Download Neurocognitive Disorders File

ABNORMAL PSYCHOLOGY,
SIXTEENTH EDITION
James N. Butcher/ Jill M. Hooley/ Susan Mineka
Chapter 14
Neurocognitive Disorders
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Brain Impairment in Adults: New DSM-5
The old category of “Delirium, Dementia, and
Amnestic and Other Cognitive Disorders”
now called “Neurocognitive Disorders.”
• New subsections based on severity are
“delirium, major/mild neurocognitive
disorder.”
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Diagnostic Issues
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Clinical Signs of Brain Damage
Damage or destruction of brain tissue
may involve wide range of outcomes
depending on
• Nature, location, and extent of neural
damage
• Premorbid competence and personality
of individual
• Individual’s life situation
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Diffuse versus Focal Damage
Moderate
diffuse
damage
Focal damage
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Figure 14.2: Brain Structures
and Associated Behaviors
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Diffuse versus Focal Damage
• Some consequences of brain disorders with
mainly focal origins commonly appear in
context of progressively diffuse damage.
• How many consequences can you
identify?
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The Neuropsychology/
Psychopathology Interaction
Interaction
• Close link between neuropsychological and
psychopathological conditions
• Psychological disorder not necessarily and
completely explained by patient’s brain damage
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Delirium
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Clinical Picture
Delirium
• State of acute brain failure
that lies between normal
wakefulness and stupor or
coma
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Clinical Picture
Delirium
Has sudden onset and involves fluctuating state of
reduced awareness
Reflects confusion, disturbed concentration, and
cognitive dysfunction
Can occur in person of any age, though the elderly
and children are at particularly high risk
May result from drug intoxication or withdrawal,
head injury, or infection
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Figure 14.3: Continuum of
Level of Consciousness
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Treatments and Outcomes
Delirium
• True medical
emergency
• Often reversible
• Most often treated
by medications,
environmental
manipulations,
and family
support
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Clinical Picture
Major Neurocognitive Disorder
(Dementia)
Not rapidly fluctuating condition
Characterized by a decline from a previously attained
level of functioning
Slow onset and a deteriorating course
Caused by over 50 different disorders
Most commonly caused by Alzheimer’s disease
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Figure 14.4: Distribution of Dementia
by Probable Cause
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Clinical Picture
Parkinson’s
Disease
Second most common
neurodegenerative disorder
Characterized by tremors or rigid
movements
Primarily caused by loss of dopamine
neurons.
About 75% eventually show signs of
dementia
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Clinical Picture
Huntington’s
Disease
Rare degenerative disorders of nervous
system
Chronic, progressive chorea
Patients usually develop dementia
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Alzheimer’s Disease
Alzheimer’s Disease
• Progressive and fatal
neurodegenerative disorder
• Associated with Alzheimer’s disease.
• Usually slow but progressively
deteriorating course terminating in
delirium and death
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Alzheimer’s Disease
Age
Genes
Risk
factors
Genetic mutations
of APP
APOE-E4 allele of
APOE gene
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Alzheimer’s Disease
Atrophy
Neuropathology
Plaques
Neurofibrillary
tangles
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Alzheimer’s Disease
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Alzheimer’s Disease
• Complete the sentence below.
• Any comprehensive approach to
therapeutic intervention must consider the
situation of ________.
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Dementia from HIV-1 Infection
Neuropsychological
features
HIV-1 virus
can result in
destruction of
brain cells
Rates of full
dementia
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HIV and mild
cognitive impairment
Vascular Disease
Vascular disease
• Series of circumscribed
cerebral infarcts cumulatively
destroy neurons over
expanding brain regions
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Amnestic Disorder
Amnestic
disorder
Characteristic feature of amnestic
syndrome
Causes of amnestic syndrome
Treatment techniques
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Head injury
Disorders Involving Head Injury
Incidence
Common causes
Risk by gender and age
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Clinical Picture
Head injuries
outcomes
Retrograde amnesia
Anterograde amnesia
Personality changes
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Clinical Picture
Retrograde
amnesia
Head injuries
results
Anterograde
amnesia
Personality
changes
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Treatments and Outcomes
Prompness
and further
damage
Treatment
team often
involves wide
variety of
health
professionals
Treatment
Aftereffects
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Immediate
and long-term
reeducation
and
rehabilitation
Unresolved Issues
Should healthy people use cognitive enhancers?
Would you take a drug approved for Alzheimer’s
disease if you thought it would help you do better on a
test?
Should schools and colleges begin to test for these drugs
prior to taking major exams?
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