This is an informative chapter about Cognitive Disorder (Amnesia Disorders, Dementia Disorders, Delirium Disorders) None of this information in here or other chapters can be used to diagnose people. Only psychiatry professions are obligated to diagnose. Psychopathology chapters are review and summary of Textbook “David H. Barlow, V. Mark Durand (2014) Abnormal Psychology: An Integrative Approach” and lecture notes.

Cognitive Disorders ( Amnesia Disorders, Dementia Disorders, Delirium Disorders)

Memory

Sensory memory send the relevant to short-term memory use for thinking and select the relevant send to long-term memory for long term storage (hippocampus, cortex [cell assembly]). Cell assemblies are organized in networks of related memories. Networks are connected by nerve pathways.

Sensory memory: All information is registered here. Important information is selected for attention and sent to the short-term memory.

Short-term memory: Information is used for thinking and processed for storage in the long-term memory, via the hippocampus. Problem: Deterioration of the hippocampus makes it impossible to store information in the long-term memory, so new memories cannot be formed. This is called anterograde amnesia.

Long-term memory: Memories are stored in cell assemblies, which are organized into networks of related memories. Problem: Deterioration of a pathway to a cell assembly makes it difficult to activate (recall) a memory. An alternative pathway may be found, but it may be slower. Difficulty to find words is aphasia. Problem: Deterioration of all pathways to a cell assembly or deterioration of the cell assembly makes it impossible to activate (recall) a memory. This is called retrograde amnesia.

How Memory fails?

Destruction in;

1- The nerve pathway to a cell assembly. (Alternative routes are used. Not direct, so a longer way. Cause the aphasia)

2- All connections or totally the cell assembly. (The stored memory is lost. Cause retrograde amnesia)

3- Hippocampus. (New experiences cannot be put into memory. Can recall information stored in memory before the problem developed, but unable to recall information after the problem developed. Cause anterograde amnesia)

Amnesia Disorders: Description

Loss of memory (Primarily retrograde amnesia, but sometimes Anterograde amnesia).
Disorder is caused by a medical condition and symptoms may be transient or chronic.

Medical conditions;

1- Drugs. (alcohol, anesthetics, benzodiazepines reduce brain activity; activity of hippocampus is blocked. Cause anterograde amnesia. Transient).

2- Head trauma, concussion. (The shaking of the brain in the skull. No brain damage but stretching or shrinking in the axons. A brief loss of consciousness and dizziness. Retrograde amnesia. It comes back in many cases.

3- Epileptic seizures and ECT. (A brief loss of consciousness and dizziness. Retrograde amnesia Memories come back in many cases)

4- Disruption of blood flow to the brain. (Transient ischemic attack. Neurons do not store energy, They must have a constant supply (glucose). If the blood flow is cut some neurons die. Symptoms; depending on the area of the brain, weakness in parts, hearing or vision problems, dizziness, slurred speech, loss of memory.

5- Lack of Vitamin B1 (thiamine). (Neurons will shrink and die. If in hippocampus: Korsakoff' s syndrome. Cause anterograde amnesia).

Dementia Disorders: Description

De: To reduce, to remove.
Ment: Mind.
Reduction or removal of the mind.

Disorder is caused by a medical condition. Symptoms have a gradual onset, become progressively worse, and are chronic.

1. Loss of memory (retrograde and anterograde).

2. One or more of the following;

• Language disturbance (aphasia).
• Problems with motor behaviors (apraxia).
• Difficulty recognizing objects (agnosia).
• Problems with planning, organizing etc.

Starts with minor problems of memory coping strategies.

Changes in personality. Because of losing control; irritable, very compliant, paranoid delusions depression.

Later pervasive and serious memory loss; aphasia, apraxia, agnosia.

Slow and gradual decline.
Due to strokes: Steplike decline.

Presenile Dementia: <65
Senile Dementia: >65

Early onset: Risk in biological relatives is higher.

Primary Dementia: Due to Alzheimer’s disease.
Secondary Dementia: Due to depression.

Dementia Disorders: Explanation

Deterioration in the brain: Normal process starts at the age of 20, at the age of 50; 15%-20% is reduced. Slowing of the brain activity.

Dementia is due to specific diseases;

• Alzheimer`s disease.
• Vascular disease.
• HIV infections (AIDS).
• Head trauma.
• Parkinson's disease.
• Huntington's disease.
• Pick's disease.
• Jacob-Creutzfeld disease.
• Substance abuse.

Delirium Disorders: Description

1- Disturbance of consciousness.(Confusion about location, problems with attention).

2- Disruption in thought processes. (Loss of memory, confusion, language problems, hallucinations)

Bizzare behavior, agitation/agression or withdrawn.

Delirium: To leave the track

Disorder is caused by a medical condition.

Symptoms develop over a short period of time, may fluctuate in severity, and are usually transient.

Delirium Disorders: explanation

1- General medical conditions: Dehydration, infections, high fever.

2- Substance intoxication or withdrawal.
Any drugs effecting the CNS.
Alcohol.
Delirium tremens.

Case Work: PERPLEXED WOMAN

A woman, 51 years old, showed jealousy toward her husband as the first noticeable sign of the disease. Soon a rapidly increasing loss of memory could be noticed. She could not find her way around in her own apartment.

She carried objects back and forth and hid them. At times she would think that someone wanted to kill her and would begin shrieking loudly.

In the institution, her entire behavior showed perplexity. She was totally disoriented to time and place. Occasionally she stated that she could not understand and did not know her way around.

At times she greeted the doctor like a visitor, and excused herself for not having finished her work; at times she shrieked loudly that he wanted to cut her.

Periodically she was totally delirious, dragged her bedding around, called her husband and her daughter, and seemed to have auditory hallucinations.

Frequently, she shrieked with a dreadful voice for many hours. Because of her inability to comprehend the situation, she always cried out loudly as soon as someone tried to examine her. Only through repeated attempts was it possible finally to ascertain anything.

Her ability to remember was severely disturbed. If one pointed to objects, she named most of them correctly, but immediately afterward she would forget everything again.

When reading, she went from one line into another, reading the letters or reading with a senseless emphasis. When writing, she repeated individual syllables several times, left out others, and quickly became tired.

When talking, she frequently used perplexing phrases and some paraphrastic expressions (milk pourer instead of cup). Sometimes one noticed her getting stuck. Some questions she obviously did not comprehend. She seemed no longer to understand the use of some objects.

Her gait was not impaired. She could use both hands equally well. Her patellar reflexes were present. Her pupils reacted. Somewhat rigid radial arteries; no enlargement of cardiac dullness; no albumin.

During her subsequent course, the phenomena that were interpreted as focal symptoms were at times more noticeable and at times less noticeable. But always they were only slight.

The generalized dementia progressed, however after 4.5 years of the disease, death occurred.

At the end the patient was completely stuporous; she lay in her bed with her legs drawn up under her, and in spite of all precautions she acquired decubitus ulcers.

'From Wilkins RH, Brody lA: "Alzheimer's Disease." Archives of Neurology 21:109-110, 1969.

The first sign of the illness was apparently delusional jealousy. Persecutory delusions, and possibly auditory hallucinations, developed later.

However, the more significant disturbance is the gradual development of a progressive Dementia with marked impairment in immediate and recent memory, disorientation to time and place, and many signs of disturbed higher cortical functioning. For example, her use of “paraphrastic expressions” (milk pourer instead of a cup) indicates aphasia, and her inability to understand the use of some objects indicates agnosia.

The evidence of Dementia with insidious onset and a generally progressive deteriorating course plus the exclusion of all other specific causes of the Dementia, indicate Dementia of the Alzheimer type.

Because the illness began before the patient was 65, With Early Onset is noted, and because of the prominent delusions early in the illness, With Delusions would be noted.

The historical significance of this case is that it was the first one in which microscopic examination of the brain revealed the characteristic histopathologic changes of what has become known as Alzheimer's disease: Senile plaques, neurofibrillary tangles, and granulovacuolar degeneration of neurons. The neurologic disorder Alzheimer' s Disease is recorded on Axis III.

Table of Contents

1.Introduction and Historical Issues
Normality and Abnormality in Clinical Psychopathology
2.Diagnostic Systems and Techniques
Interviews, Observations and Tests
3.Anxiety Disorders I
Symptoms of Anxiety, Phobic Disorders, Generalized Anxiety Disorders, Panic Disorder
4.Anxiety Disorders II
Obsessive-Compulsive Disorders, Post-Traumatic and Acute Stress Disorders.
5.Mood Disorders I
Major Depressive Disorder and Dysthymia.
6.Mood Disorders II
Bipolar Disorder and Cyclothymic Disorder.
7.Schizophrenia I
Symptoms and Issues.
8.Schizophrenia II
Explanations and Treatments.
9.Disruptive Behavior Disorders-I
Attention Deficit/Hyperactivity Disorder.
10.Disruptive Behavior Disorders-II
Conduct Disorder and Oppositional Defiant Disorder.
11.Pervasive Development Disorders
Autistic Disorder, Asberger`s and other Developmental Disorders.
12.Elimination Disorders and Tic Disorder.
13.Mental Retardation.
14.Cognitive Disorders
Amnesia Disorders, Dementia Disorders, Delirium Disorders.
15.Suicide.
16.Substance-related disorders.
17.Sexual Dysfunctions.