PSYCHIATRY: Psychological Reactions to Disability

A. General Objectives:
a. To know the development of personality with emphasis on the Filipino personality
b. To know the various psychiatric conditions as a preparation for the management of
psychiatric patients referred to physical therapy and occupational therapy
c. Distinguish between the psychiatric and physical aspects of specific conditions
d. Know the psychological and emotional aspects of significant human life events
e. Know the general principles in integrating the physical and mentally disabled into the
community.

B. Specific, the course aims to:

a. Define the different psychiatric conditions
b. Identify the importance signs and symptoms of each condition
c. Identify the possible causes of each condition
d. Describe the course and prognosis of each condition
e. Identify the management procedures for each condition
f. Identify the psychiatric aspects of specific physical conditions
g. Identify the physical aspects of some psychiatric conditions
h. Discuss the psychodynamics of sexuality, aggression, suicide, death and dying
i. Discuss common reactions of man to illness and hospitalization
j. Demonstrate appropriate treatment approaches towards these events or situations

C. Course Outline
a. The Theoretical Foundations of Psychiatry
i. History of Psychiatry
ii. The Four Schools of Thought in Psychiatry
1. The Psychoanalytic Theory
2. The Social Learning Theory of the Behavioral Approach
3. The Neurobiological Theories and Approaches
4. The Biopsychosocial Approach
b. Child, Adolescent and Adult Development
i. The Psychosexual Stages of Development of Sigmund Freud
ii. The Attachment Theory of John Bowlby
iii. The Stages of Intellectual Development of John Piaget
iv. The Psychosocial Stages of Development of Erik Erikson
c. Brain and Behavior
i. Background in the surface anatomy of the central nervous system
1. The Cerebral Cortex
2. The Limbic System
3. The Brainstem
4. The Spinal Cord
5. The Cranial Nerves
d. Neuropathologic Conditions associated with disruption in the CNS Anatomy
i. Epilepsy
ii. Drive Disorders – rage, eating, pleasure, hunger, sleep
iii. Syndromes of denial, neglect and inattention (Parietal Lobe Syndromes)
iv. Language Disorders
v. The Frontal Lobe Syndromes
vi. Movement Disorders (Brainstem Syndromes)
1. Parkinson’s disease
2. Huntington’s disease
3. Tardive dyskinesia
4. Gilles de la Tourette’s Syndrome
5. Wilson’s disease
e. Adaptive Processes and Mental Mechanism
i. Stress and how it is manifested in the human body and mind
ii. Stressful events throughout the life cycle
iii. Adaptive Mental Mechanisms
1. The Narcissistic Defense Mechanism
2. The immature Defense Mechanism
3. The Neurotic Defense Mechanism
4. The Mature Defense Mechanism
f. The Mental Status Examination Parameters
i. Review of Some Psychiatric Signs and Symptoms
g. The Brain Syndromes due to a General Medical Condition
i. Delirium
ii. Dementia
iii. Amnestic Syndrome
iv. Organic Delusional Syndrome
v. Organic Hallucinosis
vi. Organic Mood Syndrome
vii. Organic Anxiety Syndrome
viii. Organic Personality Syndrome
ix. Substance Use Disorders Drugs and Alcohol
h. The Psychotic Disorders
i. Schizophrenia and Paranoia
ii. Depression and other Mood Disorders
i. The Anxiety Disorders/Personality Disorders
j. Psychological Factors Affecting Physical Condition
i. Cardiovascular System Disorder: CAD, HTN, CHF, Syncope, Arrhythmia
ii. Respiratory System disorder: Bronchial asthma, Hyperventilation Syndrome,
Tuberculosis
iii. Gastrointestinal system disorder: Peptic ulcer, Ulcerative colitis, Obesity,
Anorexia Nervosa
iv. Musculoskeletal system disorder: Rheumatoid Arthritis, Low Back Pain
v. Headaches
vi. Endocrine system disorder: Hyperthyroidism, Diabetes Mellitus, Premenstrual
Syndrome, Menopause, Amenorrhea
vii. Chronic Pain
viii. Immune System Disorders – Infections, Allergies, Organ Transplantation,
Autoimmune diseases (AIDS)
ix. Cancer
x. Skin Disorders
k. The Somatoform Disorders
i. Somatization Disorder
ii. Conversion Disorder
iii. Hypochondriasis
iv. Body Dysmorphic Disorder
v. Pain Disorder
l. Therapeutic Interventions
i. Psychotherapy
ii. Pharmacological Therapy and other Somatic Therapies
iii. Social and Cultural Aspects of Health, Illness and Treatment
iv. Care giving and the True Essence of Helping

D. Schedule
a. Day: Tuesday
b. Time: 4:00pm to 6:00pm

E. Methods of Evaluation and Grading System

Averaging will be used.

F. References
a. Bellish, Karil. Clinical Heatlh Issues Handbook. 1997.
b. Kaplan, Harold I. Comprehensive Textbook of Psychiatry/VI, volume 1. 1995.
c. Kaplan, Harold I. Comprehensive Textbook of Psychiatry/VI, volume 2. 1995.
d. Naidoo, Jennie. Health Promotion: Foundations for Practice. 2000.
e. Sadock, Benjamin James. Synopsis of Psychiatry: Behavioral Sciences/Clinical
Psychiatry, 9th ed. 2003
MODULE 3
(PREPARED BY:
DR. MARIA ELLER ISABEL T. COLLANTES)

Neuropathologic Conditions associated with disruption in the CNS Anatomy

i. Epilepsy
ii. Drive Disorders – rage, eating, pleasure, hunger, sleep
iii. Syndromes of denial, neglect and inattention (Parietal Lobe Syndromes)
iv. Language Disorders
v. The Frontal Lobe Syndromes
vi. Movement Disorders (Brainstem Syndromes)
1. Parkinson’s disease
2. Huntington’s disease
3. Tardive dyskinesia
4. Gilles de la Tourette’s Syndrome
5. Wilson’s disease

A. Learning Outcome
At the end of the topic the learner will be able to:
1) Explain the different neuropathologic condition associated with the CNS
2) Determine the signs and symptoms of each disorder
3) Evaluate the signs and symptoms to come up with the diagnosis

B. Instructional Flow
a. Pre Activity Essay
i. What counts as understanding the brain?
ii. What are the different ways of understanding the brain?

b. Lecture

The CNS or the central nervous system is the body’s major communication network,
this is due to the localization of functions, and neurologic deficits related to disease
processes are variable in their presentation. In the brain, a lesion will cause minimal or
no symptoms, but it other areas it will cause major neurologic deficits. Some symptoms
may include change in consciousness, focal neurologic deficits, headaches, dizziness
and seizures. Edema or inflammation of tissues due to the increase of water content
often occurs on neural tissue lesions. Intracellular or cytotoxic edema is edema located
inside the cells. An extracellular or vasogenic edema is found in the interstitial space
between cells.

A CNS diseases are classified with many categories includes vascular diseases, trauma,
infections, neoplasms, degenerative diseases, toxic and metabolic disorders and
demyelinating diseases. However, neuropathology can be divided into categories that
vary amounts of gaps and overlaps. One system is genetic, idiopathic, vascular,
epileptic, immune, mechanical, metabolic, infectious, neoplastic, environmental,
nutritional and toxic (GIVE IMMINENT) (Jensen)

Epilepsy
Epilepsy is a chronic disorder that causes unprovoked, recurrent seizures. A seizure is a
sudden rush of electrical activity in the brain. A person is diagnosed with epilepsy
when there is a two unprovoked seizures that were not caused by some known and
reversible medical condition like alcohol withdrawal or extremely low blood sugar.
There are two main types of seizures, generalized and focal or partial seizure.

(Kiriakopoulos, 2017)

Classification of Onset Seizures:

1. General Onset Seizure

This type of seizure affects both sides of the brain or groups of cells on both sides of the brain
at the same time. There are types of seizures including tonic-clonic, absence or atonic.
Absence seizure is also called petit mal seizures that can cause rapid blinking or a few seconds
of staring into space. Tonic – clonic seizures also called grand mal seizures that can make the
person cry out, loss of consciousness, fall to the ground and have muscle jerks or spasms. The
person may feel tired after a tonic clonic seizure.

2. Focal Onset Seizure

Focal is used instead of partial to be more accurate when talking about where seizure begins.
Focal seizure can start in one area or group of cells in one side of the brain. Types of focal
onset seizure include focal onset aware seizures and focal onset impaired awareness. A focal
onset aware seizure is when a person is awake and aware during a seizure. It is usually called a
simple partial seizure. Focal onset impaired awareness is when a person is confused or the
awareness is affected in some way during a focal seizure. It is called a focal impaired
awareness seizure before it is termed as a complex partial seizure.
3. Unknown Onset Seizure
It called unknown onset seizure because the beginning of seizure is not known. It can be
considered unknown onset if it is not witnessed or seen by anyone.
after much information had been gathered it may be diagnosed as a focal or generalized seizure.

There are several causes of epilepsy or seizure, it includes a traumatic brain injury, an scaring on the
brain after brain injury commonly called post traumatic epilepsy, very high fever or elevated
temperature can cause it as well, a stroke is a leading cause of epilepsy for people over 35 years of age,
other vascular disease can be included as well, the lack of oxygen to the air, a brain tumor or cyst,
dementia or Alzheimer’s disease, maternal drug use, prenatal injury, brain malformation, or lack of
oxygen while the baby is inside the mother’s womb. An infectious disease such as AIDS and
meningitis, a genetic or developmental disorders or neurological disorders are also predisposing factors
to epilepsy.

However, there are psychiatric syndromes that are related to epilepsy thru the temporal relationship to
seizures these are:

1. Pre-ictal – Prodromal symptoms are vague symptoms that happen during the days and hours
before the attack of seizure. The symptoms include feeling of tenion, dysphoria and insomnia.
An aura may occur immediately before the seizure attack. This is the most common symptom
in complex partial seizures such as the temporal lobe epilepsy or extra temporal epilepsy.
Auras are typically stereotyped either autonomic or visceral aura otherwise known epigastric
sensation, deralization and depersonalization experiences, cognitive symptoms includes
dysphasia, forced thinking, ideomotor aura, déjà vu, fugue and twilight states. Affective
symptoms that includes anxiety and euphoria as well as perceptual experiences, the auditory,
visual, sensory, and olfactory hallucinations or illusions.
2. Ictal – autonomatisms occurs during seizure and suggest a focal origin for the seizure such as
the medial temporal lobe. The level of consciousness (LOC) during the ictus and amnesia for
the automatism, usually lasts less than 5 minutes. There are simple complex stereotyped
movements that tend to be disorganized and purposeless. At this time the individual seems out
of touch. Automatisms may be the basis of twilight and fugue state. An epilepsy partiallis
continuans (EPC) is a condition of prolonged complex partial seizure (CPS) last for hours or
even days. This may be confused with delirium or psychosis syndrome. There are variable
behavioural, cognitive, and perceptual symptoms and periods of amnesia plus having the
bizarre aggressive behavior.
3. Post ictal – a post ictal delirium is very common confusional state following a seizure with
disorientation, inattention, variable levels of consciousness and sometimes paranoia. This tends
to last hours to days and show a trend towards improvement and normal consciousness,
however if prolonged there will be a suspected EPC(epilepsia patialis continua). The post ictal
psychosis usually follows a cluster of seizures or an increase in the frequency of seizures, may
follow withdrawal of anticonvulsant therapy. It usually occurs in individuals with epilepsy for
more than 10 years associated with left temporal lobe focus. Clinically, there is an initial non
psychotic interval (that usually last for hours to weeks) following a seizure. After that, the
individual develops a brief psychotic episode with variable psychotic and affective symptoms.
The episode resolves after a period of days to a month. It may recur 2 or 3 times in a year. An
EEG shows marked changes during the psychotic episodes.
4. Inter ictal - a brief inter ictal psychosis occurs unrelated to seizure when there is a good control
of epilepsy. In this way seizures are antagonistic to the psychosis in that the EEG normalizes
during the psychosis. This is called forced normalization. A seizure may end the psychotic
episode. This form of psychosis is termed alternating psychosis meaning there is an inverse
relationship between severity of epilepsy and severity of psychosis, with symptoms of anxiety,
and insomnia while psychosis has hallucinations and paranoia. An anti convulsant may
aggravate psychosis while antipsychotics may reduce the seizure threshold. A chronic inter
ictal schizophrenia like psychosis is a chronic illness which is 6 -12x more common in
epileptics. Associated with left temporal love epilepsy and common in an early onset of severe
epilepsy and in women with epilepsy. It lapses usually in the period of 10-15 years between
thee diagnosis of epilepsy and onset of psychotic illness. Clinically, this is similar to idiopathic
schizophrenia, with no history and absence of premorbid schizotypal traits. Pathologically it
represents the cumulative effects of chronic kindling due to a temporal lobe focus.

Other presentations of the psychiatric aspects of epilepsy

1. Cognitive deterioration
● common outcome of chronic epilepsy

● repeated seizures with cerebral hypoxia

● neurological effects of chronic anticonvulsant therapy

2. Meuroses
● 50% risk of major depressive episode

● 25% suicidal risk

3. Mania
● Right side TLE (temporal lobe epilepsy) and manic illness
4. Epileptic personality syndrome
● Waxman – geshwind syndrome

● With chronic TLE

● Traits includes religiosity, hypsexuality, hypergraphia (desire to write), and viscosity of

personality
5. Violence
● Increased risk with TLE or frontal lobe epilepsy

● Episodic dyscontrol is a result of sub threshold kindling

● Anticonvulsant are effective in reducing outbursts

Drive Disorders – rage, eating, pleasure, hunger, sleep (INTERMITTENT EXPLOSIVE

DISORDER)
Intermittent explosive disorder or (IED) is a disorder of recurrent, problematic, reactive, aggressive
behavior. Features includes the ff
1. Aggressive outbursts have a rapid onset, without any premeditation that last less than 30
minutes usually as a response to provocation by a known individual.
2. Less severe episodes either verbal or no injurious physical with more severe episodes
3. Disproportionate impulsive aggressive response to psychosocial stressor
4. Aggressive outbursts are impulsive or provoked by anger and cause significant distress or
impairment in psychosocial functioning
5. Individual is above 6 yrs of age or comparable to developmental level
6. Aggressive acts are not better accounted for by other disorders or drugs or medical condition.

RAGE

Rage attacks are sudden, out of control bursts of anger. These outburst can start without a warning,
may also be out of proportion to what triggered the episode. However, rage is different from tantrums
because tantrums are goal oriented with intent to get what they want. But rage is to release the tension
that the person is feeling. Symptoms of rage attack may start without a warning, but signs can be seen
with an increased feeling of stressed and agitation with anxiety. However, when rage attacks the
symptoms includes yelling or shouting, an intense anger and physical aggression. The cause of rage is
unknown, but rage can be triggered with social pressure and school work. Diagnosis is similar to
seizure; however a definitive EEG (electroencephalogram) can be done. It will test the electrical
activity of the brain, an abnormal spike or wave may lead to this disorder. Treatment includes referral
to a psychologist. Psychotherapy is needed to treat with or without the cognitive behavioral therapy
that will examine the thoughts and their relation to feelings and behaviors. Treatment time will be
prolonged and should continue until the treatment is done (Sinai, 2020).

EATING DISORDER

There are two major eating disorder anorexia nervosa and bulimia nervosa. Anorexia nervosa is the
restriction of what they eat and may compulsively over exercise to maintain an excessively low body
weight. While bulimia nervosa have intense cravings, secretively overeat, and they try to prevent
weight gain by vomiting. These disorders are common to women than men. Usually it will begin in
an adolescence or early adulthood stage. But bulimia nervosa usually has later onset year like 18-19
years of age. One of the etiologic factors includes genetics; studies indicate that eating disorder has a
genetic component. Personality, such a being anxious, obsessive compulsive and depressive traits and
low self-esteem contribute to eating disorder. People with anorexia have constricted affect and reduced
emotional expressive while bulimia tends to do the opposite be more impulsive. Biologically, eating
disorder is due to altered brain serotonin function it will alter the regulation of appetite, mood and
impulse control. Childhood environment is a very strong factor to eating disorder, either because of
sexual, physical or emotional abuse. An overprotective or over controlling environment may lead to
overeating as well as having troubled interpersonal or family relationship to add the body shaming that
the person may experience. Certain cultures give more importance on bodily weight, for instance such
beauty pageants only allows a certain weight limit for the contestant and that would make them look
great rather than the person with heavily weight.

Anorexia nervosa

These are minimal food intake and exercise while bulimic is an episodic binge eating with laxative use
and induced vomiting. Diagnosis includes a morbid fear of fatness, deliberate weight loss, distorted
body image, BMI status, amenorrhea or vaginal bleeds at puberty stage, and loss of sexual interest and
potency in men. Clinical features includes preoccupation with food, self-consciousness about eating in
public, social isolating behavior, a vigorous exercise, constipation, cold intolerance and depressive and
obsessive compulsive symptoms. Physical complication includes emaciation, dry and yellow skin, fine
lanugo hair on the face and trunk, bradycardia and hypotension, anemia and leukopenia, consequences
fo repeated vomiting. Management includes a good therapeutic rapport and motivational counseling,
monitor physical health, family intervention, psychological therapies, programmes and lastly
hospitalization depending on the severity of the condition. Prognosis, anorexia has the highest death
rate and osteoporosis is the long term complication.

Bulimia nervosa

Diagnosis requires the presence of morbid fear of fatness, craving for food and binge eating, recurrent
behaviours to prevent weight gain (vomiting, laxatives, and diuretics), preoccupation with body weight
and shape. Clinical features includes normal or excessive weight, loss of control, intense self loathing
with depression, multi impulsive bulimia with alcohol and drug misuse at some point self harm is
evident. Physical complication may include amenorrhea, hypokalemia and signs of excessive
vomiting. Management includes medical stabilization, psychotherapy and antidepressant.

Binge eating disorder and obesity

This is associated with subjective loss of control and distress without purging and typically leads to
obesity. An etiological factor with obesity includes weight controlling genes, family and cultural
influences, high availability of cheap colorific foods and sedentary lifestyle. Management includes
CBT, exercise and educational programs. Anti-obesity medications are of short term benefit however
surgery may be indicated in severe cases.

PLEASURE DISORDER

Anhedonia is the inability to feel pleasure. It is a common symptom of depression and other mental
health disorders. There are two types of anhedonia: social, which means not wanting to spend time
with other people and physical, which is person does not enjoy physical sensations. It is closely linked
to depression, however sometimes the person does not need to be depressed or feel sad to have it. It
affects people with other mental illnesses like schizophrenia and bipolar disorder. Scientist thinks that
this is related to changes in brain activity or the production or responding to dopamine. Treatment
includes antidepressant medications, and talk therapy (md).

HUNGER

Hunger pangs are the 1st step in feeling hungry, which scientifically is a stomach contraction. The food
is converted to glucose. When the glucose level is low, the liver sends signals to hypothalamus –
lateral hypothalamus – in return it triggers to food seeking and consumption. The paraventricular
hypothalamus will tell what food is needed and is responsible for the food cravings. Satiety is the
feeling of time to top eating; scientifically it is the distension of the stomach and the intestine. The
hormone CCK or cholecystokinin is released when food begins to move from the stomach to intestine
and signals the ventromedial hypothalamus that it is time to stop eating. A leptin is also a hormone
released by fat cells, it will decreases appetite via the hypothalamus (Boeree, 2003).

SLEEP DISORDER

These are conditions that result in changes in the way that the person sleeps. It can affect the overall
health, safety and quality of life. However, sleep deprivation can affect the ability to drive safely and
increases the risk of other health problems. Sign and symptoms include excessive daytime sleepiness,
irregular breathing or increased movement during sleep, it also includes irregular sleep and wake cycle
and difficulty falling sleep. Some common types of sleep disorders include insomnia, sleep apnea,
restless legs syndrome (RLS), and narcolepsy. Insomnia is having difficulty falling asleep or staying
asleep throughout the night. Sleep apnea is having abnormal patters in breathing while sleeping.
Restless legs syndrome or RLS is a type of movement disorder, it is also called Willis Ekbom disease
that causes uncomfortable sensation and an urge to move the legs while trying to fall asleep.
Narcolepsy is a condition characterized by extreme sleepiness during the day and falling asleep
suddenly during the day (staff, 2019).

Syndromes of denial, neglect and inattention (Parietal Lobe Syndromes)

DENIAL

It is defined as an involuntary exclusion of unpleasant or painful reality from conscious awareness.

This maybe shown as a grief for children around 3-6 years of age, clinically it is to be of psychoses or
alcohol independencies. There is another type of denial that is the same to Stephen Colbert’s
truthiness, that is deniers adamantly refuse to accept verified scientific facts because they get in a way
of their own rigid ideas,
These are the few examples of their beliefs:
1. There is no such thing as manmade global warming
2. There is nothing that we can do to improve our climate.
3. Most immigrants are a drain on social services, schools, hospitals, and other public resources.
4. Many immigrants are criminals, rapists, dealers or terrorists.
5. The availability of guns has nothing to do with the uniquely American epidemic of shootings.
6. Gun death rates have not dropped in countries with gun control legislation.
7. Vaccines are dangerous, cause autism and other disorders.
8. Muslims are out to destroy us and our way of life.
9. Latinos are lazy, Jews are greedy, African-Americans are violent, etc.
10. Marriage is sacrosanct only between a man and a woman.
11. Planned Parenthood sells fetal parts.
12. LGBT people are either "sick" or "bad."
13. The USA is the first/greatest in the world in health, education, nutrition, generosity,
cleanliness, happiness, and safety. (It is indeed first in weaponry, shootings, military spending,
prisoners, drug trade, and other indices of "greatness.") (Levine, 2015)

There is the term delusion that means a firm belief in some idea which is known to be false, and can be
a symptom of paranoia or psychosis. People suffering this kind of disorder is not mentally ill, however
they do believe so much in these false ideas in spite of evidences against it. These people are called
fundamentalists by Pope Francis, and they can be found in all religions.

NEGLECT

Neglect occurs when an individual relies to another person for care does not receive help or attention to
maintain their health and well being. Abuse may manifest as an intentional withholding of care, it
often occurs due to oversight or inability to properly care for the person in their charge. It may be
possible that the person will not recognize that neglect is happening, but it is important to identify the
risk factors to be able to determine the signs and symptoms of neglect.

Risk factors for child neglect include the following:

1. Domestic violence
2. Chronic medical or mental health issues in family
3. Parents with drug and alcohol issues
4. Poverty
5. Lack of social supports
6. Parental or familial grief and loss
7. Stressful life events
8. Parents or caregivers who have disabilities or cognitive impairment
9. Having young children

Risk factors for elder neglect include the following:

1. Dementia or other cognitive issues
2. Lack or loss of spouse, partner, or social supports
3. Functional impairment
4. Chronic physical health issues
5. Financial stressors or poverty

Sign for child neglect include:

1. Increased mental health concerns
2. Hypervigilance
3. Weight loss or signs of malnourishment
4. Changes in school performance or attendance
5. Learning difficulties
6. Stealing or begging for food
7. Poor hygiene, dirty clothing, insufficient clothing for weather
8. Untreated injuries or illnesses
9. Frequent drug or alcohol use by caregiver or child
10. Inconsistent supervision

Sign for elder neglect include:

1. Sudden functional impairment
2. Isolation from friends and family
3. Weight loss or signs of malnourishment
4. Decreased attention to hygiene
5. Feelings of hopelessness, fearfulness, or depression
6. Disorientation or cognitive problems
7. Hoarding
8. Difficulty managing finances

During neglect, the brain does not receive the positive stimulation that is required for its growth,
instead it is full of stress hormones. It is accompanied with fear and anxiety that will negatively ffect
the child physical and mental development that will results issues as the child grows.

Problems that will arise:

1. Impaired brain development – mental health issues, cognitive and academic problems and
speech and language issues
2. Poor physical health – diabetes, adolescent obesity or poor lung function
3. Poor emotional or mental health – post traumatic stress, borderline personality, depression and
anxiety, suicidal ideation and depressive episodes
4. Poor attachment and social skills – trouble in forming attachments
5. Behavioral issues – poor boundaries and indiscriminate friendliness
6. Addiction – misuse of drugs an alcohol
\
Effect of adult neglect
1. Physical – unchecked or untreated injuries, bed sores, mal nourishment and aggravation of
preexisting health problems
2. Psychological – depression, anxiety or post traumatic stress
3. Social – face isolation, loss of social supports and loss of healthy social outlets
4. Financial – loss of vital utilities (Therapy, 2019)

PARIETAL LOBE SYNDROME

Damage to anterior portion of the parietal lobe may cause problems with the recognition of object thru
the sense of touch. This condition is called asterognosis. A Gerstmaann’s syndrome implies
disturbance or inability to distinguish the left and right side of the body and space. Not recognizing the
fingers will lead to impaired computing, writing (agraphia), in math (acalcuia), reading, disorders of
language (aphasia) and inability to perceive objects normally (agnosia) are the common symptoms of
this syndrome. Causes of this syndrome are impairing the blood flow to this area. This will result
from cerebrovascular diseases, grain damage or even a tumor in the parietal region. However an acute
damage to the non dominant parietal lobe can cause the contralateral side to be neglected leading to
diminished awareness of that part of the body, the environment and injury to it (Memory, 2020).

Language Disorder

Communication disorder may be due to disorders of thinking, abnormal speech patterns I mood
disturbances and schizophrenia, or primary speck fluency disorders such as stuttering and stammering,
disorders of the articulation and speech apparatus and CNS disturbances incovled in hearing and
speech generation or aphasias.

Allusory speech is vague, imprecise and hard to comprehend because too few cues and details are
provided. Such speech maybe heard on patients with schizophrenia or personality disorders.

Stuttering and stammering refer to disturbances in the rhythm and fluency of speech due to blocking
convulsive repetition, or prolongation of sounds.

Aphasias, impairments of language produced by brain dysfunction are being fluent and non fluent.
Fluent aphasias generally reflect dysfunction in the left temporal and parietal area, patient may be
normal or having elevated verbal output, sometimes with logorrhea however they ignore the social
conventions of conversation. They might produce well-articulated phrases with normal prosody but
only a little informational content is given. It is further divided according to the extent of
comprehension by the patient and the ability of the patient to repeat what they hear.

Nonfluent aphasias are characterized by slow and poor verbal output, difficulty with spontaneous
speech, omission of grammatical connecting words, and poor prosody. Patient may reply with one
word or very short phrases. Brain lesion causes non fluent aphasias tend to occur in the anterior left
hemisphere.

Aprosodias are the non verbal aspects of speech, the melody, pauses timing, stress, accent and
intonation are impaired. Damage to right prefrontal region is associated with expressive aprosodias
and damage to the right temporal region and insula is associated with receptive aprosodias.

Developmental language disorder, developmental communication disorder or dysphasia is also called

specific developmental disorder of speech and language. There are 3 main types:

1. Phonological disorders – also called dyslalia. It is characterized by below accuracy in the use of
speech sounds despite normal language skills.
2. Expressive language disorder – below par ability of using expressive speech. The problem
includes restricted vocabulary, difficulty in selecting appropriate words, and immature
grammatical usage.
3. Receptive language disorder – present as a receptive expressive language disorder and both
receptive and expressive language impairment. This is characterized by below par
understanding of language. Problem includes failure to respond to simple instructions.

The Frontal Lobe Syndromes

It is an impairment of the frontal lobe that occurs due to damage, lesions, injury, tumor, diseases in the
frontal lobe. Frontal lobe lesion or damage results in impairment in a person’s ability to make different
types of functions. Etiology is from a head injury, cerebrovascular event, infection, neoplasm,
degenerative disorders such as dementia, and genetic causes. It is said that frontal lobe syndromes I
basically tamping iron blown through skull that is the left frontal brain injury. After the injury usually
they have a 100% recovery; however at some point there will be dramatic personality change such as
stubbornness, lacked in consideration for others, had profane speech, and failure to execute the plans.

A frontotemporal lobar degeneration (FTLD) is neurodegenerative disease that selectively attacks the
frontal and anterior temporal regions. This is commonly associated with patients having dementia.
The initial symptom of FTLD involves changes in personality, behavior, affective symptoms and
language function. Most patients begin with language (affecting the left side of the brain) or emotional
(right side of the brain) changes associated with lack of insight, that will lead to patients to ignore or
deny their deficits. The core feature of this disorder is an early decline in social and personal conduct,
emotional blunting and loss of insight. The clinical onset is a slow gradual progression. Behavior
problems such as overeating, repetitive compulsive behaviors, apathy and agitation and disinhibition
(inability to withhold a prepotent response or suprpress an inappropriate or unwanted behavior),
develop in the majority of these patients as the disease progresses.

Patients with dorsolateral frontal lesions tend to have apathy, personality changes, abulia, and lack of
ability to plan or to sequence, patience have poor working memory for verbal information (due to the
affected left hemisphere) or spatial information (right hemisphere lesion).

Patietns with frontal operculum lesions may demonstrate broca aphasia (partial loss of the ability to
produce language) and defective verb retrieval, while patients with exclusively right opercular lesioons
tend to develop expressive aprosodia (inability to alter the intensity, frequency, duration and quality of
speech to nonverballhy express an emotion).

Patients with orbitofrontal lesions show disinhibition, emotional liability, and memory disorders.
Personality changes from orbital damage include impulsiveness, a jocular attitude, sexual
disinhibitioon and complete lack of concern for others.

Patients with superior mesial lesioons typically develop akinetic mutism (patients tending neither to
move nor speak).

Patients with inferior mesial or the basal forebrain lesion tend to manifest anterograde and retrograde
amnesia and confabulation.

Causes for frontal lobe syndrome:

● Mental retardation

● Traumatic brain injury

● Brain tumors

● Degenerative dementias including Alzheimer disease, dementia with Lewy bodies,

Parkinsonian dementias, and frontotemporal dementias.
● Cerebrovascular disease

● Szhizophrenia

● Major depression

● Multiple sclerosis

● It is associated with blood alcohol level and occurs during acute intoxication with many
recreational drugs.

Clinical features:
● Profound change in personality

● Occasionally patient are hyperactive and restless

● Mood is often euphoric and out of keeping with patients situation

● Irritability and outbursts are common

● Loss of finer senses

● Judgments are impaired

● Fail to plan and carry through ideas

Frontal lobe epilepsy is characterized by recurrent seizures arise from any of the frontal lobe area,
including orbitofrontal, dorsolateral, opercular, supplementary motor area, motor cortex or cingulate
gyrus.

Clinical feature of frontal lobe seizures:

● Clear epileptic syndrome or with unusual behavioral or motor manifestations that are not
immediately recognizable as seizures
● Associated with facial grimacing, vocalization, or speech arrest

● Preceded by somatosensory aura

● Complex behavioral events characterized by motor agitation and gestural automatisms,

viscerosensory symptoms and strong emotional feelings.

Movement Disorders (Brainstem Syndromes)

Movement disorders refers to a group of nervous system (neurological) condition that cause abnormal
increased movements, which may be voluntary or involuntary, it can also cause reduced or slow
movements (Clinic, 2017).

Movement disorder associated in Psychiatry

1. Extra pyramidal diseases with psychiatric symptoms (Parkinson’s disease)
2. Psychiatric disorders with abnormal movements (stereotypies: tics)
3. Medication induced movement disorder (EPSE’s or extra pyramidal side effects)

PARKINSON’S DISEASE

It is a brain disorder that leads to shaking, stiffness, and difficulty with walking, balance, and
coordination. It usually begins gradually and get worse over time. As the disease progresses, patients
experience difficulty in walking and talking also there is the presence of mental and behavioral
changes, sleep problems, depression, memory difficulties and fatigue.
Parkinson’s disease occurs when nerve cells or neurons, in the area of the brain that controls
movement become impaired or die. These neurons normally produce dopamine a brain chemical. En
neurons is impaired or non functional, it produces less dopamine, that causes the movement problems
of Parkinson’s. Patient’s with Parkinson’s also lose the nerve endings that produce norepinephrine, the
main chemical messenger of the sympathetic nervous system, which controls many automatic
functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might lead to
fatigue, irregular blood pressure, and decreased movement of food though the digestive tract and
sudden drop in blood pressure when a person stands up from a sitting or lying down position.
Symptoms of the disease includes: tremor or trembling of the hands, arms, legs, jaw or head, stiffness
of the limbs and trunk, slowness of movement and impaired balance and coordination sometimes
leading to falls. Other symptoms include depression and other emotional changes: difficulty in
swallowing, chewing and speaking: urinary problems or constipation: skin problems: and sleep
disruptions. There is no specific treatment for Parkinson’s disease however medicines may be
prescribed such as: drugs that increase the level of dopamine in the brain, that affect other brain
chemicals in the body and those that help control nonmotor syndrome. However, main therapy is
levodopa or L-dopa. The nerve cells use levodopa to make dopamine replenish the brain’s dwindling
supply. Usually it is taken with carbidopa that prevents or reduces the side effects of levodopa therapy
such as nausea, vomiting, low blood pressure and restlessness; in turn it reduces the amount of
levodopa needed to improve symptoms. Suddenly stopping the levodopa might lead to inability to
move or difficulty in breathing (Aging, 2017).

HUNTINGTONS DISEASE

It is a progressive brain disorder caused by single defective gene on chromosome 4 – on of the 23

human chromosomes that carry a person’s entire genetic code. The defective gene codes that blueprint
for a protein is called huntingtin. A defective huntingtin protein leads to brain changes that cause
abnormal involuntary movements, a severe decline in thinking and reasoning skills, and irritability,
depression and other mood changes. Symptoms develop between the age of 30-50 but can appear as
early of 2 and late as 80. Uncontrolled movement of the arms, legs, head, face and upper body is the
basic symptoms of the disease. It also causes a decline in thinking and reasoning skills, including
memory, concentration, judgment, and ability to plan and organize. In the disease the brain changes
leads to alterations in mood, especially depression, anxiety and uncharacteristic anger and irritability.
Another common symptom is obsessive – compulsive behavior, leading ta person to repeat the same
question or activity over and over. No specific treatment is done except on managing the symptoms in
preventing chorea or involuntary movements, irritability and obsessive compulsive thoughts and
actions

TARDIVE DYSKINESIA

It is a side effect of antipsychotc medication. These drugs used to treat schizophrenia and other mental
health disorders. TD causes stiff, jerky movements of the face and body that one can’t control.
Blinking eyes, sticking out of tongue, or waving arms without meaning to do so are also the symptoms
of the disease. Orofacial dyskinesia or oro bucco lingual dyskinesia are uncontrolled movements in the
face namely lips, jaw, or tongue. Dyskinesia of the limbs affects the arms, legs, fingers and toes. It
includes wiggling of fingers, tapping of feet, flapping of arms, thrusting out of pelvis and swaying
from side to side. It may be fast or slow movement.

GILLES DE LA TOURETTE’S SYNDROME

A developmental neuropsychiatric disorder characterized by multiple motor and one or more vocal
tics, present for at least a year, causing distress and impaired functions. Motor tics often begin between
ages of 3 and 8, a few years before the onset of vocal tics. Typically tics vary over time with more
complex tics emerging after some years. Severity is related to fatigue, emotional stress and
excitement. Corprolalia is associated with this disorder. Symptoms vary from one person to another. It
worsens during periods of excitement, stress and anxiety. No immediately treatment is done if it is not
severe, however if it is severe, there are several behavioral therapy or psychotherapy to be done. This
includes one on one counseling it also includes awareness training, competing response training and
cognitive behavioral intervention for tics. The therapy can help ease symptoms of ADHD, OCD and
anxiety. However, hypnosis, relaxation techniques, deep breathing exercises and guided meditation
cam help and assist in the treatment.

WILSON’S DISEASE
It is a rare inherited disorder that causes copper to accumulate in your liver, brain and other vital
organs. This disease is diagnosed between ages of 5 and 25, but it can affect younger and older people.
Copper is important in development of nerves, bones, collagen and skin pigment melanin. It is
absorbed from the food and excess is excreted through substance produced by liver the bile. However,
for Wilson’s disease, copper is not eliminated properly; instead it accumulates possibly to a life
threatening level. When diagnosed early it can be treated.

Symptoms include:
● fatigue, lack of appetite or abdominal pain

● yellowing of the skin and the whites of the eye (jaundice)

● golden brown eye discoloration (kayser Fleischer rings)

● fluid buildup in the legs or abdomen

● problems with speech, swallowing or physical coordination

● uncontrolled movements or muscle stiffness

Wilson’s disease is inherited as an autosomal recessive trait, which means that to develop the disease
one must inherit one copy of defective gene from each parent. If one receive only one abnormal gene,
it doesn’t affect eh person, but considered to be a carrier therefore it can pass to the offspring.

Complications include:
● scaring of the liver or cirrhosis

● liver failure

● persistent neurological problems – tremors, involuntary muscle movements, clumsy gait and
speech difficulties.
● Kidney problems – leading to kidney stones

● Psychological problems – personality changes, depression, irritability, bipolar disorder or

psychosis
● Blood problems – anemia and jaundice.

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