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Cognitive Neuropsychiatry Full Exam Notes - Utrecht University

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Course
Cognitive Neuropsychiatry (201800819)

Institution
Universiteit Utrecht (UU)

Cognitive Neuropsychiatry Exam notes covering all topics: Body perception in Anorexia, Dissociative Disorders, Borderline Personality Disorder, Post Traumatic Stress Disorder, Schizophrenia Spectrum Disorder, Hallucinations, Psychosis, Aggression, Psychopathy, Social Hierarchy, Aggression, Morality...

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Uploaded on February 27, 2024
Number of pages 7
Written in 2023/2024
Type Class notes
Professor(s) Chris dijkerman
Contains All classes

anorexia
dissociative disorders
ptsd
schizophrenia
psychosis
psychopathy
empathy
body integrity dysphoria
body integrity identity
aggression
borderline personality disorder
post traumatic stress disor

Institution
Universiteit Utrecht (UU)
Education
Neuropsychology
Course
Cognitive Neuropsychiatry (201800819)

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BID in ANOREXIA
- AN diagnosis: (A) limited food intake (B) Fear gaining weight (C) Disturbed perception/experience of body
- Body perception: see/feel/think about own body  current treatment CBT (cognition/affect)  not perception
(know/feel)
- AN = multisensory disorder  more severe than assumed
- Body representation: abstract collection of body perceptionsintegratesuses sensory inputblueprint of
body/size conscious & unconscious main function to use & move body + protect from harm not an image
o Body cognitions: emotions/attitudes/semantics
o Body perception: visual/tactile/feeling
o Body action: planning/execute motor action
- Homunculus: somatosensory/motor representation on brain rescaled using body representation
- Body awareness: body in spacelocation/coordination based on size
- AN: disturbed body size stored in brain’s body representation affects multiple senses & modalities
o Tactile Size perception: caliper overestimated in AN different receptor density and sensitivity more
sensitive but less specificimpact tactile processing receptors relay info to brain size model of object is
projected onto size in distorted body representation feel bigger
o Body Scaled Action: move body through door/crowds rotate at 40%  brain uses overestimated body size
representation (which is larger) experience self as larger
- Treatment: use perceptual distortions to improve/treat AN (RHI) synchronous = ownership  estimate hand width
pre/post RHI  change occurs in both conditions  entire VR body overestimation normalizes and remains at FU 
altered perception in body size is flexible and remains stable over time even emotional body parts & asynchronous
 not linked to body ownership  not treatment
- Intervention: hoop training choose fits body coach through size smaller over time direct evidence forced to
actually experience body size (think/talk/see/move/feel) = multisensory visual size estimation + tactile size estimation
+ action planning
Study 01: study full scope of body representation in 4 domains of BID (attitudes/visual/tactile/affordance perception) 
visual size estimation (VSE); Tactile Size Estimation (TSE); Hoop Task (HT)  HC, AN, Remitted
- Incorrect notion of body size = body image disturbance  develop/maintain ED + complicates recovery remitted
- No standard treatment targeting BID in AN  bodily experience persists after treatment possible trait factor (stable
pattern thoughts/emotions over long period)
- AN: stronger negative attitudes VSE: difference across groups AN/Remitted/HC TET: no difference across groups
(unclear)  HT: AN overestimated more than Remitted
- Confirms BID in remitted AN in visual perception and affordance perception but not in body attitudes
- Multiple sensory domains in BID can improve efficiency of conventional treatments
Study 02: full body illusion (FBI) for emotional body parts  AN showed less overestimation after FBI for circumference on
emotional/non-emotional parts also asynchronous & at FU disturbed body size experience in AN is flexible and can be
changed
- AN treatment does not target multisensory disturbance body representation: experience body & size incl. body
image (perceptual representation) + body schema (motor action)
- Overestimate tactile/haptic perception/integration of visual & proprioceptive info/ body scaled action/ interoceptive
awareness, sensitivity  cross-modal integration of sensory signals is disturbed
- Seeing touch on fake body while being touched on actual body = integrates 2 separate streams
- Initial overestimation in RHI normalizes after multisensory body illusion make size estimation on most recent visual
input  discrepancy between knowing & feeling their size (e.g, body experience) unaffected structural body
- Pre-FBI: AN misestimated width/circumference Post-FBI: decreased misestimation FU: size estimates normalized
change from pre-to-FU was largest in AN FBI alters body size perception positively affects persistent body size
disturbance in AN possible to change embodiment does not result in fake body being added to body
representation
- AN have weaker central coherence to HC (poor global processing) more detailed focused to specific body parts 
visual processing bias (overestimates body size) by blocking visual input: body estimates normalize (shift to other
senses) illusion is not related to improved body size but experimental setting is NB.
Aetiologias of Dissociative Disorders (DID)
- Dissociation: outer body/unreality/memory lapse  amnesia (forget) / absorption (focus) / derealization or
depersonalization (word/self not real)  frequency & intensity = clinical threshold
- Dissociative Amnesia: cannot recall info during trauma
- Dissociative Fugue: unplanned trips  cannot recall past  new characteristics  cannot recall the fugue state
- Reason for dissociation: sleep deprivation/trauma protection/coping high emotion intensity escape  depends on
severity & duration of abuse  more affected in critical periods
- Dissociative Identity Disorder (DID): how valid is identity fragmentation  vulnerabilities: suggestibility/ fantasy-
proneness  treatment lengthy & ineffective

, - Structural Dissociation Model (Trauma model): childhood abuse identity development dissociation don’t
develop coherent identity split to deal with trauma  Treatment: map identities  establish collaboration 
integrate into 1
- Socio-Cognitive Model (Vulnerability model): mood swings/lack behaviour control  social learning/culture factors
confused & want explanation highly suggestible play into fantasy treatment: focus on symptoms don’t
encourage separation
- Inter-Identity Amnesia: recurrent gaps in memory = inconsistent with normal forgetfulness implicit memory task
o Recall list A  Recall List B  objective transfer of information
o Use trauma related words  recollect more negative related words (same as HC)
o Evaluative conditioning: pair neutral image with negative/positive stimulus  learn words & connotations
o Affective priming: target stimuli is facilitated if prime + target have same affective valence  DID = primed
o No objective evidence for inter-identity amnesia
- New treatment: Schema Therapy: rapid shift in emotion/behaviour (like BPD) operationalized as modes in DID
express dysfunctional modes aim to develop more functional modes & replace maladaptive coping transdiagnostic
 focus on what function the identify shift is causing
- Trauma is not sufficient nor necessary to develop DID
- DSM-5: (1) inter-identity amnesia (unproven)  (2) separate identity states (difficult to prove)
- Neuroimaging: risk of cherry picking/post-hoc reasoning reverse inference (brain activity infer function)
Study 01: DID 2/more distinct personality states + discontinuity in self + recurrent memory gaps
- Psychodynamic therapy: (1) safety/stabilize (2) trauma confronted (3) identity integrated/rehab 
co-consciousness/communication/integrate need less stress, ego strength, social support
lengthy/dropout/delayed
- Schema therapy: DID experience compartmentalized identities no proof of inter-identity amnesia (intact memory
pathways) shifts in feelings/emotions/behaviour mimic BPD/PTSD/PD  role of therapeutic relation for corrective
experience  emphasize consequence of early neglect/abuse and explain drastic shifts  normalize identities 
reframe as modes  robust/low dropout  symptom reduction  adapt protocol for DID  identify identities
underlying needs  imagery to process trauma early (overcome cognitive avoidance)
Study 02: Trauma model: causal link between trauma & dissociation  Socio-cognitive model (fantasy-prone, suggestibility,
media, cognitive failure) strengths/limitations  link dissociation & sleep disturbance, hyper-associativity, set shifts,
deficits in meta consciousness, self-regulation  transtheoretical variables
- Transtheoretical/Transdiagnostic Framework: beyond TM/SCM advance etiology (metaconsciousness, cognitive
association, affective processes, emotion regulation, sleep)
- TM: dissociation = unconscious defense/coping  automatic  escape aversive event  difference in how trauma is
defined, correlation variable, no objective evidence of abuse, overlap with other disorders
- SCM: tendency to over-report/exaggerate  not objectively measured mixed findings
- Commonality: DID do not really experience multiple indwelling identities despite their subjective experience 
decreased connectivity/coherence in brain (less integrated mental functioning) disorder of self-understanding
- Meta consciousness: aware and comprehend own mental state and infer state of others (ToM)  link subjective
experience and behaviours, cognition, affect, situation antecedents  inability to reflect  fundamental attribution
error = attribute shifting cognitive-emotional-behavioural sets to multiple selves
- Self-control/self-regulation: poor executive control, self-regulation, cognitive inhibition  especially in emotional
contexts  poor parent-child attachments = cannot regulate emotions  negative emotions disrupt cognitions
- Hyper-associativity: activation & fluency of semantically & emotionally related concepts (associational threads) rapid
shift between overmodulated & under modulated emotional states automatic cognitive-behavioural-affective
association networks  associative identity disorder = integrative/associational processes
- Set switching: difficulty in sustained attention, integrating thoughts, coherent interpretations  inefficient memory
inhibition  forgetting  avoidance based set shifts = create distance/separation
- Sleep-Wakefulness: adverse events and negative emotions disrupt the sleep-wake cycle  non-trauma pathway to
dissociation  longer REM  poor sleep quality  affects daily neurocognitive activity (EFs and emotion regulation)
- Stress/Trauma: adverse events disrupt sleep  depersonalization  hyperassociation
- Dissociation in BPD: unstable self image  stress related paranoid ideation / dissociation / sleep problems
- Dissociation in Schizophrenia: sleep disturbance  unusual experiences  associational processes
- Biological etiology of dissociation: R dlPFC activated & ACC inhibited  damaged connections
- DID: hypo-aroused state (overmodulated emotion regulation) – EFs/Attention/memory/learning  hyper-aroused
state (under modulated emotion regulation) – failed prefrontal inhibition  overmodulated state to under modulated
state triggers hyper association
Body Plasticity in Borderline Personality Disorder
- BPD: (1) intense/unstable moods (2) impulsive (3) oversimplified BW thinking  unstable sense of self  radical life
changes  misinterpret actions of others  idealization/devaluation
- Functional impairments: relationship with self & others
- Treatment: CBT  symptoms studied in isolation  not managed as whole
- Main symptoms: (1) identity disturbance (2) dissociative disturbance (3) extreme mood (4) avoid abandonment

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