Developmental psychopathology 1 - childhood and adolescence

===Lecture Details===
Glenn Melvin; Week 3 MED1022; HLSD
===Lecture Content===
Psychopathology is study of psychological or mental disorders, manifestations of a mental disorder. Developmental psychopathology is how these pathologies change with development or time. Psychodynamic is intrapsychic conflicts between parts of the mind (ego, id and superego) and how these produce neurotic anxiety. Ego provides defence mechanisms to manage emotions including denial and intellectualisation.
Behavioural response is classical conditioning. Social cognitive approach is that behaviour may be learned through observation of others. Social cognition is how indivduals think about themselves, their relationships, family, peer and wider social contexts. Cognitive distortions may contribute to the onset of behavioural and emotional problems. Biological approach is that heredity may predispose a person to an increased risk of developing mental illness. Neurotransmitters have been implicated in the aetiology of mental illness.
Multifinality is that any risk factor will function differently in different individuals and may lead to varying outcomes. Equifinality is that different factors may lead to simillar outcomes. The same disorder may be expressed in different ways. ADHD includes developmental deficiencies in attention, impulse control and regulation of motor activity. More common in boys than girls. Hyperactivity can have excessive talking, has impulsivity. There must be impairment in social, academic or occupational functioning (two of these environments). There is predominantly inattentive type, combined type (6 inattentive and 6 hyperactivity/impulsivity) or predominantly hyperactive/impulsive type. There is a 0.7-0.8 concordance, frontal lobes are unresponsive to stimulation. Psychosocial component has social reasoning deficits and impulsive response style. They have difficulties in encoding, cue utilisation, perspective taking and evaluating intentions of others. Medicaiton can be psychostimulants or non stimulants. Behavioural treatments are parent training, classroom management or operant principles (reward appropriate behaviour to increase chances of it being repeated).
Delinquency is a result of persistant antisocial behaviour which emerges at an early age and persists throughout life. Related to low SES and parent supervision, impulsivity and a possible predisposition for aggressiveness. Adolescent limited antisoical behaviour is limited to minor criminal acts that are not consistently antisocial- they may be imitative and attempt to reach adult-like status. Prevention techniqes are self control techniques, teaching effective discipline and supervision skills, developing better ways of resolving family conflicts, school programs that encourage investment in performance.
Major depressive disorder: depressed mood most of the day, every day; markedly diminished interest in all or almost all activities most of the day, nearly every day; significant weight loss when not dieting or weight gain; insomnia or hypersomnia nearly every day; psychomotor agitation or retardation nearly every day; fatigue or weight loss nearly every day; feelings of worthlessness or excessive or inappropriate guilt nearly every day; diminished ability to think or concentrate or indecisiveness nearly every day; recurrent thoughts of death nearly every day, recurrent suicidal ideation nearly every day. Twice as common in females in adolescents and adults. Comorbidity is higher in adolescents than adults. The presence of depression increases the chance of comorbidity 20 times. Depression is treated with CBT and interpersonal psychotherapy as well as pharmacological treatments.
Schizophrenia is accompanied with delusion, hallucinations, organised speech, grossly disorganised or catatonic behaviour and negative symptoms (affect flattening, alogia, avolition, social withdrawal). Hallucinations can be auditory, visual, olfactory or tactile. Diagnostic criteria are social occupational dysfunction, continuous disturbance for 6 months, may include prodromal or residual symptoms. Aetiology has no exact causes known, combination of factors are unlikely. There is a genetic component and neurotransmitter involvment. Brain structural abnormalities are present including large lateral ventricles, reduced temporal lobes, possible defect during foetal development that is dormant until after puberty. Environmental stressors may influence the onset of schizophrenia. Late adolesence and early adulthood are the most common times of onset. Treated with medication, psychosocial interventions such as psychotherapy, rehabilitation and family psychoeducation.
Anorexia is refusal to maintain bodyweight at or above a minimally normal level for age and height. There is an intense fear of gaining weight or becoming fat, even though underweight. Disturbed perception of body weight/shape. Sees control over weight loss as a success.
Bulimia is eating more food than most would eat, recurrent inappropriate compensatory behaviour to prevent weight gain. Self evaluation is unduly influenced by body shape and weight. May be hard to detect and more responsive to treatment than anorexia. Aetiology of eating disorders can be family enmeshment, overprotectiveness, rigidity, psychological problems. CBT has most evidence of efficacy, antidepressants may be helpful. Nutritional rehabilitation may be required.
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