- psychotic disorders such as sz usually have their onset in the early 20s, subclinical signs are typically apparent during teenage years (Walker et al., 1998)
- Maj. of indivs diagnosed w/ sz show steep increase in adjustment problems through adolescence.
- social withdrawal, anxiety, academic difficulties, thought problems more common each year between 12 and 18.
- Sex differences in prodromal: boys more disruptive behavior. Sex differences persist into early stages. Females tend to be diagnosed 2-3 years later than males, and have more favorable long-term prognosis.
- Suggested that sex differences due to hormones: namely estrogen serving to delay onset and ameliorate course of illness. Specifically, activity of dopamine which has been implicated in the neuropathology of sz is dampened by estrogen.
Normal maturation and refinement of neural circuitry:
- volume of several regions including: frontal and temporal cortex, amygdala, and hippocampus (Giedd et al., 1996)
- Specifically, limbic structures including the hippocampus and amygdala tend to show an increase in volume. Important for emotion.
- Abstract reasoning and attentional capacities improve following puberty and into young adulthood. Interest in social activities and interpersonal awareness also increases (Spear, 2000). Likely that these changes and risk for psychopathology are associated with sexual maturation and brain changes.
Potential neural Mechanisms in adolescent-onset psychopathology
- Walker 2003
- Rise in hormones during puberty may result in the expression of a gene that codes for abnormal dopamine neurtransmission. This in turn may give rise to the brain abnormality that confers susceptibility to schizophrenia.
- Has also been suggested that sz results from a deficit in pruning of neural connections that is normally triggered by puberty. In orther words, deficient elimination of neural processes may result in faulty neuronal interconnections.
Miranda et al. 2005
- CBT for depression among African American and Latino populations is equal to or greater than White americans (i.e., it's efficacious).
- EBT for ADHD (parent training) and depression among children generalizes to af ams and latino pops
- little research speaks to value of adapting intervention for particular ethnic populations
- knowledge of culture and context of patient is curcial to treatment and clinicians must know what may be culturally adaptive versus pathological
- evidence based practice is likely appropriate for most minority individuals
- minorities are underserved by psychology. promote evidence-based care in minority communities
belief systems and value orientations that influence customs, norms, practices, and socical institutions
a category to which others assign indivivduals on the basis of physical characteristics and the generalizations and stereotypes made as a result (socially constructed)
- stewart, 2004
- social groups that distinguish themselves from other groups by sharing a common historical path, behavioral norms, and their own group identity
- stewart, 2004
- unique behavior and lifestyle shared by a group of people
major stewart 2004 points
- myth of uniformity
- voice and control personal bias by articulating worldview and evaluating sources and validity
- develop sensitivity to cultural differences without overemphasizing them
- uncouple theory from culture
- match psych tests to client characterisitcs (idiographic)
- contextualize all assessments
spirituality being part of the problem, or part of therapy?
- Pargament et al. 2005
- think of scores on MIS and how spirituality and culture can make someone appear to be schizotypic when in fact just cultural.
Twin studies and sz
- cardno and gottesman 2000
- twin studies play a pivotal role in determining the genetic contribution to the etiology of sz
- European studies between 1963 and 1987 found concordance rates for MZ twins-48% and DZ twins=17%. Heritability estimates ranged from 41-86%. Studies did not employ explicit operational diagnostic criteria.
- Laer studies did use operational diagnoses and produced heritability estimages between 83 and 87% (McGuffin et al., 1994)
- Risk of sz-like psychosis is similar in the offspring of both affected and unaffected MZ twins. Suggests that the unaffected twin carries suceptibility genes but does not express the phenotype.
Weinberger 1992 sz
discordant mz, affected twin reduced hippocampal volume and lack of blood flow to prefrontal cortex. cerebral volume and stimulation of prefrontal similar in unaffected members of discordant MZ and normal MZ controls.
Differences betwen discordant MZ twins (sz)
- cognitive function
- eye tracking
- obstetric complications
- fetal development
who to cite when describing difficulty using five factor model across cultures (collectivist vs. individualistic cultures differentially evince certain personality factors when using indiginous language/inventories in factor analysis)
Heine and Buchtel, 2009
who's a good person to cite when talking about ethics?
legal issues in the case of patient suicide?
- 1. forseeability--whether clinician should have anticipated suicide
- 2. causation--whether clinician took sufficient steps to protect the patient