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75 Cards in this Set
- Front
- Back
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What are the characteristics of substance abuse and dependence as a quick reference?
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Abuse refers to continued use of substance despite impairment
Dependence refers to use that is uncontrollable,marked by tolerance and withdrawal symptoms |
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How do abuse and dependence differ from one another?
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A maladaptive pattern of substance use leading
to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period |
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1st stipulation of substance abuse in DSM
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Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or
home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household) |
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2nd stipulation of substance abuse in DSM
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2.Recurrent substance use in situations in which it
is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use) |
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3rd stipulation of substance abuse in DSM
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3.Recurrent substance-related legal problems
(e.g., arrests for substance-related disorderly conduct) |
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4th stipulaton of substance abuse in DSM
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4.Continued substance use despite having
persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of Intoxication, physical fights) |
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The DSM definition of the Substance Dependence
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A maladaptive pattern of substance use,
leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: |
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1st stipulation of Substance Dependence in the DSM
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1. Tolerance, as defined by either of the following:
● a need for markedly increased amounts of the substance to achieve intoxication or desired effect ● markedly diminished effect with continued use of the same amount of the substance |
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3 of the following stipulations for Substance Dependence in the DSM
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three (or more) of the following... (continued):
2. Withdrawal, as manifested by either of the following: ● the characteristic withdrawal syndrome for the substance ● the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms 3. The substance is often taken in larger amounts or over a longer period than was intended 4. There is a persistent desire or unsuccessful efforts to cut down or control substance use |
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3 or more of the follwing stipulations for Subtance Abuse (continued)
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three (or more) of the following... (continued):
5. A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance ... or recover from its effects 6. Important social, occupational, or recreational activities are given up or reduced because of substance use 7. The substance use is continued despite knowledge of having ... a physical or psychological problem that is likely to have been caused or exacerbated by the substance |
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What is Tolerance?
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1. Tolerance, as defined by either of the following:
● a need for markedly increased amounts of the substance to achieve intoxication or desired effect ● markedly diminished effect with continued use of the same amount of the substance |
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What is withdrawal
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Withdrawal, as manifested by either of the
following: ● the characteristic withdrawal syndrome for the substance ● the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms |
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What is the gateway hypothesis?
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use of a less severe substance
directly leads to later use of a more severe substance |
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What is the gateway hypothesis?
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use of a less severe substance
directly leads to later use of a more severe substance |
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What evidence supports this theory?
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● Initial support for the gateway hypothesis was
found in a study of twins (Lynskey, et al., 2003) ● Individuals who used cannabis by age 17 were at about about 2-5 times higher risk for other drug use than co-twins who did not use cannabis before age 17. ● i.e., using one drug increased risk of other drugs only in twins who had used that drug |
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What evidence contradicts this theory?
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● Later, more sophisticated studies, however,
have shown that this is not due to direct effects of use of one drug on use of other drugs ● Instead, individual-specific environmental influences on use of one drug seem to be correlated with use of other drugs (Agrawal, et al., 2003, 2004) ● I.e., environmental influences are not specific to one substance ● E.g., it's not that being introduced to marijuana opens up use of cocaine, it's that something in the environment causes both marijuana and cocaine use ● sellers selling both, crime, general neighborhood problems, peers who use multiple substances ● Gateway hypothesis now seems unlikely |
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Explain the mechanisms by which the alcohol dehydrogenase gene affects alcohol use.
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● Alcohol is broken down into acetaldehyde in
body ● Acetaldehyde has a number of unpleasant effects, including headaches and sickness, and worse hangovers ● Alcohol dehydrogenase breaks down alcohol into acetaldehyde ● Aldehyde dehydrogenase breaks down acetaldehyde into acetate ● ADH is the alcohol dehydrogenase gene, and ALDH is the aldehyde dehydrogenase gene ● Certain versions of ADH and ALDH make more and less efficient dehydrogenase: ● more efficient ADH, faster breakdown of alcohol into acetaldehyde, more acetaldehyde ● less efficient ALDH, slower breakdown of acetaldehyde, more acetaldehyde |
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Why might a person with one version of the gene be more or less likely to have alchohol problems than a person with another version of it?
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● Individuals with more efficient ADH genes and
less efficient ALDH genes have more acetaldehyde when drinking alcohol ● Because they have more acetaldehyde, they are more prone to headaches, sickness, and worse hangovers when they drink alcohol ● This decreases the likelihood that they will drink, decreases their use, and decreases the likelihood of alcohol problems ● alcohol is nauseating, sickening for them |
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Characteristics of borderline
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“Borderline” is a psychoanalytic term; the
concept of borderline personality was originally psychoanalytic ● Originally, referred to idea that an individual was on the “borderline” of ● neurosis (i.e., internalizing, anxiety, depression, fear), and ● psychosis (i.e., hallucinations, schizophrenia) ● Original psychoanalytic idea has been abandoned, but name has remained ● A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Frantic efforts to avoid real or imagined abandonment 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation ● ... five (or more) of the following: 3. Identity disturbance: markedly and persistently unstable self-image or sense of self 4. Impulsivity in at least two areas that are potentially self-damaging |
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What are the DSM characteristics of Antisocial Personality Disorder?
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● A pervasive pattern of disregard for and
violation of the rights of others occurring since age 15, as indicated by three (or more) of the following: 1. Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest 2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure ● ...three (or more) of the following: 3. Impulsivity or failure to plan ahead 4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults 5. Reckless disregard for safety of self or others 6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations 7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another ● The individual is at least age 18 years ● There is evidence of Conduct Disorder with onset before age 15 ● The occurrence of anti |
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DSM characteristics of Obsessive-Compulsive Disorder?
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● A pervasive pattern of preoccupation with
orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost ● ... four (or more) of the following: 2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met) 3. Excessively devoted to work and productivity to the exclusion of leisure activities and friendships 4. Overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values 5. Unable to discard worn-out or worthless objects even when they have no sentimental value ● ... four (or more) of the following: 6. Reluctant to delegate tasks or to work with others unless they submit |
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what features do these disorders share, how do they differ?
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● Antisocial Personality Disorder
● disagreeableness and unconscientiousness ● Borderline Personality Disorder ● negative emotionality, disagreeableness, and unconscientiousness ● Obsessive-compulsive Personality Disorder ● abnormally high conscientiousness |
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What is the difference between antisocial personality and psychopathy?
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● Theorists (e.g., Hare) have speculated that
individuals with ASPD are actually a mixture of two groups ● Those with disinhibited personality ● Psychopaths ● The first group are disinhibited, aggressive, and high in negative emotionality ● Psychopaths are aggressive, controlled, and low in negative emotionality ● The idea is that there are different ways in which one can be diagnosed with ASPD ● E.g., consider arrest for homicide: ● Someone becomes angry and shoots friend over a bet; loses temper ● Someone stalks strangers on street, strangles them ● Very different psychologically, even though both would meet “aggressiveness” criterion of ASPD definition ● Individuals who are disinhibited are unpredictable, uncontrolled ● Often show remorse, because they didn't think about consequences ahead of time ● Psychopaths are more predatory, calm, and controlled ● Do not show remorse for actions ● There is substantial empirical support for different groups of ASPD “diagnosees” |
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Explain what is meant by adolescent-limited vs. lifetime-persistent antisocial behavior.
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● Adolescent-limited antisocial behavior
● begins in adolescence or early adulthood ● ends in adolescence or early-mid adulthood ● is relatively normative in males ● Lifetime-persistent antisocial behavior ● begins before adolescence ● persists after early-mid adulthood ● is more abnormal, even for males |
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Why is the distinction between the two (adolescent-limited & Lifetime-persistent) so important?
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because adolescent-limited ASPD is relatively normal in males and L-P ASPD is more abnormal (even in males)
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Describe the relative magnitude of genetic and Env. effects on substance use, with regard to severity of substance use, as well as use of specific substances versus multiple substance?
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Severity as abuse, as problem becomes more severe, genes become more important in understanding that,
For substance use, it is more envronmental. Specific substances vs. substances in general- influences on abuse and dependence: genetic influence- reward use of multiple substance, some reward a specific substance. (see slide entitled "substance use" its a diagram). From use to dependence: genes in multiple substances use and dep. and abuse gense for specific substances drops out from use to dependence. Genes influence early use and has it's impact at low levels of severity. |
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Describe the effects of child abuse and parental psychopathology on conduct problems in childhood and adolescence.
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● effects of childhood abuse on child antisocial
behavior greater in children with low-activity version of MAOA gene ● Studies have found that parental psychopathology increase risk of antisocial behavior in childhood and adolescence ● E.g., child antisocial behavior increases with ● parental depression (Kim-Cohen, et al., 2005) ● child abuse (Jaffey, et al., 2004) ● About 30-50% of the correlation between parental behavior and child behavior due to genetic effects ● 50-70% of remaining correlation due to environmental effects (i.e., parental behavior itself) |
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Explain how the ventromedial prefrontal cortex (VMPC) might be involved in the development of moral and ethical reasonin, and its role in impulsive disinhibited behavior more generally.
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● One prominent theory (e.g., Damasio, Bechara, et al.) is
that impulsive personality disorders result from malfunctioning VMPC ● Individuals with misfunctioning VMPC cannot weigh positives and negatives of decisions ● Tend to overvalue short-term benefits with low costs against long-term benefits with high cost ● Individuals who have damage to VMPC are often impulsive ● Theory was that moral reasoning develops from learning to weigh long-term positives and negatives ● As infancy-injured individuals supposedly incurred deficits in VMPC earlier, they wouldn't have had time to learn moral reasoning ● Adult-injured individuals would have learned moral reasoning before injury, but then would acquire deficits afterwards ● Results largely supported theory |
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Sex patterns in the prevalences of different forms of psychopathology
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● Antisocial PD and OCPD are much more
common in men Depression (female) Psychosis (men (slightly)) ● Antisocial PD too rare in women to detect in recent study (Torgersen, et al., 2001) ● OCPD about twice as common in men ● Borderline PD is about twice as common in women as in men (Torgersen, et al., 2001) |
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What are the characteristics of anorixa from the DSM
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● Refusal to maintain body weight at or above a
minimally normal weight for age and height ● e.g., body weight less than 85% of expected ● Intense fear of gaining weight or becoming fat, even though underweight. ● Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on selfevaluation, or denial of the seriousness of the current low body weight. ● In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. ● Specify type: ● Restricting Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas) ● Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior |
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What are the characteristics of bullimia in the DSM
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● Recurrent episodes of binge eating. An episode
of binge eating is characterized by both of the following: ● eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances ● a sense of lack of control over eating during the episode ● Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as selfinduced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise. ● The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months. ● Self-evaluation is unduly influenced by body shape and weight. ● The disturbance does not occur exclusively during episodes of Anorexia Nervosa. ● Specify type: ● Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas ● |
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3 dimensions of eating disorders; in differentiated between different forms of eating problems.
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● Recent research suggests three forms of eating
problems (Williamson, et al., 2002): ● binging ● compensatory behavior (e.g., purging, dieting) ● weight problems (e.g., low weight, distorted perceptions of weight) ● These different problems can combine in different ways; e.g., ● binging without compensatory behavior ● compensatory behavior without binging |
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the trends of eating disorders over recent decades
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There is some evidence that rates of eating
disorder have declined, then stabilized over last two decades ● Rates seemed to be highest in 1980s, then declined through 1990s ● Appear to have stabilized since ● Based on college students in U.S., however |
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sociocultural influences on eating.
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● Many individuals have suggested that eating
disorders are a cultural phenomenon, limited to industrialized Western cultures ● A review (Keel & Klump, 2003), suggests that this depends on the eating problem ● Fasting and anorexic phenomena appear to be universal, not culture-bound ● Binging, purging and bulimic phenomena appear to be culture-bound, and depend on availability of food in culture ● Abnormal fasting has been found in variety of cultures throughout history ● E.g., reports in 5th-8th century of demons causing individuals to refuse to eat, exorcised ● Reasons seem to vary, although desire for thinness and religious reasons are prominent ● Religious reasons not necessarily “normal” ● individuals with anorexia often invoke religion ● historical accounts suggest that religious figures often denounce abnormal fasting |
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keel and klump on Eating disorders..
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● Keel & Klump (2003) suggest that fasting is
relatively common throughout cultures ● Binging and purging limited to cultures where food is abundant ● They predict that heritabilities will be more stable across cultures for fasting ● Heritabilities will be less stable across cultures for binging and purging |
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evidence for and against the sociocultural eating disorder theories
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● Few cross-cultural studies on disordered eating
● Results are somewhat consistent with Keel & Klump's predictions: ● Estimates of influences on fasting behavior seem to be more consistent across settings than estimates of binging and purging behavior ● More evidence of environmental influences on binging and purging behavior ● Very preliminary, however ● Karwautz, et al. (2001) is important exception ● Examined pairs of sisters where one sister had an eating disorder (anorexia), the other did not ● Identified characteristics unique to the sister diagnosed with eating disorder ● Also genotyped sisters to look for genetic influences |
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what are some specific family environmental factors that might differ between individuals with and without eating disorders
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Found that among sisters who had eating
disorder, the following were more common: ● sexual abuse ● parents having higher expectations of them ● low self-esteem ● perfectionism-related traits ● jealousy of sister ● feeding problems in childhood ● Individuals with fasting problems tended to have higher rates of sexual abuse, and were treated more strictly by parents ● These individuals also had lower self-esteem, and were often preoccupied with how they compare to others ● What caused what is an open question, however |
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what are the characteristics of paraphilia according to DSM?
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● Recurrent, intense sexually arousing fantasies,
urges, or behavior generally involving ● nonhuman objects ● harm or suffering to another individual, or a nonconsenting individual ● These fantasies, urges, or behavior have either ● been acted on, in the case of potential harm or suffering to another individual, or ● cause distress or impairment ● Different types of paraphilia (continued): |
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what is voyeurism?
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● voyeurism (observing unsuspecting strangers
who are naked, disrobing, or engaging in sexual activity) |
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what is exhibitionism
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● exhibitionism (exposure of genitals to strangers)
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what is sexual sadism?
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● sexual sadism (inflicting pain or humiliation)
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what is sexual masochism
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● sexual masochism (being made to suffer)
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Explain what is meant by positive symptoms, negative symptoms, and disorganization in describing psychosis.
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● Positive symptom—thing present in psychosis
● Negative symptom—thing absent in psychosis ● Disorganization—confusion, confused behavior |
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what is the difference between a delusion and an idea? What are some of the common types of delusions and ideas?
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● delusions—perception of imagined thoughts as
factual ● ideas—perception of imagined thoughts as possibly factual ● Types of common delusions and ideas: ● reference—belief that events (e.g., people talking, TV, radio) secretly refer to you ● grandiosity—belief that you have special powers or status (e.g., that you are secret agent) ● persecution—belief that others are plotting against you or have malicious intent ● erotomania—belief that a person of high status (e.g., celebrity, politician) is in love with you ● jealousy—belief that your significant other is unfaithful |
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what is thought broadcasting. thought withdrawal, and thought insertion...
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● Types of common delusions and ideas (cont.):
● thought broadcasting—perception that others know your thoughts ● thought withdrawal—perception that others are taking your thoughts ● thought insertion—perception that you are thinking other people's thoughts |
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Define common forms of hallucinations
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● Also types of common hallucinations:
● audible—heard (e.g., voices) ● visual—seen (e.g., spirits, people) ● tactile—felt (e.g., insects) ● olfactory—smelled (e.g., perfume) ● Most common are audible, then visual hallucinations ● Tactile and olfactory hallucinations are less common |
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what is restricted, flat, or blunted affect?
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● Blunted affect—seems to lack emotion
● Restricted affect—limited range of emotional expression |
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what is meant by alogia or avolition?
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● Alogia—poverty of thought or speech
● e.g., telegraphic speech, brief responses ● Avolition—poverty of initiation and motivation ● e.g., only brief movements in response to request |
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schizophrenia in DSM terms?
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● Two (or more) of the following, each present for
a significant portion of time during a 1-month period (or less if successfully treated): ● delusions ● hallucinations ● disorganized speech (e.g., frequent derailment or incoherence) ● grossly disorganized or catatonic behavior ● negative symptoms, i.e., affective flattening, alogia, or avolition ● For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset, or [below ageexpected levels] ● Continuous signs of the disturbance persist for at least 6 months ● [The individual does not meet criteria for a mood disorder] ● The disturbance is not due to the direct physiological effects of a substance or a general medical condition. ● If there is a history of ... Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucina |
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Delusion Disorder (DSM)
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● Nonbizarre delusions (i.e., involving situations
that occur in real life, such as being followed, poisoned, infected, loved at a distance, or deceived by spouse or lover, or having a disease) of at least 1 month's duration. ● [Criteria for Schizophrenia] have never been met. ● Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre. ● If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods. ● The disturbance is not due to the direct physiological effects of a substance or a general medical condition. |
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schizotypal personality disorder
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● A pervasive pattern of social and interpersonal
deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: ● ideas of reference ● inappropriate or constricted affect ● suspiciousness or paranoid ideation ● ... five (or more) of the following (continued): ● odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense") ● unusual perceptual experiences, including bodily illusions ● odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped) ● behavior or appearance that is odd, eccentric, or peculiar ● ... five (or more) of the following (continued): ● lack of close friends or confidants other than first-degree |
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Explain some possible envronmental prenatal effects of psychosis and mental retardation.
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● Another well-documented trend is for psychosis
to be more prevalent among individuals born in winter and early spring. ● This is explained in terms of prenatal exposure to something that is more common in fall ● pregnancies in fall lead to births in early spring ● Other groups have suggested that other prenatal influences increase risk of psychosis ● Nutritional deficiency is often hypothesized ● Evidence for this is often seen in “famine studies” ● Rates of psychosis increase dramatically among pregnancies during famine ● Nutritional deficiency during famine may increase risk |
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Neurobiology of psychosis
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● Thus far, most research on schizophrenia has
focused on certain brain regions: ● dorsolateral prefrontal cortex ● anterior cingulate ● hippocampus and surrounding areas ● This makes sense, because these brain areas are involved in attention and memory ● Many differences observed in left hemisphere ● Hippocampus is involved in episodic memory memory ● Many studies have documented that individuals with psychosis have smaller hippocampi ● brain volume differences are greatest for hippocampus ● Their hippocampi are often less active during memory tasks than other individuals (larger ventricles) |
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patterns of congitive problems in psychosis
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● Individuals with psychosis tend to have less
activation in ● dorsolateral prefrontal cortex ● anterior cingulate ● thalamus (“gateway to frontal cortex”) ● They tend to have more activation in ventrolateral prefrontal cortex ● not sure why—maybe compensating ● DISC is also associated with cognitive performance on tasks associated with psychosis ● E.g., individuals who have DISC mutations often perform worse on ● attention tasks ● episodic memory tasks ● This is true regardless of whether they have psychotic symptoms or not |
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mental medication side effects
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● Extrapyramidal effects
● motor problems ● tardive dyskinesia—involuntary, spasmic movements ● feelings of restlessness ● Hyperprolactinemia ● excess prolactin ● sexual side effects ● Weight gain |
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DSM Definition of Mental
Retardation |
Significantly subaverage intellectual functioning:
an IQ of approximately 70 or below on an individually administered IQ test ● Concurrent deficits or impairments in present adaptive functioning in at least two of the following areas: ● communication ● self-care ● home living ● social/interpersonal skills ● at least two of the following areas (continued): ● use of community resources ● self-direction ● functional academic skills ● work ● leisure ● health ● safety ● The onset is before age 18 years. |
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2 essential criteria of retards
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● Note that two basic criteria must be met:
● abnormally low general cognitive ability ● impairment |
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DSM Definition of Dementia
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● The development of multiple cognitive deficits
manifested by both ● memory impairment ● one (or more) of the following: ● aphasia (language disturbance) ● apraxia (impaired ability to carry out motor activities despite intact motor function) ● agnosia (failure to recognize or identify objects despite intact sensory function) ● disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting) ● The cognitive deficits ... each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning. ● The deficits do not occur exclusively during the course of a delirium. |
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terminal decline
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● general tendency for cognitive abilities to drop
sharply during period (months or years) before death |
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Dilirium
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Delirium is an acute and debilitating decline in the ability to focus attention, perception, and cognition that produces an altered form of semi-consciousness. It is a systemic syndrome caused by a chemical or disease-process which is disrupting the neurons of the cerebral cortex. Though hallucinations and delusions are often present, the symptoms of delirium are clinically distinct from those induced by psychosis or hallucinogens.
In medical usage it is not synonymous with drowsiness, and may occur without it. Delirium is not the same as dementia (the two entities have different diagnostic criteria), though it commonly occurs in demented patients. |
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common types of dementia
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● There are many types of dementia, depending
on cause; e.g., ● Alzheimer's ● Vascular (e.g., due to stroke) ● Parkinsonian ● Pick's disease ● Viral diseases (e.g., HIV) ● Each of these types of dementias has a different cognitive profile associated with it |
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cognitive changes in dementia types
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Alzheimer's usually begins with
memory impairments, and as it progresses, impairments in other areas become more prominent ● I.e., first memory impairments, then language, planning, etc. ● Personality changes may also occur, especially as the disease progresses (e.g., irritability) Pick's dementia usually begins with personality and social changes (e.g., disinhibition, poor social skills), and progresses to language, then memory ● I.e., first personality impairments, then then language, planning, etc., then memory ● Course is often “reverse” of Alzheimer's disease ● Vascular dementia is dementia that results from cerebrovascular problems—e.g., strokes and other problems with blood circulation in brain ● Because of this, the profile can vary widely, depending on where the cerebrovascular problems occur ● e.g., if stroke in frontal lobes, personality and planning deficits more prominent ● e.g., if stroke in temporal lobes, memory deficits more prominent Not everyone with Parkinson's di |
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prevalence of dementia wrt age
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As one might expect, prevalence of dementia
increases significantly with age ● It is extremely rare in young to middle adulthood, and begins to increase in very late adulthood ● The prevalence is about 1-2% in individuals around the age of 70 ● Increases to around 30% for individuals around the age of 85 |
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is it more common to know or not to know the cause of mental retardations?
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NOT TO KNOW!
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in known cases what is most common cause?
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76% were due
to a chromosomal abnormality |
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what is meant by trisomy 21; Fragile X syndrome; and chromosome 22 abnormalities?
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Many X chromosome abnormalities associated
with MR (c.f. greater male prevalence) ● Most common abnormality is “Fragile X” syndrome; different individuals have different mutations, but involve the same gene (FMR1) ● Most well-understood mutation involves a repeat of a portion of the gene ● more repeats generally associated with worse cognitive functioning, but is complicated Interestingly, chromosome 22 mutations have been associated with a variety of cognitive problems, including mental retardation and psychosis ● Chromosome 22 mutations do not always result in mental retardation, but can, depending on mutation ● There are many mutations, each having slightly different effects ● The most commonly studied region of chromosome 22 is the 22q11 region ● Is on the long arm of chromosome 22 ● Mutations appear to be common there because of a set of repeats of genes in the same area ● The chromosome seems to be susceptible to rearrangement in the area of the repeats |
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why are genetic repeats important to understanding Frag. X and Chrom. 22 abnormalities?
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● Most well-understood mutation involves a
repeat of a portion of the gene ● more repeats generally associated with worse cognitive functioning, but is complicated |
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importance of amyloid-B peptides?
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● Alzheimer's is associated with amyloid β-peptide
(Aβ) plaques, which are “clumps” of protein bits ● these plaques are associated with eventual neuron degeneration and cognitive deficits There are two main ways in which Aβ appears to cause dementia ● directly, by blocking receptors involved in learning and memory ● indirectly, by causing neural degeneration ● Aβ plaques block receptors involved in learning and memory ● Experimental studies in demented mice (Ashe, et al.) demonstrate that ● Administering Aβ antibodies—and thereby removing Aβ—restores cognitive functioning, reversing dementia ● Aβ must combine with itself to impair cognition —single proteins by themselves are not sufficient ● Aβ may also cause dementia by causing neurodegeneration ● However, this is not likely not due to Aβ alone (Galvan, et al., 2006) ● can stop neurodegeneration in mice without stopping formation of Aβ plaques ● Aβ likely interacts with another protein to cause neurodegenerati |
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importance of the tau protein
why is chromosome 17 important? |
● Tau proteins are associated with the
“scaffolding” of axons, neural development ● bind to microtubules Tau proteins phosphorylated in various places ● phosphate group is added ● In dementias, tau proteins are abnormally phosphorylated, and appear in diseased tissue ● Abnormal phosphorylation ● decreases binding to microtubules ● increases binding to each other ● Chromosome 17 is involved in tauopathy dementias ● site of gene for tau protein ● also sites for genes for other proteins that are associated with dementia ● Mutations in tau gene associated with abnormal tau proteins, which are associated with dementia |
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evidence that intellectual activity decreases risk of dementia..
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● This is true even when controlling for baseline
level of intelligence, socioeconomic status, physical health, and other factors ● I.e., it's not just that individuals of higher intelligence start out functioning better ● The effect of cognitive exercise has been shown ● observationally (Wilson, et al., 2002) ● experimentally (Ball, et al., 2002) ● Individuals who engage in more cognitive exercise now lower risk for dementia later ● Increasing cognitive exercise experimentally improves cognitive functioning |
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drug treatments for dementia..
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● Various drugs and supplements have been
proposed to treat dementia ● e.g., donezepil ● These generally are cholinesterase inhibitors ● cholinesterase breaks down acetylcholine ● acetylcholine is major neurotransmitter, involved in memory ● Also gingko, which increases circulation ● None of these work very well, if at all |
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Autistic Disorder
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● Autism comprises problems in three areas:
● social cognition ● language impairments ● restricted, repetitive, or stereotyped behavior ● Onset is supposed to occur at an early age, before 3 years old ● Social cognitive problems are manifested in: ● problems with nonverbal interaction ● e.g., eye contact, nonverbal facial expression and interpretation, nonverbal gestures ● failure to develop appropriate peer relationships ● lack of expressed interest in social interaction ● e.g., does not share interests, initiate contact ● lack of social or emotional reciprocity ● e.g., does not understand sequence of normal social interaction ● Language impairments can be fairly general: ● delay in or absence of appropriate speech ● poor pragmatic and conversational ability ● stereotyped, repetitive, or idiosyncratic language ● e.g., echolalia ● lack of spontaneous pretend or imitative play ● Restricted, repetitive, stereotyped behavior and interests may include: ● abnormal preo |
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Asperger's Disoorder
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● Is basically same as autism, but without
language impairments ● Historically, diagnosis has emphasized other differences: ● Asperger's stereotyped behavior seen more in terms of interests, less so in motor behaviors ● Social impairments seen as more subtle, involving indifference to social interaction rather than impairments in nonverbal communication ● Difference is somewhat controversial |
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Pervasive Development Disorder
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● PDD NOS is fairly common in clinical settings
● Includes problems like autism or Asperger's, but without meeting criteria for either ● E.g., ● stereotyped interests without social or language impairments ● repetitive language and social impairments without stereotyped interests or behavior ● abnormal social, language, and play behavior without any meeting criteria for other diagnosis |
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PDD trends
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● Rates of PDD diagnosis have been increasing
over time in U.S. ● not clear if also elsewhere in world, though (Chakrabarti & Fombonne, 2005) ● Explaining this increase is controversial; could be due to ● genuine increase ● diagnostic criteria becoming more broad ● changes in diagnostic biases ● In general, later versions of DSM define PDDs more broadly, vaguely ● easier to meet criteria ● studies using later DSM versions estimate higher prevalences, even adjusting for year ● In 1991, Department of Education added autism as a qualifying diagnosis for special education services ● bias toward autism as way of receiving service? ● diagnostic substitution process |
