PSYC 301 > Dysfunction associated with psychiatric disorders (BPD + ADHD) > Flashcards

Dysfunction associated with psychiatric disorders (BPD + ADHD) Flashcards

(48 cards)

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1
Q

DSM-5 Criteria: Major Depressive Episode

A
  • Depressed mood
  • Loss of interest or pleasure in almost all activities
  • Weight or appetite changes
  • Sleep changes
  • Psychomotor changes (agitated or slowed)
  • Tiredness, fatigue, low energy
  • Sense of worthlessness or guilt
  • Impaired ability to think
  • Recurrent thoughts of death, suicidal ideation, or suicide attempts
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2
Q

DSM-5 Criteria: Hypomania

A

A. Abnormal, persistent elevated, expansive, or irritable mood and increased goal-directed activity or energy, most of the time, for at least 4 days

B. Some of the following:
* increased energy and activity
* persistent mild elevation of mood
* marked feelings of well-being and both physical and mental efficiency
* increased sociability and talkativeness (or increased irritability in some)
* increased sexual energy
* decreased need for sleep

  • BUT: none to the extent that they lead to severe disruption of work or result in social rejection, and no hallucinations or delusions (i.e., psychosis)
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3
Q

DSM-5 Criteria: Manic Episode

A

A. Abnormal, persistent elevated or expansive mood and increased goal-directed activity or energy, most of the time, for at least 1 week

B. 3+ of the following to a significant degree:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual or pressure to keep talking
- Flight of ideas or subjective experience that thoughts are racing
- Distractibility
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in activities that have a high potential for painful consequences
- The mood disturbance causes marked impairment in social or work life, necessitates hospitalization, or includes psychosis (hallucinations and/or delusions)

The mood disturbance causes marked impairment in social or work life, necessitates hospitalization, or includes psychosis (hallucinations and/or delusions)

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4
Q

Bipolar I and II: similarities and difference

A

Both share experiences of:
* Depression
* Hypomania

BP I: INCLUDES MANIC EPISODES

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5
Q

Commonality of bipolar I and II

A
  • 0.6% bipolar I
  • 0.4% bipolar II
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6
Q

Reward hypersensitivity model of BD

A

In this model, being hypersensitive to reward is a trait that predisposes someone to developing BD

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7
Q

Reward hypersensitivity model of BD - positive side

A
  • Hypomanic/manic pathway
  • Goal attainment can lead to excessive reward states and ultimately (hypo)mania
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8
Q

Reward hypersensitivity model of BD - negative side

A
  • Depressive pathway
  • Goal non-attainment can lead to excessive reward deactivation and a depressive state
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9
Q

Euthymic (period of normal mood) individuals with BD…

Evidence for the Reward Hypersensitivity Model

A
  • Still show excessive activity in reward areas: frontal-striatal reward-related areas in response to reward-I related cues (EX: gambling reward cues)
  • Make more risky choices than controls (e.g., on gambling tasks)
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10
Q

Prodromal (not currently diagnosed, but show minor symptoms) features…

Evidence for the Reward Hypersensitivity Model

A
  • before hypomania and mania: show excessive goal setting and increased success expectancies
  • before depressive episodes: decreased motivation and goal setting and low self-confidence
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11
Q

Teenagers (14-19) who score high on reward sensitivity are more likely to…

Evidence for the Reward Hypersensitivity Model

A

…develop bipolar disorder in a prospective study (Alloy et al., 2012)

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12
Q

Functional changes in euthymic BD patients - increased responsiveness…

A

Increased responsiveness in limbic and para-limbic areas (in red)

  • Amygdala
  • VLPFC
  • Ventral ACC
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13
Q

Functional changes in euthymic BD patients - Decreased responsiveness…

A

…in areas associated with cognitive control (in blue)

  • Dorsal ACC
  • DMPFC
  • DLPFC
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14
Q

Structural changes in BPD

A
  • Structural reductions in gray matter (similar areas to functional – PFC, limbic…)
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15
Q

What are structural changes in BPD driven by?

A
  • Driven particularly by time spent in manic episodes, which are associated with neuroinflammation, stress hormones
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16
Q

Treatments:

A

Treatment of BD
* Mood stabilizers: Lithium, (valproate, lamotrigine…); Alone or combined with..
* Atypical antipsychotics: (quetiapine, aripiprazole, asenapine, lurasidone, cariprazine…)

Psychotherapy – CBT, health education, family-focused treatments all have some evidence

Antidepressants alone are not recommended
>50% of patients do not adhere to treatment

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17
Q

ADHD: Executive Function - Regions involved:

A

Prefrontal cortex and/or associated projections

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18
Q

Executive Function

A

Cognitive control of behaviour

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19
Q

Executive Function - Items in a mental status exam (5)

A
  • Judgment tests
  • Verbal fluency
  • Luria’s 3 step test
  • Trail-making or drawing patterns
  • Clock drawing “10 past 11”
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20
Q

Researchers define 3 core executive functions

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A
  1. Working memory: Holding and mental working with information “in mind”
  2. Inhibitory control: Resisting temptations, not acting impulsively or prematurely, over-riding automatic behaviour
  3. Cognitive flexibility: Fluidly changing perspectives or approaches to solving a problem, adjusting to new demands, switching between priorities or tasks
21
Q

Testing working memory

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A
  • Digit or pointing span
  • How many can you remember? (LIKE SPOT IT)
22
Q

Testing inhibitory control

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A
  • Stroop - differing colors and texts
  • Flanker - looking at reaction times
  • Wisconsin card sort - must adapt to changing rules (Measuring to see how the participant regards old instructions and engages in new ones)
23
Q

Higher order “executive functions”

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A
  • Planning
  • Organizing
  • Multi-tasking
  • Self-awareness
  • Regulating emotions
  • Inhibiting inappropriate behaviour
  • Motivation
  • Concentrating
24
Q

Severe and extensive frontal lobe damage (i.e. stroke, brain injury…) can result in:

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A

Abulia – lack of drive

  • Sit - won’t seek out anything, like going to the bathroom, social interactions
  • Return of primitive reflexes (“frontal release signs”)
  • Utilization behaviour
  • Knows what to do with objects given - due to the inability to inhibit this
  • EX: putting on pants, licking an envelope to seal it
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Orbitofrontal circuit dysfunction ## Footnote Specific circuits in the prefrontal cortex
* Impulsive * Socially inappropriate * Poor safety judgment * Difficulty evaluating anticipated rewards and punishments * Don’t “learn from mistakes” due to diminished guilt and regret
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Dorsolateral circuit dysfunction ## Footnote Specific circuits in the prefrontal cortex
* Distractible * Disorganized * Perseverative * Difficulty multitasking * Poor time management and prioritization
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Attention deficit hyperactivity disorder (ADHD) - Key symptoms (3):
extreme inattention, hyperactivity, impulsivity
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Attention deficit hyperactivity disorder (ADHD) - Diagnosis intersects with societal norms:
* Younger children within a classroom more likely to be diagnosed * Rapid (!) rise in adult diagnoses * Presentations vary with gender – underdiagnosis of hyperactivity in girls?
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Neurobiology of ADHD
* **Reduced activity and volume of PFC** * Slower maturation of PFC (normal cortical thinning is slower; this is correlated with hyperactivity/impulsivity)
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A dual-pathway model of ADHD
* **Executive** circuit (dysfunction: **inattention**): dlPFC and caudate * **Reward** circuit (dysfunction: **lack of motivation**) * OFC, ACC and nucleus accumbens Evidence of a hypoactive dopamine system
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Major treatment for ADHD
**medications that act upon dopamine** and norepinephrine systems in PFC and subcortical structures
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ADHD SPECIFIC LECTURE
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Stigma is…
a sign of social unacceptability involving negative attitudes, beliefs, and/or behaviours about or towards an individual or group of people based on a characteristic or their situation in life.
34
Different types of stigma (3):
1. **Public Stigma** (Societal) - i.e. discrimination, stereotypes 2. **Systemic Stigma** (Institutional) - Embedded in workplaces, schools, healthcare system 3. **Self-Stigma** (Internalized)
35
Stigma involves (5)
1. Negative judgements 2. Stereotypes 3. Discrimination 4. Labeling 5. Othering (i.e., “us” vs “them”)
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What can stigma result in?
Can result in people engaging in "masking" - covering up our "otherness"
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Stigma and ADHD
* Disorders that are highly visible, perceived as controllable & misunderstood are more likely to be stigmatized * Stigma can be a barrier to care & social support * Negative bias towards individuals with ADHD contributes to increased social difficulties & social rejection * Perceived stigma can lead to social isolation, less self-compassion & lower self-esteem
38
Individuals with ADHD are more likely to experience...
negative events and stressors, often as a consequence of their condition, which can contribute to individuals with ADHD having poorer mental health and being at a higher risk for depression
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Differential diagnosis rates between genders
* Childhood: 3:1 boys to girls * Adulthood: 1:1 men to women * Lack of data on gender diverse individuals * Differential prevalence of subtype diagnoses (ADHD-I (inattentive) vs ADHD-HI (hyperactivity or impulsivity with subthreshold inattention)) * Impact of societal values & gender norms * Girls tend to be older when diagnosed & struggle socially more * Women with ADHD experience greater severity of impairment & presence of comorbid disorders * Falls under the umbrella term of Neurodiversity
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Gender and ADHD - **factors contributing to under- and misdiagnosis of women:**
* Lack of knowledge of gender differences in ADHD * Gender bias in research (e.g., diagnostic criteria) * Higher rates of comorbidities in women with ADHD * Symptom and result * Individuals with externalizing symptoms (vs internalizing) more likely to be recognized/referred * Higher threshold for symptom severity in women for referral & diagnosis
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Insights into late diagnosis of ADHD - two main types of self-responding we tend to engage in during times of struggle or hardship:
1. UNCOMPASSIONATE SELF-RESPONDING 2. COMPASSIONATE SELF-RESPONDING
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UNCOMPASSIONATE SELF-RESPONDING
Responding to oneself in a way that involves: * Self-judgement & criticism * Over-Identification with negative thoughts, emotions & experiences * Feelings of isolation in suffering
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COMPASSIONATE SELF-RESPONDING
Responding to oneself in a way that involves: * Self-kindness & understanding * Mindfulness (mindful awareness of the experience without over-identifying with negative thoughts & emotions) * Acknowledging the common humanity in suffering
44
Self-compassion is...
the practice of being kind to oneself in times of suffering such as experiencing failure or personal difficulty.
45
Self-compassion involves 3 main elements:
* How we **pay attention** to our suffering (mindfulness vs over-identification) * How we **cognitively understand** our suffering (common humanity vs isolation) * How we **emotionally respond** to our suffering (self-kindness vs self-judgement)
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Self-Compassion and ADHD
* Higher levels of ADHD traits are associated with more uncompassionate self-responding (UCS) & emotional regulation difficulties * High levels of UCS in people with ADHD contributes to more emotion regulation difficulties & greater mental health challenges * Internalizing others’ negative feedback & criticism can make individuals with ADHD more self-critical
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Positive outcomes associated with self-compassion for individuals with ADHD including:
* IMPROVED RESILIENCE, SELF-EFFICACY & HEALTHY COPING * IMPROVED PSYCHOSOCIAL WELLBEING & EMOTIONAL REGULATION * REDUCED COMORBID SYMPTOMS, NEGATIVE THINKING & STRESS
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