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)