CNP articles

Question 1

What is the main goal of Cognitive Neuropsychiatry (CNP)?

Answer 1

To analyze and explain psychiatric symptoms by linking cognitive neuropsychological mechanisms with their corresponding brain structures.

Question 2

How does CNP approach psychiatric symptoms differently from traditional methods?

Answer 2

CNP focuses on individual cognitive deficits rather than broad diagnostic categories, using single-case studies and neuroimaging to connect cognitive disruptions to neural dysfunction.

Question 3

What is Capgras delusion?

Answer 3

It is the belief that a familiar person, pet, or object has been replaced by an identical impostor.

Question 4

Which theory explains the mechanisms behind Capgras delusion?

Answer 4

The two-factor theory, which involves:

1. A disconnection between recognition and emotional response.
2. Impaired reasoning processes, often involving the right dorsolateral prefrontal cortex.

Question 5

What neurophysiological evidence supports the understanding of Capgras delusion?

Answer 5

Studies show absent skin conductance responses to familiar faces, indicating a lack of emotional resonance.

Question 6

How does depression affect motivation?

Answer 6

Depression leads to difficulties in reward anticipation, effort valuation, and perceiving controllability of the environment.

Question 7

What are key neural correlates of motivational impairments in depression?

Answer 7

Dysfunctional mesolimbic dopamine pathways and reduced activation of the prefrontal cortex and anterior cingulate cortex.

Question 8

How is the Expected Value of Control (EVC) theory related to depression?

Answer 8

It explains how low expectations of reward or high perceived effort diminish cognitive control in depressed individuals.

Question 9

What does the Flexible Emotion Control Theory (FECT) propose?

Answer 9

That the lateral frontal pole (FPl) plays a crucial role in dynamically switching between emotion regulation strategies based on context.

Question 10

What brain regions support the flexible control of emotions?

Answer 10

The lateral frontal pole, dorsolateral prefrontal cortex, anterior cingulate cortex, and posterior parietal cortex.

Question 11

What computational subtypes are identified in effort-based decision-making in schizophrenia?

Answer 11

1. Bias model subgroup: Non-systematic effort allocation due to cognitive deficits.
2. Subjective value (SV) model subgroup: Systematic allocation with impairments in effort sensitivity, linked to avolition.

Question 12

How are negative symptoms like avolition reflected in task performance?

Answer 12

They lead to reduced willingness to exert effort for rewards, especially for high-reward tasks.

Question 13

How does apathy manifest in cerebral small vessel disease (SVD)?

Answer 13

Through reduced reward sensitivity rather than hypersensitivity to effort costs.

Question 14

What neuroanatomical changes are associated with apathy in CADASIL?

Answer 14

Reduced white matter integrity in tracts connecting the anterior cingulate cortex, orbitofrontal cortex, and ventral striatum.

Question 15

What are the main neurophysiological mechanisms of hallucinations?

Answer 15

1. Hyperdopaminergic states (e.g., in schizophrenia).
2. Sensory cortex hyperactivation due to sensory deprivation (e.g., in Charles Bonnet syndrome).
3. Glutamatergic imbalances affecting auditory processing.

Question 16

How can neuroimaging personalize treatment for hallucinations?

Answer 16

By identifying specific neural mechanisms (e.g., fMRI for sensory hyperactivity or PET for dopamine synthesis) to tailor interventions.

Question 17

Which brain regions are implicated in Auditory Verbal Hallucinations (AVH)?

Answer 17

The left temporal lobe (e.g., Wernicke’s area) and right inferior frontal areas (speech perception and production regions).

Question 18

What cognitive mechanisms contribute to AVH?

Answer 18

Excessive top-down processing and misattribution of inner speech as external voices.

Question 19

What neural circuits are involved in fear acquisition and extinction?

Answer 19

Fear acquisition involves the amygdala, anterior cingulate cortex, and insula. Extinction depends on the ventromedial prefrontal cortex and hippocampus.

Question 20

How does mindfulness reduce anxiety?

Answer 20

By lowering intolerance of uncertainty, reaction times, and neural responses (e.g., late positive potential) to unpredictable threats.

Question 21

How does psychosis impact identity?

Answer 21

It disrupts autobiographical memory, self-reflection, and social roles, often leading to fragmented self-perception.

Question 22

What therapeutic approaches are suggested to address identity changes in psychosis?

Answer 22

Narrative restructuring and interventions targeting metacognition.

Question 23

Which brain structures are central to self-reflection?

Answer 23

Medial prefrontal cortex, anterior cingulate cortex, and posterior cingulate cortex.

Question 24

How does schizophrenia affect self-reflection?

Answer 24

It disrupts connectivity in cortical midline structures, impairing autobiographical memory and introspective processes.

Question 25

What interventions enhance effort-based decision-making in psychiatric conditions?

Answer 25

Increasing reward salience (e.g., visual enhancements of rewards) and manipulating reward expectancy to sustain motivation.

Question 26

How did Cognitive Neuropsychiatry emerge?

Answer 26

It arose in the 1990s from the convergence of cognitive psychology, neuroscience, and clinical psychiatry to address gaps in understanding psychiatric symptoms.

Question 27

Why are single-case studies important in CNP?

Answer 27

They provide detailed insights into individual cognitive dysfunctions, linking specific neural substrates to psychiatric symptoms.

Question 28

What role does the sympathetic nervous system (SNS) play in Capgras delusion?

Answer 28

Disruptions in SNS activity contribute to the lack of emotional familiarity, as evidenced by absent skin conductance responses to familiar stimuli.

Question 29

How does the ventral temporal cortex factor into Capgras delusion?

Answer 29

It recognizes faces but fails to communicate effectively with emotional and autonomic regions, causing emotional dissociation from familiar stimuli.

Question 30

What is learned helplessness, and how is it relevant to depression?

Answer 30

It’s a state where individuals believe they cannot control outcomes, linked to medial prefrontal cortex dysfunction in depression.

Question 31

What tasks reveal motivational deficits in depression?

Answer 31

1. Monetary Incentive Delay Task: Shows reduced reward anticipation. 2. Effort Expenditure for Rewards Task (EEfRT): Depressed individuals prefer low-effort, low-reward tasks.

Question 32

What is Expected Value (EV) in reward processing?

Answer 32

EV represents the anticipated value of a reward. Mood disorder patients often show reduced EV signal activity in the prefrontal cortex.

Question 33

What is Reward Prediction Error (RPE), and how is it affected in mood disorders?

Answer 33

RPE measures the gap between expected and actual rewards. Reduced RPE activity in the ventral striatum is a marker of reward dysfunction in these conditions.

Question 34

How does the lateral frontal pole (FPl) evaluate emotion regulation strategies?

Answer 34

By monitoring ongoing strategies and alternatives to ensure adaptive switching, especially during high emotional intensity.

Question 35

What clinical applications arise from understanding the FPl’s role in emotion regulation?

Answer 35

Targeted therapies using brain stimulation or cognitive tasks to improve adaptability in psychiatric patients with emotion regulation impairments.

Question 36

What are common symptoms of reduced goal-directed behavior in schizophrenia?

Answer 36

Avolition, diminished effort allocation, and failure to adjust behavior based on rewards and effort costs.

Question 37

How does working memory correlate with effort allocation in schizophrenia?

Answer 37

Impaired working memory reduces the ability to integrate reward and probability information into decision-making.

Question 38

What distinguishes apathetic from non-apathetic CADASIL patients in effort-based tasks?

Answer 38

Apathetic patients display reduced sensitivity to low rewards but maintain effort tolerance for high rewards.

Question 39

What role does the anterior cingulate cortex (ACC) play in apathy?

Answer 39

It integrates effort and reward information, and disruptions in ACC pathways correlate with apathetic behavior.

Question 40

How are glutamate and GABA imbalances involved in hallucinations?

Answer 40

Glutamate excess triggers hallucinations, while GABA regulates their intensity and cessation.

Question 41

What treatments target hallucination mechanisms?

Answer 41

1. Dopamine modulation for hyperdopaminergic hallucinations. 2. rTMS for sensory cortex hyperactivity. 3. Cholinesterase inhibitors for hypnagogic hallucinations.

Question 42

What distinguishes external from internal Auditory Verbal Hallucinations (AVH)?

Answer 42

External AVH are perceived as originating outside the body, whereas internal AVH seem to come from within the mind.

Question 43

How does the inner speech model explain AVH?

Answer 43

AVH arise from misattributions of self-generated inner speech to external sources, due to defective corollary discharge.

Question 44

What is spontaneous recovery in fear extinction?

Answer 44

The re-emergence of conditioned fear after time has passed, even without additional conditioning.

Question 45

How can prediction errors be maximized during exposure therapy?

Answer 45

By designing exposure sessions to contradict patients’ fear expectations, strengthening inhibitory memories.

Question 46

How does tDCS modulate prefrontal-amygdala circuits in anxiety?

Answer 46

By enhancing dorsolateral prefrontal cortex activity, it suppresses hyperactive amygdala responses to threats.

Question 47

What are behavioral improvements observed under tDCS in anxious individuals?

Answer 47

Increased accuracy in tasks requiring attention to non-threatening stimuli under low cognitive load.

Question 48

How does internalized stigma affect identity in psychosis?

Answer 48

It fosters engulfment, where the illness becomes a dominant part of self-concept, exacerbating social withdrawal and self-devaluation.

Question 49

What interventions can help rebuild identity in psychosis patients?

Answer 49

Narrative restructuring and metacognitive therapy to improve coherence and integration of self-concept.

Question 50

Why is the medial prefrontal cortex (MPFC) crucial for self-reflection?

Answer 50

It processes emotional and self-relevant information, which is often disrupted in schizophrenia.

Question 51

How do posterior cingulate cortex (PCC) deficits affect schizophrenia patients?

Answer 51

PCC dysfunction impairs autobiographical memory retrieval, disrupting the coherence of self-reflection.

Question 52

How can increasing reward salience improve motivation?

Answer 52

By making rewards more visually or contextually engaging, enhancing their perceived value.

Question 53

Why might reward expectancy manipulations fail to sustain long-term motivation?

Answer 53

Because immediate feedback is insufficient for creating lasting changes without deeper cognitive engagement.