Neurobehavioral
Disorders
(9-10-14)
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 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)
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
“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)
Dementias of the Alzheimer's Type (DAT)
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
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.