Law_Atlanta_rcg1002.ppt

NEUROPSYCHIATRY SECTIONDEPARTMENT OF PSYCHIATRY

UNIVERSITY OF PENNSYLVANIAHEALTH SYSTEM

Brain Behavior Laboratory

Neuropsychological and neurobiological research findings on

patients with psychotic disorders:Implications for “mental health” defense

Mental Health & the Criminal Law SeminarAtlanta, October 2002

Mental Health & the Criminal Law SeminarAtlanta, October 2002

Ruben C. Gur, PhDRuben C. Gur, PhD




• THE NEW SCIENCE OF THE BRAIN• NEUROPSYCHOLOGY / COGNITIVE NEUROSCIENCE• STRUCTURAL NEUROIMAGING / NEUROANATOMY• FUNCTIONAL NEUROIMAGING / NEUROPHYSIOLOGY

• IMPLICATIONS FOR PSYCHIATRIC NOMENCLATURE• DSM-IV >> DSM-V• INCORPORATION OF NEUROIMAGING & ELECTROPHYSIOLOGY• INCORPORATION OF NEUROPSYCHOLOGY

COGNITIONEMOTION

• INCORPORATION OF GENETICS & ENDOPHENOTYPIC MARKERS

• IMPLICATIONS FOR DIMINISHED CAPACITY• AMYGDALA AND THE ORBITAL FRONTAL CORTEX• EFFECTS OF ACQUIRED BRAIN DAMAGE• EFFECTS OF NEURODEVELOPMENTAL DISORDERS• BRAIN DYSFUNCTION MAY LEAD TO DIMINISHED CAPACITY

OUTLINEOUTLINE




The Neuropsychology Core Battery by Function

I. ABF: Abstraction and Mental Flexibility Wisconsin Card Sorting Test

III. VMEM: Verbal Memory Semantic Memory (WMS-R) California Verbal Learning Test (CVLT)

II. ATT: AttentionVISUAL Cancellation Tasks (Letter & Symbol) Trail Making A and B Continuous Performance Test [CPT]AUDITORY WAIS-R Digit Span

Seashore Rhythm Test

IV. SMEM: Spatial Memory Figural Memory (WMS-R) Benton Facial Memory Larrabee Continuous Visual Memory Test

V. LAN: Language WAIS-R Vocabulary Controlled Oral Word Association Animal Naming Test Visual Naming (MAE) Token Test (MAE) Paragraph Comprehension (BDAE)

VI. SPA: Spatial Functions WAIS-R Block Design Judgment of Line Orientation

VII. SEN: Sensory-Perceptual Stereognosis (LNNB)

VIII. MOT:Motor Speed Finger Tapping Test




• Does the client have a behavioral problem that can be causally attributed to brain damage?

• Are documented abnormalities in brain anatomy consistent with the putative cause(s) of the behavioral deficits?

• Are there abnormalities in brain physiology that can explain the behavioral changes and help predict long-term outcome.

• Do the behavioral, anatomic and physiologic data converge to support a specific diagnosis?

Questions we can (try to) answer:Questions we can (try to) answer:




Including Behavioral Imaging technologyin the case of a very bright client

Mr. xx

Healthy man

Coronal view

Sometimes the anatomic abnormality is plain for the eyes to see

Sometimes the anatomic abnormality is plain for the eyes to see




-5

-4

-3

-2

-1

0

1z-

sco

re A

CC

UR

AC

Y

NP Function

Male CNT

yy POWER

yy: SPEED

COGNITION EMOTION

The neuropsychological profile of Mr. yy

Note:ABF=ABSTRACTION/FLEXIBILITYATT=ATTENTIONVMEM=VERBAL MEMORYVMEM=VERBAL MEMORYVMEM=VERBAL MEMORYLAN=LANGUAGESPA=SPATIALSM= SENSORIMOTOR

HAP-ID=HAPPY IDENTIFICATIONSAD-ID=SAD IDENTIFICATIONHAP-IN=HAPPY INTENSITY DISCRIMINATIONSAD-ID=SAD INTENSITY DISCRIMINATION

But the anatomic abnormality can be subtle, requiring quantitative analysis

But the anatomic abnormality can be subtle, requiring quantitative analysis




Brain and cerebrospinal fluid (CSF) volumes (in milliliters or cubic centimeters) for healthy people (gray bars, means+SD) and Mr. yy (filled bars) - whole brain

CRANIUM BRAIN0

200

400

600

800

1000

1200

1400

1600

VO

LU

ME

(m

l)

CSF SULC VEN0

20

40

60

80

100

120

140

160

180

BRAIN CSFCNT_Men yy

*

ABBREVIATIONS:CSF=CEREBROSCPINAL FLUIDSULC=SULCAL (PERIPHERAL CSF)VEN=VENTRICULAR (CENTRAL CSF)




REGIONLDG MDG LOG MOG AMG HIG TPG STG

0

5

10

15

20

25

30

35

40V

OL

UM

E (

ml)

FRONTAL TEMPORAL

Gray matter volumes (in milliliters or cubic centimeters) for healthy people (gray bars, means+SD) and Mr. yy (filled bars) - frontal and temporal subregions

REGION ABBREVIATIONS:L=LATERALD=DORSALO=ORBITALM=MEDIALG=GRAY MATTERAM=AMYGDALAHI=HIPPOCAMPUST=TEMPORALP=POLES=SUPERIOR

CNT_Men yy




REGION

LDG MDG LOG MOG AMG HIG TPG STG-40

-30

-20

-10

0

10

20

30

40

%L

AT

ER

AL

ITY

(L

-R)

CNT_Men yy

FRONTAL TEMPORAL

*

Laterality (in %L-R) of gray matter volumes for healthy people (gray bars, means+SD) and Mr. yy (filled bars) - frontal and temporal subregions

%LATERALITY = 100*(L-R)/Mean(L,R);Where L=Left; R=Right

REGION ABBREVIATIONS:L=LATERALD=DORSALO=ORBITALM=MEDIALG=GRAY MATTERAM=AMYGDALAHI=HIPPOCAMPUST=TEMPORALP=POLES=SUPERIOR

-30

-20

-10

0

10

20

30

40

50

60

70

%LA

TER

ALI

TY (

L-R

)

HEALTHY MEN

yy

AMYGDALALaterality (in %L-R) of gray matter volumes for healthy people (empty squares) and Mr. yy (filled square) - amygdala




THERE HAS BEEN A VIRTUAL REVOLUTION IN BRAIN SCIENCES RELATED TO HUMAN BEHAVIOR (BEHAVIORAL NEUROSCIENCE) ADVANCES WERE FUELED BY MEASURES OF BRAIN-RELATED BEHAVIOR (NEUROPSYCHOLOGY), BRAIN ANATOMY (STRUCTURAL NEUROIMAGING) AND BRAIN PHYSIOLOGY (FUNCTIONAL NEUROIMAGING) SEX DIFFERENCES IN BRAIN ANATOMY AND PHYSIOLOGY PROVIDE A CONTEXT FOR UNDERSTANDING COGNITION & EMOTION OPPORTUNITIES FOR REAL INSIGHTS BUT ALSO FOR “JUNK SCIENCE” NEUROSCIENCE (NEUROPSYCHOLOGY AND NEUROIMAGING) CAN HELP DETERMINE DIMINISHED CAPACITY RELATED TO BOTH ACQUIRED BRAIN DAMAGE AND NEURODEVELOPMENTAL DISORDERS THERE IS A MAJOR REVISION TAKING PLACE IN HOW PSYCHIATRY VIEWS PSYCHOTIC ILLNESS, WITH INCREASED LINKAGE OF SYMPTOMS TO THEIR NEURAL SUBSTRATES GENETICS HAS BECOME A MAJOR NEW TOOL IN PSYCHIATRIC RESEARCH AND PRACTICE - THE VIEW OF BEHAVIORAL AND NEUROBIOLOGIC MEASURES AS ENDOPHENOTYPIC MARKERS

CONCLUSIONSCONCLUSIONS

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