Developmental psychopathology 1: childhood and adolescence

===Lecture Details===
Glenn Melvin; Week 4 MED1022; HLSD
===Lecture Content===
Developmental psychopathology is how psychological disorders arise and how they change with time or developmental stage. Psychodynamic model is that conflicts between ego, id and superego produce neurotic anxiety. In response to this, ego employs defence mechanisms such as denial and intellectualisation.
Behavioural approach is that of classical conditioning. Social cognitive approach is that behaviour may be learned through observation of other people. Social cognition is how individuals think about themselves, their relationships, family, peer and wider social contexts. Cognitive distortions can contribute to onset of behavioural and emotional problems (depression, substance abuse). Biological approach is that heredity can predispose a person to developing a mental illness eg bipolar, schizophrenia. Neurotransmitters have been implicated in mental illness aetiology (serotonin in depression, dopamine in schizophrenia).
There are many causal factors in psychopathology which interact in a dynamic way. Multifinality is that any risk factor will function differently in different individuals and may lead to varying outcomes. Equifinality is that different risk factors may lead to the same outcome. The same disorder may be expressed in different ways- developmental pathways to a disorder are many and interactive.
ADHD has deficiencies in attention, impulse control and regulation of motor activity. 5-10% of children 5-18. More common with boys than girls; comorbid oppositional defiant disorder. Inattention: failing to give attention to detail, difficulty sustaining attention, does not seem to listen when spoken to, does not follow instructions/fails to finish, difficulty organising, loses things necessary for tasks, distracted, forgetful. Hyperactivity: fidgets and squirms, leaves seat in class when inappropriate, runs and climbs where inappropriate, difficulty playing quietly, often on the go or driven by motor, often talks excessively. Impulsivity: blurts out answer before question finished, difficulty waiting turn, interrupts or intrudes on others.
There should be evidence of impairment in social, academic or occupational functioning not explained by another disorder. Combined type is 6 inattentive/6 hyperactivity, predominantly inattentive is 6 inattentive, hyperactive/impulsive is 6 hyperactive/impulsivity symptoms. Biological component- has 0.7-0.8 concordance; frontal lobes under-responsive to stimulation; psychosocial component has social reasoning deficits and impulsive response style, problems with parenting. Treatment can be with medication (psychostimulants and non stimulants), behavioural treatments (parent training, classroom management, operant principles (reward appropriate behaviour to have it repeated).
Delinquency emerges early, continues throughout life. Related to low SES, inadequate supervision, impulsivity, possible predisposition for aggressiveness. Adolescent limited antisocial behaviour is limited to minor criminal acts that are not consistenly antisocial. Prevention programs include teaching self control, teaching effective discipline and supervision, developing conflict resolution, schools that encourage performance, improvement of economic conditions.
Depression can be a mood or a disorder. They should have 5+ symptoms during the same 2 week period: depressed mood most of the day, every day; diminished interest in most activities nearly every day; weight loss or weight gain/appetite change; insomnia or hypersomnia; psychomotor agitation or retardation nearly every day; fatigue or loss of energy; feelings of worthlessness or excessive/inappropriate guilt; diminished ability to think/concentrate or indecisiveness; recurrent thoughts of death or suicidal ideation. Twice as common in females in adolescence and adulthood. Increases risk of comorbidity 20 times. Treatment is CBT, interpersonal psychotherapy.
Schizophrenia requires 2 or more over 1 month: delusions; hallucinations; disorganised speech; grossly disorganised or catatonic behaviour; negative symptoms. Delusions are beliefs that seem real to the person with a psychotic disorder. Hallucinations are unreal perceptions in the environment, can be auditory, visual, olfactory and tactile. Social occupational dysfunction is a problem with one of the two, self care below prior level achieved; duration of disorder is continuous for 6 months, may include prodromal or residual symptoms. Genetic component, 50% concordance. Dopamine is overactive. There are large lateral ventricles, reduced temporal lobes, possible defect during fetal development dormant until after puberty (not necessary or specific). Environmental stressors may play a part- high levels of expressed emotion or emotionally involved family members can be poor for outcome. Late adolescence/early adulthood is most common onset. 20% of schizophrenics only have 1 or 2 episodes. There is medication, psychosocial interventions, psychotherapy, rehabilitation of skills, family psychoeducation.
Anorexia nervosa: refusal to maintain normal bodyweight, intense fear of gaining weight or becoming fat, disturbed perception of body weight or shape or undue influence of weight/shape on self evaluation, denial of low body weight, amenorrhoea. More severe if 14-18. Bulimia nervosa is periods of eating more than another would eat, can be purging or non-purging in inappropriate compensatory behaviour. Binges are at least twice a week for 3 months. May be hard to detect but more responsive to treatment. Biological factors: serotonin may be involved in hunger or appetite; sociocultural factors: cultural messages about beauty, vulnerable/anxious individuals more likely to be affected. Family influences can be enmeshment (overinvolvement, excessive intimacy), overprotectiveness, rigidity (avoidance of dealing with issues), unclear whether they contribute to disorder or are in response to it. Psychological: low self esteem, environmental stress, negative emotion, excessive need for control, poor identity formation. Treatment with CBT, antidepressants, anticonvulsants/antiemetics. Nutritional rehabilitation may be required.
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