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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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Fundamentals of Human Neuropsychology, Sixth Edition Chapter 27 Lecture PPT

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Fundamentals of human neuropsychology sixth edition chapter 27 lecture ppt

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

Psychiatric and Related Disorders

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

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