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Bryan Kolb & Ian Q. Whishaw’s. Fundamentals of Human Neuropsychology, Sixth Edition Chapter 27 Lecture PPT. Prepared by Gina Mollet, Adams State College. Psychiatric and Related Disorders. Portrait: Losing Touch with Reality. Mrs. T. Symptoms of schizophrenia beginning at age 16

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Bryan Kolb & Ian Q. Whishaw’s

Fundamentals of

Human Neuropsychology,

Sixth Edition

Chapter 27

Lecture PPT

Prepared by Gina Mollet, Adams State College

portrait losing touch with reality
Portrait: Losing Touch with Reality
  • Mrs. T.
    • Symptoms of schizophrenia beginning at age 16
    • Began with self-consciousness and progressed to delusions and hallucinations
    • Hallucinations led to bizarre and dangerous behavior
  • PET scans of schizophrenia indicate abnormal blood flow in the prefrontal cortex
the brain and behavior
The Brain and Behavior
  • The mind-body problem
    • Dualists
    • Monists
  • Psychiatric or behavioral disorders have a biological, anatomical, or genetic basis
  • DSM-IV R
    • Delusions or beliefs that distort reality
    • Hallucinations
    • Disorganized speech, senseless rhyming
    • Disorganized, agitated behavior
    • Blunted emotions, loss of interest and drive
structural abnormalities in schizophrenic brains
Structural Abnormalities in Schizophrenic Brains
  • Less than average weight
  • Enlarged ventricles
  • Reduction in the number of neurons in the prefrontal cortex
  • Abnormal cellular structure in the prefrontal cortex and hippocampus
  • Hypofrontality during card sorting
biochemical abnormalities in schizophrenic brains
Biochemical Abnormalities in Schizophrenic Brains
  • Dopaminergic function
    • Anti-psychotics
      • Act on the dopamine synapse
  • Glutamate
  • GABA
types of schizophrenia
Types of Schizophrenia
  • Type I: Acute Schizophrenia
    • Positive symptoms
    • More responsive to neuroleptics (anti-psychotics)
  • Type II: Chronic Schizophrenia
    • Negative symptoms
    • Structural abnormalities in the brain
schizophrenia as a disorder of development
Schizophrenia As a Disorder of Development
  • Develops during late adolescence
  • Slow emergence of brain abnormalities
  • Combination of genetics and environment
    • No single gene
    • More likely to have experienced a combination of adverse events
neuropsychological assessment
Neuropsychological Assessment
  • Poor performance on long-term verbal and nonverbal memory
  • Poor frontal-lobe functioning
  • May not perform well on any test
mood disorders
Mood Disorders
  • Clinical Depression
    • Prolonged feelings of worthlessness and guilt
    • Behavioral slowing
    • Disrupted eating and sleeping
  • Mania
    • Excessive euphoria
    • Hyperactivity
  • Bipolar disorder
    • Periods of depression and mania
neurochemical aspects of depression
Neurochemical Aspects of Depression
  • Reduction of monoamines
  • Brain-derived neurotrophic factors (BDNF)
    • Downregulated by stress
    • May affect functioning of monoamine synapses
  • Hypothalamic-Adrenal system (HPA-axis)
    • Oversecretion of cortisol; chronic stress
    • Widespread influence on cerebral functioning
    • Kills granule cells in the hippocampus
neurochemical aspects of depression1
Neurochemical Aspects of Depression
  • Fluoxetine
    • SSRI
    • Stimulates BDNF and neurogenesis in the hippocampus
blood flow and metabolic abnormalities in depression
Blood Flow and Metabolic Abnormalities in Depression
  • Decreased activity in:
    • Dorsolateral and medial prefrontal regions
      • Reduced memory and attention
  • Increased activity in:
    • Orbital regions
      • An attempt to inhibit amygdala activity
      • An attempt to break persistent negative thoughts
    • Amygdala
      • May increase HPA-axis activity
    • Medial thalamus
blood flow and metabolic abnormalities in depression1
Blood Flow and Metabolic Abnormalities in Depression
  • Sleep-cycle
    • May be altered due to lowered serotonin levels
  • Thyroid-hormone
    • Decrease in production may influence mood
neurobiological aspects of bipolar disorder
Neurobiological Aspects of Bipolar Disorder
  • Decrease in gray matter in the temporal lobe and cerebellum
    • Decrease correlates with number of episodes
  • Sensitization Model
    • Bipolar patients are sensitive to stress and drugs
    • Episodes of mood disorder change the brain
snapshot cortical metabolic and anatomical abnormalities in mood disorders
Snapshot: Cortical Metabolic and Anatomical Abnormalities in Mood Disorders
  • Drevets and colleagues
    • PET images of unipolar and bipolar patients
      • 12% decrease in blood flow to the subgenual area
      • Bipolars exhibit an increase in blood flow during the manic phase
    • MRI images of unipolar and bipolar patients
      • Reduction in gray matter volume in the left subgenual area
neurobiological aspects of bipolar disorder1
Neurobiological Aspects of Bipolar Disorder
  • Sensitization Model
    • Genetically predisposed individuals may be more sensitive
    • There is a link between psychomotor-stimulants and mania
    • Bipolars are at high risk for drug abuse and may be especially sensitive to the effects
vitamins minerals and food
Vitamins, Minerals, and Food
  • Kaplan and colleagues
    • Mood symptoms may be related to:
      • Inborn errors in metabolism
      • Alterations in gene expression
      • Epigenetic alterations in genes
      • Long-latency effects of nutritional abnormalities
psychiatric symptoms of cerebral vascular disease
Psychiatric Symptoms of Cerebral Vascular Disease
  • Post-stroke patients
    • 25-50% experience depression
    • About 25% experience generalized anxiety disorder
    • Catastrophic reactions
    • 11-50% experience pathological affect
  • Destruction of a region of the brain to alleviate psychiatric symptoms
  • Neurosurgery
    • Brain surgery intended to repair damage to alleviate symptoms
  • Egas Moniz
    • Prefrontal lobotomy
  • Modern Psychosurgery
    • 13 targets
    • Smaller lesions
    • Rarely performed
    • Does not replace abnormal activity with normal activity
motor disorders
Motor Disorders
  • Hyperkinetic
    • Increase motor activity
  • Hypokinetic
    • Loss of movement
hyperkinetic disorders
Hyperkinetic Disorders
  • Huntington’s chorea
    • Genetic disorder
    • Intellectual deterioration and abnormal movements
    • Begins as a reduction of activity and a restriction of interest
    • Involuntary movements begin about a year later
hyperkinetic disorders1
Hyperkinetic Disorders
  • Huntington’s chorea
    • Movements
      • Entail whole limbs
      • Irregular, no pattern
      • Affect head, face, trunk and limbs
    • Behavioral Symptoms
      • Personality changes
      • Cognitive impairments
      • Anxiety, depression, mania, and schizophrenic-like psychoses
hyperkinetic disorders2
Hyperkinetic Disorders
  • Huntington’s chorea
    • Brain abnormalities
      • Shrinkage of the cortex
      • Atrophy of the basal ganglia
      • Imbalance among the various neurotransmitter systems
        • Death of GABA and ACh neurons in the basal ganglia
      • Poor performance on memory and frontal-lobe tests
tourette s syndrome
Tourette’s Syndrome
  • Three stages
    • 1. Multiple tics
    • 2. Inarticulate cries are added to the tics
    • 3. Articulate words
      • Echolalia: Repeating what others say
      • Coprolalia: Obscene or lewd speech
  • Age of onset: 2-15
  • Not associated with neuroses, psychoses, or other disorders
tourette s syndrome1
Tourette’s Syndrome
  • Subcortical origin
    • Small cells in the basal ganglia
  • Treatment
    • Antidopaminergic drugs
    • Norepinephrine receptor agonists
  • Abnormalities in cognitive functions supported by the right hemisphere
hypokinetic disorders
Hypokinetic Disorders
  • Parkinson’s Disease
    • Degeneration of the substantia nigra
    • Loss of dopamine
    • Variety of symptoms that vary from patient to patient
    • Symptoms resemble changes in motor activity that occur with age
hypokinetic disorders1
Hypokinetic Disorders
  • Parkinson’s Disease
    • Rigidity
    • Tremor
    • Akinesia
    • Postural disturbances
hypokinetic disorders2
Hypokinetic Disorders
  • Parkinson’s Disease: Positive Symptoms
    • Resting tremor
    • Muscular rigidity
      • Cogwheel rigidity
    • Involuntary movements
      • Akathesia
        • Cruel restlessness
      • Oculogyric crisis
        • Involuntary turns of the head and eyes to the side
hypokinetic disorders3
Hypokinetic Disorders
  • Parkinson’s Disease: Negative Symptoms
    • Disorders of posture
      • Disorder of fixation
      • Disorder of equilibrium
    • Disorders of righting
    • Disorders of locomotion
      • Festination
    • Disorders of speech
    • Akinesia
hypokinetic disorders4
Hypokinetic Disorders
  • Progression of Parkinsonism
    • Begins with tremors in the hand
    • Face becomes masklike and movement slows
    • 10-20 years of progression
    • On-again-off-again quality
causes of parkinsonism
Causes of Parkinsonism
  • Idiopathic
    • Familial
    • Part of the aging process
    • Viral origin
  • Postencephalitic
    • Occurs after encephalitis
causes of parkinsonism1
Causes of Parkinsonism
  • Drug Induced
    • Ingestion of major tranquilizers
    • Contaminant of synthetic heroin (MPTP)
    • Environmental toxins
  • Depletion of dopamine
treatment of parkinson s disease
Treatment of Parkinson’s Disease
  • Physical therapy
  • Pharmacological therapy
    • Increase dopamine function
    • Block cholinergic system
  • Stem-cell research
  • Deep brain stimulation (DBS)
psychological aspects of parkinson s disease
Psychological Aspects of Parkinson’s Disease
  • Cognitive functions
    • Generalized behavior slowing
    • Show symptoms similar to individuals with frontal lobe or basal ganglia lesions
    • Impaired on the WAIS
  • DSM-IV-R
    • Memory and other cognitive deficits
    • Impairment in social and occupational functioning
  • Degenerative dementias
    • Intrinsic to the nervous system
    • Affects the CNS selectively
  • Nondegenerative dementias
    • Diverse etiologies
  • Alzheimer’s disease
    • Most prevalent form of dementia
    • Neuritic Plaques
      • Found in the cortex
      • Positively correlated with cognitive decline
      • Amyloid surrounded by degenerative cellular fragments
    • Paired Helical Filaments
      • Found in the cortex and hippocampus
  • Alzheimer’s disease
    • Neocortical Changes
      • Shrinkage of the cortex; not uniform
  • Alzheimer’s Disease
    • Paralimbic cortex changes
      • Degeneration of the limbic system and entorhinal cortex
    • Cell changes
      • Shrinking of neurons
      • Loss of dendritic aborizations
  • Alzheimer’s Disease
    • Neurotransmitter changes
      • Reduction in two or more transmitter systems
      • ACh, Noradrenaline, DA, 5-HT, and glutamate receptors
putative causes of alzheimer s disease
Putative Causes of Alzheimer’s Disease
  • Genetics
  • Trace Metals
    • Increased concentration of aluminum
  • Immune Reactions
    • Antibrain antibodies that cause neuronal degeneration
putative causes of alzheimer s disease1
Putative Causes of Alzheimer’s Disease
  • Blood Flow
    • Decrease in blood flow to the brain
  • Abnormal Proteins
    • Increased production of abnormal proteins that accumulate in the brain
clinical symptoms and the progression of alzheimer s disease
Clinical Symptoms and the Progression of Alzheimer’s Disease
  • Gradual progression
    • Recent memory
    • Remote memory
    • Ability to recognize family members
  • Impairments on the WAIS
  • Impaired on nearly all tests of memory
    • Names of objects and distinguishing among objects in a category
  • Language impairments