Introduction to Childhood Mental Illness

1. Introduction to Childhood Mental Illness The Beginning

2. Introduction to Childhood Mental Illness • This course examines: • Clinical Paradigms: Descriptions, Etiology, Treatment of Categorical Disorders • Developmental Theory: What goes on when a child is growing up? How does this effect them later in life?

3. What is Psychopathology? The study of Nature, Development and treatment of psychological disorders Through the scientific method Mainstream stigma is the single most formidable obstacle in the progress of this study.

4. What is Disorder? • A clinically significant syndrome or pattern of behaviour associated with distress or disability or with significantly increased risk of suffering, death, pain, disability or loss of freedom *American Psychiatric Association, Diagnostic and Statistical Manual IV Text Revision (DSM-IV-TR) • Not a culturally sanctioned response to a particular event • Must be considered a manifestation of behavioural, psychological or biological dysfunction What is dysfunction? When an internal mechanism is unable to perform its natural function

5. The Social Norm • Must contain evidence from neurology, biology or medicine OR Must show a clear link between Theory and Practice • Emphasis on distress and harmful dysfunction However, our scientific psychology is mostly based on studies of middle-class first world people

6. The Social Norm Shamans show and describe behaviours western medicine would diagnose as severe psychopathology, but it is culturally sanctioned. -> Different developmental process -> Different social norms -> Different psychology

7. History of Psychopathology • Demonology, exorcism • The Dark Ages: Witch Hunts, Lunacy Trials “Lunacy”: Paracelsus (1493-1541) Abnormal behaviour attributed to a misalignment of the moon and stars Hippocrates (460? – 377? BC) – Mental health and brain functioning dependant on a balance among blood, black bile, yellow bile and phlegm. • Early Asylums

8. Past Treatments • Benjamin Rush (1745 – 1813) – “Father of Modern Psychiatry” treated patients by drawing huge amounts of blood or scaring them by convincing them they were about to die • Patients were shackled with iron collars on the walls, not allowed lie down at night and presumed to be animals. • Electro-convulsive shock therapy • Prefrontal lobotomy • Psychoanalytic Theory • Behaviourism

9. Modern Treatment in Psychopathology • Clinical Psychology – emphasis on research, statistics, neuroscience and empirical study - Techniques of assessment - Diagnosis of mental disorders - Psychotherapy • Counseling Psychology • Psychiatry - - Diagnosis - Pharmacotherapy • Psychoanalysis • Social work • Field work (psychopathologists)

10. Treatment in Children • Developmental Psychopathology studies disorders of childhood in the context of normal life-span development, enabling identification of behaviours that are considered appropriate at one stage but disturbed at another • Some disorders are unique to children • Some disorders start in childhood and continue to adulthood

11. There is an ongoing increase in the diagnosis and medical treatment of childhood psychopathology1. More research is neededBipolar disorders are more common in children than originally thought, but diagnosis classification in the DSM-IV applies mostly to adults2. Psychological treatment should be used alongside medical-Depressed children on antidepressants are more likely to become suicidal. -Suicide is most likely to occur in the first 4 weeks of treatment-Medication takes 3-4 weeks to begin to act, Cognitive Behavioural Therapy acts much more quickly.

12. Paradigms in Psychopathology A Paradigm is a set of basic assumptions, a general perspective, that defines how to conceptualise and study a subject, how to gather and interpret relevant data Useful to organise our thinking • Genetics • Neuroscience • Psychodyamics • Cognitive Behaviourism • Diathesis-Stress

13. Nature Vs Nurture • Stress • Relationships • Culture • Genetic coding • Genetic regultation and expression • Leads to Neurobiology and behaviour

14. Genetics • Almost all behaviour is heritable to some degree • Genes do not operate independently from the environment - Gene-environment Interaction Environment can alter gene expression - Genes may predispose us to seek out certain environments that then increase our risk for developing a particular disorder Psychopathology is polygenic (not caused by one gene but rather the interaction of many)

15. Neuroscience • Depression, anxiety, dementia and other psychopathologies all show associations with neurological dysfunction • Neuron: The neural cell, stimulated through a change in electrical potential to cause a nerve impulsewhich releases a chemical • Neurotransmitter: The chemical release to allow communication between neural synapses, usually generating an excitatory or an inhibitory signal

16. Neuroscience • Examples of Neurotransmitters: - Dopamine - Serotonin - Norepinephrine – stimulatory/arousal - Gamma-aminobutyric acid (GABA) • Too much or too little of a neurotransmitter can result in error in metabolic pathways which can cause alterations in the usual process of the neurons

17. Medical treatment • Antidepressant medications may help to balance sensitivity of neurons to neurotransmitters e.g. Failure to reuptake excess neurotransmitters may cause excessive excitation = Anxiety

18. Neuroscience • Do the drugs work? • Do they work as well as other psychological methods? Certain phenomena emerge only at certain levels of analysis and will be missed by investigators who focus only at the molecular level. Psychopathology is probably impossible to explain in terms of neurobiology.

19. Psychodynamics • Childhood experiences help shape adult personality • There are unconscious influences on behaviour • The causes and purposes of human behaviour are not always obvious Freud: Psychopathology results from unconscious conflict • Anecdotal evidence, not the scientific method Benefits of gameplay, maintenance of negative schema  internal cognitive processes