ch16 Neurological and Psychiatric Disorders

16: Neurological and
Psychiatric Disorders
Cognitive Neuroscience
David Eagleman
Jonathan Downar
Chapter Outline
 Alzheimer’s Disease: Burning Out with
Age?
 Frontotemporal Dementia: Like a Cancer
of the Soul
 Huntington’s Disease: A Genetic Rarity, in
Two Senses
 Tourette Syndrome: A Case of Involuntary
Volition?
2
Chapter Outline
 Obsessive-Compulsive Disorder:
Neurological or Psychiatric?
 Schizophrenia: A Dementia of the Young
 Bipolar Disorder
 Depression: A Global Burden
3
Alzheimer’s Disease: Burning
Out with Age?
 Dementias are neurologic disorders
characterized by slow deterioration of
higher cognitive functions.
 Such functions include language, memory,
judgement, and emotion.
 Alzheimer’s disease or Alzheimer’s
dementia is thought to affect about 24
million people world-wide.
4
Out with Age?
5
Out with Age?
 The major deficit of Alzheimer’s is the loss
of episodic memory.
 Executive functions decline throughout
Alzheimer’s disease.
 Biological markers of Alzheimer’s disease
include amyloid-beta plaques and
neurofibrillary tau tangles.
6
Out with Age?
7
Out with Age?
8
Out with Age?
 Most cases of Alzheimer’s disease occur
in individuals over age 60.
 The epsilon 4 variant of the apolipoprotein
E (ApoE4) gene seems to increase the
risk of developing the disease.
 Genetic forms of Alzheimer’s disease
account for only a small percentage of
cases.
9
Out with Age?
10
Out with Age?
 Treatment of Alzheimer’s disease
 There are currently no cures for Alzheimer’s
disease.
 No medications significantly slow down or
reverse the progression of the disease.
 Acetylcholinesterase inhibitors and NMDA
glutamate receptor antagonists sometimes
slow the progression of the disease.
11
Out with Age?
 A potential treatment uses the immune
system to remove plaques, but this has
not resulted in any clinical improvement.
 Social, mental, and physical activity can
decrease the risk and severity of
Alzheimer’s disease.
12
Frontotemporal Dementia: Like a
Cancer of the Soul
 This dementia results from progressive
atrophy of the brain.
 This is most common in the inferior frontal
lobes and anterior temporal lobe.
 The age of onset is typically about 40 – 50
years of age.
 Personality and social behaviors change
significantly.
13
Cancer of the Soul
14
Cancer of the Soul
 Behavioral variant frontotemporal
dementia (bvFTD) is most common.
 This is characterized by progressive
semantic dementia, personality changes
and loss of empathy.
 Frontotemporal dementia is sometimes
associated with an increase in creativity.
15
Cancer of the Soul
16
Huntington’s Disease: A Genetic
Rarity, in Two Senses
 Patients perform restless involuntary
movements of the face, trunk, and limbs.
 It commonly also includes psychiatric
symptoms such as depression, apathy,
anxiety, delusions, and hallucinations.
 The biological cause is degeneration of
the anterior caudate nucleus of the
striatum.
17
18
19
 Huntington’s disease is caused by the
mutation of an autosomal dominant gene.
 This mutation encodes the inclusion of a
trinucleotide repeat of the sequence CAG
in the final protein.
 Most people have fewer than 28 CAG
repeats, and this results in no issues.
 Individuals with more than 35 repeats are at
an increased risk of developing the disease.
20
 Risk factors for Huntington’s disease
include both genetic and environmental
factors.
 Treatment for Huntington’s disease
involves dopamine receptor antagonists.
 These relieve some of the motor and
psychiatric symptoms.
21
22
Tourette Syndrome: A Case of
Involuntary Volition?
 In Tourette syndrome, the individual
repeats purposeless movements of the
face, head, shoulders, or hands.
 There are also verbal tics, which are
purposeless noises like throat-clearing and
snorting or meaningless phrases.
23
 Tourette syndrome is typically a disorder of
childhood.
 Studies suggest there is a genetic basis to
Tourette syndrome, but no gene has been
isolated.
24
 Pediatric Autoimmune Neuropsychiatric
Disorder Associated with group A
Streptococcal infection (PANDAS)
 This is characterized by the tics of Tourette
syndrome or the intrusive thoughts and
behaviors of obsessive compulsive disorder.
 Sometimes occurs in patients shortly after
they have had a throat infection caused by the
bacteria Group A streptococcus.
25
 Patients have a decrease in gray matter in
the caudate nucleus and lateral motor and
premotor cortex.
 Gray matter is thinner in medial motor
areas.
26
27
 Therapy for Tourette syndrome includes
education and acceptance.
 Neurolepic medications are prescribed for
the most severe cases, where the tics
interfere significantly with daily life.
28
Obsessive-Compulsive Disorder:
Neurological of Psychiatric?
 “Neurological” disorders and “psychiatric”
disorders are grouped based on the nature
of the condition.
 Conditions with an observable brain
abnormality were considered neurological.
29
 A more modern criteria based on the
symptoms.
 Psychiatric conditions impact emotion,
motivation, social behaviors, personality, or
reality testing.
 Neurological conditions impact strength,
movement, sensory perception, memory,
attention, or level of consciousness.
30
31
 Obsessive-compulsive disorder is a
psychiatric disorder that affects about 2 –
3% of the population.
 Symptoms include obsessions (intrusive,
disturbing thoughts) and compulsions
(stereotyped, ritualized behaviors).
32
 Obsessions include contamination, fear of
committing inappropriate acts, symmetry
and number, and hoarding.
 The most common age of onset for
symptoms of obsessive-compulsive
disorder is either about age 11 or 23.
33
34
 There is increased activity in the circuits
connecting the basal ganglia to the
orbitofrontal, anterior cingulate, and
dorsomedial prefrontal cortex.
 The pattern of activity differs depending on
the types of obsession.
35
36
 Cognitive behavioral therapy addresses
cognitive distortions and decreases
anxiety.
 Medications than increase serotonin
reduce the obsessions, compulsions, and
anxiety.
 Neuroleptics are sometime prescribed for
severe cases.
37
Schizophrenia: A Dementia of the
Young
 Schizophrenia is characterized by loss of
contact with reality.
 The age of onset is typically around early
adulthood.
 Schizophrenia affects about 1% of the
world’s population.
38
Young
 Positive symptoms include hallucinations
and delusions.
 Delusions include paranoid delusions,
delusions of reference, delusions of passivity,
and somatic delusions.
 Negative symptoms include poverty of
speech, apathy, social withdrawal, and
loss of emotion.
39
Young
40
Young
 Antipsychotic medications treat the
positive symptoms, but do not treat the
negative symptoms.
 Such medications often cause unwanted
side effects.
 Second-generation antipsychotic
medications are no better at treating the
negative symptoms.
41
Young
 There is a genetic basis to schizophrenia,
but no specific genes have been identified.
 Environmental factors during fetal
development or early life seem important
in the incidence of schizophrenia.
42
Young
43
Young
 Neurodevelopmental factors
 Abnormal pruning of neurons
 Smaller cell bodies of neurons
 Decreased functioning of inhibitory GABA
interneurons in the cortex
44
Young
45
Young
46
Young
 Dopamine hypothesis
 There is too much dopamine signaling or the
dopamine receptors are oversensitive.
 The first-generation antipsychotic drugs were
dopamine D2 receptor antagonists.
 Drugs that increase dopamine, such as
amphetamines and cocaine, can mimic the
positive symptoms of schizophrenia.
47
Young
48
Young
 Glutamate hypothesis
 Schizophrenia is caused by too little
glutamate neurotransmission.
 NMDA receptor antagonists, like ketamine,
can mimic both the positive and negative
symptoms of schizophrenia.
 Many of the genes associated with
schizophrenia affect NMDA glutamate
receptors.
49
Young
50
Bipolar Disorder
 Normal mood alternates with periods of
depression and mania.
 This affects 1% of the population and a
milder form may affect as much as 4-5%
of the population.
 The age of onset is about 20 years of age.
 There is a genetic basis to the condition,
but no specific genes have been identified.
51
Bipolar Disorder
52
Bipolar Disorder
 Individuals with bipolar disorder show
thinner gray matter in the
 Bilateral ventrolateral frontal cortex
 Bilateral anterior insula
Dorsomedial prefrontal cortex
 Subgenual cingulate cortex
 Some of these regions are also affected in
unipolar depression.
53
Bipolar Disorder
54
Bipolar Disorder
 Common treatments include
 Mood-stabilizing drugs, such as lithium
 Anti-dpileptic drugs
55
Bipolar Disorder
56
Depression: A Global Burden
 Impact of Depression
 Causes of Depression
 Neurochemical Effects of Depression on
Brain
 Functional Effect of Depression on the
Brain
 Treatment of Depression
57
Impact of Depression
 Depression is characterized by a low
mood that makes it difficult to carry out the
functions necessary for daily life.
 Individuals with depression do not take
pleasure in typical activities, lack
motivation and energy, and have altered
sleep patterns and appetite.
58
59
 The worldwide incidence of depression is
5% at any one time.
 In the United States, the incidence is 5%
for men and 10% for women.
 Lifetime incidence is roughly double the
one-time incidence rates.
 The cost of depression is estimated to be
about $80 billion per year in the U.S.
60
61
Causes of Depression
 Mood disorders run in families, suggesting
a genetic basis.
 Depression may be an evolutionary
adaptation to suffering a trauma or defeat
 Depression causes the individual to stay
away from opponents and predators while
waiting for better times.
62
Causes of Depression
63
Neurochemical Effects of
Depression on Brain
 Monoamine hypothesis of depression
 There is a shortage of the monoamine
neurotransmitters.
 By inhibiting the enzyme monoamine oxidase,
which breaks down these transmitters, mood
will be improved.
64
Depression on Brain
 Serotonin hypothesis
 More specific than the monoamine
hypothesis.
 There is, specifically, a shortage of serotonin.
 Selective serotonin reuptake inhibitors
specifically affect serotonin levels.
65
Depression on Brain
 Other biological theories
 There are abnormalities with glutamate
neurotransmission.
 There are low levels of the neuronal growth
factor brain-derived neurotrophic factor
(BDNF).
66
Depression on Brain
67
Functional Effect of Depression
on the Brain
 Networks of brain areas are under- and
over-activated in individuals with
depression.
 The subgenual cingulate cortex is consistently
hyperactive.
 This hyperactivity returns to normal following
successful treatment of depression.
 The dorsolateral and dorsomedial prefrontal
cortex tend to be less active.
68
on the Brain
69
on the Brain
 The pattern of hyper- and hypo-active
brain regions differs across individuals.
 Current research is examining the
interactions between different brain
regions.
70
Treatment of Depression
 Three major treatments are used for
individuals with depression
 Psychotherapy
 Pharmacotherapy
 Somatic therapy
71
 In psychotherapy, the patient interacts with
a clinician to work through the causes of
their depression.
 Cognitive therapy is about as effective as
pharmacotherapy
 The effects seem to persist for a longer
time than the medication does.
72
73
 Anti-depressant medications include
 Monoamine oxidase inhibitors (MAOIs)
 Tricyclic antidepressants (TCAs)
 Selective serotonin reuptake inhibitors
(SSRIs)
 All of these are about equally effective.
 Different medications are more or less
effective for different individuals.
74
75
 Somatic therapies are more invasive.
 These include
 Repetitivetranscranial magnetic stimulation
 Electroconvulsive therapy
 Deep brain stimulation
76

ch16 Neurological and Psychiatric Disorders

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

ch16 Neurological and Psychiatric Disorders

Uploaded by

Copyright:

Available Formats

16: Neurological and

You might also like