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MIZZOU / Psychology / PSYCH 2510 / What are the three main clusters of personality disorders?

What are the three main clusters of personality disorders?

What are the three main clusters of personality disorders?

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School: University of Missouri - Columbia
Department: Psychology
Course: Survey of Abnormal Psychology
Professor: Julianne ludlam
Term: Spring 2019
Tags: abnormal psych
Cost: 50
Name: Abnormal psych, Exam 3 and Final Study guide
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Abnormal Psychology 2510


What are the three main clusters of personality disorders?



Exam 3 Study guide  

Professor Gizer, Mizzou

Spring 2019

Exam 3 Study guide

Chapter 10: Personality Disorders

Personality Disorders: Definition 

∙ Personality disorder: Dysfunctional personality traits and associated  problems like relationship disturbances and impulsive behavior. o Enduring pattern of inner experience and behavior that deviates  from cultural norms:

 Unusual ways of thinking of themselves and others  

(cognitive), experiencing and expressing emotion  

(emotion/affect), interacting with others  

(interpersonal), and controlling impulses (impulse  

control)

o Enduring pattern is inflexible and pervasive, long-standing and  often traced to childhood or adolescence

Current Conceptualizations of Personality 

∙ Deductive/ Theoretical

o Scales based on hypothesis/previous research on the structure of the personality


What is a schizoid personality disorder?



 Interpersonal circumplex

∙ Empirical

o Data dictates underlying structure

 Degree one has: Openness, Extraversion, Neuroticism  

(tendency to expresses negative emotion states),  

Conscientiousness, and Agreeableness

The Three Main “Clusters” of Personality Disorders 

∙ Odd or eccentric: Paranoid, Schizoid, and Schizotypal o People display features that seem bazar to others

∙ Dramatic, emotional, or erratic: Antisocial, Borderline, Histrionic,  and narcissistic

o People display features that seem exaggerated to others ∙ Anxious or fearful: Avoidant, Dependent, and Obsessive-Compulsive o People display features that seem apprehensive to others

Odd or Eccentric Personality Disorders: Features and Epidemiology

∙ Paranoid Personality Disorder: Pervasive distrust and suspiciousness of  others


Marked by pattern of display of grandiosity, need for admiration, and lack of empathy beginning early adulthood.



 Suspects others are exploiting, harming, or deceiving them  Preoccupied with unjustified doubts about  

friends/associates Don't forget about the age old question of the tube-like passageway found in the temporal bone that allows sound waves to reach the eardrum is an example of which of the following bone surface markings?

 Reluctant to confide in others because fear information will  be used against them

 Reads hidden demeaning or threatening meanings into  things that have no relevance

 Persistently bears grudges

o Does not occur only in course of psychotic disorder or episode o High Neuroticism, moderate conscientiousness, low  extraversion, openness, and agreeableness

∙ Schizoid Personality Disorder: Marked by social isolation and restricted  emotional expression beginning in early adulthood as indicated by 4+  of following

 Doesn’t desire or enjoy close relationships, including family  Almost always choose solitary activity

 Little interest in sex

 Takes pleasure in few, if any, activities

 Lacks close friends other than 1st degree relatives

 Appears indifferent to praise or criticism We also discuss several other topics like gluconeogenesis bypass steps

 Shows emotional coldness, detachment, or flattened affect o Doesn’t occur in course of psychotic disorder or episode and not  accounted for by medical condition or pervasive developmental  disorder

o Moderate neuroticism, agreeableness, and  

conscientiousness, low extraversion and openness ∙ Schizotypal Personality Disorder: Marked by detachment from  relationships and restricted range of emotions beginning in early  adulthood as indicated by 4+ of following

o May have Ideas of reference: believe everyday events somehow  involve them when they actually don’t

∙ Epidemiology  

o life Time Prevalence Rates:

 Paranoid: 1.9%

 Schizoid: 0.6%

 Schizotypal: 0.6%

 TOTAL: 2.1%

o Personality disorders occur in 4-15% of the population o Associated with significant social and occupational impairment,  comorbid psychopathy, lower quality of life, and suicide We also discuss several other topics like lexication
We also discuss several other topics like the layer of the gi tract wall that is responsible for motility is the

o There are not many racial and ethnic differences, but it is  considered in assessment

Dramatic Personality Disorders: Features and Epidemiology ∙ Antisocial Personality Disorder: Pervasive pattern of extreme disregard  for and violation of the rights of others, impulsivity, and involves  deceitfulness, criminal acts, irritability/aggression, and irresponsibility  occurring since age of 15

o Person must be at least 18 years old

o Must be evidence of conduct disorder (: aggression toward  people and animals, property destruction, deceitfulness or theft,  and serious violation of laws/rules) before age 15 We also discuss several other topics like text figures

o Does not occur only during courses of schizophrenia or manic  episodes

∙ Examples include “Dexter” and “American Psycho”

o Callous unemotional traits are a key feature of the syndrome  Lack of responsivity to negative stimuli (distress in others)  Abnormalities in responsivity to rewards and punishments  Preference for novel and dangerous activities

o If behavior continues, may lead to Psychopathy: Little remorse or guilt, poor behavior control, arrogance, superficial charm, exploit, and lack of empathy

o High neuroticism, extraversion, and openness, low  agreeableness and consciousness

∙ Borderline Personality Disorder: Pervasive pattern of impulsivity and  unstable affect (emotion), interpersonal relationships, and self-image;  beginning by early adulthood. We also discuss several other topics like What are the Labor Force Participation Rate and Unemployment Rate Calculations?

o 10% commit suicide and 60-70% attempt suicide

o High neuroticism, openness, moderate extraversion, low  agreeableness, consciousness  

∙ Histrionic Personality Disorder: Marked by excessive need for attention, superficial and fleeting emotions, and impulsivity beginning in early  adulthood and indicated by 5+ of following

 Uncomfortable when not center of attention

 Interactions characterized by sexually seductive or  

provocative behavior

 Rapid shifting and shallow emotion expression

 Consistently uses physical appearance to draw attention to self

o High neuroticism, extraversion, openness, agreeableness,  low consciousness

∙ Narcissistic Personality Disorder: Marked by pattern of display of  grandiosity, need for admiration, and lack of empathy beginning early  adulthood  

o High neuroticism, extraversion, openness, moderate  consciousness, low agreeableness

∙ Epidemiology

o Life Time Prevalence Rates:

 ASPD: 3.8%

 Borderline: 2.7%

 Histrionic: 0.3%

 Narcissistic: 1.0%

 TOTAL: 5.5%

Anxious or Fearful Personality Disorders: Features and Epidemiology ∙ Avoidant Personality Disorder: Marked by pattern of social inhibition,  feelings of inadequacy, and hypersensitivity to negative evaluation  beginning by early adulthood

o Want close relationships, if they get one they likely become  dependent

o High neuroticism, agreeableness, moderate consciousness,  low extraversion, openness

∙ Dependent Personality Disorder: Marked by pervasive, extensive need  to be cared for, leading to submissiveness, clinging behavior, and fear  of separation beginning by early adulthood  

o High neuroticism, extraversion, agreeableness, moderate  openness, low consciousness

∙ Obsessive-Compulsive Personality Disorder: Marked by preoccupation  with orderliness, perfectionism, and control at the expense of flexibility beginning by early adulthood  

o High neuroticism, consciousness, moderate agreeableness,  low extraversion, openness

∙ Epidemiology

o Lifetime Prevalence Rates:

 Avoidant: 1.2%

 Dependent: 0.3%

 O-C: 1.9%

 TOTAL: 2.3%

Causes of Personality Disorders 

Odd or Eccentric Personality Disorders

∙ Biological Risk Factors

o Genetics

 Basic traits of FFM are heritable (20-50%)

 Faucet-level traits show similar heritability’s

∙ Impulsivity, hostility, trust, depression, assertiveness,

altruism

∙ Environmental Risk Factors

o Distorted cognitions

o Childhood maltreatment

 Neglect

 Emotional withdrawal

Dramatic Personality Disorders

∙ Biological Risk Factors

o Brain Regions

 Smaller size in areas related to moral development

∙ Amygdala, hippocampus, prefrontal cortex, basal  

ganglia, and thalamus

 The mesolimbic system

∙ Prefrontal cortex, nucleus accumbus, and ventral  

tegmental area

o Genetics

 Moderate predisposition (0.3%-0.5%)

∙ Environmental Risk Factors

o Childhood maltreatment

o Poor parental bonding

o Cognitive beliefs

Anxious or Fearful Personality Disorders

∙ Biological Risk Factors

o Personality traits related  

 Behavioral inhibition, tendency to anticipate harm,  

excessive sensitivity to negative events, heightened  

arousal, tendency to see threat in benign events

∙ Environmental Risk Factors

o Avoidant: Anxious, introverted, and unconfident person  experiences repeated episodes of embarrassment, rejection, or  humiliation in childhood

o Dependent: Anxious/fearful temperament and insecure  attachment to parents

Prevention of Personality Disorders 

 Reducing child maltreatment

 Interpersonal/Social Skills Training

 Empathy/Moral reasoning training

 Improving emotion identification and regulation

Assessment of Personality Disorders 

∙ Self-Report Questionnaires

o Used as screening instruments

o Positives: cost and time effective

o Negatives: rely on client feedback, don’t assess level of  impairment and how long symptoms have been around/started  ∙ Structured Interviews

o Positives: Systematic, comprehensive, replicable and objective o Negatives: take time to administer, less focus on dimensional  aspects

∙ Unstructured interviews

o Positives: can ask/talk about anything

o Negatives: less reliable and more susceptible to bias

∙ Informant reports

o Informant report: People who know the client complete ratings of client’s personality traits and behaviors

o Positives: get another perspective

o Negatives: often conflict with self-reports, unsure which to trust, people may not know client as well as they think, may make  assumptions about client, have bias towards client

Treatment of Personality Disorders 

∙ Biological Treatment

o Medication (used primary to target borderline personality  disorder population)

 Ease anxiety and depression: SSRIs

 Stabilize mood: SSRIs, mood stabilizers (anti-epileptics)  Reduce psychotic symptoms: Antipsychotics

 Reduce aggression: SSRIs, mood stabilizers, antipsychotics ∙ Psychological Treatment

o Dialectical Behavior Therapy

 Key strategies:

∙ Interpersonal effectiveness skills training

o Learn to manage interpersonal conflicts,  

appropriately meeting needs/desires, saying no

to unwanted demands

∙ Emotional regulation skills raining

o Identify emotional states, understand how  

emotion effects them and others

∙ Distress tolerance skills training

o Learn to cope through stressful situations using

distraction exercises

∙ Mindfulness skills training

o Learn to self-observe attention and thought  

without being judgmental

 Often done in groups and lasts months to a year

o Cognitive-Behavioral Therapy

 Focus on easing symptoms of anxiety and depression

 Challenge cognitive distortions, social skills training, etc. o Short-Term Psychodynamic Therapy

 Frequent meetings with therapist to develop close alliance  and help client transfer negative emotions

 Focuses on conflicts/themes impeding in client’s life

Chapter 12: Schizophrenia and Other Psychotic Disorders

Schizophrenia Spectrum Breakdown 

∙ Schizophrenia: Symptoms last at least 6 months

∙ Schizophreniform Disorder: Symptoms last 1-6 months ∙ Brief Psychotic Disorder: Symptoms last less than 1 month ∙ Schizoaffective Disorder: Symptoms of schizophrenia and a mood  disorder

∙ Delusional Disorder: Non-bizarre delusions (plausible), without  other symptoms, lasting at least 1 month

Psychotic Disorders: Definitions 

∙ Psychotic Disorders/ Psychoses: Class of mental disorders marked by  schizophrenia and/or related problems

o People have unusual emotion states/affect and behaviors and  trouble organizing their thoughts to communicate well

 Flat Affect: Lack of variety of emotion expression; lack of  emotion even in times of great joy or sadness

 Inappropriate affect: Mood that doesn’t match the situation  Delusions: Irrational beliefs involving misinterpretation of  perceptions or life experiences; very rigid or bizarre  

thoughts

 Hallucinations: Sensory experiences without an  

environmental stimulus person believes is true

 Catatonic: Tendency to remain in near immovable state for  hours/ long periods of time

o People, especially in active phase, can’t work communicate with  others, think rationally, or care for themselves.

Features and Epidemiology 

∙ Schizophrenia

o At least 2+ of following symptoms present usually for at  least 1 month. Cause significant social/occupational impairment  and isn’t due to use of substance or a medical condition.  

Schizoaffective and mood disorder with psychotic features have  been ruled out. Disturbance must last at least 6 months.  Delusions

 Hallucinations

 Disorganized speech

 Disorganized or catatonic behavior

 Negative symptoms

o There are 2 groups of symptoms

 Positive Symptoms: Excessive or overt (obvious) symptoms ∙ Hallucinations-- Most common in schizophrenia is  Auditory: Hearing voices.  

o Visual: Seeing things that aren’t there.  

o Tactile: Feeling things on skin that aren’t  

there.  

o Olfactory: Smelling things that aren’t there.  

∙ Delusions—Usually very fixed beliefs, highly resistant to others attempts to persuade person otherwise.  

The most seen in people with schizophrenia is  

Persecutory delusions: Being harmed or harassed. o Control delusions: Thought insertion (people  

placing ideas in their head), thought  

broadcasting (people transmitting their  

thoughts to everyone), and thought withdrawal

(people stealing their thought and creating  

memory loss)

o Grandiose delusions: Possess unusual power

or importance

o Referential delusions: Random events have  

something to do with them/a special meaning

o Somatic delusions: Body is being affected by

outside sources

 ∙     Disorganized speech: Disconnected, fragmented  interrupted, and/or tangential speech

o Loose association: Mix phrasing

o Neologism: Make up words that don’t have  

meaning to others

o Clang association: Say words together that  

rhyme

o Tangentiality: Person speaks clearly, stops  

without warning, and talk about a completely  

different topic

o Repeat same word over and over

o Not speak at all

 ∙     Disorganized Behavior—Unable to take care of self  and engage in appropriate hygiene, dress, or eating.  Highly agitated or show inappropriate affect

 ∙     Catatonic Behavior: Unusual motor symptoms

o Catatonic stupor: Not react to environment  

events or unaware of surroundings

o Waxy flexibility/catalepsy: Persons body  

part can be moved to an odd posture and  

maintain it for long hours

o Echolalia: Repeat others words

o Echopraxia: Repeat others actions

o Adopt rigid posture that’s difficult to change

 ∙     Inappropriate affect 

 Negative symptoms: Deficit or covert symptoms; showing  too little of certain behavior

∙ Alogia: Speaking very littles and appearing  

withdrawn

∙ Avolition: Inability or unwillingness to engage in goal directed activities (Caring for self, working; person  

seems depressed)

∙ Anhedonia: Lack of pleasure or interest in life  

activities

∙ Flat affect: Showing little emotion

∙ Lack of insight: Poor awareness of one’s mental  

condition; common in schizophrenia

o Phases of Schizophrenia

1. Prodromal phase: Peculiar behavior and negative  symptoms; can last days, weeks, months, or years

a. Peculiar behaviors—Minor disturbances in speech and  thought process, odd or withdrawn social interactions,  perceptual distortions, attention and memory problems,  and symptoms of depression and anxiety

b. Negative symptoms—Make it hard to determine what  person has, may resemble severe depression

c. Positive symptoms in a lesser form—unusual perceptual  beliefs or experiences—may be in this phase

2. Psychotic prophase: 1st “full blown” positive symptom;  positive and negative symptoms must last 6 months to be  diagnosed

3. Active phase: The 6-month period must include a 1-month  phase that includes many positive and negative symptoms 4. Residual phase: Following treatment, low-grade symptoms,  similar to the prodromal phase

o Subtypes of Schizophrenia

 Paranoid  

 Disorganized

 Catatonic

 Undifferentiated

 Residual

o Dimensions of Schizophrenia (Degree to which one  experiences…)*

 DSM-5 has a rating scale for dimensions of schizophrenia  to apply to people with mixed symptoms better

∙ *Delusions

∙ *Hallucinations

∙ *Abnormal psychomotor behavior

∙ *Disorganized speech

∙ *Negative symptoms

∙ *Impaired cognition

∙ *Depression

∙ *Mania

∙ Schizophreniform Disorder: Positive and negative symptoms of  schizophrenia, episode includes all phases and last 1-6 months ∙ Schizoaffective Disorder: Positive and negative symptoms of  schizophrenia with a major depressive, manic, or mixed episode.  Delusions/ hallucinations for at least 2 weeks without prominent  symptoms of a mood disorder and symptoms of a mood disorder are  present during most of the schizophrenia phases; schizophrenia  symptoms are considered primary

∙ Delusional Disorder: 1+ delusion/s that last at least 1 month without  positive and negative symptoms of schizophrenia. No significant  interference in daily functioning and the persons behavior is not  obviously odd or bizarre. If mood symptoms present, they’re brief  compared to the delusional symptoms.

o May have 1+ of following delusions

 Erotomanic: Mistaken belief special person (celebrity,  etc.) loves them from a distance

 Grandiose: Mistaken belief one is especially powerful,  famous, or knowledgeable

 Jealous: Mistaken belief one’s spouse is having an affair  Persecutory: Mistaken belief another person is aimed to  harm them

 Somatic: Mistaken belief about one’s body

o folie a deux: Person develops a delusion because of their close  relationship with another person who has a delusion; the two  often share similar ideas with respect to the irrational idea

∙ Brief Psychotic Disorder: 1+ positive symptoms of schizophrenia,  episodes last 1 day - 1 month with return to premorbid level of  functioning  

o Postpartum psychosis: Psychotic symptoms in mother after birth  of child; symptoms often dissipate after person becomes better  at being able to cope with the stressor

Epidemiology of Psychotic Disorders 

∙ Lifetime prevalence rates

o Schizophrenia: 0.33-0.72%

o Schizophreniform: 0.09%

o Schizoaffective: 0.5-0.8%

o Delusional: 0.01-0.05%

∙ Characteristics of Schizophrenia

o Median age of onset is 22 years

o Slightly more common in males

o Age of onset slightly older in females

o Mood and substance use disorders frequently comorbid o About 5% die by suicide

∙ Associated with low SES. (2 Theories)

o Poverty as causal factor

 Says that socioeconomic inequality causes stress that  

gives rise to mental illness

o “Downward Drift” theory

 Idea is that you are afflicted with serious mental illness, or  become addicted to a harmful substance, which in turn  

leads to a slow, inevitable slide downward in social class. 

Biological Risk Factors for Psychotic Disorders 

∙ Genetics

o Immediate family (siblings, children, and parents) have a 50%  genetic overlap and relatives (Half siblings, grandchildren,  nephews and nieces, and uncles and aunts) have a 255 genetic  overlap.

o Heritability = 0.81

o Schizophrenia has a strong genetic basis; kids whose parents  have it are 12x more likely to and grandchildren are 3x  

 Genetic influences are polygenic and come from all over  the genome

 Polygenic/multilocus model: Many people with  

schizophrenia have multiple genes that work together to  

help produce the mental disorder

 De novo mutation: A mutation that occurs in parent germ  line or early embryogenesis that is not shared with either  

parent

∙ Accumulate in the male germ line with age

∙ Is believes that this underlies the relation between  

advanced paternal age and increased risk for  

schizophrenia in offspring

∙ Studies of this mutation suggest risk genes for  

schizophrenia in the Glutamate system, in synapse  

formation, overlap with autism and intellectual  

disability

∙ Brain Features

o Progressive loss of grey matter

o Lack of asymmetry

o Enlarged ventricles (Spaces/gaps in the brain)

 Either means general failure in normal brain development/  disruption of pathways from 1 area in the brain to the next  OR added space means critical areas in the brain are less  well developed than they should be

o Smaller Basal Ganglia and Cerebellum—Motor behavior output  and higher order brain areas

o Smaller Hippocampus and Amygdala-- Verbal and spatial  memory processing and emotion

o Smaller temporal Lobe—Auditory processing and language  problems

∙ Neurochemical Features

o Prominent theory of Schizophrenia is that symptoms are caused  by excess of Dopamine; lots of evidence to support:

 Positive symptoms treated with medications that lower  Dopamine levels

 Antipsychotics produce Parkinson’s-like side effects

 Excess Dopamine can produce psychotic-like effects

 L-dope can produce psychotic symptoms

∙ Cognitive Deficits

o Key deficits in:

 Memory

 Attention

 Learning

 Language

 Executive functions (Problem-solving, Decision-making)

Environmental Risk Factors for Psychotic Disorders 

∙ Toxoplasmosis

o One of the world's most common parasites; Infection usually  occurs by eating undercooked contaminated meat, exposure  from infected cat feces, or mother-to-child transmission during  pregnancy 

∙ Prenatal Complications

o hypoxic ischemia: Low blood flow and oxygen to the brain,  closely involved with psychotic disorders; can lead to enlarged  ventricles

∙ Prenatal Malnutrition

∙ Prenatal Infection

∙ Family Factors

o Communication Deviance: occurs when a speaker fails to  effectively communicate meaning to their listener with confusing speech patterns or illogical patterns

o Expressed Emotion

∙ Substance Abuse

o Drugs could lead to symptoms; excessive use common among  people with schizophrenia symptoms

o More likely to abuse weed

o Substance use disorder and schizophrenia share common risk  factors like increased mesolimbic dopaminergic activity

∙ Adverse Life Events

o Traumatic life events common

o Stress in weeks and months before onset of schizophrenia  symptoms common

Assessment of Psychotic Disorders 

∙ Interviews

o Difficult for people with this disorder because of delusions,  hallucinations, suspicions, and disorganized thoughts and  

behaviors.

o Unstructured—Gets as much information as possible

o Semi structured—Brief Rating Scales and Schedule for Affective  Disorders and Schizophrenia

∙ Behavioral Observations

o Useful to evaluate social and self-care skills

o Most effective is to observe in multiple settings and get  information from client’s family and friends

∙ Cognitive Assessment

o Intelligence testing

o Achievement testing

o Memory testing

o Executive function testing

∙ Physiological Assessment

o Symptoms may have biological bias, so medical explanations  should be ruled out

o Lab tests done to examine levels of neurotransmitters and illegal  or legal drugs

o Test client’s compliance with prescribed medication/s and note  any potentially dangerous drug interactions; MRI testing included

Biological Treatment of Psychotic Disorders 

∙ Medication  

o Reduces symptoms in 65% of patients; drugs considered more  effective than any other approach used alone; most  

improvement occurs in fist 6 months; symptoms usually return

without medications, but medications are not always  

effective;  

o Typical antipsychotics: Reduced excess levels of Dopamine in  brain; helpful in treating positive symptoms, not negative ones  Chlorpromazine, Haloperidol

 Unpleasant or irreversible side effects

o Atypical Antipsychotics: Newer drug for this mental disorder;  affects Dopamine and other neurotransmitters like Serotonin  Similar in effectiveness, better in severe cases in in  

long-term effectiveness

 Clozapine, Olanzapine, Quetiapine, Resperidone

 Unpleasant or irreversible side effects

Psychological Treatments of Psychotic Disorders 

 Aim to improve medication compliance, social and self-care skills,  employment duration, support from others, mood, and cognitive  abilities; designed to enhance quality of life and prevent relapse

 Milieu Therapy: Mental health professionals, physicians, nurses, etc.  establish an environment where prosocial and self-care skills  encouraged

o Sometimes linked with a token economy: Being rewarded for  good behaviors

 Cognitive-Behavioral Therapy

o Help prevent relapse

 Social Skills Training

o Practice how to engage in conversations, and facial expressions,  holding eye contact, etc.

 Cognitive and Vocational Rehabilitation Training

o Cognitive rehab aims to improve attention, memory, decision making and problem-solving skills and integrate into social  situations

o Vocational rehab. Aims to reintegrate person into good work  environment with on the job training, support, encouragement,  practicing language and cognitive skills and a detailed  

performance feedback

 Family Therapy

o Expressed Emotion reduced, contributed to lower schizophrenia  relapse rates

 Community Care

o Group home, etc.—Managers assist and supervise, help with  work, money management, etc.

o Assertive Community Treatment: Person lives on own, but with  frequent contact with psychiatrist and mental health professional

Chapter 13: Developmental & Disruptive Behavior Disorder

Autism 2 major Symptom Domains 

 Impairment in social communication and interactions

 Restricted repetitive and stereotyped patterns of behavior, interests,  and activities

Developmental Disorders: Features and Epidemiology 

∙ Intellectual Disability: A pervasive developmental disorder marked by  and intellectual functioning deficit (IQ<70), deficits in adaptive  functioning (: Ability to complete everyday tasks to be independent),  and onset is before the age of 18

o Formerly known as mental retardation

∙ Learning Disorders: Limited developmental disorder; discrepancy  between intelligence and achievement that causes academic  impairment and is not explained by sensory deficit

o Dyslexia: (Sometimes used to refer to) * reading and spelling  problems

o Dyscalculia: * math learning problems

o Dysgraphia: Problems of written expression (EX: writing very  slow/off the page)

o Dysnomia: Problems of naming or recalling objects (EX: saying  “fork” when seeing a spoon)

o Dysphasia: Problems comprehending or expressing words in a  proper sequence

o Dyspraxia: Problems of fine motor movements (EX: buttoning  shirt)

o Dyslalia: Problems of articulating/trouble speaking clearly and  understandably

∙ Epidemiology of Developmental Disorders

o Intellectual Disability: 1.04% of the population

 More common in boys; diagnosed preschool/elementary  years

 Appears in lower SES and in less developed nations and in  African Americans

 Can be comorbid with autism; associated with anxiety,  depression, dementia, and psychotic disorders

 Gradual onset

o Learning disorders: 5% of students

 More common in boys, African Americans, and Hispanics

 Linked a lot with ADHD (45%)

 Gradual onset

o Autism 9.5/10,000

o Rett’s: 1/ 10,000-15,000

o Childhood Disintegrative Disorder: 1.7 /100,000

o Autism Spectrum: 14.7/1,000

 Prevalence rate has increased dramatically since 2000

Biological Risk Factors for Developmental Disorders 

∙ Genetic Influences: Gene Damage

o Genes: Individual units on a chromosome with information about  traits and characteristic

 May become damaged and lead to a developmental  

disorder; many cases of sever intellectual disability relate  to genetic and organ deficits

o Fragile X Syndrome: Genetic condition where damage to the X  chromosome and that often leads to intellectual disability,  especially in males

 Less Females affected because they have an extra X  

chromosome to compensate

 People tend to have hyperactive, self-stimulatory and self injurious behavior, are aggressive, have poor social skills,  practice preservation (: doing the same thing over and  

over again), and bizarre language

o Phenylketonuria (PKU): Genetic mutation on chromosome 12;  autosomal recessive disorder (: defective gene must be inherited for problems to occur). Leads to the body’s inability to break  down phenylalanine, excess can lead to liver and brain damage  and possible intellectual disability

 Untreated may lead to physical and cognitive problems;  occurs in 1/10,000 births

o Sickle Cell Disease: Damaged red cells, slow blood movement,  and less oxidation to the body

 Could lead to brain damage and intellectual disability

 Affects 1/600 births, especially African Americans

o Tay-Sachs Disease: Genetic condition leading to severe motor  and sensory disabilities, intellectual disability, and early death  Affects 1/300,000 births

o “Sporadic autism exomes reveal a highly interconnected protein  network or de novo mutations”

 Identified 126 likely functional rare variants

 Variants were located in 124 different genes

 Suggests that there may be between 384-841 unique  

genetic loci contributing to autism

∙ Genetic Influences: Concordance

o Concordance rates for Autism are 82%-92% in identical twins and 1%-10% in fraternal

 Runs in families, siblings have 20% higher chance of  

having autism

o Concordance rates for dyslexia (learning problems) are 68%+ in  identical twins and 20%-38% in fraternal twins

∙ Chromosomal Aberrations

o Changed in all or part of a chromosome influences 22% of severe developmental problems

o Down Syndrome: 95% of the time cause by an extra  

chromosome 21 and leads to characteristic physical features and intellectual disability

 Often develop Alzheimer’s after age 40

 Affects 1/600 births; chances grow as mother ages

∙ Prenatal and Perinatal Problems

o Teratogens: Conditions that negatively impact the physical  development of a child before birth or during birth

 Early in pregnancy can lead to structural changes/ late in  pregnancy or during birth can affect brain development  

and may produce a developmental disorder with a genetic  or chromosomal problem

 A key one is maternal use of alcohol/substance(s) during  stress

 Excessive maternal stress can increase adrenaline and limit Oxygen to the baby

 EX: Disease/HIV, Lead, Mercury, Alcohol and Drugs

∙ Brain Features/Development

o Key changes with Intellectual Disability include gross  

malformations and subtle markers of brain damage

 Induction deficits: Problems in closure of neural tube  

(linking spine to brain), proper development of forebrain,  

and completion of Corpus Callosum (links between brain  

hemispheres)

 Migration deficits: Problems in cell growth and distribution  in the 2nd-5th months of pregnancy, can lead to  

underdeveloped brain areas

 Enlarged ventricles, larger cerebellum seen in youth,  

smaller cerebellum seen in adults with fragile x syndrome. o Autism is linked with increased brain volume, which relates to  less well-connected neurons, smaller Corpus Callosum (motor  and emotion regulation), and higher levels of serotonin and  changes in the amygdala.

Environmental Risk Factors for Developmental Disorders

∙ Intellectual Disability

o Traumatic injury

 Shaken baby, hitting head on sidewalk, etc.

o Sociocultural causes such as:

 Poor and unstimulating environments

 Inadequate parent-child interactions

 Insufficient early learning experiences

∙ Prenatal Complications

o Teratogens: conditions that negatively impact the physical  development of a child before or during birth

Prevention of Developmental Disorders 

∙ Genetic testing

o Most common through chorionic villus sampling (: sample of  chorionic villi is removed from the placenta for testing. The  sample can be taken through the cervix (transcervical) or the  abdominal wall (transabdominal)) or amniocentesis (: sampling  of amniotic fluid using a hollow needle inserted into the uterus)

o Done to check number of chromosomes; may need to conduct  more through DNA assessment to find missing or defective genes ∙ Prenatal care of Fetus

∙ Screening Newborns

∙ Accident Prevention

Assessment of Developmental Disorders 

∙ Cognitive Tests

o Assess for overall intellectual and problem-solving functioning o Intelligence tests assess 2 types of cognitive ability: verbal and  performance

∙ Achievement Tests

o Measure more specific types of knowledge

o Often criterion-referenced, measure child against a level of  performance

o Assessed on reading, spelling, and math to determine level on  the Wide Range Achievement Test 4

∙ Interviews

o Questions surround mental status, concerns about one’s  environment, one’s choices and quality of life, communication  ability, relationships, anxiety and depression, and needed  support

∙ Rating Scales

o Childhood Autism Rating Scale (CARS) Rating Sheet for Relating  to People

o Some focus on adaptive and behavior problems, Adaptive  Behavior Assessment System 3rd Edition

∙ Behavioral Observation

o Very important when examining specific behavior problems and  the severity and frequency of problem behavior/s, things like that that help therapist understand more

∙ Ability (IQ) vs. Achievement

∙ The “Sally-Anne Test”

o Used to investigate Theory of Mind in kids with autism. 

o The idea is to become aware someone else's suppositions even if they are contrary to fact. The key to human behavior is our  ability to put ourselves "in someone else's head" 

Biological Treatments of Developmental Disorders 

∙ Medication

o Used to treat aspects of the disorder

o Antipsychotic medications

o Sedative medications—used to ease aggression

o Fenfluramine—decreases serotonin

∙ Gene Therapy: insertion of genes into one’s cells and tissues to treat a  disorder

o May be a key treatment in the future

Psychological Treatments of Developmental Disorders 

∙ Language Training

o Discrete-trial training: structured and repetitive method of  teaching various skills to a child

o Can begin when good attention is established, child rewarded if  answer is right

∙ Socialization Training

o Taught to perform and use social skills

o Consists of imitation and observational learning

 Eye-contact, raking appropriately, playing and cooperating  with others

o Playgroups—rewarded for playing with others

o Peer-mediated training: kids with developmental disorders teach  other kids with developmental disorders social skills

∙ Self-Care Skills Training

o Involve task analysis, chaining, and feedback and reinforcement  Forward chaining: taught steps beginning to end

 Backward chaining: taught steps end to beginning

∙ Academic Skills Training

o Include readiness skills (EX: holding a pencil, using scissors,  sitting in seat) and phonetic approach to reading where kids  “break down” sounds of hard words

∙ Addressing Problem Behaviors

o Time out

o Token Economy

o Differential reinforcement of incompatible behavior: rewarding  behavior that can’t be done at same time of misbehavior

o Differential reinforcement of other behavior: rewarding absence  of a certain misbehavior after time interval

o Restitution and practice positive outcome: requirement to  practice good behavior after misbehavior

o Punishment

Disruptive Behavior Disorders: Features and Epidemiology ∙ Attention-Deficit/Hyperactivity Disorder: Symptoms of inattention  or/and hyperactivity/impulsivity that last 6 months or longer and were  present and caused impairment before the age of 12. Impairment  occurs in 2+ settings, clinically significant impairment in social,  academic, or occupational functioning.  

o 3 Key Behavior Problems:

 (1.) Inattention—constantly distracted, forgetful, sloppy,  somewhat absent-minded, reluctant to complete school  

work and other tasks

 (2.) Overactivity—constantly fidgety, talking too much,  climbing on stuff, leaving seat interrupting, not waiting  

their turn, playing loudly

 (3.) Impulsivity—Same as (2.)

o ADHD that’s predominantly inattentive (1.)

o ADHD that’s predominately hyperactive-impulsive (2. & 3.) o ADHD with a combined presentation (1., 2., &3.)

∙ Oppositional Defiant Disorder: Pattern of negativistic, hostile, and  defiant behavior lasting 6 months that causes impairment in social,  academic, or occupational functioning and doesn’t occur exclusively  during a psychotic or mood disorder

 Loses temper, argues with adults, refuses to comply with  adults, blames other for mistakes, easily annoyed,  

angry/resentful, spiteful/vindictive

∙ Conduct Disorder: Pattern of violating basic rights of others or major  social norms lasting 12 months with 3+ of the following & 1+ occurring in the past 6 months (:) causes social, academic, or occupational  functioning impairment. Must be older than 18 years and not  diagnosed with Antisocial personality Disorder

 Aggression to people or animals  

 Destruction of property

 Lie or steal

 Serious violation of rules

o If behavior continues over time, may evolve over time into  Antisocial personality disorder  

∙ Epidemiology of Disruptive Behavior Disorders

o ADHD: 5%-12 of children (4% of adults)

 Combined diagnoses of ADHD are more prevalent in a  

clinical sample (2:1), while an inattentive diagnoses of  

ADHD was more prevalent in a community sample (1:2)

 Associated with high rates of comorbidity (CD, Anxiety and  Depression)

 More common in boys

o ODD: 2%-11% of children

 More common in boys

o CD: 2%-12% of children

 More common in boys

Biological Risk Factors for Disruptive Behavior Disorders ∙ Genetic Influences

o ADHD heritability = 0.76; twin studies suggest strong genetic  influences

 1st degree relatives 2-6x more likely to have ADHD

 Meta-Analysis of ADHD Candidate Gene Studies

∙ Aim was to conduct a total meta-analytic review to  

determine which candidate genes show consistent  

evidence of association with childhood ADHD across  

studies and test for similarities in the genes of  

people with and without ADHD 

o Significant associations identified: DAT1,  

DRD4, DRD5, 5HTT, HTR1B, and SNAP25 

 ADHD GWA Studies

∙ 1st successful GWAS of ADHD identified 16 significant

loci

∙ ADHD shows genetic correlations with traits related  

to depression, impulsivity, and cognitive ability

o Conduct Disorder has a moderate genetic basis, may be due the  strong genetic overlap with ADHD

 Traits common to CD have stronger genetic basis

∙ Negative emotion: persistent experiences of  

nervousness, sadness, and anger; often associated  

with conduct disorder; some genetic basis

∙ Neurochemical Features

o ADHD: imbalances in Dopamine and Norepinephrine

o CD and aggression: low Serotonin

o DBD: Lower levels of Cortisol and higher levels of Testosterone ∙ Brain Features

o ADHD: Small or different volumes of key brain areas

 Prefrontal cortex, basal ganglia, putamen, corpus callosum, and cerebellum

 Less blood flow and poor connectivity

 Delay in development in brain areas that develop controls o Some work on aggression and antisocial behavior

 Less volume in prefrontal cortex (same as ADHD) and  

changes in the amygdala, basal ganglia, and brain stem

∙ Personality Factors

o Callous-unemotional traits: often show lack of guilt/remorse, little emotion, and manipulate others for own benefit

 Especially relevant in youths with CD

∙ ARTICLE: “Cortical Development in Typically Developing Children with  Symptoms of Hyperactivity and Impulsivity: Support for a Dimensional  View of Attention Deficit Hyperactivity Disorder”

o CONCLUSION: Reduced cortical thinning observed among kids  exhibiting subthreshold hyperactive-impulsive symptoms relative to those without symptoms

Environmental Risk Factors for Disruptive Behavior Disorders ∙ Teratogens

o Key ones related to these disorders: maternal smoking and  alcohol use, increased stress during pregnancy, pregnancy and  delivery complications, premature birth, and lower birth weight ∙ Family Conflict

o Kids model parent’s aggression to solve problems

∙ Poor Parenting

o Bribes, rewarding misbehavior, patterns of kids using coercion,  poor supervision, harsh and uncaring communication,  

overcontrol, excessive physical punishment and use of unclear  demands

∙ Deviant Peers

o Kids with these disorders, especially CD, associate with deviant  peers, are rejected by nondeviant peers, have hostile  

interpersonal relationships, and poor social and verbal skills ∙ Cognitive Factors

o Key information-processing deficits

 Misinterpret actions of others as hostile or threatening

o Kids with CD may favor aggressive solutions, fail to understand  consequences, and define problems in hostile ways

∙ Maltreatment

o Early sexual and physical maltreatment relates to disruptive  behavior problems

∙ Poverty

o Poverty and love SES strongly relate to disruptive behavior  problems

∙ Cultural Factors

o European-Americans more likely to be diagnosed with ADHD  

Assessment of Disruptive Behavior Disorders 

∙ Interviews

o National Institute of Mental Health Diagnostic Interview for  Children

o Structured Clinical Interview for Childhood Diagnoses

∙ Rating Scales

o Parent and teacher rating scales

o Child Behavior Checklist, Teacher Report Form, Conner’s Rating  Scales, & Behavior Assessment for Children

∙ Behavioral Observation

o Help add information and clarify discrepancies from other  assessment tools’ data

o Useful for examining specific aspects of behavior

o Conducted to determine why child misbehaves over time

Biological Treatment of Disruptive Behavior Disorders ∙ Stimulant Medication

o ADHD: Methylphenidate, 55%-75% benefit & Atomoxetine,  increases norepinephrine levels and improves symptoms

o CD: more effective if comorbid ADHD symptoms

 Antianxiety, mood stabilizing, and antipsychotics help  control explosive symptoms

Psychological Treatments of Disruptive Behavior Disorders ∙ Parent Training

o Educate about child’s behavior problems, the best way to  address them, how to establish clear rules for child, etc.

∙ School-Based Behavior Management

o Overlaps with parent training, so kid has clear behavior  guidelines

o ADHD: rotating rewards, giving frequent feedback about rules  and self-regulation, developing social skills, and encouraging  peers to help kid modify behavior

∙ Social and Academic Skills Training

o Done by challenging and modify irrational thought recognizing  and addressing early signs of anger and impulsivity, rewarding  prosocial behavior, and receiving tutoring where needed

∙ Residential Treatment

o New way to address severe disruptive behavior in kids is to  provide extensive family services that include many  

psychological treatments

∙ Multisystemic Treatment

o Therapy for patent psychopathy and substance use problems,  involvement with appropriate peers, social support, schools and  vocational achievement, and linkage to agencies that can  provide financial, housing, and employment support

o Affecting long-term reducing aggression, criminal activity, though ongoing access to treatment is likely

Chapter 14: Neurocognitive Disorders

Neurocognitive Disorders: Features and Epidemiology 

∙ Delirium: Temporary and reversible disturbance of consciousness o Sometimes associated with disorientation: person has difficulty  remembering personal information, where they are, or even the  time  

o Key aspect is fluctuation of the problem over hours and days  Slip in and out of sleep or consciousness

 Mood may shift quick

 Motor behavior may shift quick

 Psychotic-like symptoms of delusions and hallucinations  can occur

∙ Dementia: Involves cognitive deficits that are chronic, develop  slowly, show a progressive course, and are irreversible o Can be characterized as presenile or senile

 Presenile dementia: onset of dementia symptoms before age of 65 years

 Senile dementia: onset of dementia symptoms after age of 65 years

o Types of Dementia:

 Alzheimer’s Disease, Vascular dementia, Parkinson’s  

Disease, and Frontotemporal Dementia

∙ Major Neurocognitive Disorder: Evidence of significant cognitive  decline based on (1.) individual, informant, or clinician report OR (2.)  Standardized testing or quantified clinician assessment. Deficits  interfere with daily activities and not exclusive to episode of  delirium and not better accounted for any other Axis I disorder

o Dementia and this disorder (MNCD) are general symptoms, but  Dementia sometimes refers specifically to older people with  multiple cognitive problems

∙ Mild Neurocognitive Disorder: Evidence of modest cognitive decline based on (1.) individual, informant, or clinician report OR (2.)  Standardized testing or quantified clinician assessment. Does not  interfere with daily activities and not exclusive to episode of  delirium and not better accounted for any other Axis I disorder

∙ Dementia of the Alzheimer’s Type: Criteria met for mild or major  neurocognitive disorder; insidious (gradual) onset and impairment in  1+ cognitive domains (2 for major neurocognitive disorder)

o 1+ criteria for probable/possible Alzheimer’s Disease:  Causative genetic mutation

 All 3 of following

∙ Decline in memory/learning, one other cognitive area ∙ Progressive, gradual cognitive decline without  

plateaus

∙ No evidence of mixed etiology

o Cognitive deficits likely to occur in someone with Alzheimer’s  Disease:

 Aphasia: Impaired ability to use or comprehend spoken  language

 Apraxia: Impaired voluntary movement despite adequate  sensory & muscle functioning (EX: can’t tie shoes)

 Agnosia: Impaired ability to recognize people or common  objects

 Executive functioning deficits: Impaired ability to plan or  organize daily activities, engage in abstract thinking, or  understand sequence of events

o Alzheimer’s Disease accounts for 60%-78% of cases of dementia  ∙ Vascular Dementia: Most common blood vessel problem that leads to  vascular-based neurocognitive disorder is a stroke (sometimes called  vascular dementia)

o Ischemic Stroke: most common; caused by blood clots that block  a key artery to the brain

o Hemorrhagic/Bleeding Stroke: more unusual; caused by ruptured  blood vessels

o Damage from stroke may be limited or severe and lead to  paralysis and dementia that resemble symptoms of Alzheimer’s  Disease

o Caused by blood vessel problem/s or clot or rupture; accounts for 20% of dementias; more abrupt/acute onset

o Criteria met for mild or major neurocognitive disorder, evidence  of cerebrovascular disease, not better explained by another brain disease or disorder, and its features are consistent with vascular  etiology as suggested by:

 Onset related to cerebrovascular event

 Evidence for decline is prominent in complex attention, EF o Mixed dementia: people with a vascular-based neurocognitive  disorder also have Alzheimer’s Disease

∙ Parkinson’s Disease: A progressive neurological disorder marked by  abnormal movements that may lead to a neurocognitive disorder o Resting Tremors: uncontrollable hand shaking or “pin rolling”  behavior with fingers; called this because shaking is worse when  person is idle

o Rigidity: difficulty moving muscles and feeling stiff

o Bradykinesia: very slow movement or trouble initiating  movement

o Hypokinesia: poor quality of movement

o Akinesia: lack of movement

o Postural Instability: difficulty standing, after sitting, staying in 1  position, maintaining balance, or standing erect

o Hypomimia: lack of facial expression

o Abnormal Actions: like inability to blink, maintain appropriate eye movements, swinging arms, or walking without shuffling  o Dementia occurs in 25%-30% of people with this disease  Often display subcortical dementia: their primary cognitive  problems include slowed thinking and difficulty using newly acquired knowledge and retrieving information from  

memory

o Language is another problem—may have monotone, slurred or  repetitive speech

∙ Pick’s Disease: One of the more common forms of  frontotemporal dementia (Both frontal and temporal lobes  affected); Characterized mainly by deterioration in the frontal and  temporal lobes

o People demonstrate many of major characteristics of Alzheimer’s Disease, but generally experience earlier onset of dementia and  personality and behavior changes

o Marked by severe personality changes that can lead to  disinhibition, poor social skills, and a lack of insight into one’s  behavior

∙ Amnestic Disorders

o Memory impairment manifested as inability to learn new  information or recall previously learned information which causes

impairment and represents a significant decline in functioning  and is not exclusive to episode of delirium and is a direct result  of a medical condition

o Retrograde Amnesia: Person unable to remember any past  memories

o Anterograde Amnesia: Person unable to form new memories ∙ Epidemiology  

o Occurs in 3%-9% of adults worldwide

 Increases with age

 Most common type is Alzheimer’s Disease (estimated  as much as 66% of cases)

o Comorbid with psychiatric problems (depression, anxiety) and medical problems

 Including reduced life expectancy

 Highly comorbid with each other

o Gender differences

 Alzheimer’s Disease: more common in women

 Vascular Dementia: more common in men

 Other: no difference

Biological Risk Factors for Neurocognitive Disorders 

∙ Genetics

o Early onset of Alzheimer’s Disease is almost purely biological  problems:

 Amyloid precursor protein

∙ Normal brain substance related to a specific gene on  

chromosome 21; if mutations occur, lots of brain  

damage because of the large amounts of this protein  

made

 Presenilin 1

 Presenilin 2

o Late onset genetic factor of Alzheimer’s Disease:

 APOE4

∙ Protein related to a specific gene on chromosome 14;

highly predictive of Alzheimer’s Disease, especially in

declines of episodic memory; 1 copy of this = 25%-

60% higher risk & 2 copies = 50%-90% risk; causes  

severe brain damage

o GWAS have identified 33 genetic regions relevant to Alzheimer’s  Disease

∙ Neurochemical Features

o Parkinson’s Disease: Low levels of acetylcholine, serotonin,  norepinephrine, and dopamine

o Alzheimer’s Disease: High levels of L-glutamate

∙ Brain Features

o Neurofibrillary tangles: aggregate (cluster) of  

hyperphosphorylated tau protein

 Twisted fibers inside nerve cells of the brain; key aspect of  dementia, especially Alzheimer’s Disease

 Affects ability to coordinate behavior, communicate with  the body, higher-order, behavior and memory and  

eventually lower-order behavior motor skills

o Amyloid Plaque: accumulation of beta amyloid proteins between  neurons in the brain and are insoluble, unlike many other  

proteins in the brain

 Causes massive damage and inability to process  

information or resist minor infections

o Lewy Body: aggregate of alpha-synuclein on neurons and block  effective transmission of information

o Atrophy: deterioration of key areas related to thinking,  

personality, memory, language, and other important information  areas

o Oxidative Stress: damage to brain from extensive exposure to  oxygen related matter

 Occurs when too many free radicals (: aggressive  

substance possibly produced to fight viruses and bacteria)  are released and there are not enough antioxidants

∙ For Dementia Due to Parkinson’s Disease

o Brain Features

 Substantia nigra

 SCNA encodes for alpha synuclein protein and also related  to Parkinson’s Disease

Environmental Risk Factors for Neurocognitive Disorders ∙ Diet

o Medicines or vitamins rich in antioxidants may help slow  progression of dementia

o Daly exposure to various oxidants—the ozone—can lead to beta amyloid protein accumulation and neuron cell damage in the  brain

∙ Alcohol

o People who drink moderately less likely to get dementia that  people who don’t drink at all

o May protect from vascular damage, reduce stress, and increase  socialization in older adults

o Key element of alcohol is flavonoids, which have good  

antioxidant properties

∙ Tobacco

o Use is a substantial risk factor for dementia

∙ Aluminum

o Its toxicity produces oxidation effects and increased beta amyloid proteins and free radicals

o Could result in brain tissue damage and onset of age-related  cognitive decline

∙ Cultural Factors

o Alzheimer’s Disease more common in western nations and  vascular dementias are more common in Asian and non-white  nations

 May be due to stigma, genetic, and dietary differences

∙ Other Factors

o Virial infections, accidents leading to brain injury, poverty,  malnutrition, poor parental education, low SES, and family  history of dementia

o Stronger education background less often linked to dementia  May have more cognitive reserve: better problem-solving  strategies when taking neuropsychological tests

 Long-term potentiation: strengthening and development of  new neural connections

Causes of Neurocognitive Disorders 

 Dietary influences and toxins  Changes in amyloid precursor protein  Genetic influences

o *EACH CAN LEAD TO*

o Excess insoluble beta-amyloid  

 *CAN LEAD TO ALL OF*

 Senile plaques // Neurofibrillary tangles // Oxidative stress  & free radicals // brain inflammation

∙ *ALL CAN LEAD TO*

∙ Neurochemical changes, neuron damage and death,  

brain atrophy

o *CAN LEAD TO*

o Cognitive decline and dementia

Prevention of Neurocognitive Disorders 

 Diet

 Exercise

 Cognitive Stimulation

o Include surroundings that constantly challenge brain and help  develop new neural connections

 Medications

o Can help reduce beta-amyloid build up and reduce cascade of  problems that lead to dementia

 Lack of tobacco and substance use

 Gene therapy

o Possible future prevention effort

Assessment of Neurocognitive Disorders 

 Interviews

o Could include interview with the client, will include interviews  with family and close friends

o Done to conduct a mental status examination: involves detailed  questions and observation of key areas of functioning, mood,  orientation, appearance and odd behavior, speech or thoughts  Questionnaires

o Mini-Mental State Examination (MMSE-2) can distinguish those  with and without dementia

 Cognitive Assessment

o List learning  

 Memorize a list and recite it

o Grooved Pegboard

 Fit small, different shape-tipped pieces into their  

corresponding holes

o Finger Tapping

 Learn to control fine motor movements  

o Clock Drawing

 Draw clock from memory

o Visual Search

 Find certain tiny letter among other tiny letters

o Rey Osterrieth Complex Figure

 Examinees are asked to reproduce a complicated line  

drawing, first by copying it freehand (recognition), and  

then drawing from memory (recall) 

o Trail making Test

 Must quickly and accurately connect the numerical dots in  order

 Medical & Laboratory Assessment

o MRI & PET scans used  

Biological Treatments of Neurocognitive Disorders 

∙ Medication

o Cholinesterase inhibitors: enhance acetylcholine (deficit in  people with dementia and memory problems)

 Inhibit the NY that breaks down acetylcholine

 Produce modest increase in functioning for people with  mild to moderate neurocognitive disorder

o Memantine: help control excess L-glutamate activity

 Beneficial cognitive effect for people with moderate to  

severe neurocognitive disorder

o L-dopa: used to treat people with Parkinson’s Disease; increases  dopamine levels

∙ Gene Therapy

o Introduction of genes to a person to help increase neuron growth  and regeneration; healthy genes compensate for dysfunctions of  problematic ones

o Future treatment; highly experimental, success in animal studies ∙ Residential & Nursing Home Care

o Many biological treatments given in hospitals, residential  hospices, and nursing homes

Psychological Treatments of Neurocognitive Disorders 

∙ For Diagnosed Individuals:

o Reminiscence Therapy

 Through review of persons life to impart sense of meaning  and resolve remaining interpersonal conflicts

o Reality Orientation

 Involves constant feedback about time, place, person, and  recent events

o Memory Training

 Involves repeatedly practicing various skills like using a  microwave, relying on external cues, and mnemonic  

strategies to jog memory, increasing social interaction, and simplifying living environment so less needs to be  

remembered

 “Memory wallet”, painting different rooms different bright  colors, and cues for easy identification

o Behavior Therapy

 Focuses on reducing behavior problems and increasing  frequency of self-care skills

∙ Behavior problem examples: wandering alone,  

hypersexuality, depression, verbal and physical  

aggression, and agitation

∙ For Caregivers:

o Support Therapy

 Let out frustrations, relate to others, get other support  

resources so they don’t get burned out

o Cognitive-Behavior Therapy

∙ Changing environment: enhancing enjoyment; day care and assisted  living facilities

o “Beatitudes” model of care; “Dementia Villages” (not in US)

Chapter 15: Careers in Psychology 

Types of Therapists 

∙ Clinical Psychologist: assess and treat severe psychopathology o Provide therapy and in some states have prescription privileges o General and specialized providers

o PhD and PsyD

 PhD allows them to serve as scientists (conduct research) and practitioners (conduct range of psychological testing  and provides diagnosis and treatment)

 PsyD is a graduate program that focuses less on research  and more on developing clinical skills

∙ Counseling Psychologists: promoting normative functioning; focus on  people with less severe problems; help clients make choices to  improve quality of life

o Focus on fostering growth rather than treating pathology o Can conduct research and practice

o Practitioners often located in hospitals, college campuses, and  private practice

∙ Careers in Clinical and Counseling Psychology

o Practice, public health and policy, military,  

forensic and police, consulting, academia,  

∙ Educational Psychologist: more researched based; work in school  settings or academia to study and improve learning strategies for  youth and adults

o Master’s and doctoral level

∙ School Psychologist: embedded in schools and provide assessments  and services to students

o Master’s and doctoral level

∙ Psychiatrists: can prescribe medication

o Hold a doctor of medicine degree

o Typically, responsible for medication

o May work with psychologist to provide comprehensive treatment o Psychiatric nurses also have prescription privileges

∙ Marriage and Family Therapists: specialize in working with families or  couples

o Master’s Degree

∙ Social Workers: work to improve quality of life for people  o Provide therapy and coordinate care across agencies for  individuals

∙ Paraprofessionals: work in mental health setting and assist with  assessment and treatment procedures under supervision

o Bachelor’s Degree

Active Ingredients of Treatment 

∙ Enhancing Self-Control

o Cognitions (cognitive therapy)

o Physiological responses (relaxation training)

o Behaviors (behavioral inhibition)

 Will lead to mastery: strong control over one’s symptoms  to the point they are not problematic to the person

∙ Insight

o Self-exploration

o Positive reinforcement

o Feedback

∙ Process Variables: AKA nonspecific factors; those common to all  treatments that also contribute to treatment success

o Placebo effect: improvements in treatment due to client’s  expectation of help

o Therapist variables

 Experience of the therapist and ability to make session a  warm and respectful place

 Reassurance: regularly indicating to client that solutions to  problems can be solved if they work to do so

o Therapeutic alliance: relationship between client and therapist  should be productive, free flowing, honest, built on trust,  full disclosure from client, and hard work towards goals

o Therapeutic alignment: therapist sides with certain person to  balance communications or power

o Catharsis: venting emotion and release of tension in a client  Many clients report therapy progress when they experience this

 May involve strong grief or anger reaction or admission of  long kept secret/s

∙ Manualized Treatment

o Manuals give detailed instructions for addressing client with  certain problems and what techniques to use

o Researchers design manualized treatments for people with  certain types of mental disorders

o Advantages: empirical bias, good validity and effectiveness,  specific recommendations for session-by-session assessment and treatment procedures, and are brief (preferred by insurances and clients)

o Disadvantages: May not apply to all with that mental disorder,  doesn’t account for individual differences, some have multiple  mental disorder which could affect success

∙ Prescriptive Treatment

o Researchers evaluate different subtypes of a clinical population  and provide specific treatment to fit needs of subtype; AKA  personalized treatment

Limitations and Caveats About Treatment 

∙ Poor choice of treatment

∙ Treatment noncompliance: client fails to put into action the plan  developed with the therapist

∙ Therapist-client differences

o Therapy may not be productive is client has different values than therapist

o Sever personality conflicts

∙ Cultural differences

o Therapist may not understand, properly emphasize, or adjust to  changes in client’s point of view

o Differences in language, communication style, belief about  mental disorder and expression of symptoms

∙ Quick fixes

o Managed care and other restraints on therapy lead people to see solutions that involve less time or effort but are ineffective ∙ Negative therapist characteristics

o Bad-tempered or abrasive

o Engages in unethical behavior

o Evasive about issues (fees, therapy procedures)

o Consistently disagree with client about treatment goals o Seem uninterested in client

∙ Lack of Access to treatment

o Many can’t afford therapy, don’t have insurance, can’t transport  selves, or trouble finding low-cost services that are right for them

Misuse of Research and Weak Research 

∙ Evaluation a Research Article

o Is the sample diverse and representative?

o Were there enough participants to obtain meaningful effect? o Dependent measures in the study varied and of good reliability  and validity?

o Did the researchers rely on information gained from different  sources?

Ethics: Assessment and Treatment 

∙ General Principles

o Beneficence and nonmaleficence: protecting the welfare of  others

o Fidelity and responsibility; acting professionally toward others o Integrity; employing high moral standards in one’s work o Justice; exercising fairness and reasonable judgement

o Respect; for people’s rights and dignity, or valuing others and  minimizing conflicts

∙ Assessment

o Competency: expected to use assessment devices properly o Limitations: explain limitations regarding their evaluation results ∙ Treatment

o Informed Consent: Involves education potential client about  therapy, especially variables that could influences their decision  for therapy

o Confidentiality: based on privileged communication, so  discussions between therapist and client should be divulged  without consent

o Who is the client?

 Should clarify at onset of therapy the therapist’s  

relationship with each person/client

o Dual relationships: Shouldn’t act as a psychologists and a friend,  lover, significant other, or business partner

o Ending Therapy

 Should assist client when they can’t pay for services

 Should end treatment when client no longer benefiting  from, or being harmed by, the process

 Shouldn’t end abruptly, but prepare clients by discussing  issue in previous sessions

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