PSY2010 Abnormal Psychology: ADHD and Tourette's Syndrome

While you can read a great deal about various disorders, being able to identify such disorders when they are present is challenging. To assist you with visualizing the disorders you are studying, you will have the opportunity to view interviews with clients who have been diagnosed with various disorders.

• Click here to visit Faces of Abnormal Psychology.

• Select High Resolution or Low Resolution, depending on your computer specifications.

• Choose from the Select a Disorder menu, and then click View Disorder.

When the new window opens, select the Diagnostic, Case History, Interview, and Treatment tabs to watch the respective videos. As you watch the interviews, note the identifiable diagnostic criteria.

For this week you will be reviewing the following disorders:

• ADHD
• Tourette's syndrome
• Paranoid schizophrenia

For each disorder:

1. First review the diagnosis and case history of the disorder.
2. Go to the interview section and choose at least 3 themes, asking at least one question for each.
3. Make sure to keep notes on the questions and the answers that were given.
4. Prepare a case summary covering the following points.

Attention Deficit Hyperactivity Disorder

David, the patient is a 16 year old school student who has been found to be incredibly hyperactive in his behavior. Some of the presenting complaints were that he was not able to focus his attention for a considerable period of time and often used to get ostracized by his classmates for this behavior. Other signs and symptoms were related to regular complaints from his teachers, difficulty in studying, reports of words jumping around, and problems in expressing judgment capabilities (Faces of Abnormal Psychology, 2018). The condition was diagnosed as Attention deficit hyperactivity disorder (ADHD) based on few of the DSM-IV diagnostic criteria such as, (i) inattentive and/or hyperactive-impulsive symptoms, (ii) impairment at home, school or work, (iii) noteworthy deficiency in academic, social, or occupational environment, and (iv) excessive talkativeness (van de Glind et al., 2014). Furthermore, signs of blurting out answers even before the question has been finished were some other criteria that were used for David’s diagnosis.

Three themes that were considered while interviewing David were namely, coping at school, trying to learn, and coping with ADHD. In response to whether he liked school, David first displayed disapproval, but later talked about his interest in attending school due to the presence of his peers. According to Crump et al. (2013) ADHD most often makes children miss school and decreases their attendance. On asking if ADHD interferes with his learning, David stated that he could not read for long and could not sit quietly like his peers, thus disrupting the class (Faces of Abnormal Psychology, 2018). He also found the words bouncing and jumping over the pages that made learning even more difficult. There is mounting evidence for the negative impacts that ADHD creates on the learning grades in school and the increasing workload often makes it difficult for the affected students to cope up with the environment (Taanila et al., 2014). The final question was related to his capability in controlling the illness, with an increase in age. Hyperactivity and fidgetiness, the two primary symptoms of ADHD are found to decrease with an increase in age (Döpfner et al., 2015). David stated that the administration of medications helped in enhancing his health and with an increase in age, although he tried to control his impulsivity, he failed to do so.

The most commonly prescribed medication for ADHD is Ritalin that principally acts by acting as a norepinephrine–dopamine reuptake inhibitor (NDRI) and modulates the dopamine levels in the brain. According to Currie, Stabile and Jones (2014) this drug proves effective in increasing attention ability, staying focused on tasks, and controlling all types of behavioral problems. However, some adverse effects are associated with loss of appetite, dry mouth, and nausea. This calls for the need of behavioral therapy that addresses the problematic behavior by structuring the time, launching predictability and sequences, and snowballing positive attention.

Tourette's syndrome

The patient Ben first reported symptoms at the age of three years such as, twitching of the head and recurrent verbal tic. Further examination also revealed that his brother suffered from the same condition. The condition was diagnosed by a neurologist. Some of the common diagnostic criteria for the disorder that confirm the diagnosis in Ben are namely, (1) presence of repeated motor and verbal tic, (2) appearance of the tic several times in a day, (3) onset occurring before the age of 18, and (4) consequences that encompass marked distress or momentous impairment, in relation to social functioning (Cavanna & Seri, 2013). Although his brother was also found to manifest similar symptoms, inheritance of the disease is quite complex (Faces of Abnormal Psychology, 2018). With advancement in age, the symptoms have also shown a deterioration that can be accredited to the presence of tics in entire body and verbal tics that comprise of atrocities.

The three themes that were selected for the interview were namely, social stigma, types of tics, and friends and love life. On asking his feelings about going out to public places, Ben stated that he often felt embarrassed by the way surrounding people looked at him, especially children who might perceive him as a monster. However, his response was interrupted by tics at regular intervals. His response to what he does when the teenagers tease him was that he tries to reach out to them and help them become aware of the condition by adopting a welcoming approach (Faces of Abnormal Psychology, 2018). These two questions were vital since stigmatization and bullying is most often hurtful and creates an impact on the quality of life of the patients (Malli, Forrester-Jones & Murphy, 2016).

On asking him about the types of tics, Ben answered that he has both verbal and physical tics, while he preferred not having the verbal one (Faces of Abnormal Psychology, 2018). This question was relevant since in the words of Cohen, Leckman and Bloch (2013) the sudden, seemingly uncontrollable actions leads to a sensation of anxiety, boredom, stress and fatigue. He was also asked about having a girlfriend or wanting one because the involuntary noises often make it difficult for the partner to cope up with (O’Hare et al., 2016). This most often makes the patients isolated and feel dejected.

In response to the question Ben stated that although he likes having a girlfriend, his symptoms often scare his partners away. However, his female friends are aware of the fact that the condition is involuntary and they do display a liking towards him (Faces of Abnormal Psychology, 2018). Despite absence of proper medications, Haldol, or Haloperidol is the commonly prescribed antipsychotic drug. Dopamine receptor blocking activity of the drug makes it effective in reducing tics (Roessner et al., 2013). However, it leads to weight gain and affects voluntary activities such as, thinking.

Recent evidences have also elaborated on the role of nicotine patch in easing motor tics, the major symptoms of Tourette syndrome (Quik et al., 2014). Some alternate therapies include herbs and acupuncture. While herbal remedies such as, Lady’s slipper and Passionflower have demonstrated their effectiveness in treating the frequency and severity of tics, the signs and symptoms of the condition are found to reduce in their severity with an increase in age (Kim et al., 2014). Thus, efforts need to be taken to manage the physical and verbal tics, to the maximum possible extent.

Paranoid schizophrenia

The patient Valerie reported a normal childhood with good grades but indicated events that made her feel like a social outcast. Patient history also suggests that she was a good student during her college years, dated at that time and got married at the age of mid-twenties. The first signs and symptoms of the disorder manifested at the age of 28 years, when she was going through an unstable phase in her married life, when she began experiencing delusions of people scheming against her, which worsened with time (Faces of Abnormal Psychology, 2018). This made her husband forcefully admit her to the psychiatric ward. However, even after admission, Valerie continued experiencing terror of being imprisoned by the doctors and professionals. Diagnosis of the condition was done based on presence of some of the symptoms that are mentioned in DSM-IV namely, (1) hallucinations, (2) delusions, (3) gross disorganization, and (4) presence of negative symptoms such as, lack of speech and a flat affect (Tandon et al., 2013). Furthermore, persistence of the active symptoms for at least six months, and their interference with relationship, work and self-care, all of which were reported by Valerie helped in confirming the diagnosis.

Three themes that were selected while interviewing her were namely, onset of schizophrenia, hallucinations and delusions. She was asked about the onset of her symptoms owing to the fact that although in most patients the general signs manifest before the age of 19 years, females have an age of onset in between 25-35 years (Okkels et al., 2013). The patient suggested that she initially began experiencing the symptoms at 28-29 years, which represents no potential impact of the condition on her academic life. Upon questioning her about the first schizophrenia episode, she mentioned that during the time when she found solace in religious activities from her tumultuous marriage, she first experienced delusion that several people were infiltrating the church and trying to destroy it (Faces of Abnormal Psychology, 2018). This is in alignment with the established relationship between schizophrenia and religion (Grover, Davuluri & Chakrabarti, 2014). She was asked if she hears voices because majority of patients report auditory, visual, and olfactory hallucinations, with auditory being the most common of all (Shinn et al., 2013). She reported hearing radio like transmissions emerging from her head that made her believe that some kind of records were being played. She also reported having visual hallucinations twice, on being asked about them.

On being asked about the similarity between her delusions and religious beliefs she stated that she felt like being spied on through the television and her Protestant belief made her consider the Catholics in the psychiatric ward as dangerous (Faces of Abnormal Psychology, 2018). This question was pertinent as according to Cook (2015) religion affects the level of psychopathology. Narcoleptic drugs such as, Haldol and Thorazine by acting as effective D2 dopamine receptor antagonists, thus reducing the frequency and severity of psychotic symptoms (Laruelle, 2014). However, they have some adverse effects like akathisia, gain in weight, and movement disorder.

Conclusion

To conclude, all the three abnormal psychological manifestations are severe in their signs and symptoms and create noteworthy negative influences on the life of patients. Thus, they must be effectively managed to enhance the health and wellbeing of the symptoms.

References

Cavanna, A. E., & Seri, S. (2013). Tourette’s syndrome. Bmj, 347, f4964.

Cohen, S. C., Leckman, J. F., & Bloch, M. H. (2013). Clinical assessment of Tourette syndrome and tic disorders. Neuroscience & Biobehavioral Reviews, 37(6), 997-1007.

Cook, C. C. (2015). Religious psychopathology: The prevalence of religious content of delusions and hallucinations in mental disorder. International Journal of Social Psychiatry, 61(4), 404-425.

Crump, C., Rivera, D., London, R., Landau, M., Erlendson, B., & Rodriguez, E. (2013). Chronic health conditions and school performance among children and youth. Annals of epidemiology, 23(4), 179-184.

Currie, J., Stabile, M., & Jones, L. (2014). Do stimulant medications improve educational and behavioral outcomes for children with ADHD?. Journal of health economics, 37, 58-69.

Döpfner, M., Hautmann, C., Görtz-Dorten, A., Klasen, F., Ravens-Sieberer, U., & BELLA Study Group. (2015). Long-term course of ADHD symptoms from childhood to early adulthood in a community sample. European child & adolescent psychiatry, 24(6), 665-673.

Faces of Abnormal Psychology. (2018). ATTENTION DEFICIT HYPERACTIVITY DISORDER. Retrieved from https://www.mhhe.com/socscience/psychology/faces/smlvid.swf.

Faces of Abnormal Psychology. (2018). PARANOID SCHIZOPHRENIA. Retrieved from https://www.mhhe.com/socscience/psychology/faces/smlvid.swf.

Faces of Abnormal Psychology. (2018). TOURETTE SYNDROME. Retrieved from https://www.mhhe.com/socscience/psychology/faces/smlvid.swf.

Grover, S., Davuluri, T., & Chakrabarti, S. (2014). Religion, spirituality, and schizophrenia: a review. Indian journal of psychological medicine, 36(2), 119.

Kim, Y. H., Son, C. G., Ku, B. C., Lee, H. W., Lim, H. S., & Lee, M. S. (2014). Herbal medicines for treating tic disorders: a systematic review of randomised controlled trials. Chinese medicine, 9(1), 6.

Laruelle, M. (2014). Schizophrenia: from dopaminergic to glutamatergic interventions. Current opinion in pharmacology, 14, 97-102.

Malli, M. A., Forrester-Jones, R., & Murphy, G. (2016). Stigma in youth with Tourette’s syndrome: a systematic review and synthesis. European child & adolescent psychiatry, 25(2), 127-139.

O’Hare, D., Helmes, E., Eapen, V., Grove, R., McBain, K., & Reece, J. (2016). The impact of tic severity, comorbidity and peer attachment on quality of life outcomes and functioning in Tourette’s syndrome: parental perspectives. Child Psychiatry & Human Development, 47(4), 563-573.

Okkels, N., Vernal, D. L., Jensen, S. O. W., McGrath, J. J., & Nielsen, R. E. (2013). Changes in the diagnosed incidence of early onset schizophrenia over four decades. Acta Psychiatrica Scandinavica, 127(1), 62-68.

Quik, M., Zhang, D., Perez, X. A., & Bordia, T. (2014). Role for the nicotinic cholinergic system in movement disorders; therapeutic implications. Pharmacology & therapeutics, 144(1), 50-59.

Roessner, V., Schoenefeld, K., Buse, J., Bender, S., Ehrlich, S., & Münchau, A. (2013). Pharmacological treatment of tic disorders and Tourette syndrome. Neuropharmacology, 68, 143-149.

Shinn, A. K., Baker, J. T., Cohen, B. M., & Öngür, D. (2013). Functional connectivity of left Heschl's gyrus in vulnerability to auditory hallucinations in schizophrenia. Schizophrenia research, 143(2-3), 260-268.

Taanila, A., Ebeling, H., Tiihala, M., Kaakinen, M., Moilanen, I., Hurtig, T., & Yliherva, A. (2014). Association between childhood specific learning difficulties and school performance in adolescents with and without ADHD symptoms: a 16-year follow-up. Journal of attention disorders, 18(1), 61-72.

Tandon, R., Gaebel, W., Barch, D. M., Bustillo, J., Gur, R. E., Heckers, S., ... & Van Os, J. (2013). Definition and description of schizophrenia in the DSM-5. Schizophrenia research, 150(1), 3-10.

van de Glind, G., Konstenius, M., Koeter, M. W., van Emmerik-van Oortmerssen, K., Carpentier, P. J., Kaye, S., ... & Moggi, F. (2014). Variability in the prevalence of adult ADHD in treatment seeking substance use disorder patients: results from an international multi-center study exploring DSM-IV and DSM-5 criteria. Drug and alcohol dependence, 134, 158-166.