PSYC 2410: Exam 3
rights of mental patients
1. Right to treatment: Wyatt v Stickney- humane treatment and qualified staff in sufficient numbers. O'Connor v Donaldson - right to treatment and set limits on civil commitment standards. 2. Right to treatment in least restrictive environment: Deinstitutionalization and its problems (Not enough CMHCs, homelessness, jails now mental health holding facilities) 3. Right to refuse treatment (limited): Informed consent - (1) tell risks/benefits; (2) understand/freely consent; (3) competent. Substituted judgment. Washington v. Harper- refusal can be overruled after review and substituted judgment by 3-member panel of psychologist, psychiatrist, and deputy warden. Riggins v. Nevada- inmate could refuse treatment given to ensure competence. Sell v. U.S.- can medicate if a danger.
Civil commitment: 2 broad justifications
1. Parens patriae - "parent of nation," means "state as parent"; duty to protect - Juvenile courts too; also seen in reference to child abuse/neglect - Danger to self (imminent suicide risk) - Inability to care for self (less common) - Standards by state 2. Police power - public safety - Danger to others (imminent violence risk)
DSM-5: ASD 4 Core Symptoms
1. developmental period or hx 2. Impaired social interaction: Nonverbal - gaze aversion, odd facial expressions and gestures. No age appropriate peer relationships. Lack of interest in people, or social/emotional reciprocity. No "theory of mind"? Missing attachment mechanism? 3. Impaired Communication. Delay or lack of spoken language. 50% mute (may decrease w/ tx); Nonverbal impaired too; sign language; If speech, sharply limited conversation; Stereotyped use of language - echolalia, pronoun reversal; Lack of imaginative play; 4. Restricted, stereotyped behavior; Restricted interests - overly intense, focused (e.g., dates, numbers, weather); Inflexible adherence to ritual (and distress when routine upset); Contrast with compulsive behavior; Stereotyped motor movements (rocking, hand flapping) - self-stimulation; Preoccupation with parts of objects
Erikson's four stages of adult development
1. identity versus role confusion: major challenge of adolescence/young adulthood. Task to integrate experiences, goals,+ values into a global sense of self. 2. intimacy vs self-absorption: enters on the conflict between closeness and independence. Self-absorbed people become dependent in intimate relationships or remain aloof from others. True intimacy is balance b/w connectedness + autonomy. 3. generativity vs stagnation: Generativity is defined by accomplishments in middle adult life, ex: career and family achievements. People who stagnate may have both family and a job, but they live without a sense of purpose or direction. 4. integrity vs despair: Integrity comes from "the acceptance of one's one and only life cycle as something that had to be and that, by necessity, permitted of no substitutions". Despair comes from the impossible desire to change the past and from yearning for a second chance at life.
Elimination Disorders: Enuresis and Encopresis
1. inappropriate urination Tx = behavioral - Bell and pad (alarm when begin to wet bed), Strengthening pelvic floor muscles 2. inappropriate defecation Tx = behavioral (sometimes medical) - Toilet sits, Contingency management, Laxatives/stool softeners
ID: Treatment and Prevention
3 major categories of intervention are essential in treating IDs. 1. many cases can be prevented through adequate maternal and child health care, as well as early psychoeducational programs. 2. educational, psychological, and biomedical treatments can help people with IDs to raise their achievement levels. (Head Start) 3. lives of people w/ IDs can be normalized through mainstreaming in public schools and promoting care in the community.
Intellectual Disorders
(1) deficits in intellectual functions (such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience) confirmed by clinical assessment and individualized, standardized intelligence testing. 2. Deficits in adaptive functioning -> failure to meet developmental and sociocultural standards for personal independence and social responsibility. Limit functioning in daily life 3. Onset before the age of 18 - Cutoff IQ for an ID is 1 deviation below avg. - DSM 5 shifted emphasis from hard IQ cutoff toward functional impairment (consistent w/ AAIDD views) - Divides ID severity into mild, moderate, severe, and profound
Associated ASD Symptoms (not in DSM)
- Apparent sensory deficits - Self-stimulation -> related to stereotyped movements (Under- or over-aroused? Interferes with learning) - Self-destructive behavior (Not suicidal, Can be very serious) - Savant performance
Schizophrenia: Etiology Biological Factors
- Genetics: Lifetime morbidity risk increases with degree of relation with proband. Strong support for genetic + nonshared environment. Adoption studies: children of bio parents with SZ more likely to develop SZ (support for genetic basis) Bio relatives of SZ likely to develop Schizotypal, Schizoid, + Paranoid PDs. 100+ genes found that impact risk for SZ. -Pregnancy/prenatal complications/injury. - Paternal age - Neuropathology -- enlarged ventricles --Decreased limbic system
Marriage and Divorce
- Most (90%) of people get married - 5 / 6 women bear children - Satisfaction fluctuates, 30% may experience significant discord Divorce rate around 40% Marital satisfaction - Declines substantially following birth of first child - Doesn't usually rise again until after children leave Boundary struggles w/in the family can lead to stress Positive reciprocity (exchange of positive emotion) is key for healthy family adaptation
Ch 16: Childhood Disorders - developmental psychopathology - developmental norms
- Understanding abnormal behavior within the context of normal development. Because change is so rapid during first 18 years of life, the approach is essential for psychological disorders of childhood. - behavior typical for children of a given age. Boys are more likely to have externalizing problems during childhood, but girls have more internalizing in adolescence and early adult life.
Trauma and Stressor Related D/O: Reactive Attachment Disorder and Disinhibited social engagement disorder
1. Characterized by withdrawn behavior among very young children around adult caregivers. 2. ^ opposite behavior. Indiscriminate behavior toward caregivers (ex: will go to anyone, showing no special attachments) - Assumed to be caused by a neglectful environment, repeated changes of primary caregivers, or lack of opportunity to create meaningful primary attachments
Gottman's 4 Horsemen: Communication Problems in Relationships
1. Criticism involves attacking someone's personality rather than his or her actions, for example, "You're boring!" instead of "Can we do something different?" 2. Contempt is an insult that may be motivated by anger and is intended to hurt the other person, for example, "I never loved you!" 3. Defensiveness is a form of self-justification, such as, "I was only trying to help, but I guess my feelings don't matter!" 4. Stonewalling is a pattern of isolation and withdrawal, ex: verbally or nonverbally saying, "I don't want to talk about this anymore!"
Marcia's Four Identity Statuses
1. Identity diffusion: Young people who have questioned their childhood identities but aren't actively searching for new adult roles. 2. Identity foreclosure: Young adults who never questioned themselves or their goals but instead proceed along the predetermined course of their childhood commitments. 3. Identity moratorium: People who are in middle of an identity crisis and actively searching for adult roles. 4. Identity achievement: Young people who have questioned their identities and who have successfully decided on their own long-term goals.
Neurocognitive Disorder: Etiology
•Concordance rate in MZ twins is over 50%, which is more than double for DZ twins. •genetically heterogeneous: There's several forms of the disorder, each w/ different genes or sets of genes. •Some genes increase risk of getting the disorder, but most people who develop NCD don't possess 1 of these specific genes. •Amyloid Precursor Protein (APP Gene) •Presenilin Genes (PS1 and PS2) •APOE Gene •Neurotransmitters: •Alzheimer's disease = decrease in the availability of acetylcholine (ACh) •Parkinson's disease = dopamine deficiencies •Huntington's disease = GABA deficiencies •Immunology: •Immune system's production + regulation of antibodies, may be dysfunctional in some forms of dementia, causing a destruction of healthy brain tissue. •Environmental Factors: Edu is a protective factor.
Prevalence of Dementia with Age
•Individuals aged 65-69: 1% •Individuals aged 75-79: 6% •Individuals aged 90+: 40%
Delirium
A confused state that develops over a short period of time and often associated w/ agitation and hyperactivity. The most important sxs are disorganized thinking and reduced ability to maintain and shift attention. Usually the result of medical problems, like infection, or side effects of medication. If properly treated, typically short-lived. Can, result in serious medical complications, permanent cognitive impairment, or death, if causes go untreated. Rapid onset
Competence
A defendant's ability to understand the legal proceedings that are taking place against them and to participate in their own defense. Features of the legal definition of it: 1. defendant's current mental state, whereas insanity refers to the defendant's state of mind at the time of the crime. 2. Not the same as the psychologist's definition of mental illness. A psychotic individual may have enough rational understanding to be this in the eyes of the law. 3. defendant's ability to understand criminal proceedings, not willingness to participate in them.
Diminished emotional expression (blunted affect)
A flattening or restriction of the person's nonverbal display of emotional responses. Blunted patients fail to exhibit signs of emotion or feeling. One of the most common sxs of schizophrenia (-). They are neither happy nor sad, and appear completely indifferent to their surroundings. Faces apathetic + expressionless. Voices lack the typical fluctuations in volume and pitch others use to signal changes in mood. Events in their environment hold little consequence. May demonstrate a complete lack of concern for themselves and others.
Dementia
A gradually worsening loss of memory and related cognitive functions, including the use of language, as well as reasoning and decision making. It is a clinical syndrome that involves progressive impairment of many cognitive abilities. Its a chronic, deteriorating condition that reflects the gradual loss of neurons in the brain. person's attention span, concentration, judgment, planning, and decision making become severely disturbed. Changes in emotional responsiveness and personality typically accompany the onset of memory impairment in dementia. In DSM under major NCD.
Asperger's Disorder
A milder form of autism. Characterized by all-absorbing interests, repetitive behaviors, and problems with social relationships. Children are of normal intelligence and lack communication or cognitive deficits. No language impairement. High functioning on the spectrum.
Oppositional defiant disorder (ODD)
A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictive behavior lasting at least 6 months. Rule violations typically involve minor transgressions, such as refusing to obey adult requests, arguing, and acting angry. Such misbehavior is a cause for concern among school-aged children, and often foreshadows the development of much more serious antisocial behavior during adolescence and adult life. Children with it are angrier and intentionally rebellious, unlike ADHD where they want to "be good". The current consensus is that the two disorders are separate but frequently comorbid. 50-80% of ADHD also meet this criteria.
Conduct disorder (CD)
A persistent and repetitive pattern of serious rule violations, most of which are illegal as well as antisocial—for example, assault or robbery. There is often a developmental continuity between ODD and it, as younger rule violators "graduate" to more serious offenses. DSM-5 places both problems in a new diagnostic category called Disruptive, Impulse-Control, and Conduct Disorders. It distinguishes between conduct disorders that begin before or after the age of 10 in recognition of the fact that earlier onset predicts more life-course-persistent antisocial behavior—perhaps ASPD. Roughly equivalent to juvenile delinquency.
American Law Institute Definition
A person is not responsible for criminal conduct if at the time of such conduct as a result of mental disease or defect he lacks substantial capacity either to appreciate the criminality [wrongfulness] of his conduct or to conform his conduct to the requirements of the law.
active phase
A phase of schizophrenia marked by full-blown psychotic features such as delusions and hallucinations,and disorganized speech.
frontotemporal neurocognitive disorder
A rare form of dementia associated w/ circumscribed atrophy of frontal + temporal lobes of the brain. Similar to AD in terms of both behavioral symptoms and cognitive impairment. Patients with both disorders display problems in memory and language. - Early personality changes that precede the onset of cognitive impairment are more common among patients with this. - also more likely to engage in impulsive sexual actions, roaming and aimless exploration, and other types of disinhibited behaviors -Impaired reasoning and judgment are more prominent than anterograde amnesia
Ch 15: Autism Spectrum Disorders
A. Persistent deficits in social communication/ interaction across multiple contexts: Social-emotional reciprocity; Nonverbal communicative behaviors used for social interaction; Developing, maintaining, and understanding relationships B. Restricted, repetitive behavior/interests/activities, as manifested by 2+: Stereotyped/repetitive motor movements, use of objects, or speech; Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal/nonverbal bx; Highly restricted, fixated interests that are abnormal in intensity or focus; Hyper-/hyporeactivity to sensory input, unusual interest in sensory aspects of the environment
attention-deficit/hyperactivity disorder (ADHD)
A. Persistent pattern of inattention / hyperactivity-impulsivity that interferes with fx or development, characterized by (1) and/or (2): 1. Inattention (ex: carelessness, difficulty sustaining attention, losing things, not following directions, problems organizing, easily distracted, etc.) 2. Hyperactivity and impulsivity (ex: fidgets, "on the go," talks excessively, not quiet, interruptive, problems waiting turn, etc.) Several symptoms must begin before 12 for a diagnosis. DSM-5 classifies it as a neurodevelopmental disorder. 25% with ADHD also meet criteria for Specific Learning D/O.
ID Etiology
About 1/2 of cases of IDs are caused by known biological abnormalities (over 250). Most common known is Down Syndrome (Trisomy 21) about 25% of IDs. -Extra chromosome, By 30s, majority of adults w/ Down syndrome develop brain pathology similar to AD. Maternal age is a factor. - Fragile X syndrome: most common known GENETIC cause of ID. X chromosome break - Phenylketonuria (PKU): Abnormal levels of amino acid phenylalanine (missing enzyme for metabolizing) causes brain damage -> ID. Infectious Diseases: - Rubella - vaccination -STDs (syphilis; genital herpes) -Meningitis, encephalitis (after birth) Toxins (teratogens): -Lead poisoning -Fetal alcohol syndrome (5 oz/day = 2x risk) Prenatal/ birth complications: Premature birth, Anoxia, Malnutrition, Seizure disorder, Rh Incompatibility
status and index offenses
Acts that are illegal only because of the youth's status as a minor, ex: truancy from school. — crimes against people or property that are illegal at any age
guilty but mentally ill (GBMI)
Another attempt to reform the insanity defense. Defendants who are guilty of the crime, were mentally ill at the time it was committed, but were not legally insane at that time. They're sentenced in the same manner as any criminal, but court can order treatment for the mental disorder as well. Designed as a compromise that would reduce NGRI verdicts, hold defendants criminally responsible, but acknowledge mental disorders and the need for treatment. It is most often used in cases in which defendants simply would have been found guilty in the past.
anhedonia
Another emotional deficit, the inability to experience pleasure. It is a lack of positive subjective feelings. People typically lose interest in recreational activities and social relationships. May be unable to experience pleasure from physical sensations, like taste + touch.
inappropriate affect
Another kind of bizarre behavior involves affective responses that are obviously inconsistent with the person's situation. The most remarkable features are incongruity and lack of adaptability in emotional expression.
ID Epidemiology
Best estimate is that only 1 percent of the population has an ID. More prevalent during school years. In US are more common among poor and, as a result, among certain ethnic groups, especially w/ non specific cause.
NCD with Lewy bodies
Can be viewed as a combination of dementia and Parkinson's disease. May be 2nd most common form of dementia, after AD. Symptoms typically begin w/ memory deficits -> a progressive decline to dementia . Cognitive impairment including problems in attention, executive functions, problem solving, and visuospatial performance. - Unlike AD, patients often show fluctuation in cognitive performance, alertness, and level of consciousness. - Sxs that distinguish it from AD + vascular dementia is presence of recurrent and detailed visual hallucinations. They usually recognize the hallucinations aren't real. - Many also develop Parkinsonian features, like muscular rigidity, (appear early in disorder dev) - Patients show a more rapid progression of cognitive impairment, and shorter time from onset of symptoms to death.
cultural-familial retardation
Cases of IDs of unknown etiology are generally assumed to be variations in the normal distribution IQ. Runs in families and is linked with poverty. A controversial issue is whether this typically mild form of ID is caused primarily by genes or by psychosocial disadvantage. Accounts for 50% of IDs, but not well understood. Normal genetic variation (and its interaction with environments). - Cognitive ability is heritable, so some IDs may be those who fall lowest on the distribution BUT environments can influence the expression of genes
Parkinson's disease
Caused by a degeneration of a specific area of the brain stem known as the substantia nigra and loss of the neurotransmitter dopamine, which is produced by cells in this area. Typical symptoms include tremors, rigidity, postural abnormalities, and reduction in voluntary movements. Most do not develop NCDs
Attention deficits
Characterized by distractibility, frequent shifts from one uncompleted activity to another, careless mistakes, poor organization or effort, and general "spaciness" (ex: not listening well). As with impulsivity, it usually is not intentional or oppositional; rather, it reflects an inability to maintain a focus despite an apparent desire to do so. A particular problem is "staying on task," or sustained attention.
Multimodel Treatment of Study of Children with ADHD (MTA)
Children w/ ADHD randomly assigned to either: (1) controlled medication management, (2) intensive behavior therapy, (3) the 2 txs combined, or (4) uncontrolled community care (which typically included medication). Follow-up assessment showed the controlled med and combined txs produced significantly more improvements in ADHD sxs than alternatives. Combined (68%) > Medication management (56%) > Behavior therapy (34%) = Community (25%)
multisystemic treatment (MST)
Combines family treatment with coordinated interventions in other important contexts of the troubled child's life, including peer groups, schools, and neighborhoods. . Several studies document that it improves family relationships, and to a lesser extent, delinquent behavior and troubled peer relationships. Can help reduce recidivism in CD, but requires high intensity and is 50% effective in the long-term
Externalizing disorders
Create difficulties for the child's external world. They are characterized by children's failure to control their behavior according to the expectations of parents, peers, teachers, or legal authorities. Often break rules, are angry and aggressive, impulsive, overactive, and inattentive. Symptoms involve violations of age-appropriate social rules, including disobeying parents or teachers, annoying peers, and perhaps violating the law. 1. attention-deficit/hyperactivity disorder, 2. oppositional defiant disorder, + 3. conduct disorder.
free will and criminal responsibility
Criminal law assumes that human behavior is the product of this, the capacity to make choices and freely act on them. The assumption makes people responsible for their actions in the eyes of the law. - The legal concept of called this holds that, because people act out of ^, they are accountable for their actions when they violate the law.
Libertarianism vs. Paternalism
Debates about involuntary hospitalization highlight the philosophical tension between 1- which emphasizes the protection of individual rights and states duty to protect civil liberties and 2 - which emphasizes the state's duty to protect its citizens. The involuntary hospitalization of someone who appears dangerous serves a protective, paternalistic goal.
negative symptoms
Defined by responses or functions that appear to be missing from their behavior. Characterized by the absence of a particular response (such as emotion, speech, or willpower). Include traits like lack of initiative, social withdrawal, and deficits in emotional responding.
Separation anxiety disorder
Defined by symptoms such as persistent and excessive worry for the safety of an attachment figure, fears of getting lost or being kidnapped, nightmares with separation themes, and refusal to be alone. - School refusal, aka school phobia, is characterized by an extreme reluctance to go and is accompanied by various symptoms of anxiety, such as stomach aches and headaches.
Federal Insanity Defense Reform Act (1984)
Defined insanity defense as: An affirmative defense to a prosecution under any federal statute that, at the time of the commission of acts constituting the offense, the defendant, as a result of severe mental disease or defect, was unable to appreciate the nature and quality or the wrongfulness of his acts. Mental disease or defect does not otherwise constitute a defense.
schizoaffective disorder
Describes the sxs of patients who fall on boundary b/w schizophrenia and mood disorder with psychotic features. This diagnosis applies only to the description of a particular episode of disturbance; NOT the lifetime course of the disorder. Defined by an episode in which the symptoms of schizophrenia partially overlap w/ a major depressive or manic episode. The key to this diagnosis is presence of delusions/hallucinations for at least 2 weeks in absence of prominent mood symptoms.
Aphasia
Describes various types of loss or impairment in language that are caused by brain damage. Language disturbance in dementia is sometimes relatively subtle, but it can include many different kinds of problems.
Apraxia
Difficulty performing purposeful movements in response to verbal commands. Person has the normal strength and coordination to carry out the action and is able to understand the other person's speech. However, he or she is unable to translate the various components into a meaningful actions.
NCDs Treatment
Distinction between delirium and dementia is important! - Many conditions that cause delirium can be treated as can some secondary types of dementia (e.g., cognitive deficits that are a product of depression). -With primary types of dementia, however, a return to previous levels of functioning is extremely unlikely (management is more applicable). Treatment goals: 1.Maintaining patient's level of functioning for as long as possible 2.Minimizing the level of stress experienced by the patient and family Meds: -Donepezil (Aricept): Increases ACh activity by inhibiting acetylcholinesterase, the enzyme that breaks down ACh in the synapse. Only works for 6-9 months, cannot reverse disease progression, limited effectiveness -New drug treatments are being pursued that are aimed more directly at the processes by which neurons are destroyed. -Neuroleptic medication can be used to treat some patients who develop psychotic symptoms (i.e., hallucinations and delusions). Environmental and Behavioral Management: -Routines are helpful. Break down even simple activities into smaller and more manageable steps. -Support for Caregivers
involuntary hospitalization procedures
Emergency commitment- acutely disturbed individual is temporarily confined, typically 2-3 days. Physicians, mental health professionals, or even police officers may be allowed to institute it. Done only when the risk to self/others appears high. Formal commitment- only ordered by court. A hearing must be available to patients who object, to protect their due process. Cases reviewed after set time. (1) inability to care for self, (2) dangerousness to self, and (3) dangerousness to others. New trends: Advance psychiatric directives (balances libertarian/paternalist concerns). "Megan's Law" - community notification laws (murdered by sex offender across street). Sexual predator laws - civil commitment following criminal sentence (general rather than imminent risk; "a volitional impairment rendering them dangerous beyond their control")
transition to later life
Erikson: Integrity vs. Despair. Not typically a time of despair - Prevalence of mental disorders is lower, Including lower rates of depression. Psychological concerns may revolve around physical decline, loss of lifelong relationships. Physical health and quality relationships are keys to happiness. Men have a shorter life expectancy (by ~ 7 years). Suicide (Top 10 cause of death) - Over 65 highest risk of any group, Older white males notably high, Rational (decision some severely ill older adults make in ending their lives) and Assisted suicide. Epidemiology: 1/8 (12.5%) of U.S. population over 65 Will be ~20% by 2030. 10% of this group is oldest-old
Confidentiality
Ethical obligation not to reveal private communications, basic to psychotherapy. Limits include danger to self, others; Child/elder abuse, abuse of disabled person; Disappears in custody disputes in VA?! - Tarasoff Principle: Duty to warn (directly warn victim) Duty to protect (ex: hospitalizing if potentially violent) If the provider knows or has reason to know of probable harm to another identifiable person or the property of an identifiable person, a warning must be issued if the client's behavior cannot be controlled
Schizophrenia Psychological: expressed emotion (EE)
Expression of hostility, repeated criticism, or emotional over-involvement by family members toward ill individual - EE consistently found to relate to SZ relapse
residual phase
Follows the active phase involving peculiar thoughts and behaviors similar to the prodromal phase. At this point, the most dramatic symptoms of psychosis have improved, but the person continues to be impaired in various ways. Negative symptoms, such as impoverished expression of emotions, may remain pronounced during the phase.
Alogia
Form of speech disturbance, which refers to impoverished thinking. Literally translated: "speechlessness." 1 form known as poverty of speech, patients show reductions in amount of speech. Another form, referred to as thought blocking, their train of speech is interrupted before a thought or idea has been completed.
Stuperous state
Generally reduced responsiveness. The person seems to be unaware of their surroundings. Often associated with catatonic posturing.
Delusions
Idiosyncratic beliefs that are rigidly held in spite of their preposterous nature. Typically personal, not shared by other members of family or cultural group. Common x include belief thoughts are being inserted into their head, others are reading their thoughts, or that they're being controlled by mysterious, external forces. Many focus on grandiose or paranoid content. Together, these characteristics describe ways of identifying the severity of x beliefs. 1. In most severe cases, patients express/defend beliefs w/ utmost conviction, even with contradictory evidence. 2. Preoccupation; find it difficult to avoid thinking or talking about these beliefs. 3. May be unable to consider the perspective that other people hold with regard to their beliefs.
vascular neurocognitive disorder
If several of these small strokes occur over a period of time, and if their sites are scattered in different areas of the brain, they may gradually produce cognitive impairment. The diagnosis depends on the presence of either focal neurological signs and symptoms associated with the experience of stroke, such as gait abnormalities or weakness in the extremities, or laboratory evidence of blood vessel disease.
not guilty by reason of insanity (NGRI)
If, at the time a criminal act is committed, a mental disease or defect prevents a criminal from knowing the wrongfulness of his or her actions. Verdict states defendants aren't guilty because they were insane at the time of the crime. - M'Naghten test, this rule clearly articulated the "right from wrong" principle for determining insanity.
insanity
In U.S. law, it is an exception to criminal responsibility. The law assumes that the legally insane are not acting out of free will. As a result, defendants like John Hinckley are not criminally responsible for their actions. By calling attention to rare exceptions to criminal responsibility, the defense reaffirms the view that people are accountable for their actions.
Determinism
In contrast to free will, psychology is based on this assumption, the view that human behavior is determined (or at least constrained) by biological, psychological, and social forces. It is essential to science. We cannot hope to know what causes human behavior unless it is caused by factors that can be measured and perhaps controlled. This raises a profound question: Are people responsible for their behavior if they have no free will?
Autism Spectrum D/O: Etiology
In terms of its cause, doesn't appear to be 1 disorder. - NOT refrigerator parenting or vaccines. Genetics: Known- Rett's Syndrome, Fragile-X, PKU MZ concordance rates ~60%, DZ ~0% Brain development abnormal, likely affecting different regions and their fx - Rapid brain growth until age 2-3, then arrested - No problems in left hemisphere (language), but rather in subcortical structures including limbic system (emotions) and cerebellum (sensorimotor integration) - Mirror neurons - are involved in imitation, understanding others intentions, empathy, and language understanding - Neuropeptides: Excess in endorphins leads to reduction in value of external reward? Oxytocin/ v asopressin and social affiliation Behavioral phenotype -Multiple causes (equifinality) -Higher rates associated with fragile X, PKU, Rett's, tuberous sclerosis, infection, teratogens
temperament
Inborn behavioral characteristics including activity level, emotionality, and sociability. Thomas and Chess's grouping into easy, difficult, and slow-to-warm-up is a useful summary. Easy children are friendly and obey most rules; difficult children are unpredictable and challenging; slow-to-warm-up children are shy and withdrawn.
Delirium (cont)
Incidence increases among elderly, presumably cause the physiological effects of aging make them more vulnerable to medication side effects and cognitive complications of medical illnesses. It can be caused by many different kinds of medication, including: 1. Psychiatric drugs (esp antidepressants, antipsychotics, and benzodiazepines) 2. Drugs used to treat heart conditions 3. Painkillers 4. Stimulants (including caffeine) Develops in conjunction with metabolic diseases, including pulmonary and cardiovascular disorders (which can interfere with the supply of oxygen to the brain), as well as endocrine diseases (especially thyroid disease and diabetes mellitus). Various kinds of infections can lead to the onset, most common among elderly s urinary tract infection, which can result from the use of an indwelling urinary catheter.
Bio Factors of Externalizing D/O
Include a difficult temperament, neuropsychological abnormalities, and genetics. Minor anomalies in physical appearance, delays in developmental milestones, maternal smoking/alcohol consumption, and pregnancy/birth complications are more common among children with ADHD. Researchers yet to find specific marker of bio vulnerability. 1 idea is impairment in the prefrontal cortical-striatal network. This area of the brain controls executive functions including attention, inhibition, and emotion regulation. Several studies show that genetic factors mostly contribute to ADHD. Ex: a study concordance rates among MZ twins of 80%, and DZ twins 40%
Positive symptoms (psychotic sxs)
Include hallucinations and delusions. Name suggests suggests they are characterized by the presence of an aberrant response (ex: hearing a voice)
Externalizing D/O Epidemiology: - Rutter's Family Adversity Index
Includes 6 family predictors of behavior problems among children: (1) low income, (2) overcrowding in the home, (3) maternal depression, (4) paternal antisocial behavior, (5) conflict between the parents, and (6) removal of the child from the home. The risk for externalizing problems doesn't increase substantially when only 1 family risk factor is present. However, the risk increases fourfold with 2 factors—and even further with 3+ sources of family adversity. Also found among more than 20% of children living in inner-city neighborhoods and are associated with divorce and single parenting. ODD and CD are mostly caused by environment.
brief psychotic disorder
Includes those who exhibit psychotic symptoms—delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior—for at least 1 day but no more than 1 mo. An episode is typically accompanied by confusion and emotional turmoil, often following a markedly stressful event. After the sxs are resolved, they return to the same level of functioning prior to the psychotic episode. Long-term outcome is good for most patients.
anxious attachments
Infants w/ these are fearful about exploration and aren't easily comforted by their attachment figures- respond inadequately or inconsistently to their needs. (1) anxious avoidant: infant is generally unwary of strange situations and shows little preference for the attachment figure over others as a source of comfort; (2) anxious resistant: infant is wary of exploration, not easily soothed by the attachment figure, and angry or ambivalent about contact (3) disorganized attachments: infant responds inconsistently because of conflicting feelings toward an inconsistent caregiver who is the potential source of either reassurance or fear
Hyperactivity
Involves squirming, fidgeting, and restless behavior. These children are in constant motion. They often have trouble sitting still, even during leisure activities like watching television. Found across situations, even during sleep, but it is more obvious in structured settings than in unstructured ones. Their behavior is particularly noticeable in the classroom, so reports from teachers are critical in identifying it.
Child abuse
Involves the accidental or intentional infliction of harm to a child due to acts or omissions on the part of an adult responsible for the child's care. 4 forms: physical abuse, sexual abuse, neglect (most commonly reported form, places children at risk for serious harm by failing to provide basic and expected care), and psychological. - Munchausen-by-proxy syndrome (MBPS) is a unique, rare, form of physical abuse where parent feigns, exaggerates, or induces illness in a child. U.S. began protecting children in 1875, but 1962 is when abuse gained legal/public attention. - Dr. Henry Kempe and "Battered Child Syndrome" Mental health professionals MUST report suspected child abuse (this is a limit to confidentiality) Number of reported cases increasing - Over 67% unsubstantiated. When it is substantiated, preference is to keep child in the home (This approach does NOT increase the risk for future violence in less severe cases. Structured interventions and parenting support shows promise for reducing subsequent abuse)
disorganized speech,
Involves the tendency of some patients to say things that don't make sense. Signs of disorganized speech include making irrelevant responses to questions, expressing disconnected ideas, and using words in peculiar ways. This sxs also called thought disorder, because clinicians have assumed that the failure to communicate successfully reflects a disturbance in the thought patterns that govern verbal discourse. Common features: shifting topics too abruptly (loose associations or derailment); replying to a question with an irrelevant response (tangentiality); or persistently repeating the same word or phrase (perseveration).
Emotional and physical pain
Many of the same brain systems are involved in both physical and psychological pain. Emotional pain feels like physical pain, because both activate similar neural processes. Ex: pain of lost love. Pain is a basic, animal, subcortical emotion. Some implications: Pain and anger; hurting back; "Heart ache" "broken heart" "punch in the gut". "Hurt feelings" not just analogy -Same brain systems light up. People seek therapy for emotional pain relief
Psychostimulants
Medications that increase central nervous system activity. In appropriate dosages, the medications increase alertness, arousal, and attention. These produce immediate and noticeable improvements in the behavior of about 75 percent of children with ADHD (1st choice tx). Most commonly prescribed: Ritalin, Dexedrine, Cylert, and Adderall. Each has effect of increasing alertness and arousal. - "Paradoxical effect" they lead to restless, even frenetic, behavior when abused. Idea is WRONG.
Mitigating Factors in Sentencing
Mental health also is a consideration in sentencing, 1 of several potential x factors that judges are required to consider before sentencing a guilty party. Supreme Court ruled that an intellectual disability is another factor that makes the death penalty unconstitutional (VA vs Atkins). Judicial scrutiny is esp intense in death penalty cases requiring a thorough review of potential x factors (mitigation evaluations), including mental illness and duress at the time of the crime. Mental illness can justify longer periods of confinement. Sexual predators tend to get longer sentences, generally to protect the public. However, some criminals (ex: burglars, who commit 60% of all in-home rapes) aren't confined for dangerousness beyond their prison sentences. Moreover, confined sex offenders typically get little to no treatment - Justification for civil commitment?
Autism Spectrum D/O: Treatment
No completely effective treatment or medication produces significant benefit - Risperdal (antipsychotic) can be helpful in behavior management, SSRIs may help stereotyped behavior Facilitated communication - NO! INTENSIVE operant behavior therapy is clear treatment of choice (Applied Behavior Analysis) - Time consuming, expensive; Build communication skills, other new skills, social responsiveness, building attachments; Early intervention critical; Long-term effectiveness? Seems promising Integrated treatments (the preferred model): Focus on children, families, parents, schools, and home. Build in appropriate community and social support About 20% have "good" outcome, For most, the course remains chronic and they require substantial supervision and support.
professional responsibilities
Obligations to meet the ethical standards of their profession and to uphold the laws of the states in which they practice. - Negligence = Substandard care - Malpractice = Negligence that leads to harm
Ch 17: Adjustment disorders
One of the problems of life leading people to therapy; the development of clinically significant symptoms in response to stress that are not severe enough to be considered a mental disorder. Research suggests they fall in b/w normal reactions to stress and anxiety or mood disorders, are rarely diagnosed, and often treated with antidepressants. Grouped with acute stress disorder and PTSD in DSM-5, because stress causes all 3 conditions. However, it can be a reaction to a stressor of any severity, and unlike ASD and PTSD, it has no clear symptom pattern. 2nd is a list of other conditions that may be a focus of clinical attention, includes things like "partner relational problem" and "phase of life problem."
advance psychiatric directives
Patients can use these legal instruments to declare their treatment preferences, or appoint a surrogate to make decisions for them, should they become psychotic or otherwise are unable to make sound decisions. Used commonly among the aged, particularly for stating preferences about end of life medical treatments. This new use with severely disturbed patients nicely balances paternalist and libertarian concerns, and initial evidence indicates they greatly reduce the need for more coercive interventions
delusional disorder
People with this disorder do not meet the full symptomatic criteria for schizophrenia, but they are preoccupied for at least 1 mo. w/ delusions that aren't bizarre. These are beliefs about situations that could occur in real life, such as being followed or poisoned.
Ch 14: Cognition + Neurocognitive Disorders
Perception, Attention, Decision Making, Memory, Learning, Language •Deficits in these areas are the central, defining features of neurocognitive disorders (NCDs), whereas they're only mediating factors in the other types of disorders covered in this course.
Neurologists and Neuropsychologists
Physicians who deal primarily with diseases of the brain and the nervous system. -particular expertise in the assessment of specific types of cognitive impairments.
prodomal phase
Precedes active phase. Marked by an obvious deterioration in role functioning. Person's friends and relatives often view beginning of the phase as a change in their personality. Signs and sxs include peculiar behaviors (talking to one's self in public), unusual perceptual experiences, outbursts of anger, increased tension, and restlessness. Social withdrawal, indecisiveness, and lack of willpower are often seen.
Externalizing D/O Epidemiology
Prevalence of ODD = 3% Prevalence of CD = 4% ADHD Prevalence = 3-5%; 9.5% according to CDC - Increased by 67% in US b/w 2000-10 - Some estimates put 15-20% of high schoolers! - Affects boys 3:1 Prof think this is VASTLY +INAPPROPRIATELY over diagnosed - this is directly related to problems related to self-report (ex: people not being knowledgeable about normative differences in attention or activity levels), inadequate evaluation of symptoms, or outright malingering
Mental Health & Family Law
Primary concern: Balance competing interests of children, parents, and state. Important areas: Solving child custody disputes, Divorce mediation, Child abuse/ neglect Legal standard: Children's Best Interests, "best" is poorly defined. Courts frequently turn to mental health professionals for guidance in deciding what might be best for child
Agnosia
Problems identifying stimuli in their environments. "perception without meaning." The person's sensory functions are unimpaired, but he or she is unable to recognize the source of stimulation. Can be associated w/ visual (inability to recognize objects or faces), auditory, or tactile sensations, and it can be relatively specific or more generalized.
Internalizing disorders
Psychological problems that primarily affect the child's internally, ex: excessive anxiety or sadness. Children's symptoms include sadness, fears, and social withdrawal. DSM-5 includes no separate category of these disorders of childhood, but indicates that children may qualify for "adult" diagnoses of depressive and anxiety disorders. In assessing children's internalizing problems, mental health professionals must obtain information from multiple informants—parents, teachers, and the children themselves.
catatonic behavior
Refers to an obvious reduction in reactivity to external stimuli. It most often refers to immobility and marked muscular rigidity, but it can also refer to excitement and overactivity.
heritability - gene-environment correlation
Relative contribution of genes to a characteristic. Often estimate it with statistic called the x ratio = Variance due to genetic factors / Total variance - an association between inborn propensities and environmental experience.
informed consent
Requires that (1) a clinician tell a patient about a procedure and its associated risks, (2) the patient understands the information and freely consents to the treatment, and (3) the patient is competent to give consent.
Ch 13: Schizophrenia
Schizophrenia is a severe form of abnormal behavior ("madness"). People exhibit different psychotic symptoms, indicating they have lost touch with reality. They may hear voices or make comments that are difficult, if not impossible, to understand. Behavior may be from absurd ideas/beliefs. Most common sxs include changes in how person thinks, feels, and relates to others and the environment
hallucinations
Sensory experiences not caused by actual external stimuli or sensation. Although they can occur in any of the senses, tin schizophrenic patients they are most often auditory. Many patients hear voices that comment on their behavior or give them instructions. Others hear voices that seem to argue with one another. They strike the person as real, in spite of fact they have no basis in reality. Can vary in terms of both duration and severity. Patients who experience more severe auditory hallucinations hear voices throughout the day and for many days at a time.
expert witnesses
Specialists allowed to testify about matters of opinion (not just fact) that lie within their area of expertise. The law does limit expert testimony to opinion based on established science. - Often hired guns,sometimes appointed (Hinckley defense, Custody cases) - Often based on weak/nonexistent science - Asked philosophically impossible questions (What is "best" for children? What are limits of free will? - Debate about whether experts should testify on the "ultimate issue" - Experts do predict violence at greater than chance (if still imperfect)
life-cycle transitions
Struggles in moving from one stage of adult development into a new one. - The transition to adult life is a time for grappling with the major issues like identity, career, and relationships. - Family transitions, in the middle adult years may include very happy events like the birth of the first child, or very unhappy ones, like a difficult divorce. - The transition to later life may involve major changes in life roles such as retirement, grief over the loss of loved ones, and inner conflicts about aging, mortality, and the life one has lived. Erikson: conflict as a common theme across diverse transitions.
Behavioral family therapy (BFT)
Teaches parents to be very clear and specific about their expectations for children's behavior, to monitor children's actions closely, and systematically reward positive behavior while ignoring or mildly punishing misbehavior. More promising as a treatment of ODD and CD (the latter is very difficult to treat)
identity crisis - moratorium
The central psychological conflict of the transition to adult life. A normal period of basic uncertainty about self. Conflicts are epitomized by the searching question "Who am I?" - Erikson argued, in order to assume successful, lasting adult roles, young people need this: a time of uncertainty about themselves and their goals.
Alzheimer's disease (AD)
The cognitive impairment appears gradually, and the person's cognitive deterioration is progressive The speed of onset serves as the main feature to distinguish it from other types of dementia in DSM-5. A definite diagnosis can only be made by autopsy because it requires the observation of 2 specific types of brain lesions: neurofibrillary tangles and amyloid plaques.
schizophreniform disorder
The diagnosis if the person displays psychotic symptoms for at least one month but less than six months. - schizophrenic disorder if the person's problems persisted beyond the six-month limit.
neurofibrillary tangles
The disorganized tangles of tau left at the end of this process (-) Found in cerebral cortex + hippocampus. - The internal structure of branches that extend from each neuron includes microtubules (structural support + help transport chemicals for prod of neurotransmitters). Microtubules reinforced by tau proteins - associated w/ assembly + stability of microtubules. In patients w/ AD, enzymes loosen tau from connections to microtubule, +they break apart. The microtubules disintegrate in absence of tau proteins, and the neuron shrivels and dies.
Grief and bereavement
The emotional and social process of coping with a separation or a loss. - A specific form of grieving in response to the death of a loved one. Commonly described as proceeding in a series of stages. Ex: Kübler-Ross, developed popular model of bereavement described grief as occurring in five stages: (1) denial, (2) anger, (3) bargaining, (4) depression, and (5) acceptance.
civil commitment
The involuntary hospitalization of the mentally ill. Our laws prohibit the confinement of someone simply on the suspicion that he or she will commit a crime, except in this situation (preventive detention).
Ch 18: Mental Health - Legal Perspectives "insanity"
The legal definition of insanity is not the same as the psychological definition of mental illness. Legally sane - Jeffrey Dahmer (killed at least 17 people and stored body parts). 17 yr old Lee Malvo, who was "brainwashed" by his fellow Beltway sniper, Muhammad. Psychotically depressed and schizophrenic Andrea Yates, who drowned her 5 children in a bathtub, was found sane and guilty of murder before an appeal. "Insane"- Lorena Bobbitt (cut off husband's penis), was found not guilty by reason of insanity—in absence of any major mental illness. The paranoid schizophrenic "unabomber" Ted Kaczynski, gained fame for refusing to use the insanity defense. John Hinckley who tried to assasinate Reagan found not guilty by insanity.
gerontology
The multidisciplinary study of aging, it is common to distinguish among 1. the young-old: 65-75. Defined less by age than by health and vigor. Notwithstanding the normal physical problems of aging, they're in good health and are active members of their communities. Majority of older adults belong to this group. 2. the old-old: 75-85 who suffer from major physical, psychological, or social (largely economic) problems. Require some routine assistance in living, although only about 6% percent of Americans in this group live in a nursing home. Despite age, a healthy and active 80-year-old adult considered young-old instead. 3. oldest-old: 85+, includes a disproportionate number of widowed women and low-income groups (as a result of male mortality and financial strains, including health care costs). Diverse group, some maintain vigor; others need constant assistance. 15% live in nursing homes.
amyloid plaques
The other type of lesion in ADs. Consist of a central core of homogeneous protein material known as beta-amyloid surrounded by clumps of debris left over from destroyed neurons. These plaques are located primarily in the cerebral cortex.
avolition
The withdrawal seen among many schizophrenic patients is accompanied by indecisiveness, ambivalence, and a loss of willpower. (lack of volition or will). They become apathetic and ceases to work toward personal goals or function independently.
Influence of mental disorders on rights and responsibilities
There are 3 ways in which the U.S. criminal law assumes that mental disorders may affect an individual's ability to exercise their rights and responsibilities: (1) Defendants who aren't guilty by reason of insanity are not criminally responsible for their actions (2) Defendants who are incompetent to stand trial are unable to exercise their right to participate in their own defense (3) mental illness may be a mitigating factor that can lead to a less harsh sentence— or a harsher one.
antipsychotic drugs
They have a specific effect—to reduce severity of psychotic symptoms. Some beneficial effects on problems-agitation + hostility maybe within a week after begins taking. 2-3 weeks before improvement w/ psychotic sxs. Positive symptoms (ex:hallucinations), respond better to them than - sxs (alogia and diminished emotional expression). For patient helps them be less preoccupied by troublesome thoughts + perceptual experiences. Able to distance themselves from + sxs, despite how it seldom eliminates hallucinations and delusional beliefs completely. - Bock dopamine (D2) receptors - Atypical (less likely to have - motor side effects) and typicals used
burden and standard of proof
Under U.S. criminal law, a defendant is innocent until proven guilty "beyond a reasonable doubt." This then rests with the prosecution, and this is very high—beyond a reasonable doubt. After Hinckley, the Insanity Defense Reform Act changed federal law so in federal courts the defense now must prove defendants' insanity rather than the prosecution having to prove their sanity. Insanity must be proven by "clear and convincing evidence". 2/3 of states gained but standard is "preponderance of evidence".
Huntington's disease
Unusual involuntary muscle movements known as "chorea" are the most distinctive feature. Movements subtle 1st, appearing merely restless/fidgety. As it progresses, sustained muscle contractions become difficult. Movements of the face, trunk, and limbs eventually become uncontrolled, leaving the person to writhe and grimace. A large proportion of patients also exhibit a variety of personality changes and sxs of MDs, esp depression+anxiety. Between 5-10% develop psychotic symptoms. NCDs appear w/ Impairments in recent memory and learning being most obvious cognitive problems. Diagnosis depends on presence of a + family history. 1 of few disorders transmitted in an autosomal dominant pattern with complete penetrance.
Neuropsychological assessment
Used as a more precise index of cognitive impairment. The evaluation of performance on psychological tests to indicate whether a person has a brain disorder. Testing can involve a variety of tasks that are designed to measure sensorimotor, perceptual, and speech functions.
insanity defense: use
Used in about 1% of cases - Successful in only 25% of NGRI pleas On average, NGRI acquittees spend about the same amount of time in mental institutions as they would have served if convicted - However, confinement cannot be indefinite, because they are by definition being treated NGRI patients work their way through the privilege system toward release - Followed by a team of treatment providers to monitor ongoing risk to public and, ultimately, to facilitate release if patient is not considered a risk - U.S. Supreme Court has ruled that longer confinements are permitted because treatment, not punishment, is the goal of an NGRI verdict
disorganization symptoms
Verbal communication problems, thinking disturbances, and bizarre behavior represent this third sxs dimension.
parenting styles
Warm parent- child relationships make discipline both less necessary and more effective. Developmental psychologists classify parenting into 4 styles based on warmth and discipline. 1. Authoritative: parents are both loving and firm. Their children are well-adjusted. Yet, they lack warmth, and their discipline is often harsh and autocratic. Children are generally compliant, but they may also be anxious and perhaps rebellious. 2. Indulgent: Opposite of authoritarian parents: affectionate but lax in discipline. Children tend to be impulsive /noncompliant, but not extremely antisocial. 3. Neglectful: Parents are not concerned either with their children's emotional needs or discipline. Children w/ serious conduct problems often have these.
coercion and other psychological factors
When parents positively reinforce a child's misbehavior by giving in to the child's demands. The child, in turn, negatively reinforces the parents by ending his or her obnoxious behavior as soon as the parents capitulate. Thus, describes an interaction in which parents and children reciprocally reinforce child misbehavior and parent capitulation. - Problems with self-control, response inhibition, and delayed gratification - In CD, adolescents make hostile attributional biases- they misinterpret others intentions as aggressive, esp in social situations (sounds like ASPD)
base rates
When predicting a very infrequent event (like violence), however, a false-positive rate of two-thirds is much better than chance. This is because you must take "population frequencies" into account.
adaptive functioning
Whether the individual needs support AAIDD: 1. Conceptual skills = focus largely on community self-sufficiency, language and literacy; money, time, and number concepts; and self-direction 2. Social skills = focus on understanding how to behave in social situations, interpersonal skills, social responsibility, self-esteem, gullibility, naïveté (i.e., wariness), social problem solving, and the ability to follow rules/obey laws and to avoid being victimized 3. Practical skills = focus on tasks of daily living, activities of daily living (personal care), occupational, healthcare, travel/transportation, schedules/routines, safety, use of money, use of the telephone - Less stable than IQ too, however, meaning that IDs can be "cured" in the sense that adaptive skills can be taught or environmental demands can be shaped to match an individual's unique abilities and experiences
vulnerability marker
a specific measure that might be useful in identifying people who are vulnerable to a disorder 1. must distinguish between people who already have schizophrenia and those who do not. 2. Should be a stable characteristic over time. 3. It should identify more people among the biological relatives of schizophrenic patients than among people in the general population. - Look at measures of cognitive performance (working memory problems) - Eye impairments
relationship conflict
a type of conflict in which people focus on characteristics of other individuals, rather than on the issues, as the source of conflict. Disputes tend to follow 1 of 2 struggles: Power = dominance Intimacy = closeness or love. At deep level, all family conflicts about love or power
mild neurocognitive disorder
cognitive problems that fall short of the threshold for major NCD but also exceed the losses in fluid intelligence that are characteristic of normal aging. 1. Requires evidence of "modest" cognitive decline. 2. these cognitive sxs must NOT interfere w/ their capacity for independence in everyday activities. Ex: people who are still able to live on their own, but who also struggle with cognitive problems
outpatient commitment
mandatory, court-ordered treatment in the community (e.g., mandated therapy and/or medication). Orders must be based on the same legal standards as inpatient commitment, that is, dangerousness and, in some states, inability to care for self. Because it involves less infringement on civil liberties, however, this commitment criteria may be applied less stringently. An attempt to balance between libertarianism and paternalism.
insanity defense
mental disability should limit criminal responsibility - irresistible impulse test: broadened it to include defendants who were unable to control their actions because of mental disease. Parsons case ruled there was no deterrence purpose, justifying NGRI. - Deterrence: Idea that people will avoid committing crimes because they fear being punished for them, a major public policy goal of criminal law. - Product test: unlawful act was product of MD
deinstitutionalization - problems
movement embraced the philosophy that many patients can be better cared for in their community than in large mental hospitals. Congress passed the Community Mental Health Centers (CMHC) Act: provided for the creation of community care facilities for the seriously mentally ill as alternatives to institutional care. - higher # of mental patients homeless or living in nursing homes, jail, and other profit institutions. According to DOJ: serious mental illness (ex: schizophrenia, bipolar, major depression) 64% in local jails, 56% in state prisons, 45% in federal prisons.
major neurocognitive disorder
new term that includes dementia and related forms of significant cognitive decline. In order to qualify for this diagnosis, they must exhibit evidence of significant cognitive decline in one or more domain (such as complex attention or learning and memory), and those cognitive deficits must interfere with the person's independence in everyday activities.
Emotion regulation
process of learning to identify, evaluate, and control your feelings. As with children's conduct, emotion regulation in children progresses from external to internal control with age.
Anterograde amnesia
refers to the inability to learn or remember new material after a particular point in time. usually the most obvious problem during the beginning stages of dementia.
Retrograde amnesia
refers to the loss of memory for events prior to the onset of an illness or the experience of a traumatic event.
dysprosody - echolalia - theory of mind
subtle disruptions in the rate, rhythm, and intonation of speech. - uttering phrases back, perhaps repeatedly. —a failure to appreciate that other people have a different point of reference
Family Life Cycle - Stages
the developmental course of family relationships throughout life. 1. Married Couple 2. Childbearing 3. Preschool Age 4. School Age 5. Teenage 6. Launching Center 7. Middle-Aged Parents 8. Aging Family Members
child custody
two issues: 1. physical custody- where the children will live at what times 2. legal custody- how the parents will make decisions about their children's lives. Sole custody refers to a situation in which only one parent retains physical or legal custody of the children; in joint custody both parents retain legal or physical custody or both.