Neurobehavioral Disorders
(3-4-13)

Terminology

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-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)

arousal/(editing)

II. Limbic systems (subcortical)

arousal/attention/(editing)

biological drives (basic instincts)

emotional behavior/reinforcement

temperament (?)

consolidation of verbal learning/memory

III. Cortex

sensory unit: processing input

posterior: temporal, parietal, & occipital lobes

motor unit: executive functions, "pause and plan"

frontal: frontal lobe

arousal/attention/(editing)

forming plans

executing plans

verifying results

Neurobehavioral Disorders

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

DISORIENTATION.

CONFUSION

INATTENTION

II. Dementia

“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

declarative/semantic/verbal

procedural/nonverbal (?)

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)

Ideomotor Apraxia

Constructional Apraxia

Agnosia: DEFICIT IN OBJECT RECOGNITION IN ABSENCE OF ANY DISTURBANCE IN PRIMARY SENSORY SYSTEM (P. 278)

Visual Agnosia

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

Limbic Syndromes

Amnesiac Syndrome

psuedopsychiatric syndromes

"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

stroke

occlusion

hemorrhagic

transient ischemic attack (TIA)

arterial-venial malformation (AVM)

III. Tumor

IV. Metabolic disorder

Phenylketonia (PKU)

V. Infection

encephalitis

Acquired Immune Deficiency Syndrome: AIDS Related Dementia

VI. Toxic exposure

heavy metals: lead, mercury

organic solvents: sniffing glue

alcohol: intoxication, withdrawal (delirium tremens)

References:

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.