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PowerPoint for
Abnormal Psychology
Fourteenth Edition
James N. Butcher
Susan Mineka
Jill M. Hooley
Prepared by Andy Pomerantz
Southern Illinois University
Edwardsville
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Copyright © 2010 Allyn & Bacon
Chapter 14
Cognitive Disorders
Copyright © 2010 Allyn & Bacon
Brain Impairment in Adults

Prior to the DSM-IV, disorders involving
some kind of identifiable pathology (e.g.,
a brain tumor, stroke, drug intoxication)
were labeled organic mental disorders


Functional mental disorders were
considered not to have an organic basis
It is incorrect to assume other disorders
(such as schizophrenia) have no organic
basis
3
Copyright © 2010 Allyn & Bacon
Diagnostic Issues
This chapter deals with what were
formerly labeled organic mental disorders
 The DSM-IV-TR presents the diagnostic
coding of various neuropsychological
disorders in different and somewhat
inconsistent ways
 Both Axis I and Axis III are often used,
largely because of the involvement of
medical conditions

4
Copyright © 2010 Allyn & Bacon
Clinical Signs of Brain Damage

Damage or destruction of brain tissue
may involve only limited behavioral
deficits or a wide range of psychological
impairments depending on

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The nature, location, and extent of neural
damage
The premorbid competence and personality
of the individual
The individual’s life situation
The amount of time since the first
appearance of the condition
5
Copyright © 2010 Allyn & Bacon
Clinical Signs of Brain Damage

During the Mini-Mental State Examination, the
clinician will ask the patient questions
concerning

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Orientation (e.g., Where are we now?)
Registration (Repeat these three words.)
Attention and concentration (Count backwards by
seven.)
Recall (Do you remember those three words?)
Language (Name what I’m pointing to.)
Comprehension (Pick up the paper in front of you.)
Construction ability (Copy this design.)
6
Copyright © 2010 Allyn & Bacon
Diffuse versus Focal Damage

Attention is often impaired by moderate
diffuse damage (such as damage from
moderate oxygen deprivation)

Focal damage (such as damage from an
injury or stroke) can cause different
problems depending on what part of the
brain is affected
7
Copyright © 2010 Allyn & Bacon
Figure 14.2: Brain Structures
and Associated Behaviors
8
Copyright © 2010 Allyn & Bacon
Diffuse versus Focal Damage

Some consequences of brain disorders that
have mainly focal origins but commonly appear
in the context of progressively diffuse damage
are as follows:
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Impairment of memory
Impairment of orientation
Impairment of learning, comprehension, and
judgment
Impairment of emotional control or modulation
9
Copyright © 2010 Allyn & Bacon
Diffuse versus Focal Damage

Some consequences of brain disorders that
have mainly focal origins but commonly appear
in the context of progressively diffuse damage
are as follows:
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Apathy or emotional blunting
Impairment in the initiation of behavior
Impairment of controls over matters of propriety and
ethical conduct
Impairment of receptive and expressive
communication
Impaired visuospatial ability
10
Copyright © 2010 Allyn & Bacon
The Neuropsychology/
Psychopathology Interaction

There appears to be a close link between
neuropsychological and
psychopathological conditions

It is erroneous to assume that a
psychological disorder is necessarily and
completely explained by the patient’s
brain damage
11
Copyright © 2010 Allyn & Bacon
Delirium

Clinical Picture

Treatments and Outcomes
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Copyright © 2010 Allyn & Bacon
Clinical Picture

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Delirium is an acute confusional state that lies
between normal wakefulness and stupor or
coma
Has a sudden onset and involves a fluctuating
state of reduced awareness
Reflects a major change in the way the brain is
working
Can occur in a person of any age, though the
elderly are at particularly high risk
May result from drug intoxication or withdrawal,
head injury, or infection
13
Copyright © 2010 Allyn & Bacon
Figure 14.3: Continuum of
Level of Consciousness
14
Copyright © 2010 Allyn & Bacon
Treatments and Outcomes

Delirium
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Is a true medical emergency
Is often reversible
Is most often treated by medications,
environmental manipulations, and family
support
Neuroleptics are most common medication
15
Copyright © 2010 Allyn & Bacon
Dementia
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Dementia
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Is not a rapidly fluctuating condition
Is characterized by a decline from a
previously attained level of functioning
Has a slow onset and a deteriorating course
Can be caused by over 50 different
disorders
Is most commonly caused by Alzheimer’s
disease
16
Copyright © 2010 Allyn & Bacon
Figure 14.4: Distribution of
Dementia by Probable Cause
17
Copyright © 2010 Allyn & Bacon
Parkinson’s Disease
Second most common
neurodegenerative disorder after
Alzheimer’s disease
 Characterized by tremors or rigid
movements
 Loss of dopamine receptors is primary
cause
 About 75% eventually show signs of
dementia

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Copyright © 2010 Allyn & Bacon
Huntington’s Disease

Rare degenerative disorders of the
nervous system
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Chronic, progressive chorea
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Irregular and involuntary movements that
flow randomly from one part of body to
another
Patients usually develop dementia
19
Copyright © 2010 Allyn & Bacon
Alzheimer’s Disease

Progressive and fatal neurodegenerative
disorder

Associated with a characteristic dementia
syndrome that has
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An imperceptible onset
A usually slow but progressively
deteriorating course terminating in delirium
and death
20
Copyright © 2010 Allyn & Bacon
Alzheimer’s Disease
Age is a major risk factor for Alzheimer’s
disease, as well as for other forms of
dementia such as vascular dementia
 Genes play a major role in susceptibility
to and risk for Alzheimer’s disease
 Genetic mutations of the APP, presenilin
1, and presenilin 2 genes are implicated
 The APOE-E4 allele of the APOE gene is
also a risk factor

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Copyright © 2010 Allyn & Bacon
Alzheimer’s Disease

The characteristic neuropathology of
Alzheimer’s disease involves:
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Cell loss
Plaques (which contain a sticky protein
called beta amyloid)
Neurofibrillary tangles (which contain an
abnormal tau protein)
Alzheimer’s disease accounts for most
cases of dementia
22
Copyright © 2010 Allyn & Bacon
Alzheimer’s Disease
Alzheimer’s disease causes the
destruction of cells that make
acetylcholine, a neurotransmitter
important for memory
 Drug treatments for Alzheimer’s disease
include cholinesterase inhibitors such as
donepezil
 These drugs help stop ACh from being
broken down, making more of it available
to the brain

23
Copyright © 2010 Allyn & Bacon
Alzheimer’s Disease

Any comprehensive approach to
therapeutic intervention must consider
the situation of caregivers
24
Copyright © 2010 Allyn & Bacon
Dementia from HIV-1 Infection

The HIV-1 virus (or a mutant form of it) can
itself result in the destruction of brain cells
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Neuropsychological features include
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Mild memory difficulties
Psychomotor slowing
Diminished attention and concentration
Around 30% of people infected with the HIV
virus show signs of some mild cognitive
impairment

Rates of full dementia have decreased since
the1990s
25
Copyright © 2010 Allyn & Bacon
Vascular Dementia

In vascular dementia, a series of
circumscribed cerebral infarcts
cumulatively destroy neurons over
expanding brain regions
26
Copyright © 2010 Allyn & Bacon
Amnestic Disorder
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The characteristic feature of amnestic
syndrome is strikingly disturbed memory
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Causes of amnestic syndrome include:
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Chronic alcohol use
Head trauma
Stroke
A wide range of techniques have been
developed to assist the good-prognosis
amnestic patient in remembering recent events
27
Copyright © 2010 Allyn & Bacon
Disorders Involving Head Injury

Traumatic brain injury affects over 2
million people per year in United States

Motor vehicle accidents are most
common cause

Other causes include falls, violent
assaults, sports injuries, and war injuries

Males age 15-24 are at highest risk
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Copyright © 2010 Allyn & Bacon
Clinical Picture

Head injuries can cause
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Retrograde amnesia
Anterograde amnesia
Personality changes
Phineas Gage survived a massive head
injury but suffered from personality
changes
29
Copyright © 2010 Allyn & Bacon
Treatments and Outcomes

Prompt treatment of brain injury can prevent
further damage

Immediate treatment may need to be
supplemented with long-term reeducation and
rehabilitation

Aftereffects can include headaches, impaired
memory, lowered intellectual level, or
personality changes, among others

Treatment team often involves wide variety of
health professionals
30
Copyright © 2010 Allyn & Bacon
Unresolved Issues

Can dietary supplements enhance brain
functioning?
31
Copyright © 2010 Allyn & Bacon
End of Chapter 14
Copyright © 2010 Allyn & Bacon