PSYC31H3 Chapter Notes - Chapter 1: Telemedicine, Impulsivity, Brain Mapping

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28 Jan 2013
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Chapter One
-clinical neuropsychology is an applied science concerned with the behavioural
expression of brain dysfunction
-in the 19th century the idea of controlled observations became generally accepted, thus
providing the conceptual tool with which the first generation of neuroscientists laid out
the basic schema of brain-behaviour relationships that hand today
-in the first half of the 20th century, war-damaged brains gave the chief impetus to the
development of clinical neuropsychology
-the need for screening and diagnosis of brain injured and behaviourally disturbed
servicemen during the First World War and for their rehabilitation afterwards created
large-scale demands for neuropsychology programs
-the Second World War and then the wars in east Asia and the Mideast promoted the
development of increasingly sophisticated examination and treatment techniques
-educational psychologists, beginning with Binet & Spearman, initially developed tests to
capture that elusive concept "intelligence"
-mental measurement specialists produced a multitude of examination techniques to
screen recruits for the military & to assist in educational evaluations. some of these
techniques -such as Raven's progressive matrices, the WIS, & the wide range
achievement tests- have been incorporated into the neuropsychological test canon
-society's acceptance of educational testing led to a proliferation of large-scale, statistics-
dependent testing programs that provide neuropsychology with an understanding of the
nature & varieties of mental abilities from a normative perspective
-educational testing has also been the source of ever more reliable measurement
techniques & statistical tools for test standardization & the development of normative
data, analysis of research findings, & validation studies
-animal studies & clinical reports of brain injured persons, especially soldiers with
localized wounds & stroke patients, generated much of what was known about the
alterations & limitations of specific cognitive functions when one part of the brain is
missing or compromised
- now in the 21st century, dynamic imaging techniques permit viewing functioning brain
structures, further refining understanding of the neural foundations of behaviour
- functional neuroimaging gives psychological constructs the neurological bases
supporting analysis & comprehension of the always unique & often anomalous
multifaceted behavioural presentations of brain injured patients
-when doing assessments, clinical neuropsychologists typically address a variety of
questions of both neurological & psychological import
-the practice of neuropsychology calls for flexibility, curiosity, inventiveness, & empathy
even in the seemingly most routine situations
-each neuropsychological evaluation holds the promise of new insights into the workings
of the brain & the excitement of discovery
- the rapid evolution of neuropsychological assessment in recent years reflects a growing
sensitivity among clinicians generally to the practical problems of identification,
assessment, care, & treatment of brain impaired patients
- neurologists & neurosurgeons request behavioural evaluations to aid in diagnosis & to
document the course of brain disorders or the effects of treatment
-rehabilitation specialists request neuropsychological assessments to assist in
rehabilitation planning & management of neurological condition
-child neuropsychology has developed hand in hand with advances in the study of mental
retardation, neurodevelopment disorders including learning disabilities, & children's
behaviour problems
-adults whose cognitive & behavioural problems stem from development disorders or
childhood onset conditions may also need neuropsychological attention
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- the preponderance of the literature on their problems is in books & articles dealing with
development conditions such as ADHD, spina bifida, or hydrocephalus arising from a
perinatal incident, or with the residuals of premature birth or childhood meningitis, or the
effects of cancer treatment in childhood
-neuropsychology has been evolving naturally: assessment tends to play a predominant
role while these science are relatively young; treatment techniques develop as diagnostic
categories & etiological relationships are defined & clarified, & the nature of the patients'
disorders become better understood
-treatments planning & evaluation have become not merely commonplace but often
necessary considerations for neuropsychologists performing assessments
Examination Purposes
-any of the six different purposes may prompt a neuropsychological examination:
diagnosis; patient care-including questions about management & planning; treatment-1:
identifying treatment needs, individualizing treatment programs, & keeping abreast of
patients' changing treatment requirements; treatment-2: evaluating treatment efficacy;
research, both theoretical & applied; forensic questions are frequently referred to
neuropsychologists
-many assessments serve two or more purposes, requiring the examiner to integrate the
strategies in order to gain the needed information about the patient in the most focused &
succinct manner possible
1. Diagnosis
-neuropsychological assessment can be useful for discriminating between psychiatric &
neuropsychological symptoms, identifying a possible neurological disorder in a
nonpsychiatric patient, helping to distinguish between different neurological conditions,
& providing behavioural data for localizing the site- or at least the hemisphere side- of a
lesion
- however, the use of neuropsychological assessment as a diagnostic tool has diminished
while its contributions to patient care & treatment & to understanding behavioural
phenomena & brain function have grown. This shift is due at least in part to the
development of highly sensitive & reliable noninvasive neurodiagnostic techniques
-accurate diagnosis & lesion localization are often achieved by means of the neurological
examination & laboratory data
-still, conditions remaining in which even the most sensitive laboratory analyses may not
be diagnostically enlightening, such as toxic encephalopathies, Alzheimer's disease &
related cementing processes, or some autoimmune disorders which present with
psychiatric symptoms
-even when the site & extent of a brain lesion have been shown on imaging, the image
will not identify the nature of residual behavioural strengths & the accompanying
deficits: for this, neuropsychological assessment is needed
-cognitive assessment can document mental abilities that are inconsistent with anatomical
findings
-Neuropsychological techniques will continue to be an essential part of the
neurodiagnostic apparatus
-neuropsychological assessment can aid in prodromal or early detection & prediction of
cementing disorders or outcome
-Huntington's disease
-pharmacologic research may engage neuropsychological assessments to assist in
predicting responders & best psychopharmacological treatments in mood disorders
-in patients with intractable epilepsy, neuropsychological evaluations are critical for
identifying candidates for surgery as well as for implementing post surgical programs
-screening is another aspect of diagnosis
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