Biomed 370Biomed 370The Human Brain and The Human Brain and

BehaviorBehavior

Course ObjectivesCourse Objectives

Better understand the brain systems Better understand the brain systems involved in regulating behaviorinvolved in regulating behavior

Learn about the diagnosis and Learn about the diagnosis and treatment of major syndromes in treatment of major syndromes in psychiatrypsychiatry

Appreciate the importance of anatomy, Appreciate the importance of anatomy, neurochemistry and brain imaging for neurochemistry and brain imaging for understanding the brain and behaviorunderstanding the brain and behavior

FormatFormat

Lectures with patient demonstrationsLectures with patient demonstrations One Midterm (40%) and a Final (60%)One Midterm (40%) and a Final (60%) Review sessions before each examReview sessions before each exam Contact the TA’s for helpContact the TA’s for help Top 15% receive honorsTop 15% receive honors Exams will be multiple choice, often Exams will be multiple choice, often

built around clinical cases. built around clinical cases.

Nancy Brim

Stan Pelosi

Marisa Kastoff

Key Points the Key Points the Brain and BehaviorBrain and Behavior

Brain dysfunction affects all aspects of medicineBrain dysfunction affects all aspects of medicine Progress in the neurobiology of neurological and Progress in the neurobiology of neurological and

psychiatric disorders is advancing at a rapid ratepsychiatric disorders is advancing at a rapid rate 370 will provide an overview of current knowledge to be 370 will provide an overview of current knowledge to be

modified as new information becomes availablemodified as new information becomes available Life-long learning is essential for understanding brain-Life-long learning is essential for understanding brain-

behavior relationshipsbehavior relationships Clinical neuroscience is one field supported by advances in Clinical neuroscience is one field supported by advances in

basic neurosciencebasic neuroscience Brown has many excellent faculty on the cutting edge of Brown has many excellent faculty on the cutting edge of

clinical neuroscience research.clinical neuroscience research.

Case reports have been pivotal in providing Case reports have been pivotal in providing information about localization of function and information about localization of function and pathogenesis of disease, and have greatly pathogenesis of disease, and have greatly advanced the field of Behavioral Neurology advanced the field of Behavioral Neurology and Neuropsychiatry.and Neuropsychiatry.

The MRI of my first The MRI of my first patient with patient with CADASIL that got CADASIL that got me involved in me involved in studying the role of studying the role of genetics in small genetics in small artery disease of the artery disease of the brainbrain

Notch3 mutations chromosome 19

Key Points About Neural Key Points About Neural Systems and BehaviorSystems and Behavior

Clusters of neurons are connected to other neuronal Clusters of neurons are connected to other neuronal clusters in defined circuits. These circuits are organized into clusters in defined circuits. These circuits are organized into networks to perform specific functions.networks to perform specific functions.

Neurotransmitters within the neuronal assemblies are the Neurotransmitters within the neuronal assemblies are the chemical means of carrying out neuronal activity.chemical means of carrying out neuronal activity.

There is hemispheric asymmetry for many functions.There is hemispheric asymmetry for many functions. Injury circuits or degeneration of neurotransmitter systems Injury circuits or degeneration of neurotransmitter systems

can cause a disturbance in cognition, behavior, or can cause a disturbance in cognition, behavior, or sensorimotor function.sensorimotor function.

There is plasticity, redundancy and reserve following injury, There is plasticity, redundancy and reserve following injury, but these all decline with age.but these all decline with age.

4/2/1999 3/7/2002 3/15/2004

The Limbic SystemThe Limbic System

Lecture ObjectivesLecture Objectives

Become familiar with the anatomy and Become familiar with the anatomy and function of the limbic systemfunction of the limbic system

Understand how dysfunction in limbic Understand how dysfunction in limbic structures can lead to neuropsychiatric structures can lead to neuropsychiatric symptomssymptoms

Limbic DivisionsLimbic Divisions

Archicortical (blue)Archicortical (blue)

Paleocortical (red)Paleocortical (red)

Archicortical DivisionArchicortical Division

Hippocampus, cingulate gyrus and Hippocampus, cingulate gyrus and Papez circuitPapez circuit

Modulates sensory processing, Modulates sensory processing, encoding of information and attentional encoding of information and attentional controlcontrol

HippocampusHippocampus

Entorhinal CortexEntorhinal Cortex

Projected Prevalence of ADProjected Prevalence of AD

16

14

12

0

2

4

6

8

10

2000 2010 2020 2030 2040 2050

45.8

6.88.7

11.3

14.3

Mil

lio

ns

4 Million AD Cases Today—4 Million AD Cases Today—Over 14 Million Projected Within a GenerationOver 14 Million Projected Within a Generation

Year

Evans DA et al. Milbank Quarterly. 1990;68:267-289.

Mesial Temporal SclerosisMesial Temporal Sclerosis

31 year old woman 31 year old woman from Africa with from Africa with frequent complex frequent complex partial seizures and partial seizures and mild developmental mild developmental delay. Can you find delay. Can you find the hippocampi? the hippocampi? What is wrong with What is wrong with her scan?her scan?

39-year-old man with no past history of neurological or psychiatric illness brought to the hospital after a generalized seizure. In the ER he was confused and had a low-grade fever. Over the next 7 days he had short-term memory impairment and erratic behavior, sometimes wandering around the ward without clothes. He had trouble paying attention and could recall only one of three words at five minutes. Insight and judgment were impaired. Naming, repetition, calculations, writing and figure copying were intact.

A 30 year old man with schizophrenia was admitted to the hospital with florid psychosis after stopping his neuroleptics 3 months earlier. He had stopped eating regular meals and lost 45 pounds. He was hydrated with D5 NS in the ER and admitted to the Psychiatry Unit. 6 days after admission he developed ataxia and delirium. What does this FLAIR, non-contrast MRI show? Where is the abnormality and what caused it?

Cingulate GyrusCingulate Gyrus

H.M.H.M.

Paleocortical DivisionPaleocortical Division

Amygdala and Amygdala and orbitofrontal cortex, orbitofrontal cortex, basal forebrain, basal forebrain, hypothalamus and hypothalamus and autonomic nervous autonomic nervous systemsystem

Modulates fear Modulates fear responses and responses and emotional memoriesemotional memories

Integrates affect, drives, Integrates affect, drives, and object associationsand object associations

AmygdalaAmygdala

Anterior and medial to Anterior and medial to the hippocampusthe hippocampus

Clusters of nuclei, Clusters of nuclei, basolateral, centro-basolateral, centro-medianmedian

Connected to basal Connected to basal forebrain by stria forebrain by stria terminalisterminalis

Connected to Connected to hypothalamus by hypothalamus by ventral amygdalofugal ventral amygdalofugal pathwaypathway

HypothalamusHypothalamus

Stimulation of the Stimulation of the lateral hypothalamic lateral hypothalamic area-aggressive, area-aggressive, voracious, voracious, hypersexualhypersexual

Stimulation of the Stimulation of the ventromedial ventromedial nucleus-placid and nucleus-placid and early satietyearly satiety

Practice QuestionsPractice Questions

Key structure Key structure involved in episodic involved in episodic memorymemory

Involved in Involved in processing processing emotional memoriesemotional memories

The fornix connects The fornix connects the hippocampus to the hippocampus to which structure?which structure?

The ____ connects the The ____ connects the amygdala to the septal amygdala to the septal nuclei in the base of the nuclei in the base of the frontal lobefrontal lobe

The ventral The ventral amygdalofugal pathway amygdalofugal pathway connects to the connects to the amygdala to the _______amygdala to the _______

The only primary sensory The only primary sensory input to the amygdala is input to the amygdala is from the from the ____________________________