Psych 3551 Lecture Notes week 15: April 19 & 21
Psych 3551 Lecture Notes week 15: April 19 & 21 3551
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This 13 page Class Notes was uploaded by Amanda White on Thursday April 21, 2016. The Class Notes belongs to 3551 at Ohio State University taught by Dr. Bertrina Scott in Spring 2016. Since its upload, it has received 12 views. For similar materials see Psychology for Adolescence in Psychlogy at Ohio State University.
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Date Created: 04/21/16
PSYCH 3551 LECTURE NOTES WEEK 15 TUESDAY APRIL 19 TH AND THURSDAY APRIL 21 ST TUESDAY APRIL 19 CHAPTER: PSYCHOSOCIAL PROBLEMS IN ADOLESCENCE *Development of psychosocial pathology: study the developmental course of diseases/disorders to figure out how to prevent, intervene (very expensive and also a social cost) *Internalize problems (substance use, ailments resulting in people turning problems inward, anxiety, depression, girls more likely to have internal disorders like depression), externalizing disorders DEPRESSION 1.Criteria for diagnosis includes the following—DSM 5—involves clinical or major depression, not temporary 2.Must meet 5 of the 9 symptoms for at least 2 weeks 3.Sometimes it is underdiagnosed in adolescence because they attribute symptoms to puberty, changes in adolescence, common changes for all---but they are not! The longer it goes untreated, the more difficult to treat later on 4.Not caused by changes in adolescence 5.Most problems are transitory and in place before adolescence began, now they become more pervasive a. Depressed mood for most of the day b. Reduced interest in all or most activities c. Weight loss/gain d. Sleep problems e. Psychomotor agitation or retardation f. Fatigue g. Feelings of worthlessness/hopelessness h. Problems thinking, concentrating, making decisions i. Recurrent thoughts of suicide GENDER DIFFERENCES IN DEPRESSION 1. Female have 2x rate of depression as males—not in all cultures though! a. Coping strategies i. Girls use strategies like “rumination”/ruminate ii. Term used in farming for cows when they regurgitate food multiple times iii. Girls go over and over problems in their head and can’t stop thinking about your problems—doesn’t go away, distressing, troubles iv. Girls more likely to ruminate, boys more likely to distract themselves and not focus on the problem v. Dwell on things to the point where we can’t let go of problems vi. Need to focus on solution vii. Co-rumination: girls do this with friends 1. Not only ruminate ourselves, but when get together with friends share miseries with each others, speculate on negative feelings 2. Self-disclosing to friends is good, but we have our own issues and also friends issues to deal with 3. **leads to depression (problem focused vs. solution focused) b. Increase in estrogen—only in certain cultures c. Negative self image i. Girls is more negative because the invest a great deal on body image ii. Gain more weight---effects image d. Value placed on interpersonal relationships i. Girls invest more time in friendships and romantic relationships ii. If relationship goes sour, it impacts how they feel they are valued iii. Invest too much in relationships that won’t last long iv. Inconsistent friendships, fickleness of friendships e. Stress level i. Girls experience more levels of stress when asked about stress ii. Overinvestment in relationships, rumination, body dysmorphic, school transitions iii. Adults don’t notice these things as problems, but just attribute symptoms to typical adolescence WHAT CONTRIBUTES TO DEPRESSION? Diatheses stress model: internalizing problems are result of combination of a predisposition and exposure to stressful conditions o We all have genetic vulnerabilities to disorders (psychological) o But, here we say individuals are born with this ability, but weather or not it manifests itself is due to how much exposure to high stress they have o Biological predisposition: not a “depression gene”, but a combo of biological and genetic factors that its presence increases the chance of the disorder manifesting itself o Cant regulate emotions well, more reactive to stress, neuro- deficiencies, o Can also inherit a cognitive predisposition---inherit likelihood of thinking a certain way (always blame self, feel helpless, feel undervalued) o Combine predispositions with environment stress—family, peers, conflicts within relationships, parents emotionally unavailable, feel out of touch and that others are not concerned about them, no family cohesion, o Peer problems contribute to depression: being unpopular, feeling rejected, no close relationships to anyone else/not part of any clique or group o Difficult life changes contribute to depression Divorce, death, romantic relationships ending TREATMENT FOR DEPRESSION It is treatable!! Very effective options o Antidepressant medication (Prozac, Paxil, Zoloft) ---but not a magic pill that helps everyone regardless o Psychotherapy along with pills is important…don’t get just one or the other Used together Issues: not all medications/treatments work for everyone! SSRI: drugs that act on serotonin to regulate your mood 70% feel relief from medications not immediate relief! Can take 10-14 days to feel better must be careful in prescribing medications to children 2004: Black box warning (FDA) taking this drug carries a significant risk, can be harmful for individuals under 18 prescribe with extreme caution—increased risk of suicidal thoughts and behaviors analyzed 100,000 people who were given the meds or a placebo: control group (placebo) only 2% had suicidal thoughts experimental group: 4% felt suicide thoughts (doubled!) needs to be ongoing monitoring by parent, physician, teacher black box warning used with extreme caution because people would sensationalize their symptoms meds can be prescribed by doctor or psychiatrist---must monitor closely and also must get talk therapy o cognitive behavior therapy (cbt) always part of depression treatment strategy o interpersonal therapy teach people how to develop healthier relationships for people who have difficulty getting along with others be able to detect unhealthy relationships o family therapy family can be source of a lot of stress entire family gets therapy to address all issues still have individuals who may decide they are not worth living ADOLESCENT SUICIDE depression is a huge risk factor for suicide 3 leading cause of death for 10-19 year olds an attempt at suicide may occur right after it seems the person is experiencing relief from symptoms---change in behavior/coming out of the dark, but they were experiencing enough motivation to complete the suicide trying to get up enough courage to kill self if we can identify and treat depression early enough we can reduce suicides rate of suicide increases in adolescence o suicide in childhood is very rare o compared to adolescence: increase in attempts ethnic differences o native Americans higher rate of all other groups higher depression and alcohol use gender differences o girls: attempt suicide more than boys—choose methods that may not be fatal (pills, slit wrist)—takes a long time to end life, more superficial slits—don’t really want to end life, but just want help— od on aspirin, nothing too lethal o boys: more adept to complete suicides—use methods that are more immediate and lethal (guns, hanging), boys don’t want to be saved PREDICTORS OF ADOLESCENT SUICIDE family disruption o chaotic family environment, reaches the worst point Psychiatric problems o Substance use o Depression Worsening of relationships outside the family o Romantic relationships-betrayal Stress o Stress related to academics o Also related to sexuality and sexual identity (homosexual=higher suicide rate) o Fear of being ridiculed Family history of suicide o Not a suicide gene, but related to genetic vulnerability related to depression o Ex: Hemingway’s-so many generations committed suicide Closer in genetic relatedness=higher your risk EARLY WARNING SIGNS OF ADOLESCENT SUICIDE (WON’T BE TESTED ON THIS!!) Direct suicide threats Preoccupation with death in music, art, writing Loss of family member, pet, romantic partner Disturbances in sleeping Declining grades Drastic behavior changes Pervasive sense of gloom, helplessness, hopelessness Withdrawal from family members and friend Giving away prized possessions, getting affairs in order, series of “accidents” WHAT SHOULD I DO (NOT TESTED OVER THIS) Ask direct, straight forward questions in a calm manner Assess seriousness Listen and be supportive, don’t give false reassurance Encourage the person to get professional help and help them Do not abandon person after crisis passes or after professional counseling has begun PSYCHOSOCIAL PROBLEMS PART 2 (SLIDESHOW) SUBSTANCE USE Alcohol is the most widely used substance Can range from trying something once to every now and then More common that substance abuse!!! Like sexuality, to some degree, adolescence will want to try a substance o Curiosity, want to know what its like, others have done it Most adolescence will use a substance and not become addicted Cigarettes 2 ndmost tried (hard liquor) rd Marijuana 3 most tried/used (then hard drugs) Sequence: o Beer-wine-cigarettes-hard liquor-marijuana-hard drugs Cocaine/meth/etc.—not commonly used Early substance use (before age 15) is often predictive of later addictions o Use early, will be more likely to use when you are older/addicted Majority of info comes from “Monitoring the Future” study (1975) o Conducted by researches at UM o An ongoing study still today o See how substance use changes overtime o Ex. Decline in amount of use o Parents believe substance use isn’t a problem until high school, but some use as early as middle school---start prevention too little too late o Beer/wine/cigarettes: “gateway drugs” Pass trough the gates of beer, wine, cigarettes Rare to start cocaine without having ever drunk alcohol or smoked first Height of substance use is in COLLEGE!! o High rate due to: becoming more available, of legal age, no constant monitoring of parents THE ADOLESCENT BRAIN UNDER CONSTRUCTION Neuro-maturational processes may account for substance use in adolescence o Under developed nucleus accumbens/reward system Brain matures back to front Nucleus is close to front—still developing in adolescence Main job is a reward system: what makes us want to do things to experience pleasures/sensations (our motivation) Want to experience pleasure, but don’t want to exert a lot of effort Play video games, surf internet, use substances o Immature frontal lobes/responsible for higher-order thinking Last part of brain to develop Used to foresee consequences, impulse control, risk taking Group pressure-don’t always make best decisions Adolescence propensity to use substance can be biological Can originate within the adolescent THE ADOLESCENT BRAIN AND ALCOHOL USE Diminish sensitivity to intoxication o Adolescents Don’t think it is dangerous o But alcohol is clearly toxic to adolescent brain o Adolescent can “drink an adult amount” without feeling intoxicated o Higher metabolic rate so they can drink more without feeling drunk o Want to drink until they feel something which can be twice as much as an adult! Brain damage o More you drink, more damage o Impaired dopamine function Longer alcohol use=more damage Dopamine is a neuro transmitter that influences our feelings of pleasure More we use drugs, the lower the production of dopamine More alcohol: dopamine decreases, not feeling pleasure so drink more to feel pleasure Dopamine reduction may not be reversed---won’t be able to drink enough to feel something o Prefrontal cortex Judgment, planning, impulse control is all immature still Expose it to something that damages it More alcohol=more damages o Neuronal loss in basal forebrain and cerebellum Cerebellum: voluntary motor movement, where spine enters brain, equilibrium Drink=loose balance (cerebellum first thing effected by alcohol) Basil forebrain: contains neurotransmitters responsible for memory Helps us to remember info and impacts learning o Smaller hippocampus Drink for long period of time Primary structure for memory formation Reduced ability to form new memories and ability to retrieve new memories when formed THURSDAY APRIL 21 ADDITIONAL FINDINGS (RELATED TO SUBSTANCE USE) Poor performance on tests that require attention skills o Brain function is effected severely Alcohol withdrawal may precipitate death of neurons o If become more addicted to alcohol or if more frequent usage o Use alcohol=feel stress=experience withdrawal o Release of stress hormones like cortisol Cortisol: kills brain cells!! And neurons Withdrawal gets more severe, stress increases each time Increased vulnerability to “blackouts” o Adolescents drink quickly, large amounts in short time (binge drink) o Blackout: result of shock to the brain, brain surprised by sudden onset of tons of alcohol—brain is unprepared, becoming unconscious, lose memory o Vulnerable to engage in risky activities or may become victimized (mostly females—rape) o Girls more vulnerable White matter structural abnormalities o White matter: white appearance, gives brain myelin (fatty substance that insulate axons)-ensures messages to parts of brain go fast and efficient o Use alcohol: “insulator” is damaged, neurons can’t communicate as well as they should SLIDE OF BRAIN IMAGE Alcohol use vs. non use Adolescents asked to complete memory tasks, attention, other cognitive tasks Left: no alcohol, right: alcohol Biggest difference: heavy drinker=less pink=less brain activity Brain not “working” or processing memory –related sills Lowered ability to complete cognitive tasks, learning Adolescents don’t get the messages on how detrimental alcohol is to the brain Alcohol industry won’t admit, but they market products to a young audience!! PATTERNS OF SUBSTANCE USE ADOLESCENTS Experimental o Individual uses substance just to see what its like, curiosity Social o Use substance during social activities, “social drinker”/” social user” o Don’t use it alone, but use it always when others do Medicinal o Most dangerous usage!! o Use to relieve an unpleasant emotional state, self medicate for anxiety, stress, depression, a coping mechanism for unpleasant emotional feelings Addictive o Most dangerous and most addictive o Use substance to depend on it to get through the day o Feel they cannot function unless they use something first o Only a small amount of adolescents falls into this category FACTORS RELATED TO ADOLESCENT SUBSTANCE USE Seems to be a normative part of adolescence, peaks interest, want to know what things are like----normative, not ok to do, but it is almost expected Familial influences o Genetic contribution and family environmental factors o Early adolescent: family tends to be most important o Parents use substance, how they use it (medicinally, addictive) o Are parents supervising what adolescents are doing? o Perception of adolescents have about weather or not their parents will approve of their use---if they think parents won’t mind, then they are more inclined to use o Parents will throw parties with substance---justify that if they use it then they should do it at home---irresponsible and illegal!!!! o “if they drink I’d rather they do it at home” o impaired judgment already but will be more clouded by substance use Peer influence o Older peers=more at risk o Peers who tolerate substance use or use as well o Feel to belong in a peer group must use Individual characteristics o Feel use will increase social standing o Do it to fit in, for approval o Think its ok when you are underage despite the law o Think that because they have other adult privileges (driving, etc.) then they should be able to drink o Sensation seeking Contextual influences o Availability of substances and whether or not it is the norm in school, neighborhood, among peers Many campaigns to dissuade adolescents from trying substance at all o DARE—not effective o Just say No---least effective!! Too basic, too simplistic (despite the fact that First Lady was in charge of it) o Best campaigns: use variety of strategies Must start early with intervention Adolescents have a lot of the time already tried—start in elementary Tell dangers and tell what adolescents will lose if they use Ex. What the “costs” of smoking, drinking, etc. are Increase academic skills---they have more to lose if they use Gets parents involved!! Instruct them on how to talk to kids (kids listen to parents more than school) EXTERNALIZING PROBLEMS -any issue of maladjustment where individual turns outward, “acting out”, disruptive, violate rules overtly. Tend to be more characteristic to boys (like internal to girls) Conduct Disorder o Psychiatric disorder, a mental illness o Significant violation of social norms and rules o Difficult behaving in appropriate, socially acceptable ways o Curfew violate, skip school, lie a lot, sneak out, etc. o Con others and take advantage of others o Adults cannot have conduct disorder o If goes untreated in adolescence=turns to antisocial disorder (psychopaths) Aggression o Any type of behavior used with the intent to harm someone o Mistake aggression for assertion o Aggressive: means you are hurting others intentionally (physical or emotional) o Assertive: stand up for yourself Juvenile offending o Adolescents with conduct disorder are diagnosed because they have done something illegal that puts them into the justice system (shop lift, cons, ran away, etc.) ---had to undergo psychiatric evaluation JUVELILE OFFENDING Broad range of behaviors including socially unacceptable behavior o Can be for underage kids o Delinquency: violates juvenile justice system o Criminal behavior Steal, shop lift, burglarizing, assault: always a crime despite age o Status offenses: acts that are crimes because the individual is under age Truancy, skip class in high school 10% of adolescents have been arrested (higher for individuals who have actually committed offenses) most likely people to be arrested are males (80%) girls not committing the crimes that boys do: girls shoplift, vandalize TWO TYPES OF OFFENDERS Life course persistent offenders o Show a pattern of problems from birth onward o Individual has had problems their whole life Born with neuropsychological deficient (impulsive, temper, low serotonin) Born into environment with problems-inept parents, hostility, neglected o Neurological symptoms are made worse because of environmental factors o Chronic stress, psychiatric problems, unemployed parents o Life in high risk environment—engage in problem behaviors early Adolescent limited offenders o Show no signs of problems during childhood o Offending behaviors only seen during adolescence o Come from “good “family can be effected o High degree of sensation seeking o Want to get access to resources of adulthood, but they may steal them, shoplift o When become an adult: they have access to things they want so they don’t offend anymore PREDICTORS OF DELINQUENT BEHAVIOR Familial Influence o Neglectful parents, engage in criminal behavior o Antisocial behavior can be genetic (especially aggression) o Parents who are substance users/abusers o Siblings are delinquent Low self-control o Lower than average o Limited impulse control due to brain developing o Act now, don’t think of consequences Delinquent peer influence o Burglary, shop lift o Many adolescents don’t commit crimes alone, do with a group Neighborhood quality o Not a lot to do, boring, so become delinquent just to have something to do o Most acts are committed in hours right after school (3pm-6pm) o Increased police presence in summer to monitor adolescents o Crime is the norm where you live=more likely to engage o Way to survive in an area involves burglary Cognitive distortions o Adolescents minimize victimization-don’t feel bad for those they hurt o Self-centered, “hostile attribution bias”---infer hostility on others who you believe are out to get you o Think people always mean to hurt them even if it is an accident Low school achievement o Disengagement-not committed to learning, not interested o Starts very early in life, especially if they have a history of failure o Feel school is no value, only way to improve life is criminal behavior Early involvement with substance use o Start before age 15: higher risk for juvenile offending o If substance becomes addictive=feel that is the only way they can live PREVENTION AND INTERVENTION For life course persistent offenders o Family support and preschool intervention o Individual therapy—most effective o Our country throws people right in jail—tendency to punish vs. rehabilitate o Prisons are often over-crowded and understaffed o Need to put in smaller group rehab o If no rehab---will most likely offend again o Still need to be punished, but also need to figure out why they did this and how to intervene/educate to help them o Need to learn interpersonal skills o Best to take preventative approach as early as possible Adolescent limited offenders o Resist peer pressure o Teach parents better monitoring skills o Encourage prosocial behavior in multiple contexts o Teach consequences of misbehavior o Encourage pro-social behavior o Consequences must be immediate, consistent, and sure o Can’t punish too late otherwise will not take effect o Violate a rule: world should come crashing down Psychosocial problems are really rarities o Majority of adolescents are fine, but because they are stereotyped we feel that all of them are being bad—but these are really the exceptions! o Most adolescents do have good role models o Many will have bumps in the road, but most are in loving environments
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