Neuropsych

Neuropsychology
• understand how brain structure and function relate to psychological
processes and behaviour
Clinical neuropsychology (different from research neuropsychology)
• focuses on cognitive rather than emotional disorders
• work in hospitals (neurology, neurosurgery, psychiatry) and private
practice
Psychiatry
• medical speciality in the diagnosis and treatment of mental illness and
emotional disorders
• historically,
– Structural changes in brain (neurological) considered separate from
disorders of brain function (psychiatric)
Neuropsychiatrists
• specialise in psychiatric or functional aspects of ‘structural’ neurological
disease

• 1860s and increase in research into the brain:

– Broca, left hemisphere of brain & location of language production
– Wernicke, temporal lobes & ability to understand speech
– Localisation > school of thought where mental functions are
located in particular places in the brain
– Critique > the brain functions as an integrated, holistic unit

• Luria argued both views are partially right

• Groups of cortical zones that work together to produce complex
mental abilities
• Mental abilities are combinations of many low-level (basic
functions)
• Modern neuropsychology > Complex mental functions are produced by
dynamic neural networks;
• constellation of cortical and subcortical zones working together.
Influence of cognitive psychology
• Divides cognitive capacities into smaller processing units
• Supports use of computer-based approaches (to stimulate neural
connection in the brain)
• Not too useful in study of: emotion, motivation, personality etc.
Research methods in neuropsychology
• Clinico-anatomical correlations formed basis of neuropsychological
research (autopsy studies)
• Post World Wars I and II
– focus on brain damage during life > role of x-rays
– brain imaging (visualise soft tissue inside the skull)
– identify brain pathology
• Computerised tomographic (CT) scanning
• widely available in the 1970s (Scan of a migraine)

By the 1980s, CT largely replaced by magnetic resonance imaging (MRI)

 Research methods in neuropsychology
• Latest advance is functional brain imaging: positron emission
tomography (PET) and functional MRI (fMRI)
• Images of brain while person is exposed to task/stimulus Measure
differences in the rate of metabolic activity in the brain

PET scans showing

decreased levels of
dopamine transporters in
ADHD patients.
Children with ADHD have
less activity in areas of the
brain that control attention.
It is unclear what causes
these chemical
irregularities, but experts
believe genetics may play
• Functional MRI (fMRI) a role.
• technique for measuring and mapping brain activity that is non-invasive and
safe
 This pair of images shows fMRI
scans of study participants while
they are trying to remember
object locations.
Activity in the hippocampus is
stronger in healthy elderly controls
(left) compared with people with
mild cognitive impairment (right).
Credit: Image courtesy of Emory
University

Qualitative and quantitative approaches to clinical

neuropsychology
• Diagnosis
• Differential Diagnosis
• Predicting a person’s potential
• Evaluating response to treatment
• Matching clinical findings to imaging results
• Disability applications/ medical boarding
• Competency
• Integrated (quantitative and
qualitative) approach
• Clinical question  aim to identify a
particular pattern of cognitive
symptoms and signs that makes
clinico-anatomical sense
• Quantitative approach > use of a
standardised battery of tests to
Neuropsychology in South Africa
• Still a developing field in South Africa
• Michael Saling (Wits University) and a qualitative, Luria-based
approach to neuropsychological assessment
 • suitable for the SA’s diverse population (language, culture,
literacy) > international psychometric tests may have
limited value (i.e. norms and comparison groups)
• Professional Board for Psychology of the Health Professions
Council of South Africa (HPCSA) > www.hpcsa.co.za
• established a professional category for
neuropsychology
• the first cohort of practitioners recently took the
Board exam and are now registered.
• Certification process conducted by the South African
Clinical Neuropsychological Association (SACNA) >
www.sacna.co.za