Lecture slides
Lecture 1: introduction
Settings neuropsychologist:
General hospital
School
Mental health care organisation
Nursing homes
Historical perspective on psychiatry
o Before 1800 patients in institutions, no doctors involved
o 1790s French revolution (Pinel), moral treatment (psychotherapy)
o 1860s German universities start researching psychiatry, disorders were recognised as
biological disorders with involvement of the brain (linking brain to behaviour)
o 1890s Classification Kraepelin (basis for DSM)
o 1880s Hypnosis/Catharsis (Janet) back to childhood trauma, important predictor
of psychiatric disorders in later life
o 1890s Freud’s psychoanalysis
o 1900s biological psychiatry (ECT, Lobotomy)
o 1940s Psychopharmaca (chloorpromazine: first antipsychotic drugs): ‘proof for brain
dysfunction’
o 1950s Introduction DSM
o 1960s neuropsychology in psychiatry (e.g., schizophrenia
Modern psychiatry
brain (body) X environment interaction, for example trauma (environment)
influences the body (brain)
recovery beyond symptomatic remission e.g., focus on quality of life, participation
in society
the combination of psychosocial and pharmacological treatments (however, reduce
medication as soon as possible)
2013 DSM 5 (categorisation)
NIMH RDoC (biological disorders)
Goal of NIMH RDoC: understanding the nature of mental health and illness in terms of
varying degrees of dysfunction in fundamental psychological/biological systems. This is to
provide a different way of thinking about mental disorders without focussing on the label.
This framework is developed for research. When using labels, there is a lot of comorbidity.
Definitions:
psychiatry: medical specialty concerned with the diagnosis and treatment of mental
illness.
neurology: medical specialty concerned with the diagnosis and treatment of
disorders of the nervous system (brain, spinal cord and nerves).
, Neuropsychology: psychological speciality concerned with the relationship between
behaviour, emotion and cognition on the one hand, and brain function on the other.
Traditional neuropsychology
assessment traditionally focusses on determining specific changes in mental
processes after discrete brain lesions
helped to determine locus of lesion
knowledge on the role of brain areas in mental processes
focus on neurological patients
How we see ourselves
generating hypotheses on underlying mechanisms of symptoms
understanding the role of cognitive processes in the etiology and presentation of
psychiatric disorders (biomedical model)
understanding the clinical, behavioural, and phenomenological correlates of
‘neuropsychological impairments’
doing individual neuropsychological assessments (profile of strengths and
weaknesses)
How psychiatrists see us
useful but underutilised resource
establishing deterioration in cognitive functioning
making differential diagnosis (however, not really true because there is a lot of
heterogeneity and not every schizophrenic has the same brain activity etc.)
facilitating improved outcomes
psychiatrists need to recognise cognitive impairments and to understand common
neuropsychological tests
Interpretation errors in neuropsychiatry
Neuropsychological tests measure specific functions, and poor performance on a
single test indicates a specific neuropsychological deficit
abnormal neuropsychological test performance indicates specific regional brain
dysfunction
‘hypoactivity’ during functional imaging procedures with cognitive activation tasks
suggests regional brain dysfunction
Therapy
cognitive remediation: training people to overcome their cognitive impairments
neuropsychological test data can be used to develop treatment strategies tailored
for an individual’s specific cognitive strengths and deficits (‘rate limiting factors’)
Lecture 2: schizophrenia
, DSM-5 criteria:
A. two (or more) of the following:
1. delusions
2. hallucinations
3. disorganised speech
4. grossly disorganised or catatonic behaviour
5. negative symptoms
etc.
The content of delusions and hallucinations differs between cultures.
Many with psychotic disorders have poor insight.
Using symptom dimensions helps you pick your treatment targets.
Schizophrenia/psychotic symptoms appears in late adolescence or early adulthood (18-25).
Apart from classification, psychotic disorders can also be thought of in clinical stages
(severity). Treatment should be targeted to the specific stage of the disorder.
Treatment is also about normalising the symptoms instead of trying to get rid of them.
Some even like the voices they hear.
Psychological treatments according to clinical guidelines
standard:
o psycho-education
o family interventions
o cognitive behavioural therapy (CBT)
optional (examples):
o cognitive remediation
o rTMS
There is no such thing as a cognitive profile for psychotic disorders. There is a wide range of
cognitive functions that are affected. Moreover, cognitive deficits cannot be explained by
the presence of hallucinations, delusions, or apathy. A proportion of patients with
schizophrenia appear to remain neuropsychologically intact.
The cognitive impairments are not due to medication.
Overall, all the developmental milestones are achieved later in those with schizophrenia.
With every stage in the disorder, the cognitive impairments tend to increase. In earlier
writing, it was believed that there is intellectual decline. For example, the term ‘dementia
praecox’ implies a continuing cognitive decline. However, this is not true. After the initial
drop of cognitive decline around first onset, there is stabilisation or even improvement. We
can’t say that this is a progressive illness.
following the onset of the first psychotic episode, most patients experience a substantial
decline in cognitive functions compared to their premorbid level. Most cognitive deficits
Lecture 1: introduction
Settings neuropsychologist:
General hospital
School
Mental health care organisation
Nursing homes
Historical perspective on psychiatry
o Before 1800 patients in institutions, no doctors involved
o 1790s French revolution (Pinel), moral treatment (psychotherapy)
o 1860s German universities start researching psychiatry, disorders were recognised as
biological disorders with involvement of the brain (linking brain to behaviour)
o 1890s Classification Kraepelin (basis for DSM)
o 1880s Hypnosis/Catharsis (Janet) back to childhood trauma, important predictor
of psychiatric disorders in later life
o 1890s Freud’s psychoanalysis
o 1900s biological psychiatry (ECT, Lobotomy)
o 1940s Psychopharmaca (chloorpromazine: first antipsychotic drugs): ‘proof for brain
dysfunction’
o 1950s Introduction DSM
o 1960s neuropsychology in psychiatry (e.g., schizophrenia
Modern psychiatry
brain (body) X environment interaction, for example trauma (environment)
influences the body (brain)
recovery beyond symptomatic remission e.g., focus on quality of life, participation
in society
the combination of psychosocial and pharmacological treatments (however, reduce
medication as soon as possible)
2013 DSM 5 (categorisation)
NIMH RDoC (biological disorders)
Goal of NIMH RDoC: understanding the nature of mental health and illness in terms of
varying degrees of dysfunction in fundamental psychological/biological systems. This is to
provide a different way of thinking about mental disorders without focussing on the label.
This framework is developed for research. When using labels, there is a lot of comorbidity.
Definitions:
psychiatry: medical specialty concerned with the diagnosis and treatment of mental
illness.
neurology: medical specialty concerned with the diagnosis and treatment of
disorders of the nervous system (brain, spinal cord and nerves).
, Neuropsychology: psychological speciality concerned with the relationship between
behaviour, emotion and cognition on the one hand, and brain function on the other.
Traditional neuropsychology
assessment traditionally focusses on determining specific changes in mental
processes after discrete brain lesions
helped to determine locus of lesion
knowledge on the role of brain areas in mental processes
focus on neurological patients
How we see ourselves
generating hypotheses on underlying mechanisms of symptoms
understanding the role of cognitive processes in the etiology and presentation of
psychiatric disorders (biomedical model)
understanding the clinical, behavioural, and phenomenological correlates of
‘neuropsychological impairments’
doing individual neuropsychological assessments (profile of strengths and
weaknesses)
How psychiatrists see us
useful but underutilised resource
establishing deterioration in cognitive functioning
making differential diagnosis (however, not really true because there is a lot of
heterogeneity and not every schizophrenic has the same brain activity etc.)
facilitating improved outcomes
psychiatrists need to recognise cognitive impairments and to understand common
neuropsychological tests
Interpretation errors in neuropsychiatry
Neuropsychological tests measure specific functions, and poor performance on a
single test indicates a specific neuropsychological deficit
abnormal neuropsychological test performance indicates specific regional brain
dysfunction
‘hypoactivity’ during functional imaging procedures with cognitive activation tasks
suggests regional brain dysfunction
Therapy
cognitive remediation: training people to overcome their cognitive impairments
neuropsychological test data can be used to develop treatment strategies tailored
for an individual’s specific cognitive strengths and deficits (‘rate limiting factors’)
Lecture 2: schizophrenia
, DSM-5 criteria:
A. two (or more) of the following:
1. delusions
2. hallucinations
3. disorganised speech
4. grossly disorganised or catatonic behaviour
5. negative symptoms
etc.
The content of delusions and hallucinations differs between cultures.
Many with psychotic disorders have poor insight.
Using symptom dimensions helps you pick your treatment targets.
Schizophrenia/psychotic symptoms appears in late adolescence or early adulthood (18-25).
Apart from classification, psychotic disorders can also be thought of in clinical stages
(severity). Treatment should be targeted to the specific stage of the disorder.
Treatment is also about normalising the symptoms instead of trying to get rid of them.
Some even like the voices they hear.
Psychological treatments according to clinical guidelines
standard:
o psycho-education
o family interventions
o cognitive behavioural therapy (CBT)
optional (examples):
o cognitive remediation
o rTMS
There is no such thing as a cognitive profile for psychotic disorders. There is a wide range of
cognitive functions that are affected. Moreover, cognitive deficits cannot be explained by
the presence of hallucinations, delusions, or apathy. A proportion of patients with
schizophrenia appear to remain neuropsychologically intact.
The cognitive impairments are not due to medication.
Overall, all the developmental milestones are achieved later in those with schizophrenia.
With every stage in the disorder, the cognitive impairments tend to increase. In earlier
writing, it was believed that there is intellectual decline. For example, the term ‘dementia
praecox’ implies a continuing cognitive decline. However, this is not true. After the initial
drop of cognitive decline around first onset, there is stabilisation or even improvement. We
can’t say that this is a progressive illness.
following the onset of the first psychotic episode, most patients experience a substantial
decline in cognitive functions compared to their premorbid level. Most cognitive deficits
