Neurological Aspects of Psychopathology

1. 1 Dale Pietrzak, Ed.D. LPC-MH, CCMHC Neurological Aspects of Psychopathology Dale Pietrzak, Ed.D., LPCC, NCCMHC

2. Major Neurological Areas • Cerebral Cortex • 4 Lobe Regions • Right & left Regions • Mid-brain • Cerebellum • Brain Stem • Cranial Nerves

3. Cerebral Cortex • Frontal Lobes • Learning, Abstraction, reasoning, inhibition • Temporal Lobes • Sound discrimination, speaking, understanding speech • Parietal Lobes • Somatic sensations/discriminations, motor discriminations, motor functions • Occipital Lobes • Visual discrimination, some visual memory Ahhh!!!

4. Hemispheric Specialization • Right Hemisphere: • Controls left side of body elements (nostril, hand, etc.) except hearing • Spatial Construction, simple language, nonverbals, left visual field. • Left Hemisphere • Controls left side of body • Language. Hello!?!

5. 6 Frontal Lobes • Motor Control: • There is some motor control found in this region. Injuries can result in spasticity or paralysis (opposite). • Language: • Dominant hemisphere (left) may affect expressive language (non-fluent) (dysarthric, effortfull agrammatical). Comprehension unaffected. May be able to repeat. Difficulty with confrontational naming and prosody.

6. Frontal Lobes Con’t. • Intellectual Functions: • Injury generally affects these in some way. New learning, or complex reasoning/problem solving impairments, attentional deficits, vacillation in concentration, distractibility, Apathetic, easily misdirected, poor complex, little or no self-directed behaviors, cognitive inflexibility, poor reasoning, poor problem solving, and poor judgment. IQ tests miss it.

7. Frontal Lobes Con’t. • Personality: • Wide spectrum of changes may take place, and from subtle to marked ranges. Lack of drive/motivation, lack of initiative, diminished spontaneity, disregard for social amenities, inappropriate jocularity, excessive silliness/giddiness and/or emotional liability.

8. Frontal Lobes Con’t. • Memory: • Functions are often affected. Relationship of memory to frontal lobes is currently not understood. Where did I put my car keys!?

9. Temporal Lobes • Motor Functions: • Not involved in direct motor control but some interference is not uncommon. Apraxia of movement, ideomotor apraxia, and some constructional apraxias. • Sensory Functions • Auditory inattention (extinction/suppression of contralateral side). Visual deficits and olfactory deficits,

10. Temporal Lobes Con’t. Language: • Damage in dominant hemisphere (left) usually affects this process. May be expressive (non-fluent) or receptive (fluent). Generally more fluent. Sound substitutions, word substitutions and/or non-sense words. Non-dominant hemisphere injuries impact rhythm and failure to understand the “tone” in speech.

11. 12 Temporal Lobes Con’t. • Memory: • Dominant hemi. injury: verbal memory, esp. recent and immediate recall are generally affected. Non-dominant visual & musical memory. Sometimes complete loss of short-term memory. • Personality: • Interacts with the limbic system: Depression (dominant) or indifference (non-dominant), impulsiveness, aggressiveness, hypo/hypersexuality, increased emotionality and/or irritability.

12. Parietal Lobes • Motor: • As this region if sensory/tactile there is generally loss in these functions (contralateral). This region also connects with various motor sections so various types of motor disorders are also common. Sensory loss is generally greater than motor loss.

13. Parietal Lobes Con’t. • Sensory: • Touch perception, tactile processing deficits, (finger recognition, hand/finger graphesthesic perception, stereognosis), and contralateral (to injury) suppression/extinction. Sometimes some visual impairments are present. • Language: • The aphasias (same as temporal) but with greater sensory impairment.

14. Parietal Lobes Con’t. • Memory: • If the injury is limited to the parietal lobes the memory will be (relatively) spared. There may be some secondary memory impairments (appearance) due to sensory/language impairments. I’m never going to remember this for the test!

15. Parietal Lobes Con’t. How come I can’t draw this? • Visual-Spatial: • This is usually the function (rather specifically) of the non-dominant (right) parietal lobe. Severe constructional apraxia, visual/tactile neglect, or even whole body contralateral neglect. Dominant lobe injuries created limited impairments in these functions, primarily with attention to detail and oversimplification of drawings.

16. Parietal Lobes Con’t. • Personality: • With nondominant lobe injuries the person may develop neglect syndrome which is sometimes mistaken for personality changes. But, these patients generally display a lack of concern over their deficits and an unwillingness to accept the loss. Dominant lobe injuries have not been concretely associated with changes in personality but there has been some link to depression. My head!

17. Occipital Lobes • Of the four general lobes the Occipital lobes are most dedicated to a specific function: Visual-perceptual abilities. • Sensory: • Vision difficulties or cortical blindness may result. Because of a very high level of integration of the temporal-occipital and parietal-occipital regions there is often an overlap of the visual deficits and dysphasic deficits.

18. Occipital Lobes Con’t. • Sensory Con’t. • Alexia or agraphia may also result. Contralateral neglect, extinction/suppression are often present. Minor damage may impair the ability to discriminate objects (agnosia) or faces (prosopagnosia). • Language Functions • As there is overlap with the temporal regions and reading requires vision, language functions can be impaired.

19. Limbic System • Controls the levels of activity in various parts of the brain. • Controls motivational factors to some degree. Especially feelings of pleasure- punishment and learning. La Coo Ca Racha

20. Reticular Activating System:Autonomic Nervous System • The central part of the brain along with the brain stem are often referred to as the reticular activating system. Excitation Center Inhibition Center

21. Limbic System Structures • Hypothalamus • Hippocampus • Amygdala • Limbic Cortex

22. Limbic System • Vegetative Functions: • Cardiovascular regulation, body temperature, regulation of body water, uterine contractility, milk ejaculation, and gastrointestinal/feeding regulation. I never promised you a rose garden This teacher is nuts! Now he thinks I am a plant!

23. Limbic System Continued • Behavioral Functions : • General activity levels, overactivity sometimes leading to overt rage and fighting. • Underactivity leading to lethargic, satiety, decreased eating or tranquility. • Certain regions control fear and punishment response

24. Limbic System Continued • Behavioral Functions Continued: • Sexual drive is controlled to some extent in this region. • Reduction in appetite and thirst (or opposite) can occur if damaged. • Self-control mechanisms • Hormonal activity or regulation • Learning and memory

25. Endocrine System • Controls Body and emotional functions • Mood and affect, reactivity, activity, etc. Neurotransmitters • Control how one neuron (brain cell) communicates with another. • Brain activity/Function

26. I do believe, I have had enough of this for now.