clinical psychology

1. NEUROPSYCHOLOGYNEUROPSYCHOLOGY
PERSPECTIVES ANDPERSPECTIVES AND
HISTORYHISTORY
Lecture 41Lecture 41

2.  Very important growth area in clinicalVery important growth area in clinical
psychology.psychology.
 Increased professional membership.Increased professional membership.
 A number of training programs.A number of training programs.
 The increase in many journals and books.The increase in many journals and books.
 The primary challenge of it appears to beThe primary challenge of it appears to be
health care reform.health care reform.

3. PERSPECTIVES AND HISTORYPERSPECTIVES AND HISTORY
 Neuropsychologist have a foot in both theNeuropsychologist have a foot in both the
psychological and neurological domains.psychological and neurological domains.
 DEFINITIONS:-DEFINITIONS:-Most simply, it can be definedMost simply, it can be defined
as the study of the relation between brainas the study of the relation between brain
function and behavior. It deals with thefunction and behavior. It deals with the
understanding assessment, and treatment ofunderstanding assessment, and treatment of
behaviors directly related to the functioning ofbehaviors directly related to the functioning of
the brain (Golden, 1984).the brain (Golden, 1984).
 Neuropsychological evaluations have alsoNeuropsychological evaluations have also
provided useful information about the impact ofprovided useful information about the impact of
a patient's limitations on many areas of braina patient's limitations on many areas of brain
functioning.functioning.

4. ROLES OF NEUROPSYCHOLOGISTSROLES OF NEUROPSYCHOLOGISTS
 Neuropsychologists function in a number ofNeuropsychologists function in a number of
different roles.different roles.
 To help establish or rule out particularTo help establish or rule out particular
diagnoses.diagnoses.
 Neuropsychologists can often make predictionsNeuropsychologists can often make predictions
regarding the prognosis for recovery.regarding the prognosis for recovery.
 A third major role involves intervention andA third major role involves intervention and
rehabilitation.rehabilitation.

5. HISTORY OF NEUROPSYCHOLOGYHISTORY OF NEUROPSYCHOLOGY
 Theories ofTheories of Brain Functioning.Brain Functioning.
 Others suggest that it all began whenOthers suggest that it all began when
Pythagoras said that human reasoning occursPythagoras said that human reasoning occurs
in the brain.in the brain.
 Others are partial to the second century A.D.Others are partial to the second century A.D.
 the most significant early base forthe most significant early base for
neuropsychology seems to have been laid inneuropsychology seems to have been laid in
the nineteenth centurythe nineteenth century..

6.  The earliest signs of this understandingThe earliest signs of this understanding
came with Franz Gall and his nowcame with Franz Gall and his now
discredited phrenology.discredited phrenology.
 notion ofnotion of localization of function.localization of function.
 Observations from two autopsies ofObservations from two autopsies of
patientspatients

7. Concept ofConcept of
EQUIPOTENTIALITYEQUIPOTENTIALITY
 Although there certainly is localization of brainAlthough there certainly is localization of brain
function, the cortex really functions as a wholefunction, the cortex really functions as a whole
rather than as isolated units.rather than as isolated units.
 In particular, higher intellectual functioning isIn particular, higher intellectual functioning is
mediated by the brain as a whole, and anymediated by the brain as a whole, and any
brain injury will impair these higher functions.brain injury will impair these higher functions.
 Yet there is the ability of one area of the cortexYet there is the ability of one area of the cortex
to substitute for the damaged area.to substitute for the damaged area.

8. Both the localization and equipotentialityBoth the localization and equipotentiality
theories presented some problemstheories presented some problems
 Localizationalists could not explain why lesionsLocalizationalists could not explain why lesions
in very different parts of the brain produced thein very different parts of the brain produced the
same deficit or impairment, whereas thosesame deficit or impairment, whereas those
adhering to the equipotentiality theory could notadhering to the equipotentiality theory could not
account for the observation that some patientsaccount for the observation that some patients
with very small lesions manifested marked,with very small lesions manifested marked,
specific behavioral deficits.specific behavioral deficits.
 An alternative theory that integrates these twoAn alternative theory that integrates these two
perspectives is theperspectives is the FUNCTIONAL MODELFUNCTIONAL MODEL..

9. NEUROPSYCHOLOGICAL ASSESSMENT:NEUROPSYCHOLOGICAL ASSESSMENT:
 Notions of mass action of brain functioning.Notions of mass action of brain functioning.
 The psychological tests were used for simpleThe psychological tests were used for simple
assessment.assessment.
for example, the Benton Visual Retention Testfor example, the Benton Visual Retention Test
and the Graham-Kendall Memory-for-Designsand the Graham-Kendall Memory-for-Designs
Test.Test.
 Information about specific test correlates ofInformation about specific test correlates of
specific brain lesions was not collected veryspecific brain lesions was not collected very
efficiently.efficiently.

10.  The Beginning Of NeuropsychologyThe Beginning Of Neuropsychology..
 Work of Ward Halstead.Work of Ward Halstead.
 Halstead was able to identify certain specificHalstead was able to identify certain specific
characteristics of their behavior. Next, he tried tocharacteristics of their behavior. Next, he tried to
assess these characteristics by administering a varietyassess these characteristics by administering a variety
of psy-chological tests to these patients. Throughof psy-chological tests to these patients. Through
factor analysis, he settled on ten measures that ulti-factor analysis, he settled on ten measures that ulti-
mately comprised his test battery.mately comprised his test battery.
 Work of Ralph Reitan, a graduate student ofWork of Ralph Reitan, a graduate student of
Haistead's. This work culminated in the HalsteadHaistead's. This work culminated in the Halstead
Reitan Neuropsychological Test Battery.Reitan Neuropsychological Test Battery.
 Flexible battery approach to assessment. FlexibleFlexible battery approach to assessment. Flexible
batteries allow each assessment to be tailored to thebatteries allow each assessment to be tailored to the
individual, based on the clinical presen-tation and onindividual, based on the clinical presen-tation and on
the hypotheses of the neuro-psychologist.the hypotheses of the neuro-psychologist.

11. THE BRAIN STRUCTURE, FUNCTION, ANDTHE BRAIN STRUCTURE, FUNCTION, AND
IMPAIRMENTIMPAIRMENT
STRUCTURE AND FUCNTIONSTRUCTURE AND FUCNTION
 Two Hemispheres Left Hemisphere and RightTwo Hemispheres Left Hemisphere and Right
Hemisphe.Both controls the opposite sides.Hemisphe.Both controls the opposite sides.
 Two hemispheres communicate via corpusTwo hemispheres communicate via corpus
callosum.callosum.
 Corpus callosum helps to coordinate andCorpus callosum helps to coordinate and
integrate complex behavior.integrate complex behavior.

12.  Each cerebral hemisphere has four lobes.Each cerebral hemisphere has four lobes.
 TheThe frontal lobesfrontal lobes are the most recently developedare the most recently developed
parts of the brain.parts of the brain.
 They enable us to observe and compare our behaviorThey enable us to observe and compare our behavior
and the reactions of others to it in order to obtain theand the reactions of others to it in order to obtain the
feedback necessary to alter our behavior to achievefeedback necessary to alter our behavior to achieve
valued goals.valued goals.
 Also associated with the frontal lobes are executiveAlso associated with the frontal lobes are executive
functions-formulating, planning, and carrying out goal-functions-formulating, planning, and carrying out goal-
directed initiatives.directed initiatives.
 Finally, emotional modulation -the ability to monitorFinally, emotional modulation -the ability to monitor
and control one's emotional state-is also associatedand control one's emotional state-is also associated
with frontal lobe functioning.with frontal lobe functioning.

13.  TheThe temporal lobestemporal lobes mediate linguistic expres-sion,mediate linguistic expres-sion,
reception, and analysis. They are also involved inreception, and analysis. They are also involved in
auditory processing of tones, sounds, rhythms, andauditory processing of tones, sounds, rhythms, and
meanings that are non language in nature.meanings that are non language in nature.
 TheThe parietal lobesparietal lobes are related to tactile and kinestheticare related to tactile and kinesthetic
perception, understanding, spatial perception, andperception, understanding, spatial perception, and
some language understanding and processing. Theysome language understanding and processing. They
are also involved in body awareness.are also involved in body awareness.
 TheThe occipital lobesoccipital lobes are mainly oriented toward visualare mainly oriented toward visual
processing and some aspects of visually mediatedprocessing and some aspects of visually mediated
memory. Motor coordination, as well as the control ofmemory. Motor coordination, as well as the control of
equilibrium and muscle tone, is associated with theequilibrium and muscle tone, is associated with the
cerebellum.cerebellum.

14. ANTECEDENTS OR CAUSES OF BRAINANTECEDENTS OR CAUSES OF BRAIN
DAMAGEDAMAGE
TRAUMATRAUMA
 The occurrence of head injuries.The occurrence of head injuries.
 The outcomes are wide-rangingThe outcomes are wide-ranging..
 The major effects of head trauma can be categorizedThe major effects of head trauma can be categorized
asas
 ConcussionsConcussions
 ContusionsContusions
 LaceraLacerationstions

15.  ConcussionsConcussions (jarring of the brain) usually result in(jarring of the brain) usually result in
momentary disruptions of brain function althoughmomentary disruptions of brain function although
permanent damage is uncommon (unless there arepermanent damage is uncommon (unless there are
repeated concussions, as might b the case in football,repeated concussions, as might b the case in football,
soccer, or boxing, for example).soccer, or boxing, for example).
 Contusions refer to cases in which the brain has beenContusions refer to cases in which the brain has been
shifted from its normal position and pressed againstshifted from its normal position and pressed against
the skull. As a result, brain tissue is bruised.the skull. As a result, brain tissue is bruised.
Outcomes can often be severe and may be followedOutcomes can often be severe and may be followed
by comas and deliriums.by comas and deliriums.
 LaceraLacerations involve actual ruptures and destruction oftions involve actual ruptures and destruction of
brain tissue. They can be caused by bullets or flyingbrain tissue. They can be caused by bullets or flying
objects, for example. These lacerations are of course,objects, for example. These lacerations are of course,
exceedingly serious forms of damage.exceedingly serious forms of damage.

16. CEREBROVASCULAR ACCIDENTSCEREBROVASCULAR ACCIDENTS
 The blockage a rupture of cerebral blood vessels is oftenThe blockage a rupture of cerebral blood vessels is often
termed "stroke. “This is a very common cause of brain damagetermed "stroke. “This is a very common cause of brain damage
in adults, and stroke is one of the leading causes of death in thein adults, and stroke is one of the leading causes of death in the
United States (and other countries).United States (and other countries).
 Occlusions and its effects. InOcclusions and its effects. In occlusionsocclusions blood clot blocks theblood clot blocks the
vessel that feeds a particular area of the brain. This can resultvessel that feeds a particular area of the brain. This can result
in aphasia (language impairment), apraxia (inability to performin aphasia (language impairment), apraxia (inability to perform
certain voluntary movements), or agnosia (disturbed sensorycertain voluntary movements), or agnosia (disturbed sensory
perception).perception).
 Cerebral Hemorrhage and its effects. In the case ofCerebral Hemorrhage and its effects. In the case of a cerebrala cerebral
hemorrhage,hemorrhage, the blood vessel ruptures and the blood escapesthe blood vessel ruptures and the blood escapes
onto brain tissue and either damages or destroys it. The exactonto brain tissue and either damages or destroys it. The exact
symptoms that ensue depend on the site of the accident and itssymptoms that ensue depend on the site of the accident and its
severity. In very severe cases, death is the outcome. Thoseseverity. In very severe cases, death is the outcome. Those
who survive often show paralysis, speech problems, memorywho survive often show paralysis, speech problems, memory
and judgment difficulties, and so on.and judgment difficulties, and so on.

17. TUMORS:TUMORS:
 The reason of brain tumors. BrainThe reason of brain tumors. Brain tumorstumors may growmay grow
outside the brain, within the brain, or result fromoutside the brain, within the brain, or result from
metastatic cells spread by body fluids from some othermetastatic cells spread by body fluids from some other
organ of the body, such as the lung or the breastorgan of the body, such as the lung or the breast
 Initial signs of brain tumors are often quite subtle andInitial signs of brain tumors are often quite subtle and
can include head­aches, vision problems, graduallycan include head­aches, vision problems, gradually
developing problems in judgment, and so on. As thedeveloping problems in judgment, and so on. As the
tumor grows, so does the variety of other symptomstumor grows, so does the variety of other symptoms
(such as poor memory, affect problems, or motor(such as poor memory, affect problems, or motor
coordination).coordination).
 Treatment of tumors: Tumors can be removedTreatment of tumors: Tumors can be removed
surgically, but the surgery itself can result in moresurgically, but the surgery itself can result in more
brain damage. Some tumors are inoperable or lo­brain damage. Some tumors are inoperable or lo­
cated in areas too dangerous to operate on. In suchcated in areas too dangerous to operate on. In such
cases, radiation treatments are often used.cases, radiation treatments are often used.

18. DEGENERATIVE DISEASESDEGENERATIVE DISEASES
 Characterized by a degeneration ofCharacterized by a degeneration of
neurons in the central nervous system.neurons in the central nervous system.
 Huntington's chorea, Parkinson's disease,Huntington's chorea, Parkinson's disease,
and Alzheimer's disease and otherand Alzheimer's disease and other
dementia.dementia.
 Alzheimer's disease is the most commonAlzheimer's disease is the most common
followed by Parkinson's disease (age offollowed by Parkinson's disease (age of
onset 50 to 60 years old), and finallyonset 50 to 60 years old), and finally
Huntington's chorea (age of on­set 30 toHuntington's chorea (age of on­set 30 to
50 years old).50 years old).
 The effect of these diseases.The effect of these diseases.

19. NUTRITIONAL DEFECIENCIESNUTRITIONAL DEFECIENCIES
 Malnutrition can ultimately produce neurological andMalnutrition can ultimately produce neurological and
psychological disorders.psychological disorders.
 They are most often observed in cases of Korsakoff'sThey are most often observed in cases of Korsakoff's
psychosis (resulting from nutritional problems broughtpsychosis (resulting from nutritional problems brought
about by poor eating habits common in longtimeabout by poor eating habits common in longtime
alcoholics), pellagra (niacin/vitamin B­3 deficiency),alcoholics), pellagra (niacin/vitamin B­3 deficiency),
and beriberi (thiamin/vitamin B­1 deficiency).and beriberi (thiamin/vitamin B­1 deficiency).
TOXIC DISORDERSTOXIC DISORDERS
 A variety of metals, toxins, gases, and even plants canA variety of metals, toxins, gases, and even plants can
be absorbed through the skin. In some instances, thebe absorbed through the skin. In some instances, the
result is a toxic or poisonous effect that produces brainresult is a toxic or poisonous effect that produces brain
damage. A very common symptom associated withdamage. A very common symptom associated with
these disorders isthese disorders is deliriumdelirium (disruption of(disruption of
consciousness).consciousness).

20. CHRONIC ALCOHOL ABUSECHRONIC ALCOHOL ABUSE
 Chronic exposure to alcohol have neurologicalChronic exposure to alcohol have neurological
effects. For example, changes in neurotrans­effects. For example, changes in neurotrans­
mitter sensitivity and shrinkage in brain tissue.mitter sensitivity and shrinkage in brain tissue.
 Some regions of brain are more vulnerable.Some regions of brain are more vulnerable.
 Effect on Limbic system:Effect on Limbic system:
The limbic system is a network of structuresThe limbic system is a network of structures
within the brain associated with memorywithin the brain associated with memory
formation, emo­tional regulation, and sensoryformation, emo­tional regulation, and sensory
integration. Studies of alcoholics have indicatedintegration. Studies of alcoholics have indicated
deficits in these areas of functioning.deficits in these areas of functioning.

21.  Effect on diencephalons: The diencephalon is aEffect on diencephalons: The diencephalon is a
region near the center of the brain that includesregion near the center of the brain that includes
the mammillary bodies of the hypothalamus.the mammillary bodies of the hypothalamus.
Studies suggest shrinkage or lesions in theseStudies suggest shrinkage or lesions in these
areas as a result of chronic alcohol exposure, andareas as a result of chronic alcohol exposure, and
memory deficits in alcoholics are consistent withmemory deficits in alcoholics are consistent with
these findings. Several studies have also reportedthese findings. Several studies have also reported
findings that suggest alcoholics evidence atrophyfindings that suggest alcoholics evidence atrophy
of the cerebral cortex.of the cerebral cortex.
 Damage to Cerebellum: damage to the cerebellum,Damage to Cerebellum: damage to the cerebellum,
responsible for motor coordination, is also wellresponsible for motor coordination, is also well
documented. A history of accidental falls ordocumented. A history of accidental falls or
automobile accidents may suggest neurologicalautomobile accidents may suggest neurological
damage resulting from alcohol abuse/dependence.damage resulting from alcohol abuse/dependence.

22. CONSEQUENCES AND SYMPTOMS OFCONSEQUENCES AND SYMPTOMS OF
BRAIN DAMAGEBRAIN DAMAGE
Brain injury or trauma can produce a variety ofBrain injury or trauma can produce a variety of
cognitive and behavioral symptoms.cognitive and behavioral symptoms.
 Impaired orientationImpaired orientation..
 Impaired memory.Impaired memory.
 Impaired intellectual functionsImpaired intellectual functions..
 Impaired judgment.Impaired judgment.
 Shallow and labile affect.Shallow and labile affect.
 Loss of emotional and mental resilienceLoss of emotional and mental resilience
 Frontal lobe syndromeFrontal lobe syndrome

23. BRAIN-BEHAVIOR RELATIONSHIPSBRAIN-BEHAVIOR RELATIONSHIPS
 The popular view of localization of functions,The popular view of localization of functions,
 same sized tumors in different parts of brainsame sized tumors in different parts of brain
can cause different type of deficits.can cause different type of deficits.
 According to equipotential theory, all areas ofAccording to equipotential theory, all areas of
the brain contribute equally to overallthe brain contribute equally to overall
intellectual functioning.intellectual functioning.
 Emphasis of Equipotentialists.Emphasis of Equipotentialists.
 Many investigators have been unable to acceptMany investigators have been unable to accept
either localization or equipotentiality completelyeither localization or equipotentiality completely

24.  Thus, alternatives such as the one pro­posedThus, alternatives such as the one pro­posed
by Hughlings Jackson (Luria, 1973) haveby Hughlings Jackson (Luria, 1973) have
become prominent.become prominent.
 The functional model of brain.The functional model of brain.
 The effect of brain damage. Often clinicians areThe effect of brain damage. Often clinicians are
called upon to determine the presence ofcalled upon to determine the presence of
intellectual deterioration.intellectual deterioration.
 (1)a decline resulting from psychological(1)a decline resulting from psychological
factors psychosis, lack of motivation, emotionalfactors psychosis, lack of motivation, emotional
problems, the wish to defraud an insuranceproblems, the wish to defraud an insurance
company, and so on);company, and so on);
 (2)a decline stemming from brain injury.(2)a decline stemming from brain injury.
 Advantages of premorbid data.Advantages of premorbid data.

25. INTERVENTION AND REHABILITATIONINTERVENTION AND REHABILITATION
 Two principal questions of issues ofTwo principal questions of issues of
neurological impairment.neurological impairment.
 First, what is the nature of theFirst, what is the nature of the
deterioration or damage?deterioration or damage?
 Second, is there any real brain damageSecond, is there any real brain damage
that can account in some way for thethat can account in some way for the
patient's behavior?patient's behavior?
 Diffused or Focal damage.Diffused or Focal damage.

26. RehabilitationRehabilitation isis becoming one of the majorbecoming one of the major
functions of neuropsychologists.functions of neuropsychologists.
 First, a thorough assessment of theFirst, a thorough assessment of the
patient's strengths and deficits ispatient's strengths and deficits is
conducted.conducted.
 A program of rehabilitation is thenA program of rehabilitation is then
developed that will be maximally beneficialdeveloped that will be maximally beneficial
to the patient, given her or his deficits, asto the patient, given her or his deficits, as
well as one that will be efficient in thewell as one that will be efficient in the
sense of requiring a minimum amount ofsense of requiring a minimum amount of
staff time and supervision.staff time and supervision.

27.  Rehabilitation through spontaneous recovery orRehabilitation through spontaneous recovery or
through functional system.through functional system.