Frontal lobe &psychiatry- ppt

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This presentation is regarding relevance of frontal lobe of brain in psychiatry

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Frontal lobe &psychiatry- ppt

  1. 1. FRONTAL LOBE<br />CHAIR PERSONS:<br />Prof.DR.V.RAMANUJAM,MD.,DPM<br />DR.S.ANANDA KRISHNAKUMAR,<br /> MD.,DPM<br />PRESENTOR:<br />DR.A.GODSON<br />1st YEAR MD<br />
  2. 2. INTRODUCTION<br />EMOTIONAL CONTROL CENTER<br />HOME TO PERSONALITY<br />MORE PRONE TO INJURY<br />DEVELOPMENT<br />ARISE FROM LATERAL WALL OF DIENCEPHALON<br />DERIVED FROM ROSTRAL END OF HEMISPHERE<br />
  3. 3. ANATOMY-SUPEROLATERAL SURFACE<br /><ul><li>PRECENTRAL SULCUS
  4. 4. SUPERIOR FRONTAL SULCUS
  5. 5. INFERIOR FRONTAL SULCUS
  6. 6. PRECENTRAL GYRUS
  7. 7. SUPERIOR FRONTAL GYRUS
  8. 8. MIDDLE FRONTAL GYRUS
  9. 9. INFERIOR FRONTAL GYRUS
  10. 10. PARS ORBITALIS
  11. 11. PARS TRIANGULARIS
  12. 12. PARS OPERCULARIS</li></li></ul><li>MEDIAL SURFACE<br /><ul><li>CINGULATE SULCUS
  13. 13. MEDIAL FRONTAL </li></ul> GYRUS<br /><ul><li>PARACENTRAL </li></ul> LOBULE <br />
  14. 14. INFERIOR SURFACE<br /><ul><li>OLFACTORY SULCUS
  15. 15. GYRUS RECTUS
  16. 16. ORBITAL SULCI-H SHAPED
  17. 17. LATERAL,MEDIAL , </li></ul> ANTERIOR,POSTERIOR <br /> ORBITAL GYRI<br />
  18. 18. BLOOD SUPPLY<br />SUPEROLATERAL SURFACE<br /><ul><li>ANTERIOR&MIDDLE CEREBRAL ARTERY</li></ul>MEDIAL SURFACE<br /><ul><li>ANTERIOR CEREBRAL ARTERY</li></ul>INFERIOR SURFACE<br /><ul><li>ANTERIOR&MIDDLE CEREBRAL ARTERYA</li></li></ul><li>Major functional areas<br />
  19. 19. PRECENTRAL CORTEX<br />PRIMARY MOTOR CORTEX<br /><ul><li>Planning&refining of motor movements
  20. 20. Area 4 of Broad man’s</li></ul>PRE MOTOR CORTEX<br /><ul><li>Planning complex motor movements
  21. 21. Broadman’s area 6,8</li></ul>FRONTAL EYE FIELD<br /><ul><li>Voluntary saccades
  22. 22. Smooth pursuit eye movements
  23. 23. Fast brain pathway</li></ul>BROCA’S AREA<br /><ul><li>Motor movements of tongue&larynx
  24. 24. Speech formation
  25. 25. Broadman’s area 44,45</li></li></ul><li>BRODMAN’S AREAS<br />
  26. 26. PREFRONTAL CORTEX<br /><ul><li>Human personality
  27. 27. Anticipation
  28. 28. Planning
  29. 29. Initiative
  30. 30. Memory
  31. 31. Control of decision making</li></ul>DORSOLATERAL PFC<br /><ul><li>Control behavior
  32. 32. Longterm memory formation
  33. 33. Preparation&execution of act</li></li></ul><li>ORBITOFRONTAL CORTEX<br /><ul><li>Decision making
  34. 34. Flexible Control of exitation&inhibition
  35. 35. Emotional control of behavior
  36. 36. Brodman area 10,11,47
  37. 37. Limbic system-due to function in emotion, </li></ul>reward&rich connections with others<br /><ul><li>Related area found in rodents
  38. 38. Least understood area</li></li></ul><li>FRONTAL CIRCUITS<br /><ul><li>PREFRONTAL CIRCUITS(THREE IN NUMBER)</li></ul>dorsolateral prefrontal cortex, later orbital cortex, and anterior cingulate of the prefrontal cortex -> striatal structures ->globuspallidus and substantianigra ->specific thalamic nuclei. The functional circuit is complete with a feed back from the thalamus to the frontal lobes. <br /><ul><li>MOTOR CIRCUIT</li></ul> Supplementary motor area, the premotor area, the motor cortex, and the somatomotor cortex ->to putamen->globuspallidusexterna -> caudolateralsubstantianigra<br />
  39. 39. CONTINUED<br /><ul><li>OCULOMOTOR CIRCUIT</li></ul>Frontal eye fields , the prefrontal cortex, the posterior parietal cortex ->caudate nucleus-> globuspallidus-> substantianigra ->thalamus. <br /><ul><li>LATERAL ORBITOFRONTAL CIRCUITS</li></ul>Inferolateral prefrontal cortex -> ventromedial caudate nucleus-> dorsomedialpallidum and rostromedialsubstantianigra-> globusPallidusexterna and subthalamic nucleus. The pallidum and substantianigra connect to the ventral anterior and medial thalamic nuclei and project back to the Orbitofrontal cortex. <br />
  40. 40. FUNCTIONS OF SPECIFIC AREAS-GLANCE<br /> Primary motor cortex : planning, initiation and control of physical movement<br /> Dorsolateral frontal lobe: planning, strategy formation, and other executive functions.<br />Left prefrontal cortex : verbal memory <br />Right prefrontal cortex : spatial memory. <br />Broca's area: expressive language, i.e. language production. <br />Orbitofrontal cortex: response inhibition, impulse control, and social behaviour.ability to make choice,determine right from wrong<br />
  41. 41. FRONTAL LOBE SYNDROMES<br />PREMOTOR SYNDROME<br /><ul><li>NO PARALYSIS
  42. 42. LOSS OF FINE MOTOR FUNCTION
  43. 43. SPASTICITY,RIGIDITY,GRASP REFLEX IN SEVERE DAMAGE</li></ul>MEDIAL PREFRONTAL <br />SYNDROME<br /><ul><li>DIFFICULT IN INITIATION &PERFORMANCE OF LIMB ,EYE,SPEECH MOVEMENTS
  44. 44. HYPOKINESIA,AKINETIC MUTISM-CINGULATE LESION
  45. 45. PSEUDODEPRESSION:ADYNAMIA WITH DISORDERS OF ATTENTION AND MOTILITY</li></li></ul><li>DORSOLATERAL PREFRONTAL SYNDROME<br />(Area 8,9,10,46)<br />ATTENTION DISORDER-DYSEXECUTIVE SYNDROME<br /><ul><li>Low arousal or alertness
  46. 46. Difficulty in Sustained Attention-Digit vigilance test
  47. 47. Deficits in Selective Attention-Color trails &trail making test
  48. 48. Visual Search-Visual &pictorial scanning test </li></ul>MEMORY DYSFUNCTION <br /><ul><li>Difficulty in voluntary learning
  49. 49. Loss of recent memory
  50. 50. Impaired working memory-N back test,Delayed response ability test</li></ul>PLANNING DYSFUNCTION<br /><ul><li>Failure to formulate and carryout new plans
  51. 51. Lack of anticipation of consequence
  52. 52. Tower of london test</li></li></ul><li>CONTINUED<br />DISORDERS OF ABSTRACT <br />THINKING,CONCPT<br />FORMATION <br />AND MENTAL SET<br /><ul><li>Difficulty on conceptual task
  53. 53. Unable to inhibit customary mode of responding due to interference with voluntory control of inhibition
  54. 54. Wisconsin card sort test & Color form sorting tesT</li></ul>LANGUAGE DISORDER<br /><ul><li>Impaired ability to construct original,improvised,extended speech
  55. 55. Broca’s aphasia/Expressive aphasia-agrammatism
  56. 56. Frontal adynamic aphasia/Prefronal aphasia
  57. 57. Tested by verbal fluency and word production test</li></ul>BEHAVIOURAL SYMPTOMS<br /><ul><li>Utilization behaviour
  58. 58. Perseveration behaviour
  59. 59. Inappropriate aggression
  60. 60. Inappropriate sexual behaviour
  61. 61. Inappropriate humour and telling of pointless and boring stories referred as Witzelsucht</li></li></ul><li>ORBITOFRONTAL SYNDROME<br />DISINHIBITION-HALLMARK<br />Motor Disinhibition: Hyperactivity and increased speech <br />Instinctive Behavior: Hypersexuality, hyperphagia<br />Intellectual :Grandiose and paranoid ideas, flight of ideas. <br /><ul><li>Sensory disinhibition :Visual and auditory hallucinations </li></ul>Emotional disinhibition: Euphoria, elation, and irritability <br />
  62. 62. CONTINUED<br />syndrome characterized by:<br />Impairment in personality<br />Impairment in social behavior <br />Impairment in spontaneous arousal of attention <br />Impairment in arousal/motivation <br />Impairment in the ability to focus attention, <br />Impairment in initiating behavior <br />Impairment of goal directed and purposeful behavior<br />Tendency to display inappropriate emotions and behavior <br />Impairment in ability to change mental set <br />
  63. 63. FRONTAL LOBE EPILEPSY<br />BRIEF,RECURRENT SEIZURE<br />SECOND MOST COMMON AFTER TLE<br />CLINICAL MANIFESTATION DEPENDS AREA OF INVOLVEMENT<br />ONSET WITH ABNORMAL BODY POSTURE/SONSORIMOTOR TICS<br />RARELY UNCONTROLLABLE LAUGH OR CRY<br />BRIEF POSTICTAL CONFUSION<br />CAUSE RANGE FROM GENETIC TO TRAUMA<br />
  64. 64. FUNCTION ASSESSMENT TESTS<br /><ul><li>WORD LIST GENERATION TEST
  65. 65. ABSTRACT THINKING TEST
  66. 66. FIST- RING TEST
  67. 67. FIST-PALM-SIDE TEST
  68. 68. GO-NO-GO TEST
  69. 69. MULTIPLE LOOP TEST
  70. 70. ALTERNATE SEQUENCE TEST
  71. 71. WISCONSIN CARD TEST-USEFUL IN DYSEXECUTIVE SYNDROME,SCHIZOPHRENIA,NEURODEGENERATIVE DISEASES
  72. 72. TOWER OF LONDON TEST-DETECT DEFECT IN PLANNING DUE TO FRONTAL LOBE DAMAGE
  73. 73. LOWA GAMBLING TASK-ORBITOFRONTAL CORTEX DYSFUNCTION
  74. 74. FAUX PAS TEST-ORBITOFRONTAL CORTEX DYSFUNCTION</li></li></ul><li>PRIMITIVE REFLEXES<br />These are newborn reflexes disappear or inhibited by Frontal lobe <br />during normal development,which are not being suppressed in <br />frontal lobe injury causes frontal release signs.<br /><ul><li>WALKING/STEPPING REFLEX
  75. 75. ROOTING REFLEX
  76. 76. SUCKING REFLEX
  77. 77. TONIC NECK REFLEX
  78. 78. PALMAR GRASP REFLEX
  79. 79. PLANTAR REFLEX
  80. 80. GALANT REFLEX
  81. 81. SWIMMING REFLEX
  82. 82. BABKIN REFLEX</li></li></ul><li>Frontal Lobe&schizophrenia<br />REDUCED NMDA GLUTAMATE RECEPTORS CAUSING COGNITIVE SYMPTOMS<br />RESPONSIBLE FOR NEGATIVE SYMPTOMS<br />ANATOMICAL ABNORMALITY OF PREFRONTAL CORTEX<br />MRI&PET SHOWS FUNCTIONAL DIFFERENCE IN BRAIN ACTIVITY IN FRONTAL LOBE,HIPPOCAMPUS,TEMPORAL LOBE<br />PET SHOWS LESS FRONTAL ACTIVITY DURING WORKING MEMORY RELATED TO NEUROCOGNITIVE DEFECTS<br />
  83. 83. ANTISOCOAL PERSONALITY<br /><ul><li>ORBITOFRONTAL INJURY-POOR IMPULSE CONTROL&AGGRESSION
  84. 84. PREFRONTAL EXECUTIVE DYSFUNCTION
  85. 85. NEUROIMAGING SHOWS REDUCED PREFRONTAL CORTICAL SIZE </li></ul>DEPRESSION<br /><ul><li>LEFT DORSAL ANTEROLATERAL PREFRONTAL DYSFUNCTION
  86. 86. REDUCED FRONTAL PERFUSION
  87. 87. MRI:SMALL CAUDATE NUCLEUS & FRONTAL LOBE
  88. 88. SPECT:DECREASED BLOOD FLOW TO FRONTAL CORTEX</li></li></ul><li>continued<br />OCD<br /><ul><li>ALTERED FUNCTION IN NEURO CIRCUIT
  89. 89. INCREASED BLOOD FLOW&METABOLISM IN FRONTAL LOBE
  90. 90. COMPULSIVE HOARDING:Compulsive hoarding or pathological hoarding or disposophobia is the excessive acquisition of possessions, even if the items are worthless, hazardous, or unsanitary.
  91. 91. DAMAGE TO RT MEDIAL PREFRONTAL CORTEX CAUSE HOARDING</li></ul>DEMENTIA<br /><ul><li>COGNITIVE IMPAIREMENT,MEMORY IMPAIREMENT,PERSONALITY </li></ul> CHANGES-THOUGHT TO BE DUE TO FRONTAL INVOLVEMENT<br />
  92. 92. ADHD<br /><ul><li>GENERAL REDUCTION OF BRAIN VOLUME ,BUT PROPORTIONALLY GREAT REDUCTION OF LT PREFRONTAL CORTEX
  93. 93. RECENT RESEARCH SHOWS FOLLOWING FOUR CONNECTED FRONTOSTRIATAL REGIONS PLAY A ROLE IN ADHD-lateral prefrontal cortex ,Dorsal anterior cingulate,caudate,Putamen
  94. 94. DELAYED DEVELOPMENT OF FRONTAL CORTEX,TAMPORAL LOBE&FAST MATURITY OF MOTOR CORTEX SEEN
  95. 95. THIS CONTRIBUTES SLOW BEHAVIOURAL CONTROL &ADVANCED MOTOR DEVELOPMENT LEADS TO FIDGETINESS,THAT IS CHARACTERISTIC OF ADHD
  96. 96. PET SHOS LOW PERFUSION AND METABOLISM OF FRONTAL AREA</li></li></ul><li>FRONTAL LOBOTOMY/LEUCOTOMY<br /><ul><li>FIRST DEVELOPED BY EGAS MONIZ
  97. 97. DISORDERED THOUGHTS ARE PREVENTED TO REACH HYPOTHALAMUS& THALAMUS FROM FRONTAL LOBE
  98. 98. DISCONNECTING FRONTO-THALAMIC,FRONTO-HYPOTHALAMIC CONNECTIONS
  99. 99. DISTRESS REDUCED,BUT BLUNTING THE EMOTIONS,PERSONALITY
  100. 100. NOT ROUTINELY PRACTICED NOW</li></li></ul><li>EVOLUTION<br /><ul><li>SCIENTISTS THOUGHT THAT IMPORTANT HUMAN EVOLUTION AND DISTINCT COGNITION DUE TO LARGE FRONTAL LOBE IN HUMANS COMPARED TO OTHERS
  101. 101. SEMENDEFERI et al FOUND FRONTAL CORTEX RELATIVELY LARGE THAN LESSER APES AND MONKEYS BUT NOT THAN GREAT APES
  102. 102. TULVING DISCOVERED LEFT FRONTAL LOBE IMPORTANT IN SEMANTIC MEMORY RETRIEVAL (fMRI )
  103. 103. ANIMALS CANNOT USE FUTURE MEMORY DUE TO SMALL FRONTAL LOBE SIZE</li></li></ul><li>GAGE’S ACCIDENT<br />
  104. 104. GAGE’S ACCIDENT<br /><ul><li>IN1848 PHINEAS GAGE A FOREMAN OF GANG BLASTING GROUP MET WITH BLAST ACCIDENT
  105. 105. A LARGE IRON ROD PASSED ON SIDE OF FACE,PASSING BACK OF LT EYE,CAME OUT AT TOP OF HEAD
  106. 106. AS PER RATIU et al IT DAMAGED LT FRONTAL LOBE
  107. 107. NEUROLOGIST ANTONIO DAMASIO USES GAGE TO ILLUSTRATE LINK BETWEEN FRONTAL LOBES AND EMOTION,PRACTICAL DECISION MAKING
  108. 108. BUT ANY THEORY ON BASIS OF GAGE FACED DIFFICULTY THAT THE NATURE,EXTEND,DURATION OF INJURY’S EFFECT ON HIS MENTAL STATE ARE VERY UNCERTAIN
  109. 109. IN 1849 HENRY JACOB BIGELOW STATED THAT GAGE WAS QUITE RECOVERED IN FACULTIES OF BODY& MIND,THERE BEING INCONSIDERABLE DISTURBANCE OF FUNCTION</li></li></ul><li>THANK YOU<br />

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