any obvious external rewards like insurance money/avoiding exam
Motivation=gain sympathy
Another type: factitious disorder imposed on another (falsifying illness in another person such as your own child)
46
Body dysmorphic disorder
Excessive preoccupation with an imagined or exaggerated body disfigurement, almost to the point of delusion
Causes significant distress and impairment in daily function
Preoccupations feel tormenting/devastating
25% attempt suicide
Most imagined defect=hair (then nose and skin)
47
What group does body dysmorphic disorder fall under?
Used to be in somatoform group
Now in obsessive-compulsive and related disorders as they have prominent obsessions and compulsive behaviours
Actually more disturbed than those with OCD typically
48
How is body dysmorphic disorder different than anorexia nervosa?
Diff gender distribution, familial patterns and response to treatment
49
Etiology of somatic symptom and related disorders
Once believed that they resulted from anxiety about unconscious conflicts and sexual drives converted into somatic symptoms and distress
Now believed that a number of physiological, psychological, and social factors may interact in a series of vicious cycles with diff disorders resulting from diff patterns of interaction (biopsychosocial model)
Physiological factors: chronic stress producing activation of hypothalamic-pituitary-adrenal (HPA) axis affects immune system and creates illness-like symptoms for example, causing people to think they're sick when it's really the stress causing the issue
Cognitive factors: skewed interpretations, uncontrollable worry, excessive bodily concerns (somatic amplification = hypothesis tendency for individuals to experience bodily sensations as intense/noxious/disturbing
Personality traits like negative affectivity and tendencies to suppress emotional expression
Cognitive-behavioural concept of health anxiety
Early life experiences and social learning (childhood physical or sexual abuse)
50
Treatment of somatic symptom and related disorders
- Shifted away from traditional psychodynamic therapy to focus on cognitive, affective and social processes that maintain the excessive or inappropriate behaviour
- Co-operative therapeutic environment is very important as patient probably doesn't want to think of their symptoms as psychological (identify persons main concerns, establish position that the symptoms are "real" and distressing, negotiating a mutually acceptable treatment goal, shift attention away from somatic symptoms to life stresses and focus on symptom management and rehabilitation)
- identification of comorbid anxiety/depression and treating these is vital with meds sometimes prescribed
51
What somatic symptom and related disorders respond well to antidepressants?
Illness anxiety disorder and body dysmorphic disorder
52
Cognitive-behavioural approach to treating somatic symptom and related disorders
Involves restructuring morbid thoughts and preoccupations
Works to get behaviour patterns under control
Effective!!!
Uses self monitoring and relaxation techniques for reducing emotional arousal and behavioural management methods for increasing enjoyable activities and social interaction
53
Anorexia nervosa
-Morbid fear of fatness
See themselves as fat
-Reduce their food intake to the point of starving
-Can develop ritualistic eating behaviours like eating foods in a set order, dissecting food into small pieces or weighing food before eating
-excessive exercise to lose weight
-purging behaviours
-disturbance in body image
-disturbed cognitive/emotional/physiological functioning including social withdrawal, irritability, preoccupation with food and depression (all from semi-starvation)
54
Bulimia nervosa
- Periods of food restriction alternate with periods of binge eating
- Binges followed by attempts to compensate by either vomiting, laxative or diuretic abuse, hyper exercising or starving oneself (weight loss is mostly from dehydration with these methods)
- weight and shape info to self-evaluate
- social isolation and depression
- usually within normal weight range bc compensation strategies not good for losing weight
- medical consequences of purging include impaired renal function and cardiovascular problems like arrhythmias
55
Binge-eating disorder
New to the DSM-5
Reoccurring episodes of binge eating occur (like bulimia nervosa) but without the compensatory behaviours to try to rid the body of calories
Binge eating is instead associated with bad eating behaviours and then feeling guilty/disgusted about the binge eating
Can include dieting and overeating in cycles
Often overweight and sometimes obese, but can also be normal weight (usually younger patients)
Use binges to escape problems
56
Defining a binge
Must determine whether a binge is objective or subjective
Both associated with lack of control but amount of food differs
Objective binge=eating a large amount of food over a specific time period like less than 2 hours
Subjective binge=eating normal amounts or small amounts of food
57
Which eating disorder(s) is the most common?
Other specified eating or feeding disorder (aka partial syndrome eating disorders) but expected to DECREASE with new eating disorder criteria of DSM 5
58
What psychiatric disorder has the highest mortality rate?
Eating disorders
| Most common causes of death are starvation/nutritional complications and suicide
59
How many bulimic patients stop binging and purging with treatment?
50%
60
Two subtypes of anorexia in the DSM-5
Restricting type: strict dieting and sometimes lots of exercise
Binge eating/purging type: strict dieting, sometimes lots of exercise, binge eating and purging behaviours
Types are important bc specific treatment and own physical consequences; binge eating and purging type has possibly poorer prognosis; important in research
61
Essential 3 criterion for bulimia nervosa
- self evaluation of individuals with bulimia is majorly influenced by body shape and/or weight
- episodes of binging and purging behaviours occur on average around once a week for 3 months
- the obvious aka binging and purging behaviours
62
Binge eating disorder (BED) has to have 3+ features of binge eating episodes
Eating very quickly
Eating large amounts of food when not even hungry
Eating alone bc embarrassment
Feeling depressed guilty or disgusted after binges
63
Other specified/unspecified feeding or eating disorder
G
64
Changes in DSM-5 that will hopefully reduce "other" diagnoses for eating disorders (three)
- adding BED as its own separate disorder
- decrease in frequency of binge eating needed for diagnosis of bulimia nervosa
- removing criteria of amenorrhea for the diagnosis of anorexia nervosa
65
Purging disorder
Use of inappropriate compensatory behaviours in the absence of binge eating by individuals with normal weight
66
Night eating syndrome
Repeated eating at night (but not binge eating as that would be more like BED)
Causes distress and or impairment in functioning
There is awareness and recall of the eating
67
Unspecified feeding or eating disorder
People with symptoms that don't fit criteria for specific eating disorder but they have symptoms that cause distress or impairment
68
5 examples of other specified eating disorders
- atypical anorexia nervosa (everything but with normal weight)
- bulimia nervosa of low frequency and/or limited duration (less than once a week and/or for less than 3 months)
- binge eating disorder of "..."
- purging disorder
- night eating syndrome
- SUB THRESHOLD AN BN BED
69
Major difference between binging/purging type anorexia and bulimia
Bulimia=normal weight or obese
| Anorexia=really below normal weight
70
Support to put all eating disorders on a spectrum
Patients often change diagnoses over the course of their disorder and even go back to old diagnoses sometimes
Transition in teen years of anorexia nervosa to late teens/early adulthood bulimia =very common
71
The EDE (eating disorder examination)
Structured clinical interview for diagnosing eating disorders (has good validity and reliability)
- provides numerical ratings of frequency and degree of symptoms and normative data on dietary restraint, bulimic symptoms and eating, weight and shape concerns
- has to gather a lot of info from patient (current/past frequency and severity of food restriction, binging, purging, exercise, distorted beliefs about weight shape and eating, weight history and current/past periods)
- explores patient's relationships with others and potential history of trauma
- find if they have comorbid disorders
- medical assessment (good motivation)
- self report questionnaire
72
Physical and physiological complications of anorexia nervosa
- osteoporosis
- cardiovascular problems like lowered heart rate and low blood pressure
- decreased fertility
- lethargy
- dry skin
- dry hair
- hair loss
- lanugo (fine downy hair on body for warmth)
- amenorrhea (absence of at least 3 menstrual periods)
- cog/emotional functioning like diffs concentrating and grumpy
- impaired renal functioning and cardiac arrhythmia
73
Physical and physiological complications of bulimia or binge/purge subtype of anorexia nervosa
Dental problems
Russell's sign=scrapes/calluses on back of hand or knuckles
Electrolyte imbalance
Cardiovascular and renal problems
74
Physical and physiological complications of BED
Similar to obesity
Elevated risk of type 2 diabetes
Cardiovascular disease
Sleep apnea
75
What neurotransmitter is involved with eating disorders?
Serotonin
Anorexia associated with reduced serotonin activity
Specifically serotonin 1B receptor gene
***more likely that sets of genes+enviro factors are to blame
76
Why do females get more eating disorders than males?
- socio cultural factors
- gender diffs in serotonergic system (females more prone to dysregulation)
- dieting alters brain serotonin function in females not males
- hormonal changes in females during puberty can activate development of disordered eating
77
Socio-cultural model of eating disorders
Disorders are a product of increasing pressures for women in western society to achieve an ultra slim body
78
Personality traits that contribute to eating disorders
```
Perfectionism
Obsessiveness
Compliance
Lack of awareness of internal feelings
Sense of worthlessness
Bulimia=impulsive
```
79
Does homosexuality and male eating disorders correlate?
Some studies say yes, some no
| More likely due to body dissatisfaction and not sexuality
80
Biological treatments for bulimia nervosa
Usually treated with antidepressants (tricyclics and ssri's)
Prozac has good initial effect
Very few patients recover on these drugs though
Not as effective as CBT; both together is good but CBT alone is the most effective!!
Also anticonvulsants
81
Cognitive-behavioural therapy for eating disorders
-Most effective
-Widely accepted
-Binging/purging not only controls weight and shape but reduces anxiety and worsens self esteem
-three stages over 20 weeks
1=establishing some control over eating with psychoeducation about normalized eating and connection between restricting and binging; teaches patients to use behavioural strategies to avoid acting on urges (meal planning, distraction, stimulus control) + self-monitoring
2= continued focus on normalizing eating by eliminating dieting; teaching problem solving skills and identifying/changing bad thoughts and beliefs especially about weight and shape
3= strategies for maintaining change and preventing relapse
82
Cognitive-behavioural theory of eating disorders
Need to control eating bc western society=self worth is based on weight and shape
83
Transdiagnostic theory of eating disorders
Theory that all eating disorders have underlying psychopathological processes and maintaining factors so they can be treated using similar CBT interventions
Recognizes that there are issues other than dysfunctional beliefs about eating weight and their control aka perfectionism, low self esteem, mood intolerance and relationship difficulties play a part = adapted form of CBT called enhanced CBT
84
Interpersonal therapy for eating disorders
Only treatment with results comparable to CBT
- focus on maladaptive personal relationships and ways of relating to others as its thought to contribute to development and maintenance of eating disorders
- identify which of four areas (grief, role transition, interpersonal role disputes or interpersonal deficits) is most relevant to patient and fix it
- doesn't directly target eating behaviours or attitudes
- both CBT and IPT are same in long run but CBT has better short term effects
85
Meal support
Important part of eating disorder recovery programs
- emotional support during or after meals
- normalizing eating behaviours
- helping individuals to decrease eating related rituals
86
Family therapy for eating disorders
- focuses on stresses in the family as a whole
- mostly used for anorexia nervosa
- places responsibility on relatives and patient
- no attention is paid to cause or factors that don't directly affect normalized eating
- after weight and eating is taken care of, therapist moves on to underlying issues
- one study found improvement in body weight/menstrual status/restraint but not weight and shape concerns
87
Self-help manuals
-CBT related
Can be used in diff ways
1- accessible info for those who don't have other help or too embarrassed to seek treatment
2- in connection with guidance by non specialist professional like nurse or family doctor
3- first step in stepped-care approach to treatment delivery
4- for people on wait lists for treatment
5- facilitation of therapist given CBT
-shown to be effective
88
What does prevention in schools improve? (Eating disorders)
Less internalization of the socio-cultural ideal for weight and shape
89
To what group is eating disorder prevention programs most effective?
High risk people because more motivated than general population to improve feelings about body
90
Stereotypy
Repetition of meaningless gestures or movements
91
Developmental disorders and their manifestations
```
Unusual physical features
Deficits in language
Motor activity
Etc
Patterns of behaviour like hyperactivity, aggressiveness or stereotypy
```
92
What do people call developmental disorders in Canada, Europe and Australia?
Intellectual disability
93
Diagnostic criteria for intellectual disability (intellectual disability disorder)
- deficits in intellectual functions like reasoning, problem solving, planning, abstract thinking, judgment, academic learning, learning from experience confirmed by both clinical assessment and individualized, standardized intelligence testing
- deficits in adaptive functioning that cause lack of personal independence and social responsibility
- onset of intellectual and adaptive problems during developmental period
- replaced term of retardation and falls under category of neurodevelopmental disorders
94
What two groups influence classification and definition of intellectual disability?
American association on mental retardation (AAMR)
| American association on intellectual and developmental disabilities (AAIDD)
95
4 subcategories of IQ scores for intellectual disabilities
-mild (50-55 to 70)
-moderate (35-40 to 50)
-severe (20-25 to 35)
-profound (less than 20)
Later created fifth level called borderline
96
Diagnosis of developmental disabilities includes iq testing as well as...
Assessment of adaptive behaviours such as conceptual, social, practical abilities like communication, self care, domestic academic social or community leisure and work skills
97
Changes in ninth edition of how intellectual disability is diagnosed
New classification is more positive; addresses persons strength and capabilities
Level of functioning represents not only abilities of individual but also environmental support or services available to that person
Diagnosis changed from "moderate intellectual disability" to "able to complete activities of daily living with limited support"
Recognizes relationships between individual functioning, support, participation, health and environment
98
Critiques of IQ tests
- don't take into account sensory, motor, language deficits, which contribute to poor performance
- test situation can feel overwhelming because unfamiliar
- lack of understanding of what is expected of them or may not take initiative to solve problems
- leiter international intelligence scale=best for non verbal
99
Three measures used to assess adaptive behaviour in intellectual disabilities
Vineland adaptive behavioural scales second edition
Adaptive behaviour assessment system
Scales of independent behaviour revised
100
Adaptive behaviours generally clustered under 4 domains (intellectual disabilities)
Communication
Daily living or personal living skills
Socialization or social interaction skills
Motor skills
101
Aquiescence (developmental disabilities)
Tendency for individuals with developmental disorders to agree in interviews
Affected by social desirability, motivation and personality factors, cognitive and linguistic limitations
102
Etiology of developmental disorders
Some have clear organic causes, some environmental factors, some interaction between genetics and environment
103
Genetic causes of developmental disorders
Genetic links in 70% of disorders
| -inherited or spontaneous chromosomal abnormalities or genetic mutations
104
Behavioural phenotypes (developmental disorders)
Pattern of social cognitive and behavioural abnormalities
105
Overview of genetics
- genes in specific patterns on chromosomes
- 23 pairs of chromosomes , 1 from each parent per pair
- 44 matching autosomes and two sex chromosomes
- developmental disorders can be caused by single or multiple genes alone or together with enviro factors (single gene disorders less common)
- three types of inheritance: dominant, recessive and sex linked or X linked
- defective genes take over role of partner gene (dominant)
- X or sex linked inheritance: females=gene is recessive and will only operate if on both X chromosomes therefore only affect males
- can be identified through blood test
106
Chromosomal abnormalities in developmental disorders
Occurs because of structural alteration in the chromosome or because a person has a greater or smaller amount of chromosomes
Genetically related but not inherited and occur spontaneously
Best known=Down syndrome
107
Three types of Down syndrome
Trisomy 21
- most common
- 1 extra chromosome on pair 21
translocation
-part of 21st chromosome breaks off and attaches to another
Mosaicism
- division occurs unevenly
- less obvious or severe symptoms
108
Ways of prenatal screening for chromosomal and other abnormalities
- maternal serum screening (MSS; blood test 15-20 weeks into pregnancy and detects alpha-fetoprotein aka AFP)
- nuchel translucency test (NT test; done between 10-14 weeks and involves measuring fluid behind fetus neck through ultrasound)
- amniocentesis (between 11-18 weeks; with help of ultrasound, needle inserted into amniotic sac and withdraw amniotic fluid which is teased in the lab)
- chorionic virus sampling (CVS; obtaining cells from placenta; more risky, 10-12 weeks)
109
Phenylketonuria (PKU; metabolic disorders)
- caused by autosomal recessive gene causing liver enzyme to be inactive on chromosome 12 which then causes inability to process or metabolize the amino acid phenylalanine
- detected through blood test shortly after birth
- given special diet that doesn't have much protein (provided through supplement)
110
Other metabolic disorders
Hypothyroidism
Hyperammonemia
Gaucher's disease
Hurler's syndrome
111
Environmental causes for developmental disorders
- fetus exposed to toxins or infections
- blood supply lacks nutrients or oxygen
- not enough nutrition
- use of alcohol tobacco or drugs
- infections like rubella or AIDS
- exposure to radiation
112
Fetal alcohol spectrum disorder (FASD)
- growth retardation
- central nervous system dysfunction
- short eye openings
- elongated, flattened area between mouth and nose
- thin upper lip
- flattened cheeks and nasal bridge
- head circumference is below normal
- cleft palate, heart/kidney damage and vision defects
- lower doses of teratogen=less symptoms
- deficits in cognitive and intellectual functioning
- behavioural problems
113
Thalidomide in developmental disabilities
Old time drug that was used for nausea and was found to cause limb defences and malformations
114
Seven essential daily ingredients for development of young children
- encouraged to explore
- assistance in skills like labelling, sorting, sequencing, etc
- reinforcement of developmental achievements
- guided practice of new skills
- protection from bullying or punishment
- rich/responsive language enviro
- supportive and predictable enviro with interaction
115
Physical features of Down syndrome
Short stature
Slanted eyed with fold of skin over inner corner
Wide flat nose bridge
Short thick neck
Stubby hands
Large protruding tongue
Poor muscle tone
Sometimes congenital heart disease, gastrointestinal problems and congenital cataracts
Also delayed nonverbal cognitive development, less verbal abilities and less auditory short term memory.
116
Fragile X syndrome
X linked chromosomal abnormality caused by FMR-1 gene (enlarged)
- extra pairs of cytosine and guanine = triplet repeats (more repeats=full mutation and less=premutation)
- second most common after downs
- high forehead, elongated face, large jaw, large undeveloped ears, enlarged testes
- cognitive and behavioural symptoms like weakness in orders of things but have strengths in processing info, more receptive than expressive language
- benefit from structured educational programs that limit distractions, regular routines, lots of visual info
117
Prep for community living (developmental disorders)
Focus on developing social skills and independent living skills
Reducing bad behaviours
Use systematic observation, task analysis, various shaping and prompting procedures and operant conditioning
Audiovisual and computer technologies help
118
Three components of quality of life for developmental disorders
1- "being" in physical, physiological and spiritual domains
2- belonging in physical social and community enviros
3- becoming, focusing on strategies to achieve
119
Diagnostic overshadowing
Seeing deviant behaviours as part of the developmental disorder and not as a possible psychiatric disorder = missed diagnoses
120
Dual diagnosis
Having serious behavioural or psychiatric disorders as well as intellectual disability
Most frequently reported behaviours are bad self control or anger control, attention deficit, withdrawal, problems going to the washroom and pica
121
Most used treatment for people with dual diagnosis
Behavioural approaches and positive behaviour support opposed to punishment
Recommend biopsychosocial approach
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Autism
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Deficits in social-emotional reciprocity
Deficits in nonverbal communication
Deficits in relationships
Repetitive motor movements
Insistence on sameness
Abnormal, fixated interests
Different sensory functioning
Symptoms present in early childhood
Cause impairment
Not better explained by intellectual disability or developmental delay (intellectual disability and autism commonly happen together)
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Autism spectrum disorder characterized by three major areas of deficits
1- social interaction
2- verbal/nonverbal communication
3- behaviour and interests
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Echolalia (autism)
Repeating another person's words or phrases using similar intonation
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Pronoun reversal (autism)
Referring to yourself as he or she and not I
Related to problems in joint attention and difficulty understanding perspective of others and distinction between self and other
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Savants (autism)
Super smart autistic kids in maybe one main area
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Asperger's disorder (falls under autism spectrum disorder)
Don't have really delayed cognitive development
Social interactions are strange
-failure to establish a joint frame for reference in interaction
-don't observe social norms or show awareness of listeners feelings
-talking about their obsessions a lot and use stereotyped phrases
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Assessment of autism spectrum disorder
Assessments carried out by team with psychologist, psychiatrist, SLP, occupational and physical therapist and teacher
- can include audio and neuro tests
- developmental approach
- autism diagnostic observation schedule and autism diagnostic interview revised = recommended
- focus on social reciprocity, communication, restricted repetitive behaviours and interests
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Etiology of developmental disorders
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Genetic component
Mumps vaccine and autism=no proof
Neurological
Neuro chemical (abnormal levels of serotonin)
Infections in mothers
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Medications used to treat autism
- antidepressants (SSRIs)
- drugs used to regulate neurotransmitters (serotonin, dopamine, norepinephrine)
- wdrugs that increase 5-HT neurotransmission
- Ritalin, mellaril, Benadryl, Dilantin, haldol, tegretol
- alternative approaches like megadoses of vitamin B6 and magnesium, vitamin C, folic acid, omega 3 fatty acid
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Behavioural interventions for autism spectrum disorder
Focus on fixing tantrums, aggression, stereotypy, and self-injurous behaviour
Used to be consequence based but now stimulus and instruction based
Operant conditioning principles
Use of PECS (picture exchange communication system)
Social competence
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Learning disorders
Trouble with reading and writing math etc but otherwise normal
Core deficit in phonological processing
Four essential features of diagnosis:
1- difficulties learning and using key academic skills despite help
2- performance or skills below average for age
3- learning difficulties in school years
4- learning difficulties not to do with other neurological conditions or intellectual disabilities
Neurobiological disorder of cognitive or language processing caused by atypical brain functioning
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Controversy in diagnosis of learning disorders with iq testing
1- intelligence and academic achievement are continuously distributed variables
2- working memory and phonological processing don't have to do with intelligence level
3- could exclude gifted kids who have normal academic achievement but show processing deficits
4- no clear evidence that intelligence/achievement discrepancy is related to learning intervention outcome
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Dyslexia
Impairment in phonological processing
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Dyscalculia
Math learning disability
| Problems with computational and procedural skills that reflect deficit in working memory
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Nonverbal learning disabilities
Difficulties reading facial expressions and body language, interpreting maps, learning to tell time etc
Deficits in tactile perception, psychomotor coordination, visual-spatial info, poor nonverbal problem solving, etc
Impairment of right hemisphere (not like left for reading disorders)
Controversies between NLD and asperger
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Etiology of learning disorders
Multifactorial
Dyslexia: familial and hereditary
Math: genetics
Reading disorders can be helped by enviro changes that influence brain
(Ventral, dorsal tempo parietal, inferior frontal gyrus)
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Parts of brain associating with reading and math disorders
Reading; less activation in left hemisphere and greater reliance in right and frontal hemispheres
Math; posterior parietal
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Intervention for learning disabilities
Reading interventions: phonemic awareness, phonics, vocab development, reading fluency, reading comp strategies, close monitoring of progress and opportunities for supervised practice
-important role of schools and educators for future
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Dissociative disorders
Involve severe disturbances in identity, memory and consciousness
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How do subpersonalities interact in dissociative identity disorder? 3 ways
1- mutually amnesic relationship (no awareness of each other)
2- mutually cognizant patterns (all aware of each other)
3- one way amnesic relationship (most common; some personalities are aware of each other but awareness is not mutual)
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Psychodynamic view of DID
Support drawn from case histories with brutal childhood experiences but
Some DID patients don't have these experiences
Only few abused children develop this
Caused by repression (the most basic ego defence mechanism) used to fight off anxiety about past
Dissociative amnesia and fugue=single episodes of massive repression
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Behavioural view of DID
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Dissociation grows from normal memory processes and is a response learned through operant conditioning
Dissociation=escape behaviour
Relief of anxiety
Rely on case histories
Fails to explain everything
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Malingering and factitious disorder
Individuals intentionally pretend to be sick
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Two patterns of somatic symptom disorder
1- somatization pattern: experience Long lasting physical ailments that have little or no organic basis; dramatic and exaggerated terms used in describing, runs in families and lasts a long time
2- predominant pain pattern: primary feature is pain, often develops after accident or illness that causes real pain, fairly common
Diagnosed when psychological factors are important in onset, exacerbation, severity or maintenance of pain symptoms
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Psychodynamic view of conversion and somatic symptom disorders
Freud believed hysterical disorders=conversion of underlying emotional conflicts to physical symptoms
- focus on psychosexual development of girls and phallic stage (age 3 to 5) where girls repress sexual feelings for their fathers and if parents overreact=girl had sexual anxiety throughout life
- women hiding sexual feelings in physical symptoms
- still believe that it is translation of childhood problems
- primary and secondary gain
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Behavioural view of conversion and somatic symptom disorders
Symptoms bring rewards to sufferers (remove individual from unpleasant situation and bring attention from others)
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Cognitive view of conversion and somatic symptom disorders
Way to express difficult emotions
| Not to defend against anxiety but to communicate extreme feelings
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Multicultural view of conversion and somatic symptom disorders
Western clinics hold bias that sees somatic symptoms as an inferior way of dealing with emotions
It's a norm in other places
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Treatment of illness anxiety disorder
Similar to OCD
Antidepressant meds
Exposure and response prevention (ERP)
Cognitive behavioural therapy
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Rumination disorder
Repeated regurgitation of food
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Avoidant/restrictive food intake disorder
Failure to meet nutritional and or energy needs
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Two factors of binge eating
Loss of control and objectively large amount of food
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Best treatments for eating disorders
AN: family based treatment
BN: Also family based (and CBT?)
EDNOS: unstudied
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Prof's etiology of eating disorders
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Personality and individual factors
Family factors
Traumatic adverse events
Maturational issues
Peer environment
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Family based treatment for eating disorders
Don't blame family/parents
Parents in best position to care for child
Re-feeding copies inpatient ED unit
ED=disease separate from patient
Therapists=coach to parents
Session structure: take weight and asses binging and purging of week, concerns, build alliance
Family session include prob solving
THREE STAGES
1- re feeding to normalize eating patterns
2- gradually give patient back control with monitoring (includes the family meal with goal to support parents in having their kid eat more than they want to; intervention starts when kid decides they are done eating; authoritative style parenting)
3- look at other issues of patient
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Pervasive developmental disorders
On a spectrum like autism, asperger, Rett's syndrome, child disintegrative disorder
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Rett's syndrome
Usually occurs in females, unique pattern of cog and functional deterioration including loss of interest in social contact and hand wringing
Deceleration in head circumference growth
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Child disintegrative disorder
Marked deterioration in speech and social skills, following several years of normal development
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Non-replicated enviro risks for autism
Agricultural pesticides
Pet pesticides
Hazardous air pollutants
Endocrine disrupters
