Lecture 7 Personality (2) Flashcards
1
Q
What are 2 types of disorders?
A
- Neurological disorder: any disorder ofthe nervous system. Structural, biochemical or electrical abnormalities in the brain, spinal cord or other nerves can result in a range of symptoms.
- Mental Health disorder: behavioral or mental pattern that causes significant distress or impairment of personal functioning. Usually defined by a combination of how a person behaves, feels, perceives, or thinks.
2
Q
2+ ways to diagnose a Frontal Lobe Disorder
A
Clinical history:
- Frontal lobe disorders may be recognized through a sudden and dramatic change in a person’s personality.
Mental State Examination:
- Speech problems, with reduced verbal fluency.
- Typically lacking in insight and judgment, but does not have marked cognitive abnormalities or memory impairment (as measured for example by the mini-mental state examination).
- With more severe impairment there may be echolalia or mutism.
- Primitive reflexes (also known as frontal release signs) such as the grasp reflex.Akinesia (lack of spontaneous movement) will be present in more severe and advanced cases.
Furtherinvestigation:
- A range of neuropsychological tests are available for clarifying the nature and extent of frontal lobe dysfunction.
3
Q
4 ways to measure issues in personality
A
- Questionnaires.
- Psychometric/Neuropsychological tests.
- Neuroimaging.
- DSM-5 diagnosis (personality disorder).
4
Q
Constraints of Questionnaires for Personality
A
“Personality” is sometimes taken to mean the set of variables that result from questionnaire measures, but this confuses the instruments with the constructs
5
Q
What abilities are tested for Frontal Lobe Dysfunction?
What is a commonly used test to diagnose frontal lobe injury?
A
- To measure the ability of the patient to sequence events logically and temporally, to reason abstractly, and to behave spontaneously.
- A very commonly-used test to diagnose frontal lobe injury is verbal fluency; the Controlled Oral Word Association test.
6
Q
What is the Tower of Hanoi?
A
- Neuropsychological test to measure variance of planning ability between the subject and controls.
- Planning is a key component of the problem solving skills necessary to achieve the objective (move the entire stack to another rod, obeying the following rules:
- Only one disk may be moved at a time. Often 7-9 discs
- Each move consists of taking the upper disk from one of the rods and sliding it onto another rod, on top of the other disks that may already be present on that rod.
- No disk may be placed on top of a smaller disk.
7
Q
Frontal Lobe damage/disorders take many forms, but their impact on cognition & behaviour depends on ______ & ______
A
their location and how they disrupt normal neuronal functioning.
Frontal lobe issues generally big, problematic.
8
Q
Symptoms of Frontal Lobe Damage
A
- Making inappropriate comments.
- Alteration in patience and tolerance of others.
- Depression.
- Not responding appropriately to social cues.
- Socially inappropriate sexual comments or behaviors.
- Increased or decreased interest in sex.
- Insomnia.
- Attention and concentration problems.
- Difficulty solving complex problems.
- Slowed critical thinking.
- Increased or decreased talkativeness.
- Lack of spontaneous facial expression.
- Movement impairments.
- Language difficulty.
- Impulsive, dangerous behaviors.
- Substance abuse.
9
Q
Issues in diagnosing Frontal Lobe Damage
A
- we may not know their baseline “normal”;
- many of these on a spectrum– mental health disorders will be a ”disorder” when it gets in the way of quality of life/living a normal life;
- symptoms may be temporary, due to stress
10
Q
Frontal Lobe Damage:
Pseudodepression
A
Pseudodepression:
(Pseudo: they are not necessarily depressed, but symptoms result from FL damage…)
- Lack of drive
- Loss of interest.
- Lack of motivation.
- Reduced verbal spontaneity.
(flat affect -A severe reduction in emotional expressiveness. Common in depression and schizophrenia, e.g., monotonous voice, diminished facial expressions, appear extremely apathetic
11
Q
Basic duties of the prefrontal cortex
A
- personality
- decision-making
- planning,
- forming plans/ideas
- managing social relations.
- motor function,
- problem solving,
- spontaneity,
- memory,
- language,
- initiation,
- judgement,
- impulse control,
- social and sexual behavior.
12
Q
Psyeudopsychopathy
A
- Impulsiveness.
- Immaturity.
- Lack of restraint.
- Sexual promiscuity.
- Foul-mouthedness.
(Manic symptoms)
13
Q
General Cognitive Symptoms
(assoc. with Frontal Lobe Damage)
A
Deficits in:
- Planning and strategy formation.
- Attention.
- Memory. (free recall,
- Olfactory function. (detecting odours, either one or both nostrils;
14
Q
Dysexecutive Syndrome was formerly known as ______.
Why the change?
A
The syndrome was once known as frontal lobe syndrome, however dysexecutive syndrome is preferred because it emphasizes the functional pattern of deficits (the symptoms) over the location of the syndrome in the frontal lobe, which is often not the only area affected
15
Q
Dysexecutive Syndrome is a __________disorder, not a mental health disorder
A
Neurological
16
Q
What is DES
A
- Dysexecutive Syndrome
- Neuropsychological consequences of a frontal lobe injuryhave been characterized as a syndrome; that is, brain injury that is associated with a cluster of behavioural symptoms that reliably appear.
17
Q
What is Dysexecutive Syndrome
A
- A group of symptoms,usually resulting from brain damage, that fall into cognitive, behaviouraland emotional categories and tend to occur together.
- Dysfunction in executive functions, such as planning, abstract thinking, flexibility and behavioural control. (all things FL is engaged in)
- Example: Phineas Gage
- Essentially CEO is offline, SAS is
18
Q
3 Symptoms of DysexecutiveSyndrome
A
•Cognitive
•
•Emotional
•
•Behavioural
•
19
Q
Cognitive Symptoms of DES
A
Cognitivesymptoms:
•
- Issues in memory, the ability to learn new information, speech, and reading comprehension.
- Major difficulties in planning and reasoning.
- Difficulty transferring previous knowledge to a new event.
- Individuals with DES may suffer from confabulation. (normal for kids, saying random stories that don’t make sense. But confabulation in DES)
•
20
Q
Emotional symptoms of DES
A
•Difficulty inhibitingemotionssuch as anger, excitement, sadness, or frustration. FL is supposed to function to inhibit other parts of the brain, but isn’t
•
•Due to multiple impairments of cognitive functioning, there can be much more frustration when expressing certain feelings and understanding how to interpret every day situations.
21
Q
Behavioural symptoms of DES
A
•Difficulty knowing how to behave in group situations.
•
•Utilization behavior.
•
•Perseveration behavior– apersoncontinuesdoing something when would normally stop. (writing on page and not stopping at end of page; can’t shift out of certain mindsets?)
22
Q
What is Utilization behaviour?
A
(Has to do with response inhibition)
- Displaying compulsive actions when triggered by certain stimuli.
- Person uses objects if they are in viscinity whether appropriate or not (pen, or toothbrush, etc)
- Disordered subcortical white matter connecting the prefrontal area with the nucleus of the thalamus seems to result in utilization behavior. (person’s not getting info to stop the behaviour)
23
Q
How is DES assessed?
A
Behavioural Assessment of the Dysexecutive Syndrome (BADS):
- desined to addresses the problems of traditional tests and evaluate the everyday problems arising from DES.
- BADS is designed around six subtests and ends with the Dysexecutive Questionnaire (DEX).
- These tests assess executive functioning in more complex, real-life situations, which improves their ability to predict day-to-day difficulties of DES.
24
Q
Examples of BADS
(Behavioural Assessment of the Dysexecutive Syndrome)
A
Examples:
- Rule shift cards: assess subject ability to ignore a prior rule after being given a new rule to follow. (can you shift thinking)
- Action Program: requires the use of problem solving to accomplish a new practical task.
- Key search: person needs to find something that has been lost; assesses ability to plan task and monitor own progress.
- Temporal judgement: test ability to make sensible guesses by asking questions like “how fast do raceorsesgallop?”.
- Zoo map: tests ability to plan while following a set of rules.
25
List 2 types of therapy used to treat DES
* General Planning Approach
* Cognitive Analytic Therapy
26
How is treatment aimed for DES patients?
Focus on a number of factors in executive functioning including self-awareness, goal setting, planning, self-initiation, self-monitoring, self-inhibition, flexibility, and strategic behaviour
Other treatment:
* Medications that address impulse control issues can also be useful, particularly for people who struggle with attention and motivationeg. Stimulants ie. Ritalin. (when dealing w head injury, goals will be very personalized, as not all things are possible with all injuries)
* Use of speech and occupational therapists, doctors, psychotherapists, neurologists, imaging specialists, and other professionals.
27
What is the "General Planning Approach"
•1) Information and Awareness: patients are taught about their own problems and shown how this affects their lives. The patients are then taught to monitor their executive functions and begin to evaluate them.
•
•2) Goal Setting and Planning:patients make specific goals and devise plans to accomplish them. (how a person wants to sit down and have lunch with a friend)
•
•3) Initiation, Execution, and Regulation: requires patients to implement their goals in their everyday lives, developing a practice.Initiation can be taught through normal routines. The first step can cue the patient to go to the next step in their plan. Execution and regulation are put into action with reminders of how to proceed if something goes wrong in the behavioral script. (trying to work with what someone has, not change the brain)
28
What is Cognitive Analytic Therapy?
•Aimed towards helping people with symptoms involving trouble integrating information into their actions.
•
Encourages use of practical strategies such as:
* Programming reminders into their cell phone, which help them remember how they should behave and discontinue inappropriate actions.
* Writing a letter to themselves. They can then read the letter whenever they need to.
* Creating a diagram. The diagram helps organize their thoughts and shows the patient how they can change their behaviourin everyday situations.
29
What is a Personality Disorder?
•The DSM-5 defines a personality disorder asan enduring and inflexible pattern of long duration leading to significant distress or impairment and is not due to use of substances or another medical condition. (diagnosis based on behaviour, could not image it). (“differences in personality that causes stress/issues”); generally very sensitive to rejection. May experience it when it’s not happening. “an emotional 3rddegree burn-something that wouldn’t bother someone else, may truly bother these
30
List 10 Personality Disorders listed in the DSM-5
•Paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent and obsessive-compulsive personality disorder.
31
BPD infographics
regardez
32
What are the Brain regions involved (or co-related) with BPD
* Those involved in emotional processing, eg. amygdala, insula, posterior cingulate cortex, hippocampus, anterior cingulate cortex, and prefrontal regulatory regions (maybe not inhibiting an emotional center)
* Include the orbital frontal cortex, dorsal lateral prefrontal cortex, and ventral lateral prefrontal cortex.
* Studies have shown left amygdala and right hippocampus gray volume decreases in persons with BPD. (differences in amygdala, but not clear,
So, essentially, inhibitory areas not inhibiting the overactive emotional centers
33
Neurological processes involved with BPD:
* Serotonin function relate to impulsive aggression seen in BPD.
* FMRI findings in persons with BPD show heightened activation during processing of negative emotional stimuli in the left amygdala, left hippocampus, and posterior cingulate cortex as well as diminished activation in prefrontal regions (including the dorsal lateral prefrontal cortex).
34
More neurological underpinnings of BPD:
•One study showed that negative emotional words caused participants with borderline personality disorder to have more difficulty with the task at hand and act more impulsively.
•
•FMRI of this study showed that parts of the ventromedial prefrontal cortex—the subgenualanterior cingulate cortex and the medial orbitofrontal cortex areas—were relatively less active in patients versus controls.
35
4 types of medication for BPD
•**Antidepressants**: include tricyclic and tetracyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors(SSRIs). Research has shown that these medications may help with the sadness, low mood, anxiety, and emotional reactivity often experienced by people with BPD, but they do not seem to have a strong effect on other symptoms of the disorder (e.g., anger, impulsivity).
•
•**Antipsychotics**: have been shown to reduce anxiety, paranoid thinking, anger/hostility, and impulsivity in patients with BPD.
•
•**Mood-stabilizers**: for example, lithium, and some anticonvulsant (anti-seizure) medications, have been used to treat the impulsivebehavior and rapid changes in emotionassociatedwith BPD.
•
•**Anti-anxiety medication**: sometimes used but high risk of exacerbating symptoms.
36
What is one of the most accepted therapy modalities for BPD?
(hint: DBT)
What does it do?, What are its strategies?
Dialectical behavioral therapy:(one of the most accepted modality of therapy)
* Found to attenuate amygdala hyperactivity at baseline, which correlated with changes in a measure of emotion regulation and increased use of emotion regulation strategies.
* Teaches to notice emotion, tolerate it, and in doing so, regulate the emotion
* Teaches interpersonal skill development.
* Great therapy to be aware of
•
Strategies of DBT:
* Mindfulness.
* Tolerating stress/distress.
* Emotional regulation.
* Interpersonal Effectiveness.
37
What's going on with Grinch's personality? identify key brain regions/neurological processes that may be at play.
What treatment would you recommend?
