psych exam 3
The Portugal Experiment
The legalization/decriminalization question should be an empirical question about the impact of resource allocation and not a political question about the mortality of drug use
what does mesocortical dopamine function do
inhibits negative psychotic symptoms (NMDA activates this function to inhibit the negative psychotic symptoms)
What happens when NMDA activation is low
high mesolimbic dopamine function, which causes positive psychotic symptoms. (NO NMDA THERE TO INHIBIT IT) low mesocortical dopamine function, which causes negative psychotic symptoms. (NO NMDA there to activate the function)
Authoritative parenting
high warmth, high control
Permissive parenting
high warmth, low control
Authoritarian, Neglectful, and Permissive parenting styles are all associated with _______ risk of CD in comparison to Authoritative parenting
higher
Active psychotic episode
lasts longer than MDE can last for several months, especially if not managed with medications
Alcohol decreases a GABAnergic Interneuron that is in charge of inhibiting Dopamine (DA) release -->
if you inhibit the inhibitor (makes it less efficient), this results in DA increases leads to pleasurable effect
deficits in ADHD: Fronto-striatal network
impacts cognitive control (switching) and attention allocation Impacts ability on set switching task
deficits in ADHD: Fronto-cerebellar network
impacts timing of motor functioning and response selection Would be most impacted by the planning and sequencing task described above
Positive Symptoms of Psychotic Disorders
include delusions, hallucinations, disorganized thinking and disorganized behaviors --> "added on" symptoms - experiences of symptoms that people don't usually have
what do cns depressants do
increase GABA transmission
cannibas is a CB1 Agonist -
increase downregulation
Side effects of 2nd generation antipsychotics like zyprexa
increased risk for obesity, which increases risk for diabetes with prolonged use
Substitution treatment for drug abuse:
replace drug of abuse with a less harmful substance (e.g., methadone) that facilitates tapering out of drug of abuse
family therapy and psychoeducation
self explanatory therapy for psychotic disorders
Ritalin is cocaine's younger sister
it is basically like sorting cocaine, as stimulants (like Ritalin/Adderall) act like cocaine directly on the DA cells Why if you take Ritalin by mouth you don't get high (vs. snorting) much slower absorption than via snorting (b/c bypasses digestive process and goes into the bloodstream faster)
why does withdrawal happen in this example?
(??) is this right or would this be pharmacodynamic Goal of body is to keep GABA in normal range As Alcohol intake increases, body will begin to decrease the sensitivity of GABA receptors to counteract the increase of alcohol intake with the goal of keeping GABA transmission stable If you stop taking alcohol cold turkey (your GABA sensitivity is suppressed), the GABA transmission will drop below normal range because your GABA receptors have reduced sensitivity due to prior high rates of alcohol consumption body doesn't have enough time to reverse the desensitization of the GABA receptors #1 treatment for alcohol withdrawal symptoms is to increase GABA via GABA agonists (e.g., benzodiazepines)
Prodrome of schizophrenia
- typically occurs during adolescence - can last for years - functioning rapidly drops... grades suffer, social life nonexistent, strange beliefs, etc.
Prenatal Hormone Exposure as Risk Factor of ASD
--> children with autism had higher exposure to sex hormones in utero than children without autism
lifetime prevalence of schizophrenia
1% lifetime risk for the general population; 1.1% 12-month prevalence Approximately 3-4 million people in the US
What are the 3 subtypes of ADHD
1) Hyperactivity-Impulsivity 2) Inattention 3) Combined Type
What are the two broad categories of Childhood Disorders?
1) Neurodevelopmental Disorders 2) Disruptive Disorders
What are the restrictive behaviors associated with ASD
1) Stereotyped or repetitive speech, motor movements, or use of objects 2) Excessive adherence to routines 3) Highly restricted, fixated interests 4) Hyper- or hypo-reactivity to sensory input
Hypotheses in the field during the exploration of whether or not vaccines cause autism:
1) Total Exposure: number of vaccines received increases risk... Evidence against: No differences between those with ASD and controls in total levels of immunogens exposure 2) Thimerosal (mercury-based preservative in vaccines) content in vaccines... Evidence against: Even after thimerosal was removed from vaccinations, the rate of autism continued to increase; no differences in rates between those exposed to thimerosal vs. those who were not exposed 3) Age/Time of Exposure... Evidence against: Associations between thimerosal exposure and autism outcomes: greater exposure was associated with lower risk for autism (for all types of ASD) 4) Specific autism type - regressive autism is small portion of autism; vaccines may be linked only to regressive autism... Evidence against: greater exposure actually linked to lower risk of autism
Rate of CD tends to increase around ages ____ for both girls and boys
10-12
NC Fast Track Program:
10-year intervention starting in kindergarten in high risk schools Included PMT, social skills training, academic tutoring, home visits, universal curriculum 75% decline in CD diagnosis 50% decline in ODD diagnosis
Lifetime prevalence of CD in boys
12%
Lifetime prevalence of schizophrenia among fraternal twins who the other has it
15%
typical onset of schizophrenia in a man
18-35 years old... rarely happens after 40
Substance Use Disorder Criteria: DSM-5 requires at least __ symptoms of the following (can be any __) to be present within a 12-month period mild: 2-3 moderate: 4-5 severe: 6+
2 Excessive consumption Can't stop Drug seeking behaviors Cravings Failure to fulfill role obligations Social/interpersonal problems Use when physically hazardous Continued use despite physical consequences Tolerance our systems adapt so that more quantities are necessary to achieve the same effect; there are 3 types of tolerance:
74% of children with untreated ADHD (in comparison to controls - children without ADHD) have much poorer outcomes
2-3x less likely to complete High School 2x more likely to be held back in school 2x more likely to have psychiatric comorbidity 25% have no negative long-term outcomes 25% have severe negative long-term outcomes
Up to __% of kids with autism meet definition of recovered after many years of ABA treatment
20%
typical onset of schizophrenia in a woman
20-30 and slight increase in diagnosis after menopause (this is point of controversy in the field)
__% of all deaths each year are attributed to drug use (over 500,000 deaths per year)
21 Tobacco accounts for 443,000 of those deaths, followed by 79,000 to alcohol-related problems (e.g., drunk driving, liver complications, etc.), and 27,000 from all other illicit drugs From a research/public policy perspective, targeting tobacco use makes the most sense given the large number of deaths associated with it each year
Why did so many people believe vaccines caused Autism?
3 main reasons 1. Change in vaccine schedule in 1990s that was around the time we see a rapid increase in rate of autism 2. Wakefield article: study found relationship between vaccines and autism; however, later came out that Wakefield had completely made up these findings (all false) 3. Regressive autism (a real phenomenon in which babies begin to develop normally until around age 2 when the regress - lose functioning and skills that they had before): the time of regression is around the time when kids were getting MMR vaccine schedule (multiple vaccines), so individuals believed that this was causing regression
lifetime prevalence of offspring of both parents having schizophrenia
40%
Rate of ODD is more stable across ages, with a spike in diagnosis for boys between ages __ and __
5 and 7
Link between pot use and higher risk for schizophrenia is no longer debated Pot use during adolescence (especially early teens) is associated with:
5-6 fold increase in risk of developing schizophrenia Earlier onset of schizophrenia (3 years earlier) Among those with cannabis-induced psychosis, up to 44% will develop schizophrenia
Lifetime prevalence of schizophrenia among identical twins who the other has it
50% compared to 15% in fraternal. this means that there is huge genetic relevance, but not complete since identical MZ concordance isn't 100%
Combined Type
6 or more symptoms of Hyperactive-Impulsivity, as well as 6 or more symptoms of Inattention
The U.S. makes up 4.47% of the world population, but makes up __% of the world's drug consumption
60
Lifetime prevalence of CD in girls
7%
9% of US population used illicit drugs in the last 30 days, so __% of the total US population consumes 60% of the world's drugs
9
Lifetime prevalence of CD
9.5%
Paternal Age Risk Factor of ASD
: the older the dad, the higher chance of Autism If father >51, risk increases by 200%; Also see increased risk among fathers <25 o Quality of DNA may not be the same among very young or old fathers Correlations of diagnoses among MZ or DZ twins MZ generally much higher than DZ across paternal ages o As father gets older, difference between MZ and DZ gets smaller shared environmental exposure of older father
Negative Symptoms of Psychotic Disorders (all the others are positive)
ABSENCE of normal psychosocial functions (e.g., emotion, motivation, speech) --> the absence of experiences that should be there in a person who does not have this condition Flat affect Avolition (motivation) Alogia (speech) Anhedonia (pleasure) Asociality
Lifetime prevalence of ADHD
About 10%
How well do ADHD Treatments work
Across the board, see reductions in symptoms from time start taking medications to 14 months after beginning across time Gains made in first 14 months can remain for 8 years, but only among those with the strongest response during the 1st year Now a movement to evaluate degree of response during the first year to assess whether gains will be maintained across time
Example of withdrawal:
Alcohol binds to GABA receptors and enhances GABA enhances inhibition (why alcohol is a depressant) over time GABA receptors adapts (receptors become less sensitive)
what does alcohol do to gaba receptors
Alcohol binds to gaba receptor/interneuron which makes the receptor less sensitive which means that gaba will have a greater effect on the receptor, but it also makes the interneuron weaker (which typically functions as an inhibitor of dopamine) so inhibition of dopamine is inhibited (more dopamine)
TREAMENT FOR ADHD
American Academy of Pediatrics (AAP) 2011 clinical practice guidelines for ADHD: The primary care clinician should prescribe evidence-based parent- and/or teacher-administered behavior therapy as the first line of treatment (quality of evidence A/strong recommendation) and may prescribe methylphenidate if the behavior interventions do not provide significant improvement and there is moderate-to-severe continuing disturbance in the child's function. Controversy: Many pediatricians don't know how to help parents do behavioral management requires referral (which doesn't often happen) and kids are often put on medications automatically o Parent behavioral management alone has not been found to be more effective than medications alone, and the combination of parent management + medication is the most effective
if had THC concentration of >10% and use daily, risk increased
Biggest risk among those that began using high-potency cannabis and frequent use by age 15 years risk doubled
What is the Gold Standard Treatment of ASD
Applied Behavioral Analysis (ABA): - Identify behavior you want child to do (e.g., make eye contact) - Identify reinforcer (something in environment child likes) - Conduct multiple trials (basic behavioral principles) this is very time consuming and expensive though... therapist will come to child's home and work all day on therapies
types of hallucinations
Auditory (most common) Visual Tactile (physical contact) Olfactory (smell) (very rare; see more in brain tumors than in schizophrenia) Gustatory (taste) (very rare)
Research suggests that __________ parenting is associated with high risk for conduct problems at age 10
Authoritarian Effect remains even after accounting for age 5 conduct problems, which suggests that the effect is not due to child behavior driving parenting
In DSM-IV, what was the difference between Autism and Asperger's
Autism diagnosis included a history language delays, while in Asperger's you could not have had a history of language delays This was eliminated because there was no evidence that showed that these were two different disorders. Same prognosis, symptomatology, etc. At the time, Asperger's began to be equated to high-functioning Autism. The controversy of the merge is that Asperger's people felt like they were losing a key part of their identity that differentiated them from low functioning Autists. AND parents of low functioning Autists thought their children would be represented by higher functioning autists now.
Cannabis Short-term effects:
Bind to CB1 receptors (which block release of glutamate - when using cannabis, you have some level of cannabinoid being produced organically) Similar to alcohol, it depresses many systems while activating Opioid and DA system (on a smaller level than what you would experience on cocaine)
Types of Psychotic Disorders
Brief Psychotic Disorders Schizophreniform Schizophrenia Schizoaffective
without cannabis use, what controls the release of glutamate?
CB1 activation
After prolonged use of weed, what happens to CB1 receptors, and what does this cause?
CB1 receptors get blocked. This causes too much active glutamate, which had previously been regulated by CB1 High glutamate in adolescence → permanent downregulation and pruning of NMDA receptors (worn out due to being overworked essentially) Low NMDA activation → high DA function in limbic regions (positive psychotic symptoms) and low DA function in cortical regions (negative psychotic symptoms)
Drug Classes
Central Nervous System (CNS) Depressants increase GABA transmissio: Alcohol, Benzodiazepines CNS Stimulants: Nicotine, Cocaine, Meth Hallucinogens: LSD, Magic Mushrooms Opiates: Heroin, Morphine, Oxycodone
treatments of conduct disorder
Collaborative Problem Solving (CPS): Parent Management Training (PMT): skill-based training for parents involving the use of various parental strategies in specific frequencies; tends to be preferred for childrenUsing 5 techniques in varying proportions/frequencies Increasing special time between child and parentReward desired behaviors Clear expectations/boundaries Ignore unwanted behaviors (used infrequently)Punishment (used very infrequently)
ASD Diagnosis and Symptoms:
Communication and social interaction (MUST have ALL 3 symptoms): 1) Limited social reciprocity 2) Limited non-verbal communication 3) Limited peer relationships Restrictive Behaviors (2 or more of the following): 1) Stereotyped or repetitive speech, motor movements, or use of objects 2) Excessive adherence to routines 3) Highly restricted, fixated interests 4) Hyper- or hypo-reactivity to sensory input:
Core Symptoms of Psychotic Disorders
Delusions Disorganized Thinking Hallucinations Disorganized Behavior Negative Symptoms
Studies that have followed children with ADHD from age 10 to age 30:
Demonstrate strong downward trend: at age 10 80% of original ADHD cases met full criteria, but at age 25 the rate is around 20% o Over time, over half of all cases of childhood ADHD will not continue to meet criteria and have difficulties into late 20's and 30's Why? Because brain structures develop across time, children with ADHD learn other cognitive abilities/strategies that adapt and compensate for some of the challenges that they experience, and thus over time they do not have the same impairments
12-step program
Example: Alcoholics Anonymous (AA) Highly religious Highly controversial Unclear efficacy/effectiveness hard to study over time In studies that compare effects of individuals randomized to either AA or to no treatment those on AA did worse than those randomized to no treatment When people had the ability to choose whether they went to AA, CBT the effects of treatment via AA were greater than what we see for MI Likely due to religious aspect of AA works for those who seek that, but may be detrimental to those who are not
Causal mechanisms of conduct disorder: Callous-Unemotional (CU) Traits
Examples: lack of guilt, low empathy, shallow affect High CU traits associated with high conduct problems, regardless of parenting practice parenting style doesn't matter as much if CU present The more ineffective parenting is, the more conduct problems present (even without the presence of CU) vs. effective parenting associated with low conduct problems (w/o presence of CU) WHAT???
Name a Biological Correlate that is a Potential Cause of Autism
Frontal Posterior Under-connectivity: In autism, an under-connectivity is observed in the frontal-posterior pathway, in comparison to children without autism Unclear what this means in the development of autism. Is it a causal mechanism? Is it caused by autism? We don't currently know.
Four circuitries that have been implicated in ADHD
Fronto-cerebellar network Fronto-striatal network Executive function network: Attentional network:
motivational interviewing for drug abuse treatment
Guiding themes: collaboration, evocation, autonomy (clients are given complete autonomy) Helps to highlight discrepancies in persons desires and their actions Guiding Principles: empathy, support self-efficacy, roll with resistance, develop discrepancies MI is very effective at targeting drug addiction symptoms and having a positive social impact Effects of MI get better across time
After prolonged use of weed in adolescence, what happens to the glutamate levels in the body, and what effect does this have?
High glutamate in adolescence → permanent downregulation and pruning of NMDA receptors (worn out due to being overworked essentially) Low NMDA activation → high DA function in limbic regions (positive psychotic symptoms) and low DA function in cortical regions (negative psychotic symptoms)
Prenatal Toxin Exposure as Risk Factor of ASD
If mom had severe viral or bacterial infection during first trimester of when in utero, 3-fold increase in risk of autism o Risk decreased, but still higher than without, if exposed during 2nd trimester
CD - CU (More reactive - fear based)
Impulsive CD Can learn from "time-out" anger management training Higher amygdala reactivity - high reactivity to others' emotions
Controversy of Autism vs Asperger's
In DSM-IV there were three separate disorders: Autism, Asperger's, PDD-NOS. In DSM-V they were all clumped together into Autism Spectrum Disorder This angered the Autism community
Between 2002 to 2006, increases in autism rates tell us (note: this was almost a decade after DSM-IV diagnostic criteria introduced)
Increases in diagnoses is not due to change in dx criteria, diagnostic practices, or change in awareness Biggest increases in awareness and diagnostic criteria changes really occurred during the 1990s
Basic Neurocognitive Mechanisms Impaired in ADHD
Inhibitory control (Example from lecture: inhibit word reading based on specific rules (color of ink vs. reading word)) Set switching (Example of switching between rules when reading words/color names) - provides insight into some certain deficits planning and sequencing (multiple steps) short term and working memory (working memory is like alphabet backwards)
neurodevelopmental disorders
Intellectual Disabilities Autism ADHD Learning Disabilities
Hallucinogens
LSD, magic mushrooms
Typical onset of Schizophrenia
Late adolescence / early adulthood
FOUR Trajectories of Conduct PROBLEMS (not necessarily disorders)
Life-course persistent: 9% of population (trouble from early childhood and continue to have challenges throughout life) - Accounts for 53% of all convictions o Most costly and detrimental pattern of behavior for both individual and society Adolescent-onset: 18.7% of population Antisocial behavior is common in adolescence, but Adolescent-onset CD is rare (<50% of CD diagnoses) Childhood-limited: 22% of population Difficulties limited to early childhood Low: 50.4% of population Very low conduct concerns across lifespan
Types of disorganized thinking
Loose associations Word salad Neologisms
What are the communication and social interaction symptoms of autism
MUST HAVE ALL 3 1) Limited social reciprocity 2) Limited non-verbal communication 3) Limited peer relationships
methadone in substitution treatment
Methadone is a long-lasting opioid that produces little psychoactive effects Block cravings Suppresses opioid withdrawal Blocks effects of other opioids Cause minimal euphoria Cause less severe withdrawal Communities are often against having a methadone clinic b/c fears - "Not in my backyard" requires a lot of education to community to describe the benefits of these clinics Numerous studies have found that the opening of methadone clinics consistently reduce crime in those communities
CD + CU (more proactive - self-serving/functional)
More severe CD Less responsive to parental training Lower amygdala reactivity - lower fear and arousal
ADHD Medications
Most ADHD medications are Dopamine (DA) Agonists disrupt the DA transporter, which increases the amount of DA in the cell that increases transmission Mesocortical pathway has a high density of DA neurons networks/ neuro-circuitries noted above that are implicated in ADHD all begin or end in this region of the brain this is why increasing DA transmission is effective in treating ADHD o Stimulate DA network that is implicated in ADHD
psychosocial treatments for drug abuse
Motivational interviewing 12-step programs cbt
Conduct Disorder (CD) Diagnostic Criteria
Must have 3 out of 15 symptoms (the underlined symptoms are associated with the worst prognosis) Aggression to people and animals: Bullying Starts fights Used a weapon ***Cruel to animals Cruel to people Sexual assault ***Mugging/Robbery Destruction of property: ***Fire Setting Vandalism Deceitfulness or theft: Break-ins Cons & Lies Shoplifting Other Rule Violation: Stays out all night Runs away overnight Truant o Symptoms present for at least 12 months o Symptoms impair functioning
without cannabis use, glutamate activates
NMDA receptors
Prevention/Antagonistic Treatment
Naltrexone is an Opioid Antagonist that blocks the effects of alcohol on opioid receptors. This limits the pleasurable effects of alcohol among individuals who experience an alcohol-induced opioid effect Long-term effects of this treatment have not been as positive, as after 6 months after treatment ends the rates of drinking are similar to those who took placebo
Using Cannabis 50+ times, increased risk of development 5-fold (500%)
Never used cannabis - 0.7% lifetime prevalence; Ever used cannabis 50+ times - 4.1% life time prevalence
Held back in school
No disorder: 10% ADHD alone: ~20% ADHD + CD or ODD: ~25%
Trouble with police or suspended or expelled from school
No disorder: ~10% ADHD alone: ~35% ADHD + CD or ODD: ~65%
Difficulty making and keeping friends
No disorder: ~15% ADHD alone: ~25% ADHD + CD or ODD: ~42%
Below average school performance:
No disorder: ~20% ADHD alone: 55% ADHD + CD or ODD: 55%
Disruptive Disorders
Oppositional Defiant Disorder Intermittent Explosive Disorder Conduct Disorder
where did evidence for glutamate hypothesis come from
PCP experiments because PCP had the positive and negative effects of schizophrenia so researchers wanted to find out how it did both of these things
Causal Mechanisms of Conduct Disorders: parenting
Parenting: dysregulation or disruption in parent-child relationship may cause child to learn maladaptive patterns of behavior
Risk Factors of Autism
Paternal Age Prenatal toxin exposure Prenatal hormone exposure
Schizoaffective disorder
Presence of two or more (must include delusions, hallucinations or disorganized thinking): Delusions Hallucinations Disorganized thinking (speech) Disorganized behavior * Symptoms present for 6 or more months * Also has a history of MDD
Schizophrenia
Presence of two or more (must include delusions, hallucinations or disorganized thinking): Delusions Hallucinations Disorganized thinking (speech) Disorganized behavior Negative Symptoms * Symptoms present for 6 months or more * NO history of MDD or Bipolar Disorder
schizophreniform disorder
Presence of two or more (must include delusions, hallucinations or disorganized thinking): Delusions Hallucinations Disorganized thinking (speech) Disorganized behavior Negative Symptoms * Symptoms present for one month to 6 months * NO history of MDD or Bipolar Disorder
Trend in ASD prevalence
Rapid escalation from 1975 (1 in 5k) to 2014 (1 in 59 (almost 2%)) now rates seem to have stabilized
colorado experiment of legalizing marijuana
Rates of use have remained relatively stable since legalization Did not see increase in illicit drug use Decrease of cigarette use Age of first-time marijuana use was same as prior to legalization No differences in rates of use between CO teens and national rates among teens Number of all DUI arrests in CO have actually decreased since legalization Number of drivers in fatal crashes involving cannabinoids has increased by almost three-fold since legalization One possible explanation: methods of identifying THC in blood can detect it up to 7 days after last use Another possible explanation: increase in number of trained drug recognition experts in CO (patrol/police officers) requesting more drug analysis tests than before Rates of hospitalizations with possible marijuana exposures, diagnoses, or billing codes increased since legalization Treatment admission rates for those reporting marijuana as primary drug of abuse also decreased since legalization Reports from mental health clinicians in Colorado in labeling of severity of marijuana use, abuse, or dependence: number of people in the "dependence" category did not change at all; number of people in "use" category increased; number of people in "abuse" category decreased This change was due to what was the definition of drug abuse - required legal problems as part of diagnosis
Diagnosis of ADHD
Symptoms must be present before age 12 Symptoms must be present for at least 6 months Symptoms have to be present in 2 or more settings (e.g., home AND school) Symptoms cause impairment
Potential Causes of Autism
Risk Factors (e.g., Genetic/Parental Age/Prenatal infection exposure) --> Functional Reorganization --> frontal-posterior underconnectivity --> Autism what does this mean?!?!
main takeaway of glutamate hypothesis
Schizophrenia is believed to be related to a reduction of glutamate transmission and consequently low NMDA activation, which leads to high dopamine in Mesolimbic regions (positive symptoms) and low dopamine in the Mesocortical regions (negative symptoms) Need NMDA activation, because keeps balance of DA in two regions of brain
Drug consumption by 12th graders during last year from 2009-2018
Small and fairly stable use of crack, heroin, LSD, cocaine; cannabis use is most frequently used
Pharmacological treatments for drug abuse
Substitution Prevention/ Antagonistic: Aversive Therapy: take a medication that makes drug of abuse very aversive
Effectiveness of treatments of CD
They are pretty effective! At 6 months post-treatment (PMT or CPS), 50% of kids did not meet ODD diagnosis For children with comorbid ODD + internalizing disorder (e.g., anxiety/depression), CPS was more effective at 4 months post-treatment than PMT
Lifetime cannabis use by 8th grade
around 15% in 2018
more on the portugal experiment
Think about the effects of harm reduction strategies from an empirical standpoint All substances in Portugal became decriminalized (not legal, but not charged as a criminal crime) Recognition that society was spending so much on charging and incarcerating individuals with drug-related crimes, and that it could instead be used for drug use prevention and treatment for all drug types Results of this policy: Across the board, almost all drug use among teens decreased (for all drug types) Even as drug testing protocols were increased after decriminalization, there were a decrease in the number of positive screenings from 2000-2006 Portugal, in comparison to other countries in the EU, had the lowest rate of drug use between 2000-06 Number of deaths from any drug type decreased 2000-2006 the number from opiates decrease by almost half
ODD usually precedes CD
true
Oppositional Defiant Disorder (ODD)
a bit milder than CD (no major rule violations), but may also precede CD; frequency of symptoms is much more than a tantrum and often occurs in multiple contexts
Word salad (type of disorganized thought)
a confused or unintelligible mixture of seemingly random words and phrases, specifically (in psychiatry) as a form of speech indicative of advanced schizophrenia.
ADHD
a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
Cocaine:
acts directly on Dopamine (DA) receptors by blocking DA reuptake receptors leads to more DA in the synaptic cleft (cocaine gives u more dopamine)
what are some cns depressants
alcohol, benzodiazepines
dopamine agonists (increase transmission of dopamine)
alcohol, nicotine, cocaine, amphetamine, heroin experience of pleasure is highly dependent on dopamine (in the nucleus accumbens)
Dopamine (DA) agonists (increase transmission of Dopamine):
alcohol, nicotine, cocaine, amphetamine, heroin experience of pleasure is highly dependent on dopamine (in the nucleus accumbens) these lead to withdrawal, while others don't (???)
Higher lifetime prevalence among those with low SES ___; upper SES ___
almost 2%; 0.4%
Higher CD symptoms and CU traits associated with lower _____________ __ _____ (i.e., area associated with empathy) activity when observing others being victimized
amygdala and insula The opposite effect was observed with Reactive Aggression scores
how many people in the US have schizophrenia (12-month prevalence)
approximately 3-4 million people
Disorganized Thinking (of Psychotic Disorders)
atypical, non-linear thought processes
Four parenting styles
authoritarian authoritative permissive neglectful
Collaborative Problem Solving (CPS): (treatment of CD)
based on the idea that "kids do well if they can", but something is clearly getting in the way of them doing well; tends to be preferred for adolescents So, turn to "Plan B": Listen to child's perspective Explain your (the parent's) perspective Brainstorm ideas
Control delusion
being controlled by external forces
Grandeur delusions
belief that one has more power/prestige than he/she really does
thought insertion delusion
belief that others are inserting beliefs into your own head
Persecutory delusions
belief that people are following them or out to get them
Referential delusions
belief that people around them are always talking about them
Erotomanic delusions
belief that someone (usually a celebrity) is in love with you
thought withdrawal delusion
believes that her thoughts have been removed from her mind by an outside agency
Heroin:
binds to opiate receptor which deactivates GABA inhibition on DA neurons Opioids inhibit the GABAnergic Interneuron via the activation of opioid receptors
Prevalence in asd in boys vs girls
boys: 1 in 42 girls: 1 in 189
Rates of CD and ODD are much higher in boys than in girls
but Girls are more likely to engage in relational aggression than physical aggression
takeaway of cannabis and schizophrenia
cannabis, especially during early adolescence, is likely to have a permanent of NMDA receptors (reducing number/sensitivity), which is associated with pattern of DA functioning that is found in positive and negative sx of Schizophrenia
what does mesolimbic dopamine function do
causes dopamine production which can lead to positive psychotic symptoms (NMDA inhibits this to avoid positive psychotic symptoms)
brains of schizophrenic people
consistently enlarged ventricles general shrinkage of cortex shrinkage of amygdala and other limbic structures
Patterson's Coercive Model Inconsistent Harsh/Permissive Parenting
disengaged parenting --> bad kid --> harsh parenting --> kid doesn't listen --> disengaged parenting.....
when the dopamine hypothesis was widely believed, what were effective medications
dopamine antagonists (reduce transmission of dopamine) --> reduced positive Sx
in an alcoholic... gaba sensitivity/production will decrease because it is used to the alcohol helping it increase, and it wants to maintain the homeostatic sweet spot of gaba transmission... so in order for an alcoholic to achieve that sweet spot, they need to
drink if they don't drink... gaba transmission will plummet and then stabilize as will production/sensitivity
men's onset of schizophrenia is typically slightly ____ than females
earlier. why? we don't know. maybe because of police involvement being more likely with males so they diagnose it earlier.
without cannabis use, CB1 is activated by what?
endogenous cannabinoids (natural cannabinoids)
Delusions (of Psychotic Disorders)
false, often bizarre, beliefs that do not change despite evidence
what may be related to regressive autism
functional migration of the brain: age 2-3 is the time of functional migration in the brain, so regressive autism may be when impairments first present
Disorganized Behavior of Psychotic Disorders
grossly disorganized behaviors; catatonia
Opiates
heroin, morphine, oxycodone
Deficits in ADHD: Executive function network
involved in planning, sequencing, organization, and working memory
deficits in ADHD: attentional network
involving sustained attention
Learning disability involves a certain area lacking whereas intellectual disability
is consistent across the board
Those who began using after age 20, increase risk disappearedAppears to be a sensitive period during early adolescence, during which exposure may increase risk for schizophrenia
is this to just the high thc? ?????
whats the problem of the dopamine hypothesis?
it doesn't explain the negative symptoms of schizophrenia!! it actually would imply that the opposite of negative symptoms (like low affect) would exist (like high affect) because of high dopamine
drug dependence
leads to the 3 types of tolerances our system adapts so that more quantity is needed to reach the same effect
Authoritarian parenting style
low warmth, high control
neglectful parenting
low warmth, low control
Brief Psychotic Disorder
may be the first diagnosis that someone with schizophrenia will receive Presence of one or more (must include delusions, hallucinations or disorganized thinking): Delusions Hallucinations Disorganized thinking (speech) Disorganized behavior * Symptoms present for one day to one month * NO history of MDD or Bipolar Disorder
TREATMENTS of psychotic disorders (schizophrenia)
medications are most effective: antipsychotics most are DA and 5HT antagonists these decrease positive symptoms, but don't impact negative symptoms very much because they only target the mesolimbic dopamine function
Behavior Therapy as treatment for ADHD
most programs focus on learning structured yet positive parenting skills; help parents help kids gain self-regulation skills; help parents help kids develop compensatory skills EXAMPLES:
Diagnostic Criteria of Hyperactivity-Impulsivity
need 6 or more symptoms in 2 or more settings (e.g., home AND school) Excessive motor drive symptoms: Fidgets Can't stay seated Running Always on the go Inhibitory Control Symptoms: Unable to play quietly Talks excessively Blurts out answers Unable to wait turn Interrupts others
Diagnostic Criteria of Inattention (harder to diagnose, as there are not the hyperactive sx present)
need 6 or more symptoms in 2 or more settings, with many of the symptoms o Making careless mistakes o Limited sustained attention o Unresponsive (hyper-focused) o No follow through o Poor organization o Avoids complex tasks o Loses things o Easily distractible o Forgetful of daily routines
CNS stimulants
nicotine, cocaine, meth
Loose Associations (type of disorganized thought)
non-linear speech that changes topic based on loosely related topics... grammatically correct sentences
HOW does weed cause schizophrenia?
normal glutamate hypothesis. Causes low glutamate which leads to low nmda activation which leads to high dopamine in mesolimbic regions (positive symptoms) and low dopamine in mesocortical (negative symptoms)... if nmda was activated, it would inhibit mesolimbic dopamine functioning and activate mesocortical dopamine functioning BUT THATS REVIEW! so how does weed cause low glutamate? because it blocks cb1 receptors (which typically down regulate glutamate) from endogenous cannabinoids, which causes way too much dopamine to be produced... so it's called an inverse dopamine agonist because at first it reduces dopamine (by attaching to cb1 receptor) and then it increases it by blocking the cb1 receptor, which usually down regulates glutamate... so we have too much glutamate during adolescence! and this causes NMDA to be overworked... that leads to permanent downregulation of NMDA receptors, which leads to low NMDA activation... which brings us back to high dopamine in mesolimbic regions (positive symptoms) and low dopamine in mesocortical regions (negative symptoms)
Summary of autism and vaccines Over 100 studies have been conducted and millions of dollars have been sent -->
not a single case control study found a link between autism and vaccines VACCINES DO NOT CAUSE AUTISM
management focused CBT (therapy for psychotic disorder)
not to reduce sx, but more about increasing functioning by facilitating the management of the disorder (e.g., medication compliance, necessary accomodations to do well in job)
Therapy for psychotic disorders
not very effective on its own modern: Management focused CBT Family Therapy and Psychoeducation Social Therapy *freud's psychoanalytic stuff doesn't work
Social therapy for psychotic disorders
o Decision making o Social skills training o Medication management o Employment counseling o Housing support
4:1 Ratio of boys to girls in community samples 9:1 ratio of boys to girls in clinical samples
o Gender differences could be due to: Girls more likely to be diagnosed with inattentive type Boys having more outbursts
What is "recovery" from autism
o Has clear hx of autism o Must be learning and applying skills at a developmental level that is within the age expected in typically developing persons of the same age o Must not meet DSM criteria for ASD o Must not meet ASD cutoff on social or communication domain on the ADOS o Must not review special education services targeted to remediate key features of autism o Must be functioning within a regulate education class w/o individualized assistanceo IQ > 80 o Vineland communication and socialization scales must be within the normal range (78 or above)
What predicts recovery from Autism
o High IQ o Receptive language o Verbal imitation o Early diagnosis
Oppositional Defiant Disorder (ODD) Diagnostic Criteria
o Must have 4 out of 8 symptoms Angry/Irritable Mood: Often loses temper Hostile Easily annoyed or angered; resentful Argumentative/Defiant Behavior: Refuses to comply with rules Argues with adults (teachers, parents, coaches, etc.) Deliberately annoys others Blames others Vindictiveness: Spiteful or vindictive o Symptoms must be present for at least 6 months o Symptoms must impair functioning (at home, school, etc.)
Possible mechanisms leading to recovery from autism
o Normalizing input through attention o Promoting social stimuli as reinforcing o Early intervention = enriched environments o Early intervention = mass practice/trials o Compensatory learning
Dopamine (DA) Hypothesis:
original hypothesis about why schizophrenia occurs at the neurotransmitter level - held that schizophrenia was due to excessive DA
Behavioral tolerance:
physiological adaption occurs rapidly in anticipation of the drug The body seeks to maintain a homeostatic level of neurotransmitters, so in anticipation of the ingestion of drug that results in rapid increase in neurotransmitter, the body will compensate by not allowing the neurotransmitter to get too high the body understands and identifies what environmental cues signify that there will be exposure to the drug, and so the body compensates even before a person gets a drug more and more drug will be needed (i.e., tolerance) to get the desired effect A standard process through learning mechanisms in which the body begins to associate particular cues with the fact that the drug is going to be ingested
Food & sex can also inhibit the GABAnergic Interneuron which leads to
pleasurable effects
if u give a healthy person a dopamine agonist like cocaine, what might they experience
positive symptoms of schizophrenia due to too much dopamine
Why are lower socioeconomic classes more likely to develop schizophrenia?
possible reasons 1) Social causation hypothesis: assumes that being poor increases exposure to stressors, which may increase risk for the development of schizophrenia; believes that low SES is part of causation of disorder 2) Social drift hypothesis: being poor itself doesn't increase risk for development of schizophrenia; rather, having schizophrenia increases risk of being poor (much harder to maintain middle- or upper-class lifestyle, and thus "drift" to lower SES); schizophrenia as causing shift in social class - then their kids would be poor and more likely to have it due to 1)
Pharmacodynamic tolerance:
receptors in the brain adapt (down regulate) to counteract overexposure to neurotransmitters (e.g., cocaine)
Hallucinations (of Psychotic Disorders)
sensory-like experiences that occur without an external stimulus; occur from: (a) direct stimulation (surgery), (b) uncontrolled neural firing (seizures), (c) reduced frontal cortex integration (fatigue), (d) reduced external sensory input (meditation, drugs, fatigue)
Withdrawal:
severe physiological symptoms that occur after stopping or reducing drug use
Conduct Disorder (CD)
severe violations of social norms and often results in involvement in legal system
Treatment of CD: Parent Management Training (PMT)
skill-based training for parents involving the use of various parental strategies in specific frequencies; tends to be preferred for children Using 5 techniques in varying proportions/frequencies Increasing special time between child and parent Reward desired behaviors Clear expectations/boundaries Ignore unwanted behaviors (used infrequently) Punishment (used very infrequently)
Remission of psychotic episode
symptoms subside... can function better than before but not better than prior to active (worse than prodrome) might happen without medication
Aversive therapy
take a medication that makes drug of abuse very aversive Example: Antabuse influences the clearance of alcohol from the body (i.e., typically converted via ethanol acetaldehyde acerbic acid); if you drink while on Antabuse, it will make you feel very horrible (hangover effects, etc.) People don't like to take this, so the effectiveness is limited
Side effects of 1st generation antipsychotics
tardive dyskinesia (uncontrollable movements)
explain the glutamate hypothesis
the glutamate hypothesis explains schizophrenia. in a healthy human brain, NMDA does two things 1) inhibits mesolimbic dopamine function. this is because mesolimbic dopamine function causes dopamine production--and it would produce an excess amount of dopamine that would lead to positive psychotic symptoms if NMDA did not inhibit it. 2) activates the mesocortical dopamine function, which inhibits negative psychotic symptoms.... in a schizophrenic brain where nmda isn't activated (?) the mesocortical dopamine function wouldn't be present to inhibit these symptoms.
Nihilistic delusion
the individual has a false idea that the self, a part of the self, others, or the world is nonexistent
relationship between active phase and remission phase in psychotic disorders
the individual oscillates between active and remission. the goals of medication are to: 1) reduce the time frame of the active phase 2) reduce the intensity and impact of the symptoms of the active phase 3) increase the time of the remission phase
Metabolic tolerance:
the liver becomes more efficient at metabolizing the drug, thus more drug is needed to produce the same effect (e.g., alcohol)
what caused fighting in the autism community about the portrayal of Autism
the wide spectrum of the disorder
course of schizophrenia
to some degree, episodic in nature
schizophrenia has equal incidence across gender
true
Controversy of autism treatments:
unfortunately, there are many money-making treatments out there for autism that are not empirically supported Examples: B6 & supplements; Secretin; Facilitated Communication; Hyperbaric Treatments; Kelation; Weighted vests; Enzyme supplements Randomized trials demonstrate that these are not effective at treating the symptoms of autism o Weighted vests: ABAB design number of symptoms did not change, regardless of weight of vest Debate about effectiveness for children with sensory processing difficulty data mixed
Neologism (type of disorganized thought)
using completely new words that don't actually exist
major challenge for treatment of drug abuse is
using the drug keeps the withdrawal symptoms away
However, the prevalence changes in autism across time do not match vaccination practices
we see rapid acceleration in rates, despite removal of Thimerosal from vaccines and the decline in vaccination rates (see slide 6 for graph)
Alcohol binds to gaba receptor/interneuron which makes the receptor less sensitive which means that gaba will have a greater effect on the receptor, but it also makes the gaba interneuron weaker (which typically functions as an inhibitor of dopamine) so inhibition of dopamine is inhibited (more dopamine)
yup. gaba puts body into lower gear (its inhibitory on the nervous system)
