Cognitive, behavioral, and emotional disorders associated with damage or dysfunction in the CNS. In the past these have been labeled as Organic Mental Syndromes/Disorders Organic Brain Syndromes OBS; Strub & Black (1981) prefer Neurobehavioral Disorders
DSM 5 uses the terminology: neurocognitive disorders
DSM-IV-TR uses the terminology: COGNITIVE DISORDERS
Delirium, Dementia, and Amnestic and other Cognitive Disorders
where the primary difficulty is a disturbance in cognition or memory, and the etiology is assumed to be either a general medical condition or a substance (drug of abuse, medication, toxin).
Within the other major groupings of Mental Disorders in DSM-IV there are categories to cover cases where brain damage or disease are believed to be the cause of the problems, e.g., Conditionor Personality Change associated with a General Medical Condition.
Anatomy of Behavior
I. Ascending reticular systems (brain stem)
II. Limbic systems (subcortical)
biological drives (basic instincts)
consolidation of verbal learning/memory
sensory unit: processing input
posterior: temporal, parietal, & occipital lobes
motor unit: executive functions, "pause and plan"
frontal: frontal lobe
I. Acute Confusional States (Delirium)
alternative terminology: encephalopathy (neurologists may use this term), delirium, altered mental status (ER physicians may use this), acute confusional state
Causes of Delirium
A RAPIDLY DEVELOPING, YET FLUCTUATING, REVERSIBLE CHANGE IN BEHAVIOR THAT IS CHARACTERIZED BY A CLOUDING OF CONSCIOUSNESS, INCOHERENCE IN THE TRAIN OF THOUGHT, AND DIFFICULTY WITH ATTENTION AND CONCENTRATION. (STRUB & BLACK, P. 109).
REDUCED CLARITY OF AWARENESS OF ENVIRONMENT
A SLOWLY PROGRESSIVE DETERIORATION IN INTELLECTUAL AND ADAPTIVE FUNCTIONS. (STRUB & BLACK, P. 146)
Subtypes of Dementia
Dementias of the Alzheimer's Type (DAT)
Alzheimer & genes
DAT & Depression
amyloid beta & tau
Vascular Dementias (Multi-Infarct Dementia/MID)
III. Amnestic Syndromes: memory
IV. Focal Lesion Syndromes
Aphasias: DISTURBANCE CAUSED BY DAMAGE TO LANGUAGE AREAS OF THE BRAIN
Broca's Aphasia expressive
Wernicke's Aphasia receptive
Apraxia: DISORDER IN CARRYING OUT OR LEARNING COMPLEX MOVEMENTS that cannot be accounted for by strength, coordination, sensation, comprehension, or attention. (p. 274)
Agnosia: DEFICIT IN OBJECT RECOGNITION IN ABSENCE OF ANY DISTURBANCE IN PRIMARY SENSORY SYSTEM (P. 278)
Prosopagnosia: INABILITY TO RECOGNIZE FAMILIAR FACES
Frontal Lobe Syndromes
Disinhibited: POOR JUDGEMENT, UNINHIBITED SOCIAL BEHAVIOR, CRUDE LANGUAGE & HUMOR, IMPULSIVE
Amotivational: APATHETIC, LOW ENERGY LEVEL, LACK OF SPONTANEOUS BEHAVIOR
"epileptic personality [disorder]": perseveration, excessive religiosity, paranoia, egocentric selfishness, impulsivity, mental slowness, emotional viscosity, circumstantiality, irritability, mood fluctuations
Etiologies Associated with Neurobehavioral Disorders
I. Head injuries
Donders & Hoffman (2002) found that male gender was associated with an increased risk for retrieval deficits on the CVLT-C after pediatric TBI, possibly due to reduced speed or efficiency of information processing.
penetrating brain damage
closed head injuries
Glasgow Coma Scale
II. Cerebrovascular disease
transient ischemic attack (TIA)
arterial-venial malformation (AVM)
IV. Metabolic disorder
Acquired Immune Deficiency Syndrome: AIDS Related Dementia
VI. Toxic exposure
heavy metals: lead, mercury
organic solvents: sniffing glue
alcohol: intoxication, withdrawal (delirium tremens)
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Text Revision. (4th ed.), Washington DC: Author, 2000.
Arciniegas, D.B. & Beresford, T.P. (2001). Neuropsychiatry: An introductory approach. New York: Cambridge University Press.
Kolb, Bryan & Whinshaw, Ian Q. Fundamentals of Human Neuropsychology. (4th ed.), New York: W.H. Freeman and Company, 1995.
Martin, G. Neil. Human Neuropsychology. London: Prentice Hall Europe, 1998.
Moscovitch, M. & Rozin, P. Disorders of the nervous system and psychopathology. Rosenhan, D.L. & Seligman, M.E.P. Abnormal Psychology, 3rd Ed., pp. 645-692. New York: W.W. Norton. 1995.
Sacks, Oliver. The Man Who Mistook His Wife for a Hat and Other Clinical Tales. New York: Harper & Row, 1985.
Strub, Richard L. & Black, F. William. Neurobehavioral Disorders: A Clinical Approach. Philadelphia: F.A. Davis Company, 1981.