NEUROBEHAVIORAL PROBES

1
Neuropsychological and neurobiological research
findings on patients with psychotic
disorders Implications for mental health
defense
Ruben C. Gur, PhD
Mental Health the Criminal Law Seminar Atlanta,
October 2002
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OUTLINE

• THE NEW SCIENCE OF THE BRAIN
• NEUROPSYCHOLOGY / COGNITIVE NEUROSCIENCE
• STRUCTURAL NEUROIMAGING / NEUROANATOMY
• FUNCTIONAL NEUROIMAGING / NEUROPHYSIOLOGY
• IMPLICATIONS FOR PSYCHIATRIC NOMENCLATURE
• DSM-IV gtgt DSM-V
• INCORPORATION OF NEUROIMAGING
  ELECTROPHYSIOLOGY
• INCORPORATION OF NEUROPSYCHOLOGY
• COGNITION
• EMOTION
• 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

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The Neuropsychology Core Battery by Function
I. ABF Abstraction and Mental Flexibility
Wisconsin Card Sorting 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
II. ATT Attention VISUAL Cancellation
Tasks (Letter Symbol)
Trail Making A and B
Continuous Performance Test CPT AUDITORY
WAIS-R Digit Span Seashore Rhythm Test
III. VMEM Verbal Memory Semantic
Memory (WMS-R) California Verbal
Learning Test (CVLT)
IV. SMEM Spatial Memory Figural Memory
(WMS-R) Benton Facial Memory
Larrabee Continuous Visual Memory Test
VII. SEN Sensory-Perceptual
Stereognosis (LNNB) VIII. MOTMotor Speed
Finger Tapping Test
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Questions we can (try to) answer

• 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?

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Including Behavioral Imaging technology in the
case of a very bright client
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Mr. xx
Sometimes the anatomic abnormality is plain for
the eyes to see
Healthy man
Coronal view
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But the anatomic abnormality can be subtle,
requiring quantitative analysis


The neuropsychological profile of Mr. yy
Male CNT
yy POWER
yy SPEED
1
0
-1
z-score ACCURACY
-2
Note ABFABSTRACTION/FLEXIBILITY ATTATTENTION VM
EMVERBAL MEMORY VMEMVERBAL MEMORY VMEMVERBAL
MEMORY LANLANGUAGE SPASPATIAL SM
SENSORIMOTOR HAP-IDHAPPY IDENTIFICATION SAD-IDS
AD IDENTIFICATION HAP-INHAPPY INTENSITY
DISCRIMINATION SAD-IDSAD INTENSITY
DISCRIMINATION
-3
-4
-5
COGNITION
EMOTION
NP Function
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Brain and cerebrospinal fluid (CSF) volumes (in
milliliters or cubic centimeters) for healthy
people (gray bars, meansSD) and Mr. yy (filled
bars) - whole brain
BRAIN
CSF
CNT_Men
yy
1600

180
1400
160
1200
140
120
1000
VOLUME (ml)
100
800
80
600
60
400
40
200
ABBREVIATIONS CSFCEREBROSCPINAL
FLUID SULCSULCAL (PERIPHERAL CSF) VENVENTRICULAR
(CENTRAL CSF)
20
0
0
CRANIUM
BRAIN
CSF
SULC
VEN
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Gray matter volumes (in milliliters or cubic
centimeters) for healthy people (gray bars,
meansSD) and Mr. yy (filled bars) - frontal and
temporal subregions
REGION ABBREVIATIONS LLATERAL DDORSAL OORBITAL
MMEDIAL GGRAY MATTER AMAMYGDALA HIHIPPOCAMPUS
TTEMPORAL PPOLE SSUPERIOR
40
35
30
25
20
VOLUME (ml)
15
10
5
0
LDG
MDG
LOG
MOG
AMG
HIG
TPG
STG
FRONTAL
TEMPORAL
REGION
CNT_Men
yy
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Laterality (in L-R) of gray matter volumes for
healthy people (gray bars, meansSD) and Mr. yy
(filled bars) - frontal and temporal subregions




REGION ABBREVIATIONS LLATERAL DDORSAL OORBITAL
MMEDIAL GGRAY MATTER AMAMYGDALA HIHIPPOCAMPUS
TTEMPORAL PPOLE SSUPERIOR
40
30
20
10
LATERALITY (L-R)
0
-10
-20
-30

-40
LDG
MDG
LOG
MOG
AMG
HIG
TPG
STG
CNT_Men
yy
FRONTAL
TEMPORAL
LATERALITY 100(L-R)/Mean(L,R) Where LLeft
RRight
REGION
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AMYGDALA
Laterality (in L-R) of gray matter volumes for
healthy people (empty squares) and Mr. yy (filled
square) - amygdala
70
60
HEALTHY MEN
yy
50
40
30
LATERALITY (L-R)
20
10
0
-10
-20
-30
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CONCLUSIONS

• 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