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Psychiatric disorders

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Attention Deficit/Hyperactivity Disorder (ADHD) Mega & Cummings, 2001. Mayberg H., 2001 ... Attention Deficit/Hyperactivity Disorder AD/HD diagnostic criteria ... – PowerPoint PPT presentation

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Title: Psychiatric disorders


1
Lecture 7
  • Psychiatric disorders

2
Diagnostic difficulties
3
Psychiatric disorders linked to frontal
dysfunction
  • Depression and mania
  • Schizophrenia
  • Obsessive-Compulsive Disorder (OCD)
  • Phobias and other anxiety disorders
  • Autism-Asperger syndrome
  • Attention Deficit/Hyperactivity Disorder (ADHD)

4
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Mega Cummings, 2001
9
Mayberg H., 2001
10
Mayberg H., 2001
11
Maybergs model of depression
Mayberg H., 2001
12
Andreasen N., 2001
13
Hypofrontality in schizophrenia
  • First shown by Ingvar and Franzén 1973
  • Most pronounced in chronic patients with very
    long-lasting hospitalization and treatment with
    neuroleptics. Patients display predominantly
    negative symptoms.
  • Unmedicated acutely ill schizophrenic patients
    show slightly decreased, normal or even elevated
    frontal (resting) blood flow levels dependent
    upon the symptoms displayed
    positive negative

14
Hypofrontality in schizophrenia cont.
  • Functional brain imaging during the execution of
    tasks engaging the frontal lobes have
    consistently shown abnormalities also in young
    unmedicated schizophrenic patients.

15
rCBF differences between 12 controls and 18
schizophrenic patients during performance of an
auditory recognition task
Holcomb et al., Am. J. Psychiatry, 157,
1634-1645, 2000
16
rCBF differences between controls and 6
schizophrenic patients with abnormal performance
on the auditory recognition task
17
Reduced communication between frontal and
temporal lobes during talking in schizophrenia
Ford et al., Biol. Psychiatry, 51, 485-492, 2002
18
Reduced communication between frontal and
temporal lobes during talking in schizophrenia
19
Two trends of cortical development
Archicortical trend
Paleocortical trend
20
Mega Cummings, 2001
21
Obsessive-Compulsive Disorder
  • Neuropsychological, brain imaging and
    electrophysiological research have consistently
    shown a dysfunction of fronto-striato-thalamic
    pathways in subjects with obsessive-compulsive
    disorder.
  • Hyperactivity of attention/executive control
    mechanisms in obsessive-compulsive patients?

22
Mapping structural brain alterations in
obsessive-compulsive disorder
  • Structural MR in 72 outpatients with OCD and 72
    age- and sex-matched control subjects.
  • The brains of patients with OCD showed reduced
    gray matter volume in the medial frontal gyrus,
    the medial orbitofrontal cortex, and the left
    insulo-opercular region. A relative increase in
    gray matter volume was observed bilaterally in
    the ventral part of the putamen and in the
    anterior cerebellum.
  • Specific parts of the frontostriatal system are
    altered in patients with OCD.

Pujol et al., Arch Gen. Psychiatry, 61, 720-730,
2004
23
The Basal Ganglia
Caudate Putamen Nucleusaccumbens
24
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25
Psychiatric disorders linked to frontal
dysfunction
  • Depression and mania
  • Schizophrenia
  • Obsessive-Compulsive Disorder (OCD)
  • Phobias and other anxiety disorders
  • Autism-Asperger syndrome
  • Attention Deficit/Hyperactivity Disorder (ADHD)

26
Prevalence of autism
  • Autism between 0.1-0.3
  • Aspergers syndrome 0.20-0.48
  • Autism spectrum disturbance 0.1-0.6
  • Later studies show that the total prevalence for
    autism spectrum disturbances is between 0.5-0.8

27
Cognitive disturbances in Autism spectrum
disorders
  • Deficient mentalizing (theory of mind, empathy)
  • Deficient central coherence
  • Deficient executive functions
  • Difficulties with automatization and
    generalization

28
10 functional brain imaging studies of mentalizing
Frith, U. Frith C., Phil. Trans. R. Soc. Lond.
B, 358, 459-473, 2003
29
Aspergers syndrome (Gillberg Gillberg 1989)
  • 1. Severe difficulties in social interaction.
  • 2. Narrow solitary interests.
  • 3. Routines and rituals.
  • 4. Speech and language problems.
  • 5. Problems in non-verbal communication.
  • 6. Motor clumsiness.

30
Differences between autism and Aspergers
syndrome?
  • Autism more severe language problems, often
    lower general intelligence, earlier recognition.
  • Aspergers syndrome often normal intelligence,
    normal language, problems are often realized
    later.

31
Brain pathology in autism
  • Subnormal frontal activation during execution of
    theory of mind tasks.
  • Cerebellar abnormality (smaller or larger vermis
    area).
  • Less activation of face specific brain areas.
  • Deviant visual search in social situations
    difficulties recognizing social meaning.

32
Causes of autism spectrum disorders
  • Multiple causes Chromosomal abnormalities,
    fetal disturbances (infections, toxins).
  • 75 - 90 of all cases of autism are genetically
    determined. Probably several co-operating genes.
  • Psychosocial factors do not cause autism, but are
    important for the quality of life of the patient.

33
Attention Deficit/Hyperactivity Disorder AD/HD
diagnostic criteria
  • 6 out of 9 criteria for attention deficit (AD).
  • 6 out of 9 criteria for hyperactivity/
    impulsivity (HD) fulfilled.
  • Symptoms present before the age of 7 years.
  • Functional disturbances have to be present within
    at least to areas (school, home, relations, work).

34
Attentional deficits
  • Inattentive
  • Seems not to listen
  • Does not follow instructions
  • Looses objects
  • Easily distracted
  • Difficulties organizing/planning
  • Forgetful
  • Dislikes tasks that require mental endurance
  • Difficulties with sustained attention to tasks

35
Hyperactivity
  • Difficulties to remain on one place
  • Speeded
  • Excessive talkativeness
  • Running around anxiously
  • Leaves the place
  • Difficulties to perform task in a quite and
    orderly way

36
Impulsivity
  • Answers before the person asking has finished the
    question
  • Interrupts, intrudes
  • Difficulties waiting for ones turn

37
Prevalence of AD/HD
  • 3-7 of all school children
  • More boys than girls

38
Cognitive problems in AD/HD
  • Short attentional span and poor working memory
  • Prefers concrete thinking
  • Difficulties with automatized functions
  • Deficient ability to generalize
  • Low level of general knowledge
  • Slow learning
  • Deficient awareness of time and space
  • Difficulties with reading and writing
  • Bad handwriting

39
Brain pathology in AD/HD
  • Some studies Structural changes in
    fronto-striatal networks.
  • Some studies Subnormal function in the
    prefrontal cortex and striatum.

40
Treatment by central stimulants
  • Amphetamine, methylphenidate (Ritaline).
  • Good or very good effect in about 70 of treated
    children (about 200 controlled studies since the
    1930-ies).
  • Adults A few studies, good effect in 50 60.
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