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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


Schizophrenia
Schizophrenia

  • 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 Mood Disorders

  • 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 Mood Disorders

  • 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 Mood Disorders

  • Post-stroke patients

    • 25-50% experience depression

    • About 25% experience generalized anxiety disorder

    • Catastrophic reactions

    • 11-50% experience pathological affect


Psychosurgery
Psychosurgery Mood Disorders

  • 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


Psychosurgery1
Psychosurgery Mood Disorders

  • Modern Psychosurgery

    • 13 targets

    • Smaller lesions

    • Rarely performed

    • Does not replace abnormal activity with normal activity


Motor disorders
Motor Disorders Mood Disorders

  • Hyperkinetic

    • Increase motor activity

  • Hypokinetic

    • Loss of movement


Hyperkinetic disorders
Hyperkinetic Disorders Mood 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 Mood 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 Mood 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 Mood Disorders

  • 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 Mood Disorders

  • 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 Mood 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 Mood Disorders

  • Parkinson’s Disease

    • Rigidity

    • Tremor

    • Akinesia

    • Postural disturbances


Hypokinetic disorders2
Hypokinetic Disorders Mood 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 Mood 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 Mood 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 Mood Disorders

  • Idiopathic

    • Familial

    • Part of the aging process

    • Viral origin

  • Postencephalitic

    • Occurs after encephalitis


Causes of parkinsonism1
Causes of Parkinsonism Mood Disorders

  • 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 Mood Disorders

  • 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 Mood Disorders

  • Cognitive functions

    • Generalized behavior slowing

    • Show symptoms similar to individuals with frontal lobe or basal ganglia lesions

    • Impaired on the WAIS


Dementia
Dementia Mood Disorders

  • 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


Dementia1
Dementia Mood Disorders

  • 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


Dementia2
Dementia Mood Disorders

  • Alzheimer’s disease

    • Neocortical Changes

      • Shrinkage of the cortex; not uniform


Dementia3
Dementia Mood Disorders

  • Alzheimer’s Disease

    • Paralimbic cortex changes

      • Degeneration of the limbic system and entorhinal cortex

    • Cell changes

      • Shrinking of neurons

      • Loss of dendritic aborizations


Dementia4
Dementia Mood Disorders

  • 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 Mood Disorders

  • 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 Mood Disorders

  • 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


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