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PowerPoint for
Abnormal Psychology
Fourteenth Edition
James N. Butcher
Susan Mineka
Jill M. Hooley
Prepared by Andy Pomerantz
Southern Illinois University
Edwardsville
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Copyright © 2010 Allyn & Bacon
Chapter 14
Cognitive Disorders
Copyright © 2010 Allyn & Bacon
Brain Impairment in Adults
Prior to the DSM-IV, disorders involving
some kind of identifiable pathology (e.g.,
a brain tumor, stroke, drug intoxication)
were labeled organic mental disorders
Functional mental disorders were
considered not to have an organic basis
It is incorrect to assume other disorders
(such as schizophrenia) have no organic
basis
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Copyright © 2010 Allyn & Bacon
Diagnostic Issues
This chapter deals with what were
formerly labeled organic mental disorders
The DSM-IV-TR presents the diagnostic
coding of various neuropsychological
disorders in different and somewhat
inconsistent ways
Both Axis I and Axis III are often used,
largely because of the involvement of
medical conditions
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Clinical Signs of Brain Damage
Damage or destruction of brain tissue
may involve only limited behavioral
deficits or a wide range of psychological
impairments depending on
The nature, location, and extent of neural
damage
The premorbid competence and personality
of the individual
The individual’s life situation
The amount of time since the first
appearance of the condition
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Clinical Signs of Brain Damage
During the Mini-Mental State Examination, the
clinician will ask the patient questions
concerning
Orientation (e.g., Where are we now?)
Registration (Repeat these three words.)
Attention and concentration (Count backwards by
seven.)
Recall (Do you remember those three words?)
Language (Name what I’m pointing to.)
Comprehension (Pick up the paper in front of you.)
Construction ability (Copy this design.)
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Diffuse versus Focal Damage
Attention is often impaired by moderate
diffuse damage (such as damage from
moderate oxygen deprivation)
Focal damage (such as damage from an
injury or stroke) can cause different
problems depending on what part of the
brain is affected
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Figure 14.2: Brain Structures
and Associated Behaviors
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Diffuse versus Focal Damage
Some consequences of brain disorders that
have mainly focal origins but commonly appear
in the context of progressively diffuse damage
are as follows:
Impairment of memory
Impairment of orientation
Impairment of learning, comprehension, and
judgment
Impairment of emotional control or modulation
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Diffuse versus Focal Damage
Some consequences of brain disorders that
have mainly focal origins but commonly appear
in the context of progressively diffuse damage
are as follows:
Apathy or emotional blunting
Impairment in the initiation of behavior
Impairment of controls over matters of propriety and
ethical conduct
Impairment of receptive and expressive
communication
Impaired visuospatial ability
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The Neuropsychology/
Psychopathology Interaction
There appears to be a close link between
neuropsychological and
psychopathological conditions
It is erroneous to assume that a
psychological disorder is necessarily and
completely explained by the patient’s
brain damage
11
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Delirium
Clinical Picture
Treatments and Outcomes
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Clinical Picture
Delirium is an acute confusional state that lies
between normal wakefulness and stupor or
coma
Has a sudden onset and involves a fluctuating
state of reduced awareness
Reflects a major change in the way the brain is
working
Can occur in a person of any age, though the
elderly are at particularly high risk
May result from drug intoxication or withdrawal,
head injury, or infection
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Figure 14.3: Continuum of
Level of Consciousness
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Treatments and Outcomes
Delirium
Is a true medical emergency
Is often reversible
Is most often treated by medications,
environmental manipulations, and family
support
Neuroleptics are most common medication
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Dementia
Dementia
Is not a rapidly fluctuating condition
Is characterized by a decline from a
previously attained level of functioning
Has a slow onset and a deteriorating course
Can be caused by over 50 different
disorders
Is most commonly caused by Alzheimer’s
disease
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Figure 14.4: Distribution of
Dementia by Probable Cause
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Parkinson’s Disease
Second most common
neurodegenerative disorder after
Alzheimer’s disease
Characterized by tremors or rigid
movements
Loss of dopamine receptors is primary
cause
About 75% eventually show signs of
dementia
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Huntington’s Disease
Rare degenerative disorders of the
nervous system
Chronic, progressive chorea
Irregular and involuntary movements that
flow randomly from one part of body to
another
Patients usually develop dementia
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Alzheimer’s Disease
Progressive and fatal neurodegenerative
disorder
Associated with a characteristic dementia
syndrome that has
An imperceptible onset
A usually slow but progressively
deteriorating course terminating in delirium
and death
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Alzheimer’s Disease
Age is a major risk factor for Alzheimer’s
disease, as well as for other forms of
dementia such as vascular dementia
Genes play a major role in susceptibility
to and risk for Alzheimer’s disease
Genetic mutations of the APP, presenilin
1, and presenilin 2 genes are implicated
The APOE-E4 allele of the APOE gene is
also a risk factor
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Alzheimer’s Disease
The characteristic neuropathology of
Alzheimer’s disease involves:
Cell loss
Plaques (which contain a sticky protein
called beta amyloid)
Neurofibrillary tangles (which contain an
abnormal tau protein)
Alzheimer’s disease accounts for most
cases of dementia
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Alzheimer’s Disease
Alzheimer’s disease causes the
destruction of cells that make
acetylcholine, a neurotransmitter
important for memory
Drug treatments for Alzheimer’s disease
include cholinesterase inhibitors such as
donepezil
These drugs help stop ACh from being
broken down, making more of it available
to the brain
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Alzheimer’s Disease
Any comprehensive approach to
therapeutic intervention must consider
the situation of caregivers
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Dementia from HIV-1 Infection
The HIV-1 virus (or a mutant form of it) can
itself result in the destruction of brain cells
Neuropsychological features include
Mild memory difficulties
Psychomotor slowing
Diminished attention and concentration
Around 30% of people infected with the HIV
virus show signs of some mild cognitive
impairment
Rates of full dementia have decreased since
the1990s
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Vascular Dementia
In vascular dementia, a series of
circumscribed cerebral infarcts
cumulatively destroy neurons over
expanding brain regions
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Amnestic Disorder
The characteristic feature of amnestic
syndrome is strikingly disturbed memory
Causes of amnestic syndrome include:
Chronic alcohol use
Head trauma
Stroke
A wide range of techniques have been
developed to assist the good-prognosis
amnestic patient in remembering recent events
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Disorders Involving Head Injury
Traumatic brain injury affects over 2
million people per year in United States
Motor vehicle accidents are most
common cause
Other causes include falls, violent
assaults, sports injuries, and war injuries
Males age 15-24 are at highest risk
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Clinical Picture
Head injuries can cause
Retrograde amnesia
Anterograde amnesia
Personality changes
Phineas Gage survived a massive head
injury but suffered from personality
changes
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Treatments and Outcomes
Prompt treatment of brain injury can prevent
further damage
Immediate treatment may need to be
supplemented with long-term reeducation and
rehabilitation
Aftereffects can include headaches, impaired
memory, lowered intellectual level, or
personality changes, among others
Treatment team often involves wide variety of
health professionals
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Unresolved Issues
Can dietary supplements enhance brain
functioning?
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End of Chapter 14
Copyright © 2010 Allyn & Bacon