Download Depression

CHAPTER 16
DEVELOPMENTAL
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
 Developmental Issues
 Nature/Nurture & Continuity/Discontinuity
 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”
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%
Depression
 Infancy
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Somatic symptoms
Depressive-like states
Related to poor attachment
“At risk” if mother depressed
“Failure to thrive” syndrome may
occur
Childhood
 Externalizing Problems
 “Undercontrolled” disorders
 Acting out
 Aggressive, out of control
 Internalizing Problems
 “Overcontrolled” disorders
 Inner distress, shyness
 More girls
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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
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
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Cognitive symptoms
Behavioral acting out
Genetic link
Environmental triggers
 Suicide: Third leading cause of death
 Males commit 3/1; girls attempt
3/1
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
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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.