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FAU / CLPS / CLP 4144 / What is the use of biological paradigm?

What is the use of biological paradigm?

What is the use of biological paradigm?

Description

School: Florida Atlantic University
Department: CLPS
Course: Abnormal Psychology
Professor: Larry miller
Term: Spring 2017
Tags: abnormal and Psychology
Cost: 50
Name: Abnormal Psychology Notes - Midterm
Description: All notes of material covered in the first midterm.
Uploaded: 03/01/2017
43 Pages 43 Views 16 Unlocks
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MHD CLP 4144 Abnormal Psychology  


What is the use of biological paradigm?



Lecture 1 (1/11/17)

- Abnormality

• out of the normative range

• violating a social norm

• statistical infrequency

• distress or disability  

- State vs trait  

• Continuous variable: majority of human traits

• Dichotomous variable: either/or

- Diagnoses usually categorizes a person into dichotomous variable - “label”  - Explanations for abnormal behavior

• Demonology  

• Astrology

- Identity: mind, body, family, culture, society, religion, philosophical views • all factors overlap  


What is the freudian metapsychology?



Don't forget about the age old question of Who got the belgium parliament to limit leopold’s power in congo?

- True-self vs False-self: most frequent way of behaving is one way, yet another us  comes out now and then  

- Free will

- Determinism

- Somatogenesis: mental states come from the body, e.g., bad feeling in your gut - Psychogenesis: person is product of experiences that happen to them  - 1919 influenza epidemic: children with bad behavior due to lesions in brain  - Medication: alleviates symptoms, but cannot help people solve problems  - Symptom-driven diagnosis system  

1If you want to learn more check out What is meant by liberty and equality?

MHD CLP 4144 • Psychiatrists want to prescribe meds

• Not hear people stories, hence psychologists  


Carl jung focused on what?



Don't forget about the age old question of What is a marginal utility example?

- Paradigm: general world-view of something  

• Industrial age: follow technology that we are familiar with

• Steam engine, hydraulic model, electrical model, telephonic model, cybernetic  model.  

- Psychologist:  

• doctoral level degree in psychology

• PhD/PsyD/EdD

• requires a state test to acquire license

• non-medical practitioner

• administer and interpret psychological tests  

- Psychiatrist: medical doctor taken residency in psychiatry If you want to learn more check out What does a residual plot tell you?

- Psychotherapist:

• LCSW: licensed clinical social worker

• LMHC: licensed mental health counselor

• LMFT licensed marriage and family therapist

- Psychoanalyst:  

• type of psychotherapy prominent in last century

• based on Freudian beliefs  

- Biological paradigm:  

• medical model  

• 1870s-1910s: discovery of the brain We also discuss several other topics like What grief means?
We also discuss several other topics like What did ada lovelace do?

• Optimistic that regions of the brain would be discovered to define psychological  abnormalities  

• 1910-1950s: dynamic psychiatry (psychoanalyst/neopsychoanalysts) 2

MHD CLP 4144 • 1950s-1980s: psychopharmacology -> deinstitutionalization  

• 1990s-present: neuroimaging, brain fingerprinting, genomic science  - Behavioral genetics:  

• gene is a segment of DNA on a chromosome that codes for a specific protein  • Protein: either structural or functional (enzymes)  

• Functional found in brain and dictate how brain operates  

• Physical and psychological traits: polygenetic

- affected by more than one gene

• stress-diathesis model: tendency towards something; affected by environment  • Gene-environment correlation

Lecture 2 (1/13/17)

- Gene doesn't produce behavior or feelings.

- Genes results in either structure or enzyme.

- Enzymes allow neurons to communicate with one another.

- Neurobiological/Psychopharmacological Paradigm:

• neuron: cell specialized for information transfer  

• Summate input from various sources - other neurons

• Soma and dendrites receive information from other sources  

• Dendrites: extension of surface area

• Inputs: excitatory or inhibitory  

• Axon transmits information

• Terminal ending/button contain vesicles with NTs

• NT currency depends on the strength of the action potentials

• Strong signal: firing at slightly higher rate

• paradigm focuses on the synapse area

3

MHD CLP 4144 • after NT depolarizes or hyperpolarizes, they are either reabsorbed but the vesicles  or broken down to its basic components.

- Neurotransmitters: each fit into special shape of receptor  

• dopamine:  

- energizing/“feel good” NT

- deficit leads to scattering/depression (ADHD)

- excessive amount leads to delusion or OCD

- broken down into NE

• norepinephrine:  

- same as adrenaline

- secreted by nervous system  

- alerting/arousing NT

- weary vigilance

- self-protective  

• serotonin: 5Ht

- mood-stabilizing effect

- balances out ratio of all other NTs

- low levels it: negative affectivity/impulsive personality  

• GABA:

- generally sedating effect

- Barbiturates  

- benzodiazepine  

• AcH:  

- main NT in neuromuscular transmission

- movement

- parasympathetic nervous system

4

MHD CLP 4144 - thinking

• Glutamate:

- excessive is toxic

- most prominent NT

- Antipsychotic: dopamine down

- Anti-depressant: dopamine and NE increase  

- Mood-stabilizer: serotonin increased  

- Anti-anxiety/anxiolytics: GABA, serotonin  

- Anti-paroxysmal: treat seizures

- Polypharmacy

- SSNRIs: selective serotonin & NE re-uptake inhibitors  

- Lithium carbonate: stabilizes bipolar disorder  

- Medications can be used to treat/prevent symptoms.The issue with  psychopharmacology is that it doesn't solve problems.  

- Freud initially practiced neurology

- Psychoanalysis/psychodynamic model:

• deals with the subconscious mind  

• Hysteria: physical complaint without any known medical causation  • Symptoms

• Parapraxes - Freudian slips

• Royal road to the unconscious - dreams; repressed wishes  

• Freud’s Theory of Psychosexual Stages

- Oral stage:  

• nourishment from one’s mother (physical and emotional)

• around age 1

• independence/dependency  

5

MHD CLP 4144 - Anal stage:  

• children learn issues of control and moderation

• around age 2

• perfectionist/controlling

- Phallic stage:  

• around age 2-3

• boys experience Oedipal complex - castration anxiety

• unable to resolve this complex - difficulty with male authority figures • Electra complex for girls - penis envy  

- Latency stage:

• around age 4-9

- Genital stage:

• Teenage years

• physical and emotional intimacy  

- Freudian Metapsychology

• id: stores subconscious urges, operated on basis of pleasure principle

• ego: greek for I; more rational reality oriented, reality principle, display wishes/ desires in a socially acceptable manner  

• Superego: punitive conscious, constricts behavior

Lecture 3 (1/18/17)  

- Defense Mechanisms: ways of fooling yourself in an adaptive way, avoid painful  truths about self

• the healthier a person is, the less likely that they are to use defense mechanisms  • Repression - suppression  

• Denial  

• Rationalization  

6

MHD CLP 4144 • Displacement: displacing feeling of one thing towards someone else; taking it out  on others

- rebound relationships

• Reaction formation: people trying to refrain from a bad habit; fanatical attitude  • Projection: taking unwanted feeling and projecting it onto somebody else  

• Sublimation: “healthiest defense mechanism”; take bad wish/impulse/trait and turn  it into something positive  

- Reductionistic idea  

- Psychoanalytic psychotherapeutic techniques

• give people insight into how these disorders began in the first place, person is able  to accept themselves

• Fundamental rule of psychoanalytic psychotherapeutic: patient does most of the  talking  

• takes a long time - typical months or years; never considered to completely explore  a person’s psyche  

• Free association: saying anything that comes to mind without controlling or  abstaining; saying whatever you want to say  

- Difficult; naturally inhibit what we are trying to say  

- Emerging of things that we want to say  

• Dream interpretation: unconscious material shows up in dreams  - Empirically, no relationship between dreams and unconscious processes  - rarely used today, even by psychoanalysts  

• Transference:  

• Interpretation: working-through process; gives patient insight into how they are they  way they are

- understand how mind created problems

- free up ego from constrictions of id and superego

7

MHD CLP 4144 - Alfred Adler: individual psychology - split from psychoanalytic community  

• started out as ophthalmologist  

• less concerned with sexual aspects of development  

• A person’s personality stems from striving for superiority  

• inferiority complex: person feels inhibited from completing/achieving goals  • Issues arise from a person not being able to achieve goals in life

• less sexual, more in regards to power and success

- Carl Jung: analytic psychology  

• psychiatry background  

• focused on creative, self-actualizing cultural and spiritual dimensions of the human  mind  

• Collective unconscious: personal has personal unconscious, but also a reminisce of  creatures that have come before them  

- we have urges that we share with other animals  

- Substrate of all humanity and pre-humanity  

• Animus: males with feminine traits  

• Anima: females with masculine traits  

- both in terms of personality  

• Introversion vs extroversion: difference in people’s personalities  

• Still believed in unconscious, differed in its content  

- Ego psychologists  

• Cognitive functions of the ego  

• each individual develops in a certain way that the ego functions in a certain style  • people deal/cope with things differently  

- Levelers  

- Sharpeners  

8

MHD CLP 4144 • influences how we deal with things  

• focus on the role that ego plays with defense mechanisms  

• impulsive vs reflective (analytic) individuals

- Legacy of psychodynamic paradigm

• unconscious exists  

• things that we aren't conscious of, but not because we aren't thinking of them • things about ourselves that we may not recognize  

• Influences on our adult personality based on our childhood  

• symptoms can be metaphors for wishes, fears, etc  

• idea that unconscious mind isn't all negative, but contains talents/potentiality (Jung) - Behaviorism

• Began in early 1900s  

• reaction against mentalist beliefs

• Classical conditioning

- Pavlov’s experiment with salivating dogs  

- UCS: meat (needs no learning to elicit a response)  

- UCR: salivation

- CS: bell  

- CR: salivation  

- Bell ringing without meat following it led to extinction (unlearning the association  temporarily between the UCS and CS)

- Re-association took shorter time after extinction  

- Generalization  

• Operant conditioning  

- Person most associated with this theory - B.F. Skinner

- master operant conditioning would led to creation of euthopian society  9

MHD CLP 4144 - Worked with rats, pigeons  

- all behavior is shaped and maintained by its consequences

- reinforcing behavior leads to repetition

- radically empirical system  

- positive reinforcement: anything that is followed by an increase in behavior  - negative reinforcement: anything which when withdrawn increases the rate of  behavior  

• removing something unpleasant  

- punishment: decreases rate of behavior

• Ineffective way of training behaviors  

• positive

• negative:  

Lecture 4 (1/20/17)  

- Schedules of Reinforcement:

• Shaped by successive approximations

• Backwards chaining

• Extinction: formerly reinforced behavior is no longer followed by reinforcement  • Schedule of reinforcement

• Variable ration schedule of reinforcement: for every number of behaviors you get a  reinforcement (constant or changing); tend to generate greatest rate of response  

• Interval schedule: no matter how many times the response occurs, the  reinforcement comes at a fixed time (?)

- rate of behavior increases as it gets closer to the reinforcement  

- Learning is cumulative

- Generalization

10

MHD CLP 4144 - Pyschopathalogical behaviors are learned in the same manner as other behaviors are  too  

- Person’s learning history leans towards their genes; the brain is pre-wired - Behaviorists had an euthopian idea in that people could be taught “good” behaviors - Behavioral model has been applied when it comes to behavior therapies  - Behavior Therapy

• goal: to make therapies obsolete and generalize in a manner that can be applied to  different aspects in people’s lives

• Counterconditioning: usually used in a step-wise way; hierarchy of fear responses • Systematic desensitization: people learn to feel more comfortable  

• Biofeedback: employs same technology as polygraph; increased arousal allows  person to know how to relax when anxiety occurs; control physiological responses

• Behavioral medicine

• Aversive conditioning: punishment; wait for positive behavior to occur in order to  reinforcement; if a person cannot produce the positive behavior, then an aversive  stimulus is added  

• Time-out: kids start acting out and you remove them from social reinforcement;  used in combination with DRO

- reinforcing opposite behavior - more effective  

• token economy: people in a group; for every unit of time, explain rules. If rules are  followed, a reward is given.  

- Cognitive psychology

• cognitive therapy: developed by psychiatrist, Aaron Beck

• correcting dysfunctional conditions  

• Therapists as coach or guide that teaches different ways of thinking  • effective in terms of mood disorders

• Found to be as effective as anti-depressant medication  

11

MHD CLP 4144 - Evolutionary psychology

• Organisms adapt to fit their environment  

• fitness: survive long enough to leave copies or yourself behind  

- Individual

- Inclusive

• Many organisms are social organisms

• humans evolve in social groups  

• like traits, certain behaviors have survival values that are categorized • getting along with others is important for survival

• interaction is always a balance between competition and cooperation  • hierarchical structure found on societies - occurs naturally by humans

• Relationship between sex and power; higher power allows an individual to  reproduce

• aggression to a point allows you to have more access to food, mate, etc - same occurs with other traits; excessive amounts of such traits are also  troublesome

• society: range of personalities = true diversity; allows any given society to adapt to  environmental contingencies  

• Assortive mating

• stress dia-thesis model: nature vs nurture  

• Gene-environment correlation: people often seek out environments that support  their own innate tendencies  

- Classification  

• Assessments or prediction of people in categories; leads to diagnosis • main system - diagnostic and statistical manual of mental disorder (DSM)

• DSM III: attempt for medical psychiatry to seize back mental health; multi axial  system of diagnosis  

12

MHD CLP 4144 - I. Mental disorders

- II. Personality - MR

- III. Medical disorders related to mental disorder or independent

• DSM 5: a single axis

• in order for diagnosis to be useful, it needs to meet the following conditions: - Reliability: people in same subject will come up with similar diagnosis  - Validity

Lecture 5 (1/25/17)  

- Psychological Assessment

- Clinical Interview

- Psychological Testing  

• Background info (age, sex, family history, ect)

• history of presenting problem, appearance and behavior of individual

• testing falls into two branches (Cognitive testing used in neuropsychological  context, patient may have dementia, ADHD) (Personality testing, assesses less  quantative traits, patient may be narcissistic)

- Signs/symptoms of abnormal behavior: cannot be assessed used normal behavior is  determined

- sign: objectively observed by clinician; observation by test or naked eye (blood test) - Symptom: reported by the patient; cannot be directly observed

- Decision-making: combining both symptoms and signs to diagnose  - syndrome: cluster of signs and symptoms that occur together in a regular pattern and  that are associated with a given cause of etiology  

- Syndrome produces impairment in function or quality of life = disorder  - medical disorders: medical = ego-dystonic; person is aware of problem and wants to  get rid of it

13

MHD CLP 4144 - mental disorder: some mental disorders are ego-dystonic; but there are some  symptoms that are ego-syntonic. Person condones the symptoms

- General behavior

- mental status exam

- orientation: intact except in mood disorders; for time, place and person; the more  impaired, the more the orientation in deteriorated  

- speech and language:  

• pressured (manic episode)

• latency: delay between communication

• Preservation: can’t get off a specific/same topic

• circumstantial: returning to same form or output after a delay

• tangential speech: cannot stay on topic of conversation; tangents  • Aphasias:

- Expressive: individual difficulty in producing understandable language; they may  know what they want to say

• mild - anomia

- receptive: difficulty understanding what other people say

- Thinking

• flight of ideas: fast paced stream of consciousness; tangential thinking and speech - Flipping from one theme to the other  

• Paranoia: overly suspicious; making invalid conclusions  

• Grandiose ideas: narcissism; inflated view of ones own self-importance or  accomplishments

• Ideas of reference: neutral things that I connect with me  

Lecture 6 (1/27/17)  

- Delusions & hallucinations: congruent

14

MHD CLP 4144 - Mood: elevated, expansive; pervasive, long-term emotional state  

• Depression

• Angry, irritable  

- Flat, constricted  

- Affect: moment to moment expression of emotions  

• Constricted: shows limited range of emotions; focus on one emotion (one direction) - Labile affect: changeable to abnormal degree; easy to change; rapid mood swings - cannot effectively treat that which you have not adequately assessed  - Psychotherapy: application of principles of psych to help people with real problems  • Transformative: 

- goal is to transform the person’s psychological functioning

- personality altering experience  

- explore contents of own psyche  

- psychodynamic therapies  

- existential therapies

• corrective:  

- cognitive-behavioral approaches

- apply direct approach to alleviate the problem  

• Adaptational: 

- person is situation that they can’t fundamentally change  

- supportive expressive psychotherapies

- deal with unresolvable situations  

- less distress under circumstances

- Applications of psychotherapy: began as/dominated by individuals  • individual

• family therapy

15

MHD CLP 4144 • couples therapy  

• Child therapy: through proxy of parents; lots of problems come from parental  incompetence/negligence

• group therapy: non-related people; insights that one may resist council if provided  directly to him/her

- YAVIS:

• young  

• Affluent: better educated; more prone to listen to council

• verbal  

• Intelligent

• stable

- Internalizing problems: ones that are of distress to person themselves • Anxiety

- externalizing problems: person acts out; person causes distress to others  - psychotherapy as a treatment modality is effective; compared to most mental  treatments

• sometimes exceeds other medical treatments  

- Research established set of common factors that appear to have therapeutic effect  despite the brand of therapy being used.

• Eclectic psychotherapies: range of modalities that you pick and choose based on  person/problem

• Integrated psychotherapies: combine different types of modalities in unique ways  for each individual  

- Common facts: 

• Working alliances: patients and therapists work together

• Agreement in therapeutic goals

• realistic goals in terms of scope, time-frame, and reality factors  

• positive expectation: patient’s are optimistic in regard to therapy  16

MHD CLP 4144 • rationale for the change process

• patient's ability/willingness to change  

• perceived positive qualities of therapist

- Patients vary in criteria  

- leads to optimism in patient  

- Nurturance, support

• therapist's knowledge and flexibility

- subject matter must be known by therapists  

- therapist must be able to adapt to the circumstances of different patients  - Diagnosis/assessment  

- therapeutic techniques  

• therapists own interpersonal skills and maturity  

• patient’s opportunity for catharsis  

• creation of meaningful narrative

• Opportunity to learn and practice new attitudes and behaviors  

• most forms of psychotherapy seem to effective if the follow the points listed above

Lecture 7 (2/1/17)  

- Forensic Law  

- civil law: plaintiff-> lawsuit-> defendant

• family law  

• personal injury (fort)

• civil competency: static, impatient, recovery  

- Recording***

- Criminal Justice System

• charge against the defendant

17

MHD CLP 4144 • State: state attorney/district attorney or federal attorney  

• juvenile court: lacks a jury unlike adult court  

• judge: makes sure that all things are done in the right way; following all guidelines/ rules; gives out sentence

• Criminal competency: some defendants are so impaired to their attorney; that  examination of criminal competence is assigned by the court  

- evaluation of defendant: establish presence/absence of mental condition and  assess ability of what charges they’re facing, understand range of possible  penalties, participate in their own defense. and understand adversarial nature of  the law  

- person gives coherent account of what they did or what others are accusing them  of

- person must have rudimentary knowledge/understanding of how cases works in  order to defend themselves

- Non-competent: either released back into community or placed into secure  mental facility to receive treatment and competency restoration

• Insanity defense

- MSTO: Mental state at time of the offense

- NGRI: not guilty by reason of insanity  

- if a person is so impaired that they don't understand that nature of the act - sets  up the insanity defense

- Actus reus: a crime was committed

- Mons Rea

- invoked in 1/100 cases; 25% are successful  

- law excludes voluntary intoxication

- often people are not released and better yet confined to mental facility - law requires evaluation every 6 months to check if sanity and safety have been  restored  

18

MHD CLP 4144 - most people spend much longer in mental health facility than in prison for the  time that they would have been convicted  

• Prediction of future offending

- a person’s “dangerousness”

- Traumatic brain injury - most common around young adults

- Any part of the body within the skull = brain  

- Spinal cord:  

• conveys information upstream and downstream  

- medulla: life sustaining reflexes of the body (heart rate, breathing rate) - pons: cranial nerve involvement; contains bulge on ventral surface with cords that go  throughout the brain

- Midbrain: eye movement, postural movements  

- 85 billion neurons that connect with several thousands of other neurons  - Thalamus: major relay station for sensory and motor pathways of the brain • all senses go through it on way to cerebral cortex

• except olfactory sense

• coordinates info from limbic system, basal ganglia  

• Thalamus - cerebral cortex - thalamus - rest of body  

- Hypothalamus: center for bodily regulation functions

• Temperature  

• Hunger

• thirst

• sleep  

• Wakefulness

• Reproductive features

• agression  

19

MHD CLP 4144 • direct connection to pituitary gland (main controller of endocrine system) - Cerebellum: 1/5 volume of entire brain  

• more than half of the neurons/synaptic connections of brain  

• coordination of voluntary movement  

- Basal ganglia: responsible for postural, involuntary, and motivational aspects of  movement  

Lecture 8 (2/3/17)

- Amygdala: assesses how environmentally important something is - Hippocampus: ENCODES memory (doesn’t store it)

• Disruption: impairs encoding of memory in just that moment- “memory gap” • “Pay attention to this, it sounds important!”

- Hypothalamus: keeps you alive

• Hunger/thirst/body temperature

• Sleep/aggression

• Linked w/ pituitary gland- sends out messengers

• MAINTAINS homeostasis

- Cortical Lobes:

• Frontal: Broca’s area/speech

• Enables you to make plans, goals

• Make movements

• Everything you hope/dream/aspire to do

• Parietal: Gets info from senses; TOUCH

• Occipital: Interprets sights/vision

• Temporal: Auditory, some memory/motivation/emotion

- “Left” Brain:

• Controls right side of the body

• Number skills

20

MHD CLP 4144 • Math/scientific skills

• Written language

• Spoken language

• Analytical skills

• Logic/Reasoning

- “Right” brain:

• Controls left side of body

• 3D shapes

• Music/Art ability and skills  

• Intuition

• Creativity  

- There are ~85 billion neurons in the brain, and 86 billion glial cells - More advanced creature more folds in the brain (to make room for all of that  information!)  

- More complex a certain function is, the more likely it is to be lateralized to left/right  side of the brain

• Cross-representation for many senses (move on right, felt on left brain) • Left: Breaking things into small parts and analyzing them rapidly over time • Right: Processing things better over SPACE- intuitive/creative

• Analyzing visually over space  

• ***FEMALES TEND TO BE LESS LATERALIZED THAN MALES*** - 7 white fibers between sides:  

• Corpus callosum- helps you “put it all together” to have a singular experience - The more complex/evolved it is, the more bilateral a function likely is  - You tend to see brain/neurological issues in the two age extremes (old and young) • Young kids: developmental problems

• Older people: Neuro-degenerative conditions

- Neurodevelopmental Disorders

21

MHD CLP 4144 - Rarely is something purely physical or psychological

- Internalizing (primary effect on yourself- autism) or externalizing (primary effect is  on other people- ADHD)  

- ADHD- Attention Deficit Hyperactivity Disorder

• **MOST COMMONLY DIAGNOSED DISORDER**

• Hyperactive type: can’t sit still, super hyper

• Inattentive type: Distracted, daydreaming- can’t focus

• Generally no behavioral issues, just trouble focusing

• Mixed type: combination of the two

- It’s not like you have a “bucket” of attention and yours has a hole in it- you  allocate attention based on a higher goal

- Problem is self-moderating/self-control/regulation

- Used to think that the hyperactivity is a symptom of the inattention • It’s hard to focus on things your amygdala tells you isn’t important - Seems to be an issue in dopamine regulation- missing in many ADHD kids - Symptoms:  

• Attention dysregulation: lacking ability to efficiently allocate attention  • Distractibility  

• Impulsivity  

• Likely to become a bully (lash out)

• Impacts speech/behavior/emotions- also easy to BE bullied- react easily • Emotional lability- shows emotional response very quickly

• Impaired socialization

• Perceived by peers to be fundamentally immature

- Only consider personal needs

- Emotionally reactive

- Can’t hand delay in gratification

- Tend to have friends younger than themselves

22

MHD CLP 4144 - Poor self-regulation

• Planning

• Staying on/completing a task

- 2-4x more common in boys

• Girls tend to show more inattentive type (not as hyper)

• Tends to be overall more severe in boys

- Cause:

• Some genetic basis

• Some interruption of dopamine in ventral striata

- Most treatment involves correcting a deficit or overexpression of  neurotransmitters

- There IS an environmental aspect

• Most “child” therapy is training the parents on how to help their own kids - Why does it continue to exist in the population?

• Genetic diseases don’t often show until later in life

• But why CHILDHOOD traits like ADHD?

- Many maladaptive traits have adaptive qualities in their milder forms - A LITTLE adventurous, a little immature, a little out of the box can be a  good thing

- Severe ADHD, not so much

• Hyperactivity tends to decline with age, but the inattention/impulsiveness  tends to remain

- Treatment:  

• Life-changing results when treated correctly

• Psychostimulants: Caffeine/Meth/Nicotine/Adderall/Ritalin all have basically  the same effect

• Increases dopamine, more focus

• Too much dopamine Paranoid, jittery  

• Results can be seen almost immediately  

23

MHD CLP 4144 • SOMETIMES more structure can help too- you can help a kid learn how to  manage symptoms too

• Drugs may act as a “cast” on the brain to help the person get to a place  where they can then learn behavioral strategies to help even more  

• Most kids get SOME benefit, some none, some ALL the benefit

- Requires:  

• Thorough assessment of the patient

• Thorough knowledge of the issues/options for diagnosis

- Co-morbidities: Often occur together with ADHD- Kids not getting along with peers,  adults

- ODD- Oppositional Defiance Disorder

• Spectrum of pretty standard “bratty” behavior

• Breaking rules, lying, deceit, not doing their HW

- CD- Conduct disorder

• “mini psychopath”  

• The only difference in diagnostic criteria between CD and psychopaths is AGE  (under or over 18)  

• Extreme form of ODD- destruction, physical violence, extreme lying, theft, etc.  • Callous- “cold-blooded”

• Tend to start experimenting with drugs/sex at earlier than average ages  • Thrill-seekers, may take advantage of drugs

• Socialization factor- do happen in adopted children

• Some kids are pre-wired this way, even if the parents do everything right • Treatment: It’s hard to treat a personality

- Often unsuccessful in the most extreme cases

- Seem to be impervious to pain/punishment

- “Reproductive cheaters” even though they often end up on the outskirts of society,  they are slick and manipulative enough to manipulate/lie/take advantage their way  into reproducing

• Milder forms can reproduce too  

24

MHD CLP 4144 - SORT OF IRRELEVANT: IF GAY PEOPLE DON’T HAVE KIDS, HOW DOES THE  GENETIC TRAIT PERSIST?

• Sisters of gay men have 0.2 more children than other women

• Sisters can carry this genetic trait onto their own children

• Cause and effect can be tricky

- Moffit

- Adolescent- limited delinquency

• Typically starts around age 10/11 and ends by age 16/17

- Life-course persistent delinquency  

• Starts earlier and doesn’t stop by 16/17- continues into adulthood  • Persistent, severe aggression  

- LD- Learning Disorders

• Functioning at a level 2 grades below their actual age-based grade level • Theoretically can’t be diagnosed until 3rd grade

• Some tests exist to help diagnose 5-6 year olds, but can’t really be diagnosed  earlier than that because many kids are developmentally ready to learn in an  academic way until this age anyway

- Reading disorder- dyslexia

• These kinds of conditions are often named for what develops when adults  experience trauma in these areas of the brain  

• Brain can’t figure out symbols and linguistics

• Often more difficulty reading phonetically difficult works

• THREW may be easier to read than THROUGH

• Letters/words/comprehension

- Written expression: Writing disorder

• Small correlation between disorder and bad handwriting

• Inability to translate a thought into proper words/sentences

• Ability to read and write are usually below their age level

- Mathematic disorder: impacts ability to perform mathematical computations  25

MHD CLP 4144 - Aphasia: Difficulty understanding/expressing words

• Expressive, Receptive

- Communication Disorders

• Expressive language disorder: difficulty putting thoughts into words that can be  understood by others

• Speech: ORGANS of articulation; physical aspect of talking

• Language: CONTENT of what is being said; ability to interpret sounds as concepts  OR ability to turn these concepts into words  

• Inability to articulate

• Less developed vocabulary

• VOCABULARY: Strongly correlated with intelligence

• More words=More ways to articulate thoughts

• Many kids have language problems AND speech problems, even though they’re  technically separate things

- Phonological disorder  

• Stuttering: Trouble expressing CONSENANTS

• Stammering: Trouble expressing VOWELS  

• Difficulties expressing the finer aspects of speech

• Can be co-morbid with language disorders

- Normal Geschwind: Noticed clusters of these disorders tend to occur together  

• Left-handedness also has a higher predominance in people with these disorders;  males too

• Theorized that at the point in which the gonads differentiate during embryonic  development, there is an influx of testosterone in utero in males  

• Males with higher testosterone tend to have higher levels of aggression, learning  issues

• Boys are also slightly more likely to be left handed, because testosterone tends to  cause more neurons to go into the right hemisphere of the brain during  development

- NVLD- Nonverbal learning disorder

26

MHD CLP 4144 • Good at language, but are very clumsy, awkward, have a hard time imagining and  conceptualizing things

• Strong right hemisphere- good at school, but not as good at mechanical/conceptual  things

- Ribol’s Law: If you have become fluent in a second language after the critical period  and your language area is damaged, you are more likely to see regression of the  second language, not your first

- ASD- Autism Spectrum Disorder

• Close to/often confused with NVLD

• 3 classes:  

- Mild Asperger’s

- Moderate  

- Severe

• Severe impairment of different classes of socialization

- Can often see an increase in other cognitive functions (memory/language)  • Symptoms:  

- Impairment in social contact

- Won’t make eye contact- don’t see the value in it

- Impaired verbalization/communication  

- Even if they have elevated language skills  

- Need for sameness, regularity, stability, ROUTINE

- Language tends to be repetitive/sometimes made up words

- Enjoy motoric stimulation- twirling, spinning 

- **Most symptoms are typically non-specific**

- Pathognomic: a symptom that is almost always associated specifically with one  specific disorder

• Very distinct finger flapping movement  

• Ritualistic behavior- disrupting rituals can cause aggression

• Preoccupation with inanimate objects  

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MHD CLP 4144 • Puzzles/games

- Syndrome: collection or group of signs/symptoms that typically occur together;  characterized by having the full set

- Disorder: syndrome that causes some sort of IMPAIRMENT  

- Asperger’s

• No longer recognized by DSM- Just mild ASD

• Better communication skills than more severe ASD

• Language is often better

• Tends to be very formalistic

• Detached fascination with morbid things (sometimes)  

• Still likes motoristic stimulation, rituals, etc.  

• Brings up issue of competency to stand trial

• These people can know the law right down to the statutes, but if they can’t  emotionally process the effect that breaking the law can have on them  individually, can a person be considered competent to stand trial?

• Preservation of interpersonal communication skills

- Axis II of DSM- Personality and Mental Retardation

- Mental Retardation:  

• IQ below a certain level AND associated with behavioral issues

• IQ >70: Mild mental retardation; may just be the lower end of the standard IQ  spectrum

• 50-60: Moderate mental retardation

- Likely needs some degree of help, but can somewhat function by themselves • Under 50: Severe mental retardation; usually requires institutionalized care - Often associated with chromosomal abnormalities  

Lecture 9 (2/8/17) *recording*  

- Oppositimal defiant disorder

- Conduct disorder (asp)

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MHD CLP 4144 • Different than anti-social personality because it is diagnosed in individuals under  age 18  

• callous disregard for other people  

• cold-blooded  

• small percentage of population  

• aggression towards people  

• theft

• try substances by age 11  

• taking advantage of other sexually  

• precocious aggressiveness  

- Adolescent- limited delinquency  

• Rambunctious as children  

• by 16-17 years old, aggressiveness fades down and become more social - Life-course persist

• as children, tend to be rambunctious  

• peaks around puberty and remain constant for rest of their life  

• Severe aggression against other kids  

- ODD and OCD are co-morbid with ADHD  

• could lead to criminal behavior, substance abuse, seek excitement by lying,  stealing, taking advantage of people, etc  

- Adoptive Children

• early age child may get into trouble  

• parents are normal

• Children are pre-wired to be troublesome  

• most parents would blame themselves for child behavior  

- Treatment can't fix a personality  

29

MHD CLP 4144 • Unsuccessful treatment methods  

- Evolutionary psych states that there are reproductive cheaters

• Individuals that are good at manipulating people and leave enough of DNA behind  so that they may continue to exist in the population  

• male dominant although female examples exist as well  

- Sisters of gay men have slightly more children than the sisters of straight men  • among those offspring, some may carry trait for gayness  

- Learning disorders: performing two grades lower than actual level  • Diagnoses can occur as early as 3rd grade  

- reading disorder  

• dyslexia

• 18th  

- Writing disorder - written expression  

- mathematics disorder

- Communication disorders

• expressive language disorder  

• Phonological disorder

• Stuttering  

• Stammering  

- language is the content of what is being said  

- Geschwind

- NVLD: Non-verbal learning disorder syndrome = right hemisphere learning disorder  syndrome  

- ASD: autism spectrum disorder  

• Mild - asperger’s

• Moderate  

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MHD CLP 4144 • Severe  

- Ribot’s Law

- Pathognomonic: sign of a symptom often associated with a certain syndrome - mental retardation  

Lecture 10 (2/15/17)  

- Tourette’s Syndrome

- Acute organic brain syndrome - delirium  

• clouding of consciousness  

• difficulty having awareness of environment  

• impairness in alertness (how sleepy and aware you are)

• may vary between agitation, excitement, or lethargy

• Non-systematized delusions: person believes something is going on with no  narrative behind it. (ex. being scared of the color red for no reason)

• feelings of fear due to confusion  

• unfamiliarity breeds suspicion  

• acute (abrupt) or subacute (develops over hours or days) time course • caused by anything that messes with your brain  

- toxic metabolic systems, drugs (voluntary/involuntary), heart disease, anoxia,  diabetes, kidney disease, liver disease, high fever, malaria  

• Elementary hallucinations

- most people with disorders have hallucinations where they hear things more than  seeing things

- COMP: disturbances in cognition, orientation(time, place, person), memory and  perception (mainly elementary)  

- Dementia

• general term for progressive impairment of brain function  

31

MHD CLP 4144 • Alzheimer's disease (degenerative dementia)

- most common diagnostically  

- degeneration of neurons in various areas of the brain

- Build-up of abnormal proteins that cause degeneration of microtubules that keep  neurons alive

- build up of plaque that leads to degeneration of neurons  

- MRI/CAT scan of brain shows shrinking of brain by a significant amount  - Episodic memory  

- new learning  

- attention and memory working  

- language processing: aphasia - speech is shortened/clipped, difficulty coming up  with right word, uses closely related words  

- visuospatial abilities: agnosia - impairment in higher order perception; seeing or  hearing something but difficulty identifying it

- complex movement: apraxia - disturbance in complex movement  - executive functions: reasoning, planning, task completion, emotional and  behavioral self-regulation

• Mediated by frontal lobe

• impulse control is also a problem  

- may begin with changes in attention, concentration, recall, memory  - language disorder: anomia - inability to come up with the right word; typically  nouns

- behavior tends to remain constant  

- Seconds stage: changes in language (tangential), more concrete, less abstracts,  more perseverative

- Pathognomonic: particular symptom that occurs with a specific symptom - Sundowning: person becomes more agitated at night, in a dark room, or in an  unfamiliar place

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MHD CLP 4144 - Corphologia: imaginary picking; regressive self-grooming behavior  - Loss of inhibitory control  

- memory is the main function to be affected  

- Stage three: development of true cortical signs of degeneration of the cerebral  cortex (aphasia, alexia, agraphia, agnosia, apraxia, amnesia)  

- temporal gradient in memory: as disease progresses the more recent memories  are more vulnerable to forgetting than the older memories  

- mirror sign: individuals look at themselves in mirror examining their face  • Prosopagnosia: impairment in recognizing human faces

• Lewy body dementia

- motor stiffness and rigidity  

- Attentional impairment  

- PPT SLIDES  

• Frontotemporal dementia

- Degenerative disease  

- memory is relatively intact and functions of frontal lobe are impaired  • Vascular/multi-infarct dementia  

- due to small hemorrhages in the brain  

- could be caused by cardiovascular disorders o

- not a primary disease of the brain itself  

- step-wise decline: drop in functioning followed by stability then a drop

Lecture 11 (2/17/17)  

***Midterm: March 3rd, 2017***

- Differential diagnosis: consider age of patient  

- Alzheimer’s: most common degenerative dementia  

33

MHD CLP 4144 - NPH: normal pressure hydrocephalus  

• Obstruction of cerebral spinal fluid outflow

• Overproduction of cerebral spinal fluid  

• CSF: found flowing through the nervous system; absorbed in larger veins of the  brain  

• Interference of the flow may lead to degeneration  

• build up in later adults - impairs brain function with distance triad of symptoms • affects frontal and thalamic brain regions  

• Impairments in gait - people cannot control their steps

• Unsteady on feet

• Urinary incontinence  

• Frontal lobe impairment - leads to impulsivity, aggression

• NPH: treatable disorder through a shunt  

- Sub-cortical dementias: more difficult to diagnose  

• Parkinson’s, Huntington’s

• affect subcortical structures and cortes  

• Symptoms:

- thinking and physical movement slow down

- apathy  

- lack of motivation  

- inertia: have trouble initiating and stopping activities  

- failure to learn new information  

- changes in emotion - mood swings  

- Depression  

• alteration in concentration  

• Trouble retrieving memories

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MHD CLP 4144 • low stamina

• motivation and activity slows down  

• can precede Alzheimer’s  

- Anxiety  

- Delusional disorder  

• Perfection, jealousy, grandiosity

- Capgrass Syndrome

• delusion of doubles  

• Believes that a close person was replaced by an identical double  - Charles Bonnet Syndrome  

• beauty and the beast  

• people claim that objects are moving on their own  

- Traumatic brain injury  

• Comes as a results of a head injury  

• types

• open or penetrating injury  

- any breach of the skull

- any exposure of inner content of the skull to the outside world

• closed

- no breach  

• concussion

- mild: recover pretty much 100%

• coup injury: point where the brain strikes the skull

• Rupture of brain tissue and blood vessels (contusions)

• Formation of gas bubbles  

• Inertia causes opposite side to be damaged as well  

35

MHD CLP 4144 • Hematomas  

• death of neurons  

- DAI: diffuse axonal injury  

• Rupture and twisting of axons - disrupt ability to conduct processes to keep cell  alive

- Edemas  

- Mild: produces loss of consciousness for no more than one hour  - Post-concusison syndrome  

• physical: headaches, dizziness, fatigue, problems with sleep, hypersensitive to  noise or light (phonophobia/photophobia)

• cognitive: impaired attention and concentration, difficulties with memory and new  learning, person becomes less organized, problems with speech, reading, and  spelling, poor judgment, difficulty conceptualizing things, impulse control

• emotional: irritability, anxiety, depression, sleep disorder, over-concern or not  concerned at all with health

• individual is disinhibited and goes towards the direction of who they already were  • symptoms overlap with symptoms of post traumatic brain disorder - Population most at risk for TBI: young males  

- Risk factors following TBI is risk for epileptic seizures

• indicate that there is a cause - brain tumor, mini-stroke, subtle damage to areas of  the brain  

- Seizure disorder = epilepsy  

• syndrome characterized by pattern of seizures  

• grand mal seizure: loss of consciousness, muscles tighten up, last several seconds  to minutes before consciousness is achieved again

• the more seizures you have the more unstable the brain becomes and the more  prone you are to seizures in the future  

• focal seizures: only affects one part of the context and only affects that part  36

MHD CLP 4144 • petit mal seizure: 

- young and early teens

- involve momentary loss of consciousness,no muscle tightness, out for a few  seconds,

- becomes serious when there are more than about a dozen occurring in a day

Lecture 12 (2/22/17)  

• Temporal lobe seizure or psychomotor seizures or partial-complex seizures  - Micropsia

- Macropsia  

- Oscillopsia  

• Psychological symptoms:

- oneirism: dream-like state  

- forced thoughts or emotions

- deja vu: sense of having experienced something previously even when you  logically know you haven't  

- Jamais étendu

• Autonomic nervous symptoms  

- bodily fluids  

- Pyloerection  

- salivation  

- Hunger pains

- pelvic symptoms  

• Somatomator phase

- automatisms: rubbing, patting, opening and closing objects  

• Postictal stage: after seizure  

- amnesia during part of seizure  

37

MHD CLP 4144 - may progress to grand Mal seizure

• Interictal behavioral/personality syndrome  

- children who grew up with seizures showed distinct behavior/personality  differences but not due to seizures

- occurs during period between seizures  

- Emotional deepening: take things very seriously

- Kids don't act like kids  

- Overly serious demeanor  

- Hyper-moralism

- Hyper-religionism  

- Hyper-philosophism  

- Obsessionalism  

- Hypergraphia: compulsive obsessive overly writing; use ever mm of space on a  page

- Viscosity: uncomfortable closeness of interpersonal communication - hypo-sexual: far less interest in sex; casual celibacy  

- fetishes: unusual sexual interest or practices  

- sometimes misdiagnosed with childhood schizophrenia  

- BIFGS  

- Substance abuse: use of any substance that interferes with one’s life in any way  • use of the substance causes you to fail to meet certain obligations  • repeated use in situations where its dangerous to do so  

• increased strife with family  

- Substance dependence:  

• implies level of addiction

- tolerance: more of the substance is needed to produce the same effect  38

MHD CLP 4144 - withdrawal: removing drug causes rebound effect; usually opposite to substance  effect  

- Intoxication

• diagnostic criteria: often usage of the drug and increase of intake; person cannot  slow down or stop taking it; currently trying to get substance; substance used  despite drawbacks and problems in life  

- Genetic predisposition to substance addiction/abuse has been found in some people  with a specific allele

• they are 5-10 times more likely to become addicted/dependent than another perps  without the allele while taking the same amount  

- Alcohol  

• sedative & hypnotic (helps you goes to sleep) drug  

• Helps you sleep but doesn't help you stay asleep

• High tolerance and withdrawal - like barbiturates  

• Severe withdrawal symptoms  

• Alcoholic dementia  

• Associated with anxiety, depression, and social phobia  

• hepatic encephalopathy  

• fetal alcohol syndrome in pregnant women  

Lecture 13 (2/24/17)  

- Sedative-Hypnotic drugs  

• alcohol  

• Anxiolytics  

- barbiturates

- benzodiazepines: librium, valium, xanax

- Stimulants

• amphetamines  

39

MHD CLP 4144 • cocaine  

• stimulate the production of dopamine  

• post synaptic receptor molecules downgrade

• motivation molecule - dopamine

• Rebound effect: system crashes

• slowed down, depressed feeling - withdrawal  

• amphetamines are also used medically  

• appetite suppressants  

• aid in concentration in small doses - children with ADHD whose dopamine systems  are functioning completely  

• People with moderately high of caffeine = lower rate of diseases such as  Parkinson’s  

• Amphetamine high is similar to manic episode  

- Hallucinogens  

• Produce an altered sensory, perceptual and emotional state

• LSD: first use in aid with interrogations

• no withdrawals symptoms  

• no known overdose - illegal  

• long term effects target the serotonin system  

• ecstasy= amphetamine and hallucinogen

• THC/Marijuana: mild hallucinogen

- high doses produces hallucinogen  

- usual doses it produces a calm euphoria  

- known to induce tachycardia  

- stimulates appetite

- can affect memory - slightly  

40

MHD CLP 4144 - time dilation: things seem to take longer than they are  

- no clear lethal dose  

- THC: extremely fat soluble  

- Opiates

• Receptors in brain found - endorphins  

• Poppy plant boiled to produce opium  

• opium can be synthesized to create morphine  

- Analgesic dose is lower than the euphoric dose

• euphoric dose is what addicts crave - “the buzz”

• Produce a sense of rushing bliss, comfort, and release of pain  

• Heroin: synthesized an non-addictive alternative to morphine

• Methadone, Vicodin

• drugs occupy part of the receptor molecule but not all of it completely  • Produce tolerance, withdrawal symptoms

• lethal dose exists  

• Naloxone (Narcam): blocks receptor so that the opiate is inhibited  - “unhighs you”

- Organic hydrocarbons

- anabolic steroids: analogs of testosterone  

• increase in muscle mass

• Pumped feeling  

• Side effects

- roid rage - aggressiveness

- increased acne  

- hypothalamus slows down

41

MHD CLP 4144 - Production of releasing factor slows down, testes produces less endogenous  testosterone, testes shrink up to 20%

- testosterone leads to production of estradiol which leads to breast development  - Personality: trait/type  

- personality disorder: extreme degree that causes a problem to an individual or to the  people around them  

• disorders are a controversial topic in regards to diagnosis  

• people usually have mixtures of personality disorders at different degrees  • Disorders found in DSM: article on BB

- a. Odd

- b. Dramatic

- c. Anxious  

• Odd disorders

- Schizoid

- Schizotypal  

• Schizoid symptoms plus more bizarre thinking, strange behavior, somewhat  delusional, hold strange beliefs  

- Paranoid  

• always seem to be watching their back  

• accurate in perceptions about people  

• know about human nature  

• have difficulty in interpretation which are usual malevolent  

• have obsessive compulsive traits  

• often in conflicts  

• Dramatic disorders

- narcissistic  

- histrionic

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MHD CLP 4144 - bordeline  

- Anti-social  

• anxious disorders  

- Avoidant  

• social inhibition  

• feelings of inadequacy, hypersensitive to negative evaluation or criticism  • afraid of people  

• uncomfortable by people, not against them  

• wish they could be more social  

• Long for human companionship which is hard to achieve  

• co-morbid with mood an anxiety disorders and substance abuse  • seen as likable but reserved  

• seen more in women than men  

- Dependent  

• pattern of submissive and clinging behavior stemming from excessive need  from being taken care of  

• desperately need people, job, employer, position  

• Co-morbid with panic, mood, anxiety, eating disorders

• Assertive mating: may link up with someone who has a narcissistic disorder • clawing, clinging, jealous, paranoid, insecure in relationships

• relationship batterers  

- Obsessive compulsive  

• Preoccupied with orderliness, perfection, control, rigidity, stubbornness, and  attention to detail

- J  

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