Week 1 Introduction (No literature)
Lecture notes
Lecture 1 - Introduction - 11 September
Exam
7-10 Open questions
Answer in Dutch/English
Historical perspective
Before 1800
No medication, doctors involved
1790 - French revolution
Human rights more taken in account
Moral treatment
Contact with psychiatric disorders → psychotherapy
1860 researching psychiatry (linking brain to behavior)
Malfunctioning brain to brain disturbance
1890 - Classification of Kraeplin
First close to describe as DSM
First calling Schizophrenia
1880 - hypnosis
Catharsis: relieve yourself from your problems
1890 - Freud Psycho-analysis
1900 - Biological psychiatry
ECT: persistent depression guidelines method.
Lobotomy: pierce with sharp thing in frontal lobe
Malfunction in this area, you will be quit relaxed (no higher
functions)
Relieve complaints of people with mental disorders
1940 - Psychopharmaceutic
Chlorpromazine - antipsychotic drugs = proof for brain dysfunction
Nowadays: psychosis medication for lifelong >2 psychoses. More
balancing the advantages and disadvantages if psychosis is stable
for 3 months or longer.
1950 - Introduction DSM
, Classify people, to find labels what fits the person best. Not
helping why people are in a specific situation and why are difficulties
in functioning?
Specific wishes of person, symptoms and social functioning is
needed for treatment!
1960 - Neuropsychology in psychiatry
Schizophrenia
Severe cognitive impairments in psychotic disorder and
comparable with neurological disorders (TBI).
First attempt of cognitive training in people with
schizophrenia.
Difficulties with allocated effort to specific tasks →cause to
much energy of keep level up to pay attention
Modern Psychiatry
Brain and environment interaction (earlier nature vs nurture)
Mental disorders never exist on a vacuum. Always personal history
and social context
Criticism if you don’t fit in a box, you get a label with a disorder. A
lot of expectations for people on how to live. More awareness of
interaction with individuals and the context. Less try to change the
individual
Recovery beyond symptomatic remission - treatment
Try to avoid internal voices, relieve delusional thoughts. =
symptomatic recovery (doctors) → Change over the years:
Functional recovery = able to function in society (job,
study), participating again in their roles → role of
neuropsychologists increasing as clinician
Cognitive remediation
You can reach functional recovery without symptomatic
recovery.
Personal recovery = living a life with our own purposeful
lives, values and spirituality. Strive for the person you want to
be
NIMH RDoC:
Biological disorders: dimensions and focus on domains/units
of analysis
Transdiagnostic framework: how to think about
disorders. Less using labels
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 nervous system (brain, spinal cord and nerves)
Neuropsychology: psychological specialty concerned with relationship
between behavior emotion cognition on the one hand and brain function
on the other
Traditional neuropsychology: Link brain regions/lesions to specific behavior.
Knowledge on the role of brain areas in mental processes → moved away from
specific brain part in these days
Neuropsychology as profession
Generating hypothesis on underlying mechanisms of symptoms
Understanding why person is acting ina specific way and which
cognitive functions involves
Understand role of cognitive processes in the etiology (onset) and
presentation of psychiatric disorders
Before onset of psychotic episode, increase in impairment in social
cognition and unable to read mind of other people = Theory of
Mind→ you can become untrust people and reject your own ideas
on others. What you think will happen and explain the onset of
paranoid
Understand clinical behavioral and phenomenological correlates of
neuropsychological impairment
Doing individual neuropsychological assessments (profile of strengths and
weaknesses)
How psychiatrists seen neuropsychology
Underutilized resource → make yourself visible
Establishing deterioration in cognitive functioning
Making differential diagnosis → hard for NP because severe impairment can
come along with a lot of NP disorders. No specific profiles for disorders
Facilitating improved outcomes
Problems/questions in psychiatry
Not only based on neuropsychological assessment making a DSM 5 label
(or differential diagnosis)
More information needed about social context, substance use,
family, education, how problem arises
Making predictions if someone is able to go back to previous level of
functioning in social, work
Difficult to make predictions based on the NP tests
, Cognitive limitation should be taken into account in treatment of this
person
Extra break through when someone has severe memory problems.
Make more summaries, write things down
Evaluate effect of pharmacological interventions on cognitive functioning
Repeat assessment and stop treatment
In parallel version (learning effect)
Interpretation errors
NP tests measure specific functions, poor performance on a single test.
Lower score
Deficit on specific test
Or poor attention during test
Abnormal test scores is not related to a specific bain dysfunction
Hypoactivity (less) during functional imaging with cognitive activation task
suggests regional brain dysfunction
Schizophrenia: making MRI scan and do Tower of London test →
hypoactivation in frontal lobe compared to normal population
Did not understand task, not allocating → a lot is possible
Interpretation eros in neuropsychiatry
Directly link brain areas and disorders/personality/sexual orientation: neo-
phrenology = misinterpretation
Making a psychiatric diagnosis based on neuroimaging studies = not
possible
Reductionism: psychological conditions are brain disorders associated with
a state of chemical imbalance
Feeling depressed: me of my brain? Insufficiency dopamine level in
brain, but there are more neurotransmitters and brain regions
involved
Assuming an association between functional impairments and NP
impairment is disorder-specific
Social cognition leads to poor social functioning in schizophrenia is
NOT the case. Links between cognitive domains are transdiagnostic
and does not have anything to do with the label a person has
Assuming NP dysfunctions causes such functional impairments
Not knowing the direction based on test scores
Therapy/treatment
, Cognitive remediation = brain training by using it over it = drill and
practice. Use it or lose it. People gets better on specific task/exercise → no
generalization
Helping people to think of strategies. To wipe out cognitive
impairments. Can you visuale the things you have to remember?
In neurological setting, not in psychiatry setting. Effect Size as big as
CBT, but specified to a specific domain.
Optional treatment for psychosis
NP test data used to develop treatment strategies tailored for an
individual's specific cognitive strengths and deficits
Lecture notes
Lecture 1 - Introduction - 11 September
Exam
7-10 Open questions
Answer in Dutch/English
Historical perspective
Before 1800
No medication, doctors involved
1790 - French revolution
Human rights more taken in account
Moral treatment
Contact with psychiatric disorders → psychotherapy
1860 researching psychiatry (linking brain to behavior)
Malfunctioning brain to brain disturbance
1890 - Classification of Kraeplin
First close to describe as DSM
First calling Schizophrenia
1880 - hypnosis
Catharsis: relieve yourself from your problems
1890 - Freud Psycho-analysis
1900 - Biological psychiatry
ECT: persistent depression guidelines method.
Lobotomy: pierce with sharp thing in frontal lobe
Malfunction in this area, you will be quit relaxed (no higher
functions)
Relieve complaints of people with mental disorders
1940 - Psychopharmaceutic
Chlorpromazine - antipsychotic drugs = proof for brain dysfunction
Nowadays: psychosis medication for lifelong >2 psychoses. More
balancing the advantages and disadvantages if psychosis is stable
for 3 months or longer.
1950 - Introduction DSM
, Classify people, to find labels what fits the person best. Not
helping why people are in a specific situation and why are difficulties
in functioning?
Specific wishes of person, symptoms and social functioning is
needed for treatment!
1960 - Neuropsychology in psychiatry
Schizophrenia
Severe cognitive impairments in psychotic disorder and
comparable with neurological disorders (TBI).
First attempt of cognitive training in people with
schizophrenia.
Difficulties with allocated effort to specific tasks →cause to
much energy of keep level up to pay attention
Modern Psychiatry
Brain and environment interaction (earlier nature vs nurture)
Mental disorders never exist on a vacuum. Always personal history
and social context
Criticism if you don’t fit in a box, you get a label with a disorder. A
lot of expectations for people on how to live. More awareness of
interaction with individuals and the context. Less try to change the
individual
Recovery beyond symptomatic remission - treatment
Try to avoid internal voices, relieve delusional thoughts. =
symptomatic recovery (doctors) → Change over the years:
Functional recovery = able to function in society (job,
study), participating again in their roles → role of
neuropsychologists increasing as clinician
Cognitive remediation
You can reach functional recovery without symptomatic
recovery.
Personal recovery = living a life with our own purposeful
lives, values and spirituality. Strive for the person you want to
be
NIMH RDoC:
Biological disorders: dimensions and focus on domains/units
of analysis
Transdiagnostic framework: how to think about
disorders. Less using labels
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 nervous system (brain, spinal cord and nerves)
Neuropsychology: psychological specialty concerned with relationship
between behavior emotion cognition on the one hand and brain function
on the other
Traditional neuropsychology: Link brain regions/lesions to specific behavior.
Knowledge on the role of brain areas in mental processes → moved away from
specific brain part in these days
Neuropsychology as profession
Generating hypothesis on underlying mechanisms of symptoms
Understanding why person is acting ina specific way and which
cognitive functions involves
Understand role of cognitive processes in the etiology (onset) and
presentation of psychiatric disorders
Before onset of psychotic episode, increase in impairment in social
cognition and unable to read mind of other people = Theory of
Mind→ you can become untrust people and reject your own ideas
on others. What you think will happen and explain the onset of
paranoid
Understand clinical behavioral and phenomenological correlates of
neuropsychological impairment
Doing individual neuropsychological assessments (profile of strengths and
weaknesses)
How psychiatrists seen neuropsychology
Underutilized resource → make yourself visible
Establishing deterioration in cognitive functioning
Making differential diagnosis → hard for NP because severe impairment can
come along with a lot of NP disorders. No specific profiles for disorders
Facilitating improved outcomes
Problems/questions in psychiatry
Not only based on neuropsychological assessment making a DSM 5 label
(or differential diagnosis)
More information needed about social context, substance use,
family, education, how problem arises
Making predictions if someone is able to go back to previous level of
functioning in social, work
Difficult to make predictions based on the NP tests
, Cognitive limitation should be taken into account in treatment of this
person
Extra break through when someone has severe memory problems.
Make more summaries, write things down
Evaluate effect of pharmacological interventions on cognitive functioning
Repeat assessment and stop treatment
In parallel version (learning effect)
Interpretation errors
NP tests measure specific functions, poor performance on a single test.
Lower score
Deficit on specific test
Or poor attention during test
Abnormal test scores is not related to a specific bain dysfunction
Hypoactivity (less) during functional imaging with cognitive activation task
suggests regional brain dysfunction
Schizophrenia: making MRI scan and do Tower of London test →
hypoactivation in frontal lobe compared to normal population
Did not understand task, not allocating → a lot is possible
Interpretation eros in neuropsychiatry
Directly link brain areas and disorders/personality/sexual orientation: neo-
phrenology = misinterpretation
Making a psychiatric diagnosis based on neuroimaging studies = not
possible
Reductionism: psychological conditions are brain disorders associated with
a state of chemical imbalance
Feeling depressed: me of my brain? Insufficiency dopamine level in
brain, but there are more neurotransmitters and brain regions
involved
Assuming an association between functional impairments and NP
impairment is disorder-specific
Social cognition leads to poor social functioning in schizophrenia is
NOT the case. Links between cognitive domains are transdiagnostic
and does not have anything to do with the label a person has
Assuming NP dysfunctions causes such functional impairments
Not knowing the direction based on test scores
Therapy/treatment
, Cognitive remediation = brain training by using it over it = drill and
practice. Use it or lose it. People gets better on specific task/exercise → no
generalization
Helping people to think of strategies. To wipe out cognitive
impairments. Can you visuale the things you have to remember?
In neurological setting, not in psychiatry setting. Effect Size as big as
CBT, but specified to a specific domain.
Optional treatment for psychosis
NP test data used to develop treatment strategies tailored for an
individual's specific cognitive strengths and deficits
