Return to Behavioral Science

Download a copy of this study guide

MENTAL STATUS EXAMINATION:

• ALERT: Normal response to average level of stimulus.
• SOMNOLENT: Like when you wake up in the morning.
• STUPOR: No response to stimulus except brutal force, at which point only aversive behavior is displayed.
• COMA: Absolutely no response to stimulus except autonomic responses and spinal reflexes.

Three components of behavior

• COGNITION: Learning and memory
• EMOTION: Also involves memory
• Aversive (avoidant) behavior
• Appetitive (desirous) behavior
• Hunger
• Sex
• CONATION: Goal-seeking, directed, or planned motor behavior.
• FRONTAL LOBES are required for conation. Lesion of frontal lobes results in normal cognition, but inability to execute planned (conative) motor tasks.

BROCA'S MOTOR SPEECH AREA 44: Inferior frontal gyrus, near temporal lobe, and near the facial motor homunculus. Responsible for expressive speech.

WERNICKE'S RECEPTIVE SPEECH AREA 39: Superior temporal gyrus.

• Receptive Aphasia: Inability to interpret speech, results from damage to Wernicke's area.

MEMORY:

• IMMEDIATE (ATTENTIONAL) MEMORY: Ability to maintain conversation and focus on immediate surroundings.
• Duration of seconds to minutes.
• ANATOMY:
• Neocortex must be intact to mediate attentional memory.
• Reticular Thalamic Nucleus exhibits inhibitory influence on cortices receiving extraneous stimuli, to which you are not currently paying attention.
• DIGIT SPAN: 7 forward 5 backward, OK?
• SHORT-TERM MEMORY: Memory for a period of hours to about a day.
• ANATOMY: These two structures are responsible for putting attentional memory into short-term memory
• Hippocampus:
• Dorsomedial Thalamic Nucleus:
• LONG-TERM (HISTORICAL) MEMORY:
• ANATOMY: Has a diffuse representation throughout the cortex. Around half of the cortex must be gone before long-term memory is severely deficient.
• It is never lost, or is the very last thing to go in brain disease.

SPEECH ABNORMALITIES:

• Dysarthria: Abnormalities in motor production of speech, producing garbled sound.
• Aphasia: Inability to formulate meaningful speech, due to a language-based deficit -- not due to motor deficit.
• Receptive Aphasia: WERNICKE'S APHASIA; inability to interpret speech.
• Expressive Aphasia: BROCA'S APHASIA; inability to generate speech
• COMMUNICATION APHASIA: Disconnection between Wernicke's and Broca's. Can occur from multiple strokes in Carotid circulation.
• You can't hear yourself talk, which results in fluent language but in gibberish.

AMNESIAS:

• RETROGRADE AMNESIA: Loss of attentional memory immediately preceding a traumatic event. The amnesia only goes back to the extent of short-term memory. It is an erasure of current short-term memory, and long-term memory is unaffected.
• ANTEROGRADE AMNESIA: The inability to form new memories, at any time forward from a traumatic event.
• LACUNAR MEMORY DEFICIT: A hole in memory surrounding a traumatic event; the sum of retrograde plus anterograde amnesia.

Acute Delirium:

• Wernicke's Encephalopathy
• DELIRIUM TREMENS: Sedative/hypnotic drug (alcohol) withdrawal.
• Symptoms:
• Hyperreflexia, clonus reflexes
• Autonomic instability (tachycardia, hypertension)
• Cortical hyperactivity: vivid dreams, hallucinations, sensory illusions)
• ICU PSYCHOSIS: Multifactorial delirium, acute brain failure.
• CAUSE: Sleep deprivation, effect of multiple drugs, no sense of time and place, hemodynamic, respiratory, and metabolic problems.
• TREATMENT: Cause is unknown. Treat the underlying physiological problems where possible, and eliminate all unnecessary drugs.
• WERNICKE'S ENCEPHALOPATHY: Acute Thiamine deficiency, resulting in edema and hemorrhaging due to disruption of basement membranes.
• Cardinal Symptoms:
• Abducens Palsy (Double Vision), from hemorrhaging Abducens nerve in Periaqueductal Grey.
• Truncal Ataxia, from hemorrhaging cerebellar vermis.
• Global Amnesia: Hemorrhage of hippocampus, dorsomedial thalamic nuclei, mamillary bodies.
• Pathophysiology: Hemorrhaging and edema
• Mamillary bodies and dorsomedial thalamic nuclei
• Hippocampus
• Cerebellar Vermis
• Tegmentum and Periaqueductal gray.

PARKINSON'S DISEASE: Dopamine deficiency in Substantia Nigra ------> loss of inhibition to motor output in Thalamus ------> tremor

• Symptoms:
• Resting Tremor: Inability to initiate movements, and tremor while not moving.
• Loss of facial expression and gestures
• EXTRAPYRAMIDAL NUCLEI:
• They provide inhibitory input to the motor strip.
• Motor learning skills

Visual Deficits:

• Cortical Blindness
• Visual reflexes still remain intact (flinching from a light stimulus) as long as you are intact as far back as the LGN.
• BALINT'S SYNDROME: Lesion to dorsal secondary visual cortex.
• Simultagnosia: Inability to treat the visual field as a whole; inability to interpret the entire visual field in association with other cortices (such is the job of the secondary cortex)
• Optic Ataxia: Inability to correctly and accurate target their vision and visually focus.
• Ocular Apraxia: Inability to shift gaze.
• VENTRAL VISUAL LESIONS: The effects are different than Balint's
• Alexia: Inability to read and write. Occurs primarily with left, but with either side since right side is concerned with spatial recognition of shapes (letters).
• Anomia: Inability to name objects you are looking at. Occurs with left-side lesion.
• Prosopagnosia: Results from a lesion to the right ventral secondary cortex. Inability to recognize faces.
• TERTIARY LESIONS: Unilateral Visual Neglect, as in neglect syndrome.
• Consistent lack of attention to objects in left visual field.
• When asked to draw a clock, only draw the right half of the clock face.

DEMENTIAS:

• ALZHEIMER'S DISEASE: Generalized brain atrophy occurring with age.
• Official diagnosis is used made post-mortem based on histological studies, but the disease isn't treatable anyway so it doesn't matter.
• SIGN: Ventricular enlargement with brain atrophy. Atrophied brain results in enlarged spaces in ventricles.
• MULTI-INFARCT DEMENTIA:
• Symptoms similar to Alzheimer's.
• Sudden onset, with large stepwise decrements in function.
• Showers of microemboli spread diffusely throughout cortex.
• KORSAKOFF'S PSYCHOSIS: Permanent loss of Mamillary Bodies and Dorsomedial Thalamic Nuclei, resulting in complete lack of short-term memory. This is the residual effects of prolonged Wernicke's Encephalopathy and is irreversible.
• Attentional Memory remains intact: neocortex is probably just fine, except for any unrelated effected of alcoholism.
• Long term memory remains intact, although it may be difficult to retrieve directed information.
• Person lives in permanent state of current world.
• Normal Pressure Hydrocephalus: Disturbance in CSF circulation.
• CSF is no longer absorbed and refluxes into the ventricular system
• SIGN: Ventricular enlargement without corresponding brain atrophy.
• SYMPTOMS:
• Truncal ataxia
• Urinary incontinence
• Dementia
• POST-TRAUMATIC DEMENTIAS: Physical injury to brain (auto-accident) resulting in damage to anterior fossa (where the skull is bumpy) ------> damage to hippocampal and thalamic structures.
• SYMPTOMS: Irreversible loss of short-term memory and attention, with long-term memory intact.

KLÜVER-BUCY SYNDROME: Bilateral amygdalectomy.

ANTERIOR HYPOTHALAMUS: Associated with male-pattern sexual arousal.

CNS DEVELOPMENT:

• CRITICAL DEVELOPMENT PERIODS: As you develop, you make more and neuronal (synaptic) interconnections, utilizing fewer and fewer and neurons. That is, many neurons undergo apoptosis after initial neonatal period.
• 2^nd and 3^rd trimesters
• 8 months - 2 yrs old.
• 6-7 years
• 8-9 years
• HARLOW'S MONKEYS: Experiments raising monkeys in different environments and observing them as adults. Three conditions were set up:
• Raised in bare-wire cage, artifical nipple, wooden armature, and source of food:
• The monkeys died
• Raised in similar cage, but arm and nipple were covered by terry cloth, providing snugly cutaneous touch:
• They survived to become antisocials but had no reproductive success.
• Raised as in (2) but they saw a picture of a simple face
• Grew up to be nerd monkeys and tried to interact with other monkeys but had very little reproductive success. They had more success than the other groups though.
• CRECHE SYNDROME: Baby's denied love in neonatal period have higher mortality rate and higher rate of illness. Baby's raised in a prison where they were allowed to interact with their mother thrived even better than the babies raised by an orphanage without such interaction.
• Talking to baby's is crucial for language development.
• PARENTING:
• Child should be able to engage parent's attention but should not have total control over parent's attention (for fear of manipulation)
• Child should have reasonable boundaries for undergoing exploratory behavior.

PERSONALITY DISORDERS: There is a strong contribution of genetics to personality and personality disorders, even though many disorders are difficult to characterize.

• ADJUSTMENT DISORDER: Usually comes to psychiatrist's attention as an adjustment disorder. Episodic and self-limited disturbances of mood.
• CLUSTER-A DISORDERS: SCHIZOID
• DESCRIPTION: Emotional constriction, aloofness, difficulty forming relationships with others
• EXAMPLES: Schizoid Personality, Paranoid Personality, Avoidant Personality
• CLUSTER-B DISORDERS: NARCISSISTIC
• DESCRIPTION: Self-absorption, indifference to the needs of others, self-centeredness, emotional instability
• EXAMPLES: Antisocial Personality, Borderline Personality, Histrionic Personality
• ANTISOCIAL PERSONALITY:
• Characteristics:
• Repeated problems with rules and authorities as a child.
• No response to punishment; unaffected by it.
• Frequently impulsive.
• Demographics:
• Far more prevalent in males than females.
• Behaviors reach peak in early adult years and decline with age.
• Strong evidence for genetic determinant, and one of the most clearly delineated disorders.
• Genetic link to Somatization Disorder.
• Son of antisocial disorder is 20x more likely to exhibit same behaviors.
• In contrast, learning (adoptive studies; no genetic component) only increases risk by 2x. Thus genetics play a much larger role than learning!
• Schizotypal Disorder is the other disorder that is well characterized and documented, and may have a genetic link.
• BORDERLINE PERSONALITY:
• Characteristics:
• Intense need for attachment, affection, and support from others.
• Narcissistic: only see world in relation to one's own needs.
• Reduced ego strength
• Treatment: Difficult; anti-depressants or anti-anxiolytics
• CLUSTER-C DISORDERS: OBSESSIVE
• DESCRIPTION: Rigid coping, restrictive behavioral patterns, dysfunctional relationships.
• EXAMPLES: Obsessive-Compulsive Personality, Passive-Dependent Personality.
• OBSESSIVE-COMPULSIVE DISORDER: There is no evidence of a link between the personality and the true syndrome (which has physiological basis). Those exhibiting the personality are not at increased risk of acquiring syndrome.

Return to top