After the course the student knows:
- 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 cognitive rehabilitation of patients
with psychiatric disorders
Historical Perspective on Psychiatry
- Before 1800 patients in institutions, no doctors involved.
o No real psychiatry, symptoms were not seen as a disease. People were just put away
and circumstances were terrible.
- 1790s French revolution (Pinel), moral treatment (psychotherapy).
o People started to get more awareness regarding psychiatric disorders. Pinel saved
people with mental disorders from their chains. ‘we should treat them as normal
people’. First time doctors were involved in treatment.
- 1860s German universities start researching psychiatry (moral behaviour)
o They labeled the problems that we see in psychiatric patients as a lack in moral
behaviour. Over the time this changed to a more biological perspective, so now we
see it as a brain disease.
- 1890s Classification Kraepelin (Kompendium: basis for DSM)
- 1880s Hypnosis/Catharsis (Janet): Mainly focused on patients with posttraumatic stress and
anxiety disorders.
- 1890s Freud’s psycho-analysis: More space for psychosocial treatment.
- 1900s biological psychiatry (ECT, Lobotomy): More biological approach.
- 1940s Psychopharmaca (chlorpromazine: first antipsychotic drugs): ‘proof of brain
dysfunction’ – important milestone. It made the patients more quiet (before that they
screamed a lot).
- 1950s Introduction DSM:
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,Modern Psychiatry
- Brain x Environment
o It is not only the brain that is involved, but it is important that there is an interaction
between the brain and the environment. Genes are not the whole story. Nowadays
also more focus on the environment, the context.
- Recovery beyond symptomatic remission:
o 20 years ago we focused on symptomatic remission: the most important outcome
would be that the symptoms would be in remission. Nowadays treatment should
also aim at other aspects, as participation in society, or leading a fulfilling life. A
patient can see himself as recovered (has a job etc.), although still hearing voices.
- Psychosocial and pharmacological treatments:
o Psychosocial treatments have become increasingly popular (e.g. CBT, cognitive
remediation). 20 years ago people with schizophrenia would not be treated with
CBT, but nowadays we do use this and treat the delusions people have as
dysfunctional believes, like we treat any other dysfunctional believe with CBT.
- 2013 DSM 5 (categorization)
o Uses categories. Would be better to have dimensions.
- NIMH RDoC (biological disorders: dimensions and focus on domains / units of analysis)
o Reply to the DSM-5. Also a system to describe mental disorders, but then from a
neuroscience perspective. This system does not classify patients, but describes them
on the base of specific dimensions (e.g. cognitive / social functioning).
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 specialty concerned with relationship between behaviour, emotion,
and cognition on the one hand, and brain function on the other.
Neurology Psychiatry
Diseases of the brain’s anatomic structure Diseases of the mind
Structural diseases Functional diseases
Localization in the brain Non-localization in the brain (localization not
possible)
Clinical-pathological correlation No clinical-pathological correlations
Distinct syndromes and disease entities, Unclear disease entities, demarcated by clinical
demarcated by neuroanatomical findings observation (unclear if there is an underlying
disease)
Organic brain Psychological brain
Traditional Neuropsychology
- Assessment traditionally focusses on determining specific changes in mental processes after
discrete brain lesions
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, - Helped to determining locus of lesion
- Knowledge on the role of brain areas in mental processes
- Focus on neurological patients
- Often worked together with neurologist
How do 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)
o E.g. when someone is hearing voices, processes like source monitoring are involved.
- Understanding the clinical, behavioral, and phenomenological correlates of
‘neuropsychological impairments’
o What does it look like, how do people behave with certain impairments
o Neuropsychologist can help to translate impairments into behavioural aspects
- Doing individual neuropsychological assessments (profile of strengths and weaknesses)
How psychiatrists see us
- Useful but underutilized resource
- Establishing deterioration in cognitive functioning
- Making differential diagnosis
- Facilitating improved outcomes
- Psychiatrists need to recognize cognitive impairments and to understand common
neuropsychological tests
As a neuropsychologist you can only describe the cognitive impairments of a patient, and you can
never establish a psychiatric diagnosis on the basis of neuropsychological testing. You can only say
that some symptoms are in line with symptoms that a lot of people with a certain diagnosis deal
with.
Assessment questions in psychiatry
- What is the DSM 5 label? (can you make a differential diagnosis?)
o You should include e.g. MINI-scan – an interview
- Will this person be able to go back to school/work?
- Are there cognitive limitations that should be taken into account in the treatment of this
person?
- Can you evaluate the effect of pharmacological interventions on cognitive functioning?
- Are the cognitive impairments due to ADHD or drug use?
- Please assess cognitive functions!
Cognitive dysfunctions are not impairment specific, can be caused by many factors.
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