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Depression
<1% of preschoolers
2-3% of school age hilden
No geder differences
Comorbid wih adhd and conduct disorder
Factors:
Heredity - genetics
Early adversity and negative life events cognitive distortions and attributional
styules
Parental factors having depressed arents, parental rejection, marital conflict
awkward kids = ultimate set up for depressed kids
Biological Therapies:
SSRIs as first line treatment > TCAs
The TASS (Treatment for adolescents with depression) was an RCT which
compared fluoxetine, CBTm or both for depression (no placebo = unethical to have)
Resuls: showed: combination therapy was superior vs all other groups even
after 36 weeks
However a sub analysis revealed that fluoxetine alone group experiences
more benefits than the CBT alone groups
Anxiety
Common fears arent usually pathological
Ex: fear of the dark and imaginary creatures <5 y/o (beyond, its nt
appropriate)
Fear of being separated from parents <10y/o
N> functioning impairment for fears and worries to be classified as disorders
However the child doesnt need to regad the fear as excessive and
unreasonable; kids can believe in the imaginary and itss ok
Epidemiology: prev = 12-20% among kids and adolescents
Social Phobia more prev if you have slow to warm up kids; can be comorbid with a
feature of selective mutism; may be related with specific situation such as reading
aloud, writing on the board, performing in front of others usu. React with crying,
avoidnc e and somatic
OCD
1-4% boys>girls
Bimodal onset depending on age: mostly boys in kids, but as they grow older,
mostly in girls
Symptoms are similar to adults
More common obsessions in childhood: dirt/contamination; aggressive thoughts
More common obsessions in adolescence: sex and religion, where compulsions
(religion) undo the obsession (to sex);
Etiology of Anx: heritable, 29-50%; psych factors: parental control, emotion-
regulaion prolems and insecure attachment in infancy
Treatment f Anx: CBT
CBT typically involves working with both kids and parents; includes psychoeduc, cog
restructung, modelling, skills training relapse prevention; coping cat workbook
iwith kids 7-13y/o which focuses on confronting fears and developing new ways to
think about fears, exposure, practice, and relapse prevention
Learning Disability:
Problem area of academic domain, language, speech or motor; not due to mental
retardation or lack of educ opps.
Includes 3 categories: learning disorders (reading[dyslexia is most prevalent, ad is
heritable; same genes associated with typical reading disabilities; common
problems include language processing problems in like phonological awareness],
writing, math), communication d/o (expressive language unclear speech and
improper articulation, phonological, stuttering), motor disorders:
Mood Disorders
Mood as a spectrum of being very very happy or very very sad; most people are in
the middle
Dx: MDE
DSM5 Crit: 5_ symptoms present during 2 week; if you have a major depressive
episode, it doesnt necessarily mean you have MDD.
MDE can be MDD or BPD (BPD1 or 2) or Schizoaffective DO
Sx of MDE: 5+ sx present in same 2 week period, with at least one core sx of
depressed mood or anhedonia with 4+ of the other sx: sig weight loss/weight gain
5% of bw; insomnia (wanna sleep but cant) or hypersomnia (too much sleep),
psychomotor agitation or retardation (very slowed down),
For all dsm critertia, dontstop with criterion A. look at the others: MDE: sig distress
and impairment ad symptoms arent due to substance/medical,
Becomes a disorder if you can rule out SAFF d/o schzo, delusional or other psychotic
disorders
MDD if no manic or hypomanic episode (because the MDE will be part of BPD)
Cant be both MDD or BPD; MDD with psychotic
Mood disorder cant be accompanied by psychotic disorders
Epidemiology 15%; 25% for women; mean age of onset is 40 years old
2-fold greater prevalence of mDD in women than in men
MDD have happy moments
Psychosocial Fx
Stressful life events preced very first episode of mood disorders
Life event most often associated with depresson: losing (dioverce, death) a parent
before the age of 11 and then the next episodes dot have to have severe triggers;
brain is rendered more vulnerable to the bad events; environmental fx: loss of
spouse followed by unemployment
Manic Episode dsm 5: happy or mad lasting 1 week or any duration if hospitalization
is necessary
Manic ep is possible to coexsist with psychotic features
If its predominantly mood with psychotic feature = manic ep with psychotic featu
Because mood d/o cant coexist w/ psychotic d/o
Bpd2 = no manic episode; has hypomania (at least 1ep) and 1+ MDD
Cyclothymic d/o
Like dysthymia/pdd but with hypomania with depression that are NOT manic or
MDEs
Anxiety D/O
DSM5 : not ocd and ptsd;
DSM5 = Phobias, Social AD, PD, Agoraphobia, GAD
Most Common psychiatric d/o 28%report anx sx
Biological paradigm
Slides
Benzodiazepines are first line; increased GABA (relaxation)
Generalized social phobia = SSRIs are first line
Biologial Etiology
Neurochemical theory:
Increased NE
Decreased GABA or
Increased activity in locus ceruleus
SSRI for rapid control then slowly with benzodiazepine as it tapers
DSM 5
GAD
50% ina da of Worry in at least 2 life domains where the worry is sustained for
3mos+ AND is associated with the ff:
Restlessness, on edge; being easily fatigued; difficulty concentration;
irritability; muscle tension; sleep disturbance
1:2 male female onset
Most often comorbid: 75% of GAD people
Not enough GABAneuron activity
Ssri with tapering by benzo then maintenance with antideoressant therapy
OC and related D/O
DSM4tr vs DSM5 OC and Trauma were under Anxiety D/O
Body Dysmorphic D/O was in Somatoform before, not put into OC-D/O
Hoarding is new in DSm5
etiology
Psych theories:
psychanalytic theory and behavioral and cognitive theory
oc sexual/aggressive mpulses hard to moderate beause of overly harsh
toilet training person fixated in the anal stage
overcleanliness and meticulousness my be a reaction formation (which is now
thought to be more applicable for OCPD)
behavioral and cog:
operant conditioning
cog: yedasentience deficiency (sense of completeion/good enough)
biological theory
decreased 5HT
antidepressants and brain surgery (remove cingulate gyrus)
Body DD
Preoccupation is not resitricted to concerns about weight or fat (to rule out eating
disorders)
Trauma related
PTSD with fear and helplessness, relives the experiences persistently, tries
avoiding being reminded
ASD same symptoms but could resolve within 1 month; symptoms occur 3 days
1month; asd can become ptsd
Asd starts in 3 days because its normal naman to bounce back after 2 days
Neurochemical: NE inc levels = hypervigilance and inc startle response inc
sensitivitiy to noradrenergic receptors in ptsd
Subs Abuse
Most common drugs
DSm5 criteri encompasses subs abuse d/o as a whole
Dsm5:No longer distinction between subs abuse and subs depenced.
Even if the womn still weighs the same as a man, alcohol still affects women more
Alcohol increases both 5ht and dopamine
Nicotine increases cerebral blood flow which causes short term increase in attention
and concetration
Mariuana mild to moderate = relaxation and sociability;; large dose: mood swing,
cognitive slowing, loss of short term memory, psychomotor impairment, extremely
heavy = schizo
Brain has cannabinoid receptors cb1 and cb2; able to recude nausea, vomiting, loss
of appetite or chemotherapy patient
Opiates
Downers sedatives
Addictive and pain relief, induces sleep
Uppers
Amphetamines meth las, synthetic stimulants; shabu to remove congestion;
vasoconstriction;
Acts by 2 mechanisms:
Causes release of ne and dopamine
Blocks reuptake of ne and dpamine
Cocaine coca plants
Local anes and vasoconstriction
Acts by blocking reuptake of dopamine in mesolimbic areas = pleasure
Schizophrenia
Bimodal onset
10-25y/o for men
25-35 for women
NT etiology: before: high dopamine schizo but now we know there are 4 tracks in
the brain: tubero infundibular,mesocortical, mesolimbic and nigro striatal.
Now we know: meso limbic +dopamine for positive symptoms
Negative symptoms = not enough dopamine in mesocortical
Enlarged ventricles from lobes shrinking (brain vol shrinks) ventricles enlarge for the
loss of brain cells
Schizoaffective
Mix of schizo and mood disorders
Has MDD or Manic Ep or a mixed episode while meeting criterion A for schizo for
uninterruoted period f illness
Delusions and hallucination occur for at least 2 weeks without the mood
Can either be diagnosed as bpd1 with psychotic features or mdd with psychotic
features if more mood thn psychotic features
Schizo people dont know they have schizo because they are so fixed in their reality;
many of them dont take medication
1st gen antipsychotics cheap! Work by directly blockin d2 receptors in all dopamine
pathways = more useful in preventing positive rather than negative symptoms
2nd gen antipsychotics - were found to be useful for those who didnt respond t
typical antipsychotics
Atypicals decreased both positive and negat and disorganized symptoms
Personality D/O
Comorbidity rates for personality d/o are high
1/22 meet criteria for another PD
2/3rds meet critera for an Axis I disorder
Dsm4 tr exactly the same as dsm5. There are research criteria, but not used
Paranoid PD: have doubts about people; pervasive mistrust, believes others are
judging them
Schizoid: extreme apathetic loner; asexual, takes few pleasure in any activities ,
emotionally detached, flat affect
Schizotypal: odd magical beliefs, eccentric appearaces, very weird sila,
suspiciousness, inappropriate affect, alays awkward TRELAWNEY
Narcs
M>F
Clinical population, Military, Surgeons
Silent narcs
Feels better than everyone; grandiose sense of self importance and needs respect
even w/o achievement
Preoccupied with fantasies of unli success, power, brilliance, beauty and ideal love
Believes they are special and unique and should only associated with high status
people
Requires excessive admiration, sense of entitlement, interpersonall exploitative,
lcks empathy, envious of others or thinks others are envious of her, arrogant,
haughty
Etiology:
Decreased sense of self worth
Failed to respond with them with warmth and respect
Parenting dimensions noted to increase risk: emotional coldness and overemphasis
on achievemens
Narc kid: if I dont achieve, I am worthless
So even in the outside world, they only talk about their achieveents
Avoidant pd and schizoid: similar they are loners, but avoidant pd is really really shy
nd desperately wnants to be with people but fear rejection
Dependent pd
Hghly prevalent in cultures thaht are socially invested (?)