1
Q
Schizophrenia
A
- a neurodevelopmental disorder of the brain- expressed in abnormal mental functions and disturbed behaviour
- characterized by severe psychotic symptoms, bizarre delusions, hallucinations, thought disturbances, grossly disorganized behaviour or catatonic behaviour, extremely inappropriate or flat affect, and significant deterioration or impairment in functioning
2
Q
Child onset schizophrenia (COS)
A
- rarer and possibly more severe (but not distinct) form of schizophrenia
- occurs during childhood
- gradual, rather than sudden onset
- likely to persist into adolescence and adulthood
- has profound negative impact on developing social and academic competence
3
Q
Positive symptoms
A
- things that are there/ added
- delusions (beliefs)
- hallucinations (most common auditory- occurs in 80%)
4
Q
Negative symptoms
A
- loss of function
- slowed thinking, speech, movement; emotional apathy; lack of drive; indifference to social contact; self- neglect
- can be very persistent and difficult to treat
- difficult to recognize
5
Q
DSM-5 diagnostic criteria schizophrenia
A
A) severe disturbance in sensory functioning and/ or behaviour (2+) (at least one delusions, hallucinations, or disorganized speech)
B) social/ occupational dysfunction
C) duration 6+months with at least one month of symptoms that meet criteria D) Schizoaffective and mood disorder exclusion
E) substance/ medical condition exclusion
F) relationship to autism spectrum disorder or communication disorder- schizophrenia only diagnosed if delusions and hallucinations present for one month
6
Q
Other times psychotic symptoms can occur
A
- depression
- bipolar disorder
- substance abuse
7
Q
Precursors childhood onset schizophrenia
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- gradual onset
- almost 95% have history of behavioural, social, and psychiatric disturbances before onset of psychosis
- developmental precursors
8
Q
Comorbidities childhood onset schizophrenia
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- 70% meet criteria for another diagnosis
- most commonly mild disorder or ODD/ CD
- number links between COS and ASD
- one study found that COS preceded ASD in 30-50% cases (both deficits in TOM, accelerated brian development near onset of disorder, similar abnormalities in rural connectivity)
9
Q
Prevalence COS
A
- extremely rare (1/10,000)
- dramatic increase adolescence, model onset around 22 years of age
- COS earlier onset in boys by 2-4 years (gender differences disappear in adolescence)
- most psychotic diagnosis onset I. Late adolescents/ early adulthood (peak 15-25 males, 20-29 females)
- prodromal period thought to precede psychotic diagnosis by 1-6 years
10
Q
Potential problems in assessment COS?
A
- screening measures developed for adolescents and young adults
- children responses to these measures need to be Interpeted with caution
- children’s questionarire endorsement of hallucinations
- delusions and persecutory ideas also found common in childhood
11
Q
Neurodevelopmental model causes of COS
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- genetic vulnerability and early neurodevelopmental insults result in impaired connections between many brian regions
- defective neural circuitry increases a child’s vulnerability to stress
12
Q
Biological factors for causes of COS
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- strong genetic contribution (several potential susceptibility genes)
- best represented by continuum of risk with many GxE interactions
- CNS dysfunction and improvements with medication suggest it is a disorder of the brain (enlarged ventricles, grey matter shrinkage, and other structural differences)
- widespread developmental disruption of neural connectivity
13
Q
Environmental factors causes of COS
A
- familial disorder and no genetic factors may place a role trough interaction with a genetic susceptibility
- do not alone cause schizophrenia
- high communication deviance
- stress, distress and personal trashed experienced by families and children with schizophrenia
14
Q
Treatment of COS
A
- chronic disorder with poor long- term prognosis
- antipsychotic medications (block dopamine transmission but serious side effects) combined with psychotherapy and social and educational support programs
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Q
Mood disorders
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- run spectrum grime severe depression to extreme mania and involve extreme, persistent, or poorly regulated mood states
16
Q
DSM-5 divides mood disorder into Eros general categories:
A
- depressive disorders and
- bipolar disorders
17
Q
Depressive disorders
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- excessive unhappiness (dysphoria) and loss of interest in activities (anhedonia), irritability
18
Q
Bipolar disorder
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- mood swings from deep sadness to high elation (euphoria) and expansive mood (mania)
19
Q
Major Depressive Disorder DSM-5 criteria
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A. 5 or more present during same 2 week period: depressed mood, diminished interest/ pleasure, weight & appetitie, insomnia/ hypersomnia, psychomotor agitation/ retardation, fatigue/ loss of energy, feelings or worthlessness/ excessive guilt, diminished ability to think/ concentrate or indecisiveness, recurrent thoughts of death/ suicidal ideation
B. Distress/ impairment
C. Not due to substance or another medical condition
D. Not better explained by another psychiatric disorder
E. Has never been a manic or hypermanic episode
20
Q
Depression and development
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- experience/ expression of depression changes with age
21
Q
Children under 7 (as young as 3-5) depression
A
- less easily identified
- anaclitic depression (spitz)- infants raised in clean but emotionally cold institutional environment displayed reactions resembling depression, sometimes resulting in death (similar symptoms can occur in infants raised in severely disturbed families)
22
Q
Preschoolers depression
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- somber/ tearful
- lack enthusiasm
- excessive clinging/ whiny behaviour around others
- separation/ abandonment fears
- irritability, physical complaints
23
Q
School-aged children depression
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- increased irritability, disruptive behaviours, tantrums, combativeness
- physical complaints (et loss, headaches, sleep)
- suicide threats begin
24
Q
Preteens depression
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- self- blame and low self- esteem
- persistent sadness
- social inhibition
- sleep/ eating disturbances
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Compared to younger children adolescents (depression):
- more likely to report hopelessness
- predictors of depression may differ: negative life events (younger) vs pessimistic attributions style (older)
- more reporting low self esteem
- more neurovegetative symptoms
- more suicidal ideation, attempts
- diurnal variation
- social withdrawal
- girls (negative body image, weight- appetite disturbance, worthlessness/ guilt)
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Depression as a symptom
- feeling sad or miserable
| - occurs without existence if serious problem and is common at all ages
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Depression as a syndrome
- a group of symptoms that occur together more often than by chance
- sadness, reduced interest, cognitive and motivational changes, somatic, psychomotor changes
- mixed symptoms of anxiety and depression that tend to cluster on A single dimension of negative affect
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Depression as a disorder
- MDD
- persistent depressive disorder (P-DD) or dysthymia
- disruptive mood disregulation disorder (DMDD)
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Major Depressive disorder (MDD)
- minimum duration of two weeks; associated with depressed mood, loss of interest, other symptoms, and significant impairment in functioning
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Persistent Depressive disorder (P-DD) or dysthymia
- depressed mood, generally less severe but longer lasting symptoms ( a year or more), and significant impairment in functioning
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Disruptive mood dysregulation disorder (DMDD)
- frequent and severe temper outbursts that are extreme over- reactions to situation
- chronic, persistently irritable or angry mood present.l between severe temper outbursts
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Prevalence MDD
- rate preschool and school age increased two- three fold by adolescence
- modest increase from preschool to elementary school
- sharp increase in adolescence
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Comorbidity depression
- ~90% have one or more other disorders
- most common anxiety disorders (especially GAD), specific phobia, separation anxiety disorder
- others dysthymia, conduct problems, ADHD, eating disorders and substance use disorders
- personality disorders
34
Onset course and outcome depression
- gradual or sudden (usually history of milder episodes that do not meet diagnostic criteria)
- age onset 13-15 years
- average episode 8 months, most recover (linger if parent has depression)
- high chance recurrence
- 1/3 bipolar switch (develop bipolar disorder after being diagnosed with depression)
- overall outcome not optimistic (continue high risk for later episodes of mood and other disorders $ children often continue to experience adjustment and health problems and chronic stress)
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Gender depression
- before adolescence approx equal
- after puberty females 2-3x that if males
- symptoms generally similar, but some differences
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Persistent Depressive Disorder (P-DD)
- characterized. T symptoms of depressed mood that occur in most days, and persist for at least one year, with 2 or more of: eating, sleeping, energy, low self esteem, poor concentration difficulty making decisions, and feelings of hopelessness
- less severe symptoms but more chronic than MDD
- prevalence rates lower than MDD
- most comirbid disorder is MDD
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P-DD onset, course, and outcomes
- common age onset 11-12 years
- childhood indent leads to prolonged duration
- may be precursor to MDD for some children
- most recover but high risk for developing other disorders especially MDD, anxiety disorders, and conduct disorders
- increased risk for bipolar disorder and substance use disorder
- receive less social support than those with MDD
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Associated characteristics of Depressive disorders
- intellectual and academic functioning
- social and peer problems: can lead to socially helpless behaviour or aggressive behaviour which both lead to neglect
- family problems (less supportive/ more conflicted, feel socially isolated and prefer to be alone)
- negative self esteem
- congnitice biases and disturbances
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Suicide
- second leading cause death in adolescents and young adults in Us
- most youths with depression report suicidal ideation
- females with depression have more suicidal ideation and attempt more than males, but girls usually less successful than boys
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Depressogenic/ distorted cognitions
- negative perceptions, attributions, thoughts, and beliefs associated with Depressive symptoms
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Hopelessness theory
- make internal, stable, global attributions to explain causes of negative events
- depression prone individuals have a negative attributions style- blame self for negative events in life and leads to helplessness and avoidance of these events in the future which leads to helplessness and depression
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Beck's cognitive model
- depressed individuals make negative interpretations about life events because they use biased and negative beliefs as interpretative filters for understanding these events
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Becks cognitive problems in 3 areas
- information processing biases (negative automatic thoughts, biased attention)
- negative cognitive schema
- negative cognitive triad: negative outlook regarding oneself, the world, and the future
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Causes depression
- multiple pathways likely
- genetic risk influences neurobiological process and is reflected in early temperament characterized by: over sensitivity ti negative stimuli, high negative emotionality, and disposition to feeling negative affect
- early dispositions shaped by negative experiences in family
- abnormalities brain regions
- stressful life events
- emotion regulation
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Why is it important to treat depression in children and adolescents?
- impaired functioning/ quality of life
- adverse impact on cognitive, social development
- increased suicidality/ ideation
- risk factor for other psychological problems
- poor psychological outcome
- predicts adult psychopathology
- more virulent/ longer duration than adults
46
Increased diagnosis of pediatric BP possibilities
1. Was precious under- diagnosed now accurately diagnosed
Or
2. Now being over diagnosed
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Disruptive mood dysregulation disorder
Depressive disorder characterized by chronic severe persistent irritability with 2 main features
1. Temper outbursts
2. Irritable of angry mood (prior to age 10)
- cannot come exist with ODD or bipolar disorder
- can cooccur with MDD, ADHD, CD, or substance abuse
48
Bipolar disorder
- a period of unusually and persistently elevated, expansive or irritable mood, alternating with or accompanied. G one or more major Depressive episodes
- symptoms: restlessness, agitation, sleeplessness, pressured speech, flight if idead, racing thoughts, sexual disinhibition, surges of energy, expansive grandiose beliefs
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Youth with BP
- may display atypical symptoms: changes in mood, psychomotor agitation, mental excitation, volatile and erratic, irritability, belligerence, and mixed manic- Depressive features
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Four subtypes of bipolar disorder
- bipolar I disorder
- bipolar 2 disorder
- cyclothymic disorder
- other specified type
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Manic episode
period of 1 week or more with ongoing, pervasive, unusually elevated/ irritable mood, persistently increased goal directed activity or energy
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DSM- 5 criteria manic episode
A. Distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting st least 1 week
B. 3 or more: inflated self esteem grandiosity, decreased. Red for sleep, more talkative, flight of ideas, distractibikity, increase goal directed or psychomotor agitation, excessive involvement in pleasurable activities high potential for painful consequences
53
Issues diagnosing BP
- difficulty young people- just tantrum?
- very similar to ADHD (differentiated by grandiosity, elated mood, flight of ideas, decreased need for sleep, hypersxuality, increased goal directed activity)
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Why is it important to recognize pediatric bipolar disorder?
- earlier age I sent associated with:
- more difficult/ complicated course of illness
- prolonged rules and recurrent episodes
- overall more severe course with earlier onset
- younger you are when bipolar beings, longer until you receive treatment
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Prevalence
- youth bipolar II and cyclothymic disorder are more likely than bipolar I
- rapid cycling more common
- extremely rare in young children, but increases after puberty
- affects males and females equally but boys may show more manic mood and girls more depressed mood
56
Comorbidity BP
- anxiety, GAD, ADHD, oppositional and conduct
- substance use
- suicidal thoughts and ideations
- co-occurring medical problems (cardiovascular & metabolic, epilepsy, and migraine headaches)
57
Onset course and outcome bipolar disorder
60% prior to age 19
Peak 15-18 years
Risk factors mania: major Depressive episode & family gistory
- 4-6m untreated
- early onset and course is chronic and resistant to treatment, with poor lung- term prognosis
58
Causes BP
- adults genetic and environmental
- multiple genes
- modify fluctuations related to abnornalitu s in areas of brain related to emotion regulation
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BP treatment
- no cure
- close monitoring of symptoms
- education
- medication, usually lithium
- psychotherapeutic interventions
60
Anxiety
- a mood state characterized by strong negative emotion and bodily symptoms of tension in anticipation of future danger or misfortune
61
Three interrelated anxiety response systems
Physical system: danger- SNS- fight it flight
Cognitive system: fight or flight--> search for threat
Behavioural system: fight or flight--> urges: aggression and desire to escape threatening situation
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Anxiety
Future- oriented mood state, which may occur in absence or realistic danger; characterized by feelings of apprehension and lack of control over upcoming events
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Fear
Present- oriented emotional reaction to current danger, characterized by strong escape tendencies and surge in sympathetic nervous system
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Panic
Group of physical symptoms of fight/ flight response that unexpectedly occur in the absence of obvious danger or threat
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Children with anxiety do not necessarily worry more
They worry more intensely than other children
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Seven categories of anxiety disorders
- separation anxiety disorder (SAD)
- specific phobia
- social anxiety disorder
- selective mutism
- panic disorder (PD)
- agoraphobia
- generalized anxiety disorder (GAD)
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Separation anxiety disorder
age inappropriate, excessive, and disabling anxiety about being apart from parents or away from home
- worry of loss, separation event; refusal to go away from home; excessive fear of being alone; excessive fear to sleep away from attachment figure; repeated nightmares about separation; repeated complaints of physical symptoms
- one of most common anxieties in children
- earliest reported age of onset 7-8 years
- progresses from mild to severe
- associated with major stress
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School reluctance/ refusal in SAD
- refusal to attend classes or difficulty remaining in school for an entire day
- equally common in boys and girls
- ages 5-11
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Specific phobia
Age inappropriate persistent, irrational, or exaggerated fear that leads to avoidance of the feared object or event and causes impairment in normal routine
- 6 months
- extreme and disabling fear of objects or sutuations that in reality pose little or. I danger it threat
- avoids
- tends to have more than one
- not that diff from specific phobia in adults but more anticipatory anxiety, don't recognize that worry is extreme and unreasonable
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Social anxiety disorder (social phobia)
a marked, persistent fear of social or performance requirements that expose the child to scrutiny & possible embarrassment
- twice as common I. Girls
- average age onset early to mid adolescents
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Selective mutism
- failure to talk in specific situations, even though they may speak loudly and frequently at home or other settings
- average age onset 3-4 years
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Panic attack
- sudden, overwhelming period of intense fear or discomfort accompanied by four out more physical and cognitive symptoms characteristic of fight or flight response
- rare in young children, common in adolescents
- related to pubertal development, not age
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Panic disorder
- recurrent unexpected panic attacks followed by at least one month of persistent concern about having another attack, constant worry about the consequence, or a significant change in. Rehabilitation related to the attacks
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Agoraphobia
in severe cases, high anticipatory anxiety and situation avoidance may lead to agoraphobia:
- marked fear/ anxiety in certain places or situations
- fears related to having a panic attack in situations where escape would be difficult or help is unavailable
- distinct disorder conceptualizer independently from panic attacks and PD
- does not usually develop until age 18 or older
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Generalized anxiety disorder (GAD)
- equally common in boys and girls
- average age early adolescence
- older children have more symptoms
- symptoms persist over time
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OCD age of onset
Average 9-12 years
- two beans 6-10 "early onset" (more boys, strong family history OCD; prominent motor patterns, co-occuring tic disorders)
- late adolescent
- chronic
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OCD related disorders
- body dysmorphic disorder
- hoarding disorder
- Trichotillomania
- excoriation disorder
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Habituation
The process of tolerating anxiety
- if you enter situation with high anxiety, and leave the anxiety goes down immediately, however you associate leaving with anxiety decreasing
- with treatment stat with the situation and the anxiety will decrease in it's own
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Cognitive disturbances with anxiety
- intelligence generally normal: disturbance in how info is perceived and processes
- threat related attentional biases
- cognitive errors and biases
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Physical symptoms anxiety
- somatic complaints (more common in all except specific phobia, more common in adolescents than younger children
- sleep related problems
- reduced accidents and accidental deaths in young adulthood but higher rates of non- accidental death later in life
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Social and emotional deficits anxiety
- low social performance and high social anxiety
- likely viewed as anxious and socially maladjusted
- see themselves as shy and sexually withdrawn
- report low self esteem, loneliness, difficulty initiating and. Maintaining friendships
- difficulties with peers/ siblings difficulty understanding emotio
82
Anxiety and depression.
- strong relationship between anxiety and depression in children
- anxiety generally precedes and predicts symptoms of depression
- link negative affeftivity
- positive affextivity negatively correlated with depression, but independent of depression
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Gender, ethnicity, culture anxiety
- more common girls
- ethnicity and culture may affect expression, developmental course, and interpretation of anxiety symptoms
- pervasive across cultures
- behaviour lens principle
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Theories and causes of anxiety
- psychoanalytic
- behavioural and learning theories: learned through classical conditioning maintained through operant conditioning (two- factor theory)
- bowlbys theory of attachment
- no single theory sufficient
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Temperament
- variations in behavioural reactions to novelty
- behavioural inhibition: low threshold for novel and unexpected stimuli, tend to be fearful/ anxious as toddlers, shy withdrawn as young children
86
Family and twin studies anxiety
- disposition to become anxious is inherited
- highest genetic influence for OCD and shyness/ inhibition l
- serotonin and dopamine e
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Neurobiological factors
- no single structure or neurotransmitter
- HPA axis
- overactive BIS
- more pronounced right- left hemisphere brain asymmetries and an over excitable amygdala
- primary neurotransmitter system GABA- ethic
88
Trauma and stressor related disorders
- acute stress disorder
- adjustment disorder
- PTSD
- reactive attachment disorder
- disinhibited social engagement disorder
89
Child maltreatment
- physical abuse
- neglect
- sexual abuse
- psychological abuse
90
Non- accidental trauma
- wide ranging effects of maltreatment on the child's physical and emotional development
91
Victimization
- abuse or mistreatment of someone whose ability to protect himself or herself is limited
92
Expectable environment
- protective and nurturing caregiver(s)
- opportunities for socialization within a culture
- contact with peers
- opportunities to explore and master environment
- gradual shift of control from parent to child and the community
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Boys more likely to be abused by
Male nonfamily members
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Girls more
| Likely to be sexually abused by
Male family members
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Disorders related to social neglect
- reactive attachment disorder
- disinhibited social engagement disorder
Child has experienced a pattern of extrememes and insufficient care evidenced by at least 1 of: social neglect or deprivation, repeated changes primary caregivers, rearing in unusual settings
96
Treatment trauma
- exposure
| - CBT
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Why is spanking ineffective;
1. Goals to adhere to the principle of learning: the conditions that must exist for punishment to be effective
2. Children learn by more complicated methods than just what behaviours eleicit a punishment
3. Often illogical and confusing
4. Spankin is fear based
Developmental Psychopathology
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