5a. General & Depression (neuropsychiatry)

Question 1

In all neuropsychiatric disorders discussed there is a common deficit in EF, which might be a … ?

Answer 1

Transdiagnostic intermediate phenotype (this may be a marker predictive of these disorders.

Question 2

Where are the frontal-subcortical networks located (involved in neuropsychiatry)?

Answer 2

EF networks are located in the frontal region, projecting to subcortical structures (striatum, basal ganglia, thalamus)

Question 3

Which 3 networks are involved in the manifestations of neuropsychiatric disorders where there is case of hypo-activity?

Answer 3

1. Dorsolateral PFC network: EF
2. Lateral orbitofrontal network: disinhibition, personality changes
3. Anterior cingulate cortex/network: apathy (absent motivation)

Question 4

Which 4 neurotransmitters are involved in neuropsychiatric disorders? And on what cognitive processes do these rely?

Which medication can be used for what neurotransmitter?

Answer 4

1. Dopamine: set-shifting, inhibiton, attention
2. Norepinephrine: arousal
3. Serotonin: general executive control, attention
4. Acetylcholine: cognitive flexibility, attention

Medication:

1. Stimulants such as methylphenidate (Ritalin)
2. Atomoxetine (Strattera) for MDD & ADHD
3. Anti-depressants, SSRI (Prozac)
4. Anti-psychotics

Question 5

Which cognitive domain is mostly affected in depression?

Answer 5

EF, which are used all the time. There is a significant relationship between depression severity and EF deficits.

Question 6

Which 2 biased information processing phenomena can be distinguished in depression?

Answer 6

1. Attentional bias = people that already are feeling down, tend to be more focused on negative stimulu and information (mood > attention)
2. Mood congruency effect = we are better able to remember information that is congruent with out mood than neutral information

Question 7

What can trigger the cascade in developing depression? (cascade of 5 things)

Answer 7

Genetic/personality vulnerability > environmental trigger can activate schema’s > these are related to the biased information processing > this creates new negative emotions > and this can reactivate the schema’s again.

Question 8

DSM-5 criteria Depression

1. Depressed mood or loss of interest/pleasure for >2 weeks
2. > 4 of the following … (7x)

Answer 8

1. Change in weight or appetite
2. Insomnia or hypersomnia
3. Psychomotor retardation or agitation
4. Loss of energy or fatigue
5. Worthlessness or guilt
6. Impaired concentration or indecisiveness
7. Suicidal ideation/thoughts of death

Question 9

Cognitive impairment profile (explain in more detail):

1. Cognitive flexibility
2. Inhibition
3. Updating
4. Verbal/visuospatial WM
5. Fluency
6. Memory
7. Impaired reversal learning
8. Processing speed
9. Planning (no explanation)

Answer 9

1. Cognitive flexibility
2. Inhibition
3. Updating
4. Verbal/visuospatial WM
5. Fluency
6. Memory
7. Impaired reversal learning
8. Processing speed
9. Planning (no explanation)

Explanations:

1. Issue with task impurity
2. Cognitive inhibition > motor inhibition
3. Issue with updating the content of WM to verify what is still relevant for your goal and what information is irrelevant
4. Mainly the manipulation part is affected (and not maintenance)
5. Mainly semantic, but also phonemic
6. Passive memory (recognition) is better than the retrieval and encoding part
7. Inability to disengage from maladaptive behavior
8. Mostly general on all responses of a NPA

Question 10

What are observations of a depressed person during a NPA? (6x)

Answer 10

1. Slow workspace
2. Fatigue, loss of energy
3. Lack of motivation
4. Difficulty initiating efficient cognitive strategies
5. Indecisiveness
6. Negative self-perception

Question 11

Depression or dementia?

1. Level of insight
2. Observations (3x)
3. Affect
4. Orientation

Answer 11

1. In depression there is awareness of shortcomings, in dementia not, with a tendency toward hushing up failures.
2. In depression (1) limited cooperation, makes impression of reduced effort (2) stereotype answers like ‘I do not know’ (3) inconsistent performance. In dementia (1) often good cooperation, wants to ‘put up a good show’ (2) often erroneous/incorrect answers (3) consistent performance.
3. In depression this is constant gloomy/depressed, while in dementia this is changeable.
4. In depression this is good but slowed down, while in dementia this is disturbed.