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Summary Neuropsychology and Psychiatric Disorders (PSMNB-3)
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English summaries of all 7 weeks of exam material, including lecture notes and article summaries, as well as additional information. 29 pages.
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Neuropsychology & Psychiatric Disorders SummariesWeek 1 – Introduction
Lecture notes
Learning Objectives:
- contributions of neuropsychology to psychiatry,
- associations between psychiatric disorders and cognitive impairments,
- factors influencing cognitive functioning of patients with psychiatric disorders,
- concepts explaining certain symptoms of psychiatric disorders on the basis of
neuropsychological findings and assumptions,
- brain abnormalities underlying cognitive deficits of patients with psychiatric disorders,
- approaches to the assessment of cognitive functions of patients with psychiatric disorders,
- strategies for the neuropsychological management and rehabilitation of patients with
psychiatric disorders.
Definitions
Psychiatry = medical specialty concerned with the diagnosis and treatment of mental illness.
Neuropsychology = psychological specialty concerned with relationship between behavior,
emotion, and cognition on the one hand, and brain function on the other.
From traditional neuropsychology – assessment focusing on determining specific changes in
mental processes after brain lesions – to assessing impairments and strengths of cognitive
processes. Develop hypotheses of underlying mechanisms based on symptoms.
,Week 2 – Schizophrenia
Lecture notes
Schizophrenia DSM-5 criteria
- Delusions
- Hallucinations
- Disorganized speech
- Catatonic behavior
- Negative symptoms
Symptom dimensions can be used to assess severity of symptoms (psychosis, negative
symptoms, cognitive deficits, depression, mania) – high heterogeneity.
Epidemiology: lifetime prevalence 1%. Onset during late adolescence, early adulthood.
Etiology: high genetic component (48% identical twins).
Stages of psychotic disorders
- 0: increased risk, no symptoms
- 1a: mild symptoms
- 1b: ultra-high risk, moderate symptoms
- 2: first episode, moderate to severe symptoms
- 3a: incomplete remission
- 3b: recurrence or relapse which stabilizes with treatment
- 3c: multiple relapses with worsening in clinical extent
- 4: severe, persistent, unremitting
Treatment
- Use of antipsychotic drugs since 1950s.
- 30% does not respond to medication.
- Antipsychotics are more efficient at treating positive than negative symptoms.
- Other treatments include psycho-education, family intervention, CBT
, Cognitive profile
- Wide range of cognitive functions affected (MATRICS).
- Significant cognitive impairment is the norm (75-85%), but a small proportion of
patients with schizophrenia remain neuropsychologically intact.
- Cognitive deficits persist during remission (“dementia praecox” – premature
dementia).
- Deficits seem stable over the years, no further deterioration. With the exception of
elderly patients with schizophrenia, with such significant cognitive decline that
dementia will be diagnosed.
- Antipsychotics can impair cognitive functioning, but only mildly.
- Cognitive rehabilitation is an optional treatment, but not standard.
Articles
Bora et al. (2017): Duration of untreated psychosis and
neurocognition in first-episode psychosis: A meta-analysis
Neurodevelopmental model = cognitive deficits in schizophrenia are mostly a consequence
of problems in acquisition of cognitive abilities (developmental lag) during development.
Neurotoxicity hypothesis of psychosis = cognitive deficits might emerge as a consequence
of untreated active psychosis in the early years of the illness.
Duration of untreated psychosis (DUP) = time elapsing between onset of first psychotic
symptoms and initiation of first effective intervention.
- Neurotoxicity hypothesis suggests that longer DUP can lead to structural brain
changes and cognitive deficits in first-episode psychosis (FEP).
- The meta-analysis of 27 studies found no significant correlation between DUP and
global cognition.
- The only domain significantly correlated with DUP was planning/problem-solving
ability.
- Findings are therefore consistent with the neurodevelopmental hypothesis of
schizophrenia and not with the neurotoxicity hypothesis.
- Instead, longer DUP might be a severity marker of poor prognosis, rather than being
the cause of poor outcome.
Halverson et al. (2019): Pathways to functional outcomes in
schizophrenia spectrum disorders: Meta-analysis of social cognitive
and neurocognitive predictors
- Prior research suggests a strong link between functional outcomes in schizophrenia
and impairments in social cognition (SC) and neurocognition (NC).
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