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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 This multimedia product and its contents are protected under copyright law. The following are prohibited by law: • any public performance or display, including transmission over any network; • preparation of any derivative work, including the extraction, in whole or part, of any images; • any rental, lease, or lending of the program. ISBN: 0-205-50294-6 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 3 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 4 Copyright © 2010 Allyn & Bacon 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 5 Copyright © 2010 Allyn & Bacon 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.) 6 Copyright © 2010 Allyn & Bacon 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 7 Copyright © 2010 Allyn & Bacon Figure 14.2: Brain Structures and Associated Behaviors 8 Copyright © 2010 Allyn & Bacon 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 9 Copyright © 2010 Allyn & Bacon 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 10 Copyright © 2010 Allyn & Bacon 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 Copyright © 2010 Allyn & Bacon Delirium Clinical Picture Treatments and Outcomes 12 Copyright © 2010 Allyn & Bacon 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 13 Copyright © 2010 Allyn & Bacon Figure 14.3: Continuum of Level of Consciousness 14 Copyright © 2010 Allyn & Bacon 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 15 Copyright © 2010 Allyn & Bacon 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 16 Copyright © 2010 Allyn & Bacon Figure 14.4: Distribution of Dementia by Probable Cause 17 Copyright © 2010 Allyn & Bacon 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 18 Copyright © 2010 Allyn & Bacon 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 19 Copyright © 2010 Allyn & Bacon 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 20 Copyright © 2010 Allyn & Bacon 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 21 Copyright © 2010 Allyn & Bacon 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 22 Copyright © 2010 Allyn & Bacon 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 23 Copyright © 2010 Allyn & Bacon Alzheimer’s Disease Any comprehensive approach to therapeutic intervention must consider the situation of caregivers 24 Copyright © 2010 Allyn & Bacon 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 25 Copyright © 2010 Allyn & Bacon Vascular Dementia In vascular dementia, a series of circumscribed cerebral infarcts cumulatively destroy neurons over expanding brain regions 26 Copyright © 2010 Allyn & Bacon 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 27 Copyright © 2010 Allyn & Bacon 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 28 Copyright © 2010 Allyn & Bacon Clinical Picture Head injuries can cause Retrograde amnesia Anterograde amnesia Personality changes Phineas Gage survived a massive head injury but suffered from personality changes 29 Copyright © 2010 Allyn & Bacon 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 30 Copyright © 2010 Allyn & Bacon Unresolved Issues Can dietary supplements enhance brain functioning? 31 Copyright © 2010 Allyn & Bacon End of Chapter 14 Copyright © 2010 Allyn & Bacon