Chapter 14

Schizophrenia
Symptoms of schizophrenia generally fall into two categories: negative and positive
symptoms. Negative symptoms include flat affect and catatonia. Positive symptoms
include delusions, hallucinations, and disorganized thought.

Frontal lobe functions such as working memory, planning, and voluntary control of eye
movements are deficient in schizophrenia. A common neuroimaging finding is
hypofrontality, or reduced frontal activation.

Temporal lobe regions are also dysfunctional in schizophrenia, particularly in the left-
hemisphere regions implicated in auditory comprehension and speech perception.

Disruptions in coordinated activity among brain regions may also contribute to

disorganized thought and hallucinations in schizophrenia.

Depression
Depression is defined by a loss of ability to feel pleasure, combined with feelings of
helplessness, hopelessness, and disruptions in sleep and appetite.

People who are depressed perform poorly on frontal lobe tasks, particularly tasks that
require allocation of effort or learning from feedback. Dorsolateral prefrontal cortex and
regions of the anterior cingulate cortex regions have been implicated as functioning
atypically in depression.

Evidence indicates decreased activity in the left frontal region, compared to the right
frontal region, in people who are depressed or at risk for depression.

Depression is further characterized by changes in limbic system structures such as the

amygdala, reward pathways, and hippocampus.

New treatments for depression, such as rTMS, DBS, and VNS, attempt to intervene on a
neurological level when mainstream treatments, such as pharmacotherapy and
behavioral therapy, do not work.

Anxiety Disorders
There are many different subtypes of anxiety disorders, including phobias, panic
disorder, posttraumatic stress disorder, obsessive-compulsive disorder, and
generalized anxiety disorder. All involve fear reactions that are out of proportion to
the circumstances.

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The amygdala plays a key role in anxiety disorders, which is not surprising given its role
in fear learning and extinction. Anxiety disorders may also be characterized by poor
frontal lobe regulation of subcortical structures such as the amygdala. Such
dysregulation can contribute to an inability to extinguish acquired fears and an
increased attentional bias toward threatening cues.

Two dimensions of anxiety, anxious apprehension and anxious arousal, have been
linked to different neural correlates. Anxious apprehension, or worry, is associated
with activity in the left frontal region near speech areas. Anxious arousal is associated
with elevations in right-hemisphere systems of arousal and attentional vigilance.

The basal ganglia motor structures are involved in the compulsive and ritualistic
actions observed in obsessive-compulsive disorder.

Individual differences in anxiety and depression are linked to variations in the

serotonin transporter gene, which influences neurotransmission in the serotonin
system. Individuals who have an “S” gene variant respond more strongly to negative
information than do those with two copies of the “L” gene variant.

Substance Abuse and Addiction

The main feature of substance abuse is the inability to stop drug-seeking behavior
even when the consequences are very bad.

Studies in nonhuman animals indicate that the reward pathway, from the midbrain to
the nucleus accumbens, plays an important role in the reinforcing effects of many
addictive drugs and the neural adaptations that occur with chronic substance use.

Accumulating evidence indicates that orbitofrontal cortex function, particularly the

ability to weigh positive and negative outcomes, is disrupted in substance abusers.
Other regions, such as the insula, amygdala, and cingulate cortex, have also been
implicated in addiction, but their specific role is not yet certain.