Transcript Depression
CHAPTER 16 DEVELOPMENTAL PSYCHOPATHOLOGY Learning Objectives • What criteria are used to define and diagnose • • • psychological disorders? What is the perspective of the field of developmental psychopathology? What sorts of questions or issues do developmental psychopathologists study? How does the diathesis-stress model explain the causes of psychopathology? Abnormality – Maladaptiveness • Interferes with personal and social life • Poses danger to self or others – Personal distress – DSM-IV diagnostic criteria (APA) – Statistical deviance Developmental Aspects • Development, not disease – A pattern of maladaption, not defects • Social and Age Norms – Poor person-environment fit • Developmental Issues – Nature/Nurture – Risk factors – Prediction The Diathesis-Stress Model • Interaction of genes and environment • Example: Depression • • – Genetic vulnerability – Environmental trigger(s) Not specific stressors for specific disorders “Bad things have bad effects for some people some of the time” Learning Objectives • What are the characteristics, suspected • • causes, treatment, and prognosis for individuals with autism and its related syndromes? In what ways do infants exhibit depressionlike conditions? How is depression in infants similar to, or different from, depression in adults? Autism • Begins in infancy, more boys • Several autistic spectrum disorders • Impaired social interaction, communication • Repetitive, stereotyped behaviors • 80% retarded: savant syndrome common • Severe cognitive impairment • Biologically based • Concordance: MZ=60%, DZ= 0% Video: Developmental Psychopathology Autism PLAY VIDEO • The number of diagnosed cases of autism spectrum disorder has been increasing. These data are from Göteberg, Sweden. Of 546 cases identified over the 18-year period, 38% had autism, 17% Asperger syndrome, and 44% “pervasive developmental disorder not otherwise specified.” These numbers of cases translate into a pervalence rate of 53 cases per 10,000 population for the entire period, but 80 per 10,000 in the last 6-year period. The male to female ratio was almost 3 to 1. Depression • Infancy – Somatic symptoms – Depressive-like states – Related to poor attachment – “At risk” if mother depressed – “Failure to thrive” syndrome may occur Learning Objectives • What are the symptoms, suspected causes, • • treatment, and long-term prognosis for children with ADHD? How is depression during childhood similar to, or different from, depression during adulthood? How do interactions of nature and nurture contribute to psychological disorders? Do childhood problems persist into adolescence and adulthood? Childhood • Externalizing Problems • – “Undercontrolled” disorders – Acting out – Aggressive, out of control Internalizing Problems – “Overcontrolled” disorders – Inner distress, shyness – More girls • Relationships between behavior at age 3 and psychological disorders at age 21. Part A shows that children with uncontrolled, externalizing behavioral styles are more likely than other children to show antisocial behavior and repeated criminal behavior at age 21. Part B shows that inhibited, internalizing children are at high risk of depression, but not anxiety disorders, at 21. Attention-Deficit Hyperactivity Disorder • DSM-IV Criteria, some combination of the • • • following: – Inattention, Impulsivity, Hyperactivity – More boys; 3-5% of US kids – Comorbidity common Overactive behavior wanes with age Attentional, adjustment problems remain Most well-adjusted in adulthood ADHD-Causes and Treatment • Neurological: Low Dopamine, other NT’s • • • – Differential processing – Underactivity in motor area Genetic predisposition; Environmental stress 70% helped by stimulants (like Ritalin) – Overprescription a problem Most successful if combined with behavioral treatment Depression • Childhood • – Somatic symptoms; school, social also – Psychotherapy, medication effective – Nature/Nurture question Adolescence – Often related to childhood symptoms Learning Objectives • Are psychological problems more prevalent • • • during adolescence than other periods of the life span? Explain. What are the characteristics, suspected causes, and treatment of eating disorders such as anorexia nervosa? What is the course of depression and suicidal behavior during adolescence? What factors influence depression during adulthood? Adolescence • Storm and Stress? • • – Only about 20% – Heightened vulnerability to psych disorders Alcohol and drug problems Eating Disorders – Anorexia nervosa; more girls (3/1) – Bulimia nervosa; binge-purge – Some genetic predisposition; stress also – Psychological treatment usually successful Adolescent Depression and Suicide • 35% depressed; 7% diagnosable • – Cognitive symptoms – Behavioral acting out – Genetic link – Environmental triggers Suicide: Third leading cause of death – Males commit 3/1; girls attempt 3/1 Learning Objectives • What are the characteristics and causes of dementia? • • Adulthood Rates of disorder decrease after age 18 Depression – Concern with elderly – Elderly less vulnerable to major depression • Depression often related to health • 15% have some symptoms • 1-3% diagnosable • Difficult to diagnose from other conditions – More women (2/1) Depression and Dementia • Many undiagnosed and untreated • Elderly can benefit, should NOT be excluded • • from treatment Dementia: Progressive Deterioration – Not normal aging (Senescence) Alzheimer’s Disease – Leading cause of dementia – Progressive and irreversible Causes of Cognitive Impairment • Genetic: e.g., Alzheimer’s Disease • Vascular dementia -multi-infarct • • • • – Minor strokes: Deficits accumulate – Related to lifestyle: Diet and exercise Reversible dementia, about 20% Delirium: Reversible, often drug related Depression: Treatable Critical to distinguish for proper treatment • Alzheimer’s disease emerges gradually over the adult years; brain cells are damaged long before noticeable cognitive impairment results in old age. Changes in brain functioning are significantly different from those associated with normal aging. • Number of suicides per 100,000 people by age and sex among European and African Americans in the United States.