Abnormal Psych Psyc 3330 - 01
University of Louisiana at Lafayette
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This 8 page Class Notes was uploaded by Lauren Notetaker on Friday February 19, 2016. The Class Notes belongs to Psyc 3330 - 01 at Tulane University taught by Constance Patterson in Winter 2016. Since its upload, it has received 10 views. For similar materials see Abnormal Psychology in Psychlogy at Tulane University.
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Date Created: 02/19/16
Some issues to consider • Traditional views: brain damage (structural or chemical) meant poor prognosis for recovery and little potential for improved functioning. • Our knowledge is increasing • Newer research and treatment techniques show more hopeful outcomes • Brain cells do regenerate and new connections are formed throughout lifespan Social politcal changes • Rosa’s Law was signed into law by President Obama in October, 2010. Under IDEA and in federal legislation the term is no longer “mental retardation” but is now “intellectual disability.” The deﬁnition itself, however, did not change and is deﬁned as… • Has to have impaired functioning • Life long challenge; can't cure intellectual disabiltes • “…signiﬁcantly subaverage general intellectual functioning, existing concurrently with deﬁcits in adaptive behavior and manifested during the developmental period, that adversely affects a child’s educational performance.” [34 CFR §300.8(c)(6)] NOTE: DSM-5 Neurodevelopmental Disorder • Intellectual Developmental Disability - likely to become the international label for this disorder (also: intellectual disability) 1. Deﬁcits in general mental abilities such as reasoning, problem solving, planning, abstract thinking (they think concretely), judgment, academic learning and learning from experience (they learn ﬁne but have to have lots of support) a. May not have cause effect udnerstanding: changing something and making it different 2. Impairment in adaptive functioning in at least one aspect of daily living (communication, social participation, functioning in school or work, or personal independence at home or in the community (necessitates ongoing support) 3. Onset during the developmental period (before age 18) Intellectual Developmental Disorder • We have commonly used a speciﬁer to indicate the level of support and intervention needed: ◦ Mild, Moderate, Severe, Profound, Unspeciﬁed Intellectual disability • Assessment and Diagnosis requires two parts: • Part 1. Use a cognitive ability test to determine cognitive disability. ◦ An Full Scale IQ test score below 70 indicates a limitation in intellectual functioning (Average IQ = 100). • Part 2. Standardized tests also determine limitations in adaptive behavior, in three skill types: ◦ Conceptual skills —language and literacy; money, time, and number concepts; and self- ◦ direction. ◦ Social skills —interpersonal skills, social responsibility, self-esteem, gullibility, naïveté (i.e., wariness), social problem solving, and the ability to follow rules/obey laws ◦ and to avoid being victimized. ◦ Practical skills —activities of daily living (personal care), occupational skills, healthcare, ◦ travel/transportation, schedules/routines, safety, use of money, use of the telephone. Causes of Intellectual Disabilities: • Cultural – Familial impairments – combination of genetic and environmental impacts combine to produce intellectual disability; they may not look it • Environmental – abuse, neglect, deprivation • Prenatal – exposure to a range of teratogens prenatally (drugs, disease, environmental toxins) • Perinatal – difﬁculties during birth (labor or delivery) • Postnatal – infections, injury, toxins such as lead Intellectual disability • Statistics: ◦ About 90% are mildly impaired ◦ 1-3% of the general population • Treatment: ◦ Chronic condition ◦ Early identiﬁcation, extensive intervention and support, education ◦ Communication training ◦ Community support • Prevention: ◦ Good prenatal care ◦ Genetic counseling ◦ Early intervention and education programs Neurocognitive disorders • Most occur later in life; mid life or later • Can be either “major” or “mild” – ambiguous criteria • Learning, memory and consciousness are affected • Profound changes to personality and behavior are common • Previously called “organic mental disorders” to indicate brain damage • Paranoia is common • One person may have multiple neurocognitive disorders Delirium • Confusion, disorientation, or being “out of touch” with surroundings indicates consciousness is disturbed • Includes a change in cognitive functioning (e.g., memory loss) or development of a perceptual disturbance that is not accounted for by another disorder or previously existing dementia • Medical or historical evidence documents disturbance is a direct physical consequence of a general physical condition • Causes include: ◦ Can be treatable in a small way or they can be treated so that problem will subside ◦ Acquired Immune Deﬁciency Syndrome (AIDS) ◦ Intoxication with drugs/alcohol ◦ Poisons ◦ Withdrawal from drugs ◦ Infections ◦ Head injury ◦ Brain trauma ◦ Improper use of medications* ◦ Children can experience delirium with high fevers ◦ NOTE: Determining the cause of delirium may be quite difﬁcult • Statistics: ◦ 30% of older adults admitted to ER/acute care ◦ 6 X more common among older adults ◦ Not as degenerative than other kinds of neuro problems • Treatment: ◦ Antipsychotics to calm the patient ◦ Psychosocial interventions – ground in the familiar ◦ Treat medical condition • Prevention: ◦ Medical care for known problems ◦ Healthy habits for older adults ◦ Effective medication monitoring Dementia • Development of multiple cognitive deﬁcits manifested by memory impairment and at least one of the following: • Language disturbance (aphasia=loss of language skills), • Impaired ability to carry out motor activities despite intact motor functioning (apraxia = impaired motor function); may be able to walk but it’s odd • Failure to recognize or identify objects despite intact sensory functioning (agnosia = failure to recognize objects; facial agnosia = failure to recognize familiar people’s faces); eyes are okay though • Disturbance of executive functioning (attention, planning, organizing, sequencing, abstracting) • (NOTE: hallucinations can occur; paranoia is common) • Dementia, Alzheimer’s type: ◦ Most common kind of dementia ◦ Multiple cognitive deﬁcits that develop steadily over time ◦ Loss of ability to integrate new information into memory ◦ Forgetting important events ◦ Lose objects ◦ Lose interest in social relationships and people and become isolated ◦ Interest in non-routine activities, and interests narrow ◦ Agitation, depression, and anxious (sometimes combative; worse late in day) ◦ Language problems ◦ Impaired motor functioning ◦ Failure to recognize objects and faces ◦ Difﬁculty planning, organizing, sequencing or abstracting information Alzheimer's • Statistics: ◦ Abut 50% of dementia cases ◦ About 5 million in the U.S (2010) ◦ Rising incidence : such a large baby boom population ◦ Some indication of higher incidence with less education and among women • Treatment: ◦ Depends on the damage ◦ Can use drug therapy to delay onset and progression ◦ Help adapt and cope with deteriorating condition • Prevention: ◦ Prevent drug use and other complicating factors ◦ Early identiﬁcation Vascular Dementia: • Progressive brain disorder that includes blocked or damaged blood vessels, restricting blood ﬂow and oxygenation to the brain • One or more strokes can cause multiple sites of brain injury • Impact and loss of skills depend on brain areas affected • There is an overlap between vascular dementia and Alzheimer’s • Statistics: ◦ Men are more susceptible partly due to heart problems ◦ Approx. 1.5% among 70-75 year olds ◦ Up to 15% of over 80 year olds • Treatment: ◦ Depends on location of brain damage ◦ Teach compensatory skills ◦ Medications are sometimes helpful ◦ Training to recover lost skills • Prevention: ◦ Healthy life choices while aging ◦ Effectively treating hypertension and heart problems ◦ Social and intellectual activities • Dementia due to other general medical conditions: ◦ A catch all category, including deteriorating mental functioning due to causes such as: ◦ HIV (about 10% of patients), Head trauma, Huntington’s disease (20-80% of patients), Picks disease (about 5% of cases), Creutzfeldt-Jakob disease (approximately 1 per million), Hydrocephaly, hyperthyroidism, brain tumors, Vitamin B12 deﬁciencies, head injury caused athletic activities, abuse of drugs/alcohol (7% of alcohol dependent individuals) CTE: Growing awareness of repeated head injury and degenerative brain disorders Chronic Traumatic Encephalopathy - a progressive neurodegenerative disease • Can result from repeated blows to the head • symptoms include memory loss, cognitive decline, changes in moods and behavior similar to symptoms of Alzheimer's, Parkinson's disease and Lou Gehrig's disease. (repeated traumatic brain injury confers higher risk for developing these conditions later in life). • Researchers – currently inadequate to understand the association between traumatic brain injury and long-term cognitive decline. • Studies indicate repeated traumatic brain injury can cause a buildup of tau and amyloid plaques in the brain, (also present in Alzheimer's). CASE EXAMPLE: 88-year-old woman • Presented with confusion and signiﬁcant anxiety – prescribed Risperdal (antipsychotic) • Developed difﬁculty walking and another physician determined she had untreated hypothyroidism, which can contribute to dementia • Placed into a nursing home to bring problems under control, adjust medications • Became “out of it” drooling, screaming, uncontrolled physical twitches, complete confusion • Psychiatrist at Nursing home took her off Risperdal; prescribed 2 other antipsychotics and a sedative; her condition became worse • Daughter was convinced medication was causing problems but could not convince physician to stop medication until another physician intervened and took her off all medication. • She recovered and was able to resume living independently • CURRENT ESTIMATE: 1/3 of nursing home patients are prescribed antipsychotics to eliminate agitation, combative behaviors, and other features of dementia but research shows these are no better than placebo in changing these behaviors! Amnestic Disorder • Primary deﬁcit is: • Failure to transfer information to long term memory, so that no new learning is possible (Anterograde amnesia) •O • Failure to recall previously learned information (Retrograde amnesia) • *Causes signiﬁcant impairment in social and vocational • functioning • *Does not occur ONLY with dementia or delirium • Transient = lasts for one month or less • Chronic = lasts over one month • Before I go to sleep ﬁlm ◦ “As I sleep, my mind will erase everything I did today. I will wake up tomorrow as I did this morning. Thinking I'm still a child, thinking I have a whole lifetime of choice ahead of me...” • Causes ◦ Deﬁciency in Vitamin B1 that is common in alcohol abusers (Wernicke- Korsakoff Syndrome ) ◦ External trauma, such as a blow to the head ◦ Internal trauma, such as stroke ◦ Emotional trauma ◦ Exposure to a toxic substances such as carbon monoxide ◦ Inadequate diet ◦ Brain tumors ◦ Seizures • Statistics: ◦ Relatively rare ◦ Treatment: ◦ Psychotherapy ◦ Hypnosis ◦ Amytal (sodium amobarbital) ◦ Hospitalization only with the risk of harm to self ◦ Prevention: ◦ Difﬁcult to prevent in most cases ◦ Use of alcohol in moderation, vitamin use ◦ Healthy lifestyle choices • Dissociative fugue ◦ Jeffrey Alan Ingram, 40 ◦ diagnosed with dissociative fugue, a type of amnesia. • http://www.nbcnews.com/id/15373503/ns/us_news-life/t/man-amnesia-reunited- family-friends/#.VsXea-HnaUk An important issue raised by your text • Is “normal aging” a mental disorder? • Revision of DSM-5 broadens criteria • Will most people eventually meet criteria for mental disorders based on cognitive decline? • Pharmaceutical companies are incentivized to ﬁnd more consumers (Francis, 2010)
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