Abnormal psychology studies the behavior and disorders deemed as not reasonable by societal standards. Neurodevelopmental disorders are disabilities that hinder brain function and affect the behavior, memory, or the cognitive ability of a child in areas such as learning, attention, and socializing (Butcher, 2014). Neurocognitive disorders are disabilities hat impair cognitive function due to changes in the brain caused by trauma, injury, or illness (Butcher, 2014). Identifying and understanding the causes, treatments, and symptoms in these disorders give a clearer understanding into the foundation of abnormal psychology. Cerebral palsy, a neurodevelopmental disorder explains the outcome of brain trauma from the womb throughout adulthood. Delirium, a neurocognitive disorder, explains how brain trauma could potentially bring one to die. This paper looks at disorders from conception until death shedding light on the vitality of seeking proper treatment to allow for an individual live an ordinary life with a brain disorder.
Neurodevelopmental Disorder: Cerebral Palsy
Cerebral Palsy is a neurodevelopmental disorder marked as a group of permanent non-progressive disorders that impair motor function (Cerebral Palsy). The disorder occurs in young children before, during, or after birth and commonly described as an impairment of movement and posture (Cerebral Palsy). Cerebral Palsy is induced by brain injury or malformation during development. During development, the brain may become injured. During prenatal development, the brain may experience a disturbance in cell migration not allowing the brain cells to get the appropriate placement to support necessary development for a healthy mind. The brain may also experience poor myelination of the nerve cell fibers leaving it more susceptible to injury as the protective covering decreases (Stem Law Group, 2015). During birth, the brain is also susceptible to damage by way of brain cell death which may occur through the lack of oxygen or broken blood vessels. Postnatal damage may occur when trauma, asphyxia or infection deprive the brain of making the appropriate synapses between brain cells (Stem Law Group, 2015). Other causes of the disorder include jaundice, rubella, and Rh incompatibility (Cerebral Palsy). Though the disorder is most common at birth, it may be acquired later through abuse, injury, or even illness (Stem Law Group, 2015).
The damage takes place in the motor areas of the brain and affects the child’s muscle control, tone, and coordination, reflexes, posture, and balance (CDC, 2015). The child’s fine, gross, and oral motor skills may also be affected (Cerebral Palsy). Motor impairment may present in any or all of the limbs and face (Stem Law Group, 2015). The impaired motor function may result in paresis, incoordination, or involuntary movement (Bjorgaas, Boe, & Hysing, 2013). Associative disorders such as epilepsy, learning disabilities, sensory impairment and pain may also present even if it did occur as a result of the same injury (Stem Law Group, 2015). Additionally, mental health problems have also been factored into the symptoms of the disorder (Bjorgaas, Boe, & Hysing, 2013).
Symptoms of Cerebral Palsy
Symptoms vary by the degree in each individual. Some symptoms may be evident at birth whereas others may not present for three to five years after birth (Stem Law Group, 2015). Often, children with cerebral palsy experience developmental delays in which major milestones such as crawling and walking are not attained until after the average child in the general population (Cerebral Palsy). Standard tasks such as tying shoes, walking, and grasping objects may prove to be difficult for individuals with the disorder (Cerebral Palsy).
Prevalence of Cerebral Palsy
Cerebral Palsy is the most common childhood motor disability. It affects about two to three children born in the United States each year. Spastic cerebral palsy identifies in about sixty-one percent of all cases. In conjunction with cerebral palsy, the CDC found forty-one percent of children with cerebral palsy also associated with epilepsy and seven percent reflected Autism Spectrum Disorder as well (CDC, 2015).
Treatment of Cerebral Palsy
Cerebral Palsy is a permanent, chronic, but non-progressive disorder for which there is no cure. However, with the proper treatment and support, individuals can lead near-normal lives. A combination of physicians, therapists, and educational providers will assist an individual in attaining a full life (“Mayo Clinic”, 1998-2015). The treatment aims to improve the quality of life, reduce associative disorders, enhance socialization, optimize mobility through decreasing pain, and maximize learning potential (Stem Law Group, 2015). Predominantly, medication may be necessary to reduce spasticity in muscles that cause tightness increasing functional ability, decrease pain, and manage other symptoms. Drug treatments include Botox injections directly into the affected muscle or nerve to alleviate isolated plasticity. Botox is primarily used for drooling in children, but the injection may cause bruising, pain, or severe weakness (“Mayo Clinic”, 1998-2015). Generalized spasticity may treated through an array or oral muscle relaxants including Valium, Dantrium, and Gablofen. Side effects of muscle relaxants may include chemical dependency as with Valium; therefore, the prescription is usually controlled and only prescribed in severe instances. Other side effects of the drugs may include drowsiness, confusion, and nausea. In many cases, the drugs are combined with each other in an effort to alleviate other symptoms the individual may be experiencing (“Mayo Clinic”, 1998-2015). The effect of the drugs varies among individuals; therefore, the medicinal regimens may need altering to allow for the most positive benefit of the drugs (Stem Law Group, 2015).
Therapies are also effective in improving functional abilities. Therapy fosters independence through the attainment of mobility and functionality. Behavioral therapy is grounded in the belief that behavior is learned through the environment, therefore, can be altered (Butcher, 2014). The relationships between thoughts, feelings and behaviors are examined to establish proper coping methods (Butcher, 2014). Behavioral therapy has a positive influence over the individual with the disorder, as well as the individual’s family and friends. It is recommended if the quality of life for the child is compromised due to behavior deficiencies, socialization issues, or if the child feels rejection from peers (Stem Law Group, 2015). Life skills, stress management, and traumatic events that may produce adverse outcomes are learned through behavioral therapists. Additionally, behavioral therapy also addresses educational and social deficiencies experienced by the individual (Stem Law Group, 2015). Behavioral therapists assist the individual through many techniques including role-playing, skills training, conditioning, systematic desensitization, and cognitive reversal. The degree of the symptoms and the degree of the effect of the symptoms establishes the type, degree, and length of therapy (Stem Law Group, 2015).
Neurocognitive Disorder: Delirium
Delirium is a state of acute mental confusion, disturbed concentration, and cognitive dysfunction (Butcher, 2014). It also causes the deterioration of memory and attention leading to disorganized thinking. Additionally, one who suffers from delirium may experience abnormal psychomotor activity and sleep disturbance (Butcher, 2014). It is not entirely understood what causes delirium; however, it has been established that it occurs due to confusion among the sending and receiving signals from the brain (Mayo Clinic, 1998-2015). Individuals who become delirious, usually have an underlying illness and have become exposed to an environmental trigger or trauma creating a vulnerability in the brain triggering confusion (Mayo Clinic, 1998-2015). Other common causes include substance withdrawal, multiple medical issues, dehydration and malnutrition, previous delirious episodes, old age, and dementia. Dementia is the most common risk factor of delirium, occurring in about two-thirds of all cases (Mayo Clinic, 1998-2015).
Symptoms of Delirium
According to the DSM-V, an individual must demonstrate disturbances in both attention and awareness. The disturbance must occur over a period of a few hours to a few days, cause a change in attention and awareness, and fluctuate in severity. During the period of delirium, one must also experience a cognitive disturbance such as memory deficit. A pre-existing disorder must not cause the disturbances nor can it occur during periods of severely reduced arousal. Additionally, a full assessment of the patient history and current status must prove the delirium to be a consequence of an underlying illness, substance withdrawal, or toxin exposure. It can also prove to be the byproduct of multiple etiologies (Butcher, 2014).
Reduced awareness of the environment includes being withdrawn, attention that deviates away from the focal point, being easily distracted by insignificant things, and the inability to focus or change focus (Mayo Clinic, 1998-2015). Cognitive impairment presents with short term memory deficits, disorientation, and arduous communication and writing skills. One may also experience hallucinations, extreme emotions, sleep deprivation, or hostile temperament (Mayo Clinic, 1998-2015). Symptoms are acute, and the severity fluctuates allowing for intermittent episodes to occur.
Prevalence of Delirium
Delirium is most prominent in the elderly and is triggered by traumatic events or environmental factors that may cause chaos within an individual. Surgical patients, primarily heart surgery patients may experience delirium in recovery. It is estimated that between ten and fifty-one percent of surgical patients will experience delirium (Butcher, 2014). Since delirium is associated with cognitive decline, its prognosis is very low. It associates with more illness, longer hospital stays and increased mortality. Twenty-five percent of elderly patients who experience delirium die within six months of onset (Butcher, 2014).
Treatment of Delirium
Delirium is a medical emergency and treatment must be sought immediately (Butcher, 2014). In order to treat delirium, it is essential to learn the underlying cause of the episode. If the cause is a medication, it must be stopped immediately. If the cause is an underlying illness, it must be treated immediately. Once the cause is found, the focus of treatment is to create a healing environment and calm the brain (Mayo Clinic, 1998-2015). A supportive, non-drug approach is to support the individual in the lacking areas. It is vital to provide a managed environment for the individual through schedules, proper nourishment, and environmental cues to remind the individual where they are and time of day (Mayo Clinic, 1998-2015). It is also important to keep the individual comfortable in the surroundings through lighting, noise, and familiar company. A disruption to schedule or exposing him or her to unfamiliarities could create a negative response and hinder recovery (Mayo Clinic, 1998-2015).
Medication is not the best choice of treatment, however, in combative, hostile patients, it is the best choice (Mayo Clinic, 1998-2015). Delirium caused by substance withdraw may be treated with sedatives such as benzodiazepine, but only for a brief period as it may cause delirium itself (Butcher, 1998-2015). Neuroleptics are antipsychotics drugs that are the primary choice of drug treatment for delirium. Neuroleptics are also used to treat schizophrenia that has similar symptoms of delirium (Butcher, 2014). Although drugs may be useful in certain circumstances, environmental manipulations, and family support are the most often used treatment method (Butcher, 2014).
From the point of conception, it is possible for the brain to suffer the trauma that may affect an individual throughout the lifespan. In the later years of life, illness, trauma, or injury could cause damage to the brain that may leave one in a debilitating state that may bring hem to their death. Brain disorders may be genetically wired into an individual or may be caused by illness or injury later in life. There is also self-inflicted brain trauma that occurs via substance abuse that may initiate for mental illness that may not be reversible. At the first sign or thought of a brain deficiency, it is important to seek treatment, as treatment may bring the individual back into balance and enjoy a meaningful life. Both types of disorders prove that therapy is essential in dealing with mental illness. It also demonstrates the potential of medicinal therapies through the use of drugs for treatment.
Bjorgaas, I. E., Boe, T., & Hysing, M. (2013). Mental Health in Children with Cerebral Palsy: Does Screening Capture the Complexity?. The Scientific World Journal, 2013(Article ID 468402), 7. doi:10.1155/2013/468402
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