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Frontal lobe &psychiatry- ppt
- 1. FRONTAL LOBECHAIR PERSONS:Prof.DR.V.RAMANUJAM,MD.,DPMDR.S.ANANDAKRISHNAKUMAR, MD.,DPMPRESENTOR:DR.A.GODSON1st YEAR MD
- 2. INTRODUCTIONEMOTIONAL CONTROL CENTERHOMETO PERSONALITYMORE PRONE TO INJURYDEVELOPMENTARISE FROM LATERAL WALL OF DIENCEPHALONDERIVED FROM ROSTRAL END OF HEMISPHERE
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- 13. MEDIAL FRONTAL GYRUSPARACENTRAL LOBULE
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- 17. LATERAL,MEDIAL , ANTERIOR,POSTERIOR ORBITAL GYRI
- 18. BLOOD SUPPLYSUPEROLATERAL SURFACEANTERIOR&MIDDLECEREBRAL ARTERYMEDIAL SURFACEANTERIOR CEREBRAL ARTERYINFERIOR SURFACEANTERIOR&MIDDLE CEREBRAL ARTERYAMajor functional areas
- 19. PRECENTRAL CORTEXPRIMARY MOTORCORTEXPlanning&refining of motor movements
- 20. Area 4 ofBroad man’sPRE MOTOR CORTEXPlanning complex motor movements
- 21. Broadman’s area 6,8FRONTALEYE FIELDVoluntary saccades
- 22. Smooth pursuit eyemovements
- 23. Fast brain pathwayBROCA’SAREAMotor movements of tongue&larynx
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- 31. Control of decisionmakingDORSOLATERAL PFCControl behavior
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- 33. Preparation&execution of actORBITOFRONTALCORTEXDecision making
- 34. Flexible Control ofexitation&inhibition
- 35. Emotional control ofbehavior
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- 37. Limbic system-due tofunction in emotion, reward&rich connections with othersRelated area found in rodents
- 38. Least understood areaFRONTALCIRCUITSPREFRONTAL CIRCUITS(THREE IN NUMBER)dorsolateral prefrontal cortex, later orbital cortex, and anterior cingulate of the prefrontal cortex -> striatal structures ->globuspallidus and substantianigra ->specific thalamic nuclei. The functional circuit is complete with a feed back from the thalamus to the frontal lobes. MOTOR CIRCUIT Supplementary motor area, the premotor area, the motor cortex, and the somatomotor cortex ->to putamen->globuspallidusexterna -> caudolateralsubstantianigra
- 39. CONTINUEDOCULOMOTOR CIRCUITFrontal eyefields , the prefrontal cortex, the posterior parietal cortex ->caudate nucleus-> globuspallidus-> substantianigra ->thalamus. LATERAL ORBITOFRONTAL CIRCUITSInferolateral prefrontal cortex -> ventromedial caudate nucleus-> dorsomedialpallidum and rostromedialsubstantianigra-> globusPallidusexterna and subthalamic nucleus. The pallidum and substantianigra connect to the ventral anterior and medial thalamic nuclei and project back to the Orbitofrontal cortex.
- 40. FUNCTIONS OF SPECIFICAREAS-GLANCE Primary motor cortex : planning, initiation and control of physical movement Dorsolateral frontal lobe: planning, strategy formation, and other executive functions.Left prefrontal cortex : verbal memory Right prefrontal cortex : spatial memory. Broca's area: expressive language, i.e. language production. Orbitofrontal cortex: response inhibition, impulse control, and social behaviour.ability to make choice,determine right from wrong
- 41. FRONTAL LOBE SYNDROMESPREMOTORSYNDROMENO PARALYSIS
- 42. LOSS OF FINEMOTOR FUNCTION
- 43. SPASTICITY,RIGIDITY,GRASP REFLEX INSEVERE DAMAGEMEDIAL PREFRONTAL SYNDROMEDIFFICULT IN INITIATION &PERFORMANCE OF LIMB ,EYE,SPEECH MOVEMENTS
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- 45. PSEUDODEPRESSION:ADYNAMIA WITH DISORDERSOF ATTENTION AND MOTILITYDORSOLATERAL PREFRONTAL SYNDROME(Area 8,9,10,46)ATTENTION DISORDER-DYSEXECUTIVE SYNDROMELow arousal or alertness
- 46. Difficulty in SustainedAttention-Digit vigilance test
- 47. Deficits in SelectiveAttention-Color trails &trail making test
- 48. Visual Search-Visual &pictorialscanning test MEMORY DYSFUNCTION Difficulty in voluntary learning
- 49. Loss of recentmemory
- 50. Impaired working memory-Nback test,Delayed response ability testPLANNING DYSFUNCTIONFailure to formulate and carryout new plans
- 51. Lack of anticipationof consequence
- 52. Tower of londontestCONTINUEDDISORDERS OF ABSTRACT THINKING,CONCPTFORMATION AND MENTAL SETDifficulty on conceptual task
- 53. Unable to inhibitcustomary mode of responding due to interference with voluntory control of inhibition
- 54. Wisconsin card sorttest & Color form sorting tesTLANGUAGE DISORDERImpaired ability to construct original,improvised,extended speech
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- 57. Tested by verbalfluency and word production testBEHAVIOURAL SYMPTOMSUtilization behaviour
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- 61. Inappropriate humour andtelling of pointless and boring stories referred as WitzelsuchtORBITOFRONTAL SYNDROMEDISINHIBITION-HALLMARKMotor Disinhibition: Hyperactivity and increased speech Instinctive Behavior: Hypersexuality, hyperphagiaIntellectual :Grandiose and paranoid ideas, flight of ideas. Sensory disinhibition :Visual and auditory hallucinations Emotional disinhibition: Euphoria, elation, and irritability
- 62. CONTINUEDsyndrome characterized by:Impairmentin personalityImpairment in social behavior Impairment in spontaneous arousal of attention Impairment in arousal/motivation Impairment in the ability to focus attention, Impairment in initiating behavior Impairment of goal directed and purposeful behaviorTendency to display inappropriate emotions and behavior Impairment in ability to change mental set
- 63. FRONTAL LOBE EPILEPSYBRIEF,RECURRENTSEIZURESECOND MOST COMMON AFTER TLECLINICAL MANIFESTATION DEPENDS AREA OF INVOLVEMENTONSET WITH ABNORMAL BODY POSTURE/SONSORIMOTOR TICSRARELY UNCONTROLLABLE LAUGH OR CRYBRIEF POSTICTAL CONFUSIONCAUSE RANGE FROM GENETIC TO TRAUMA
- 64. FUNCTION ASSESSMENT TESTSWORDLIST GENERATION TEST
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- 71. WISCONSIN CARD TEST-USEFULIN DYSEXECUTIVE SYNDROME,SCHIZOPHRENIA,NEURODEGENERATIVE DISEASES
- 72. TOWER OF LONDONTEST-DETECT DEFECT IN PLANNING DUE TO FRONTAL LOBE DAMAGE
- 73. LOWA GAMBLING TASK-ORBITOFRONTALCORTEX DYSFUNCTION
- 74. FAUX PAS TEST-ORBITOFRONTALCORTEX DYSFUNCTIONPRIMITIVE REFLEXESThese are newborn reflexes disappear or inhibited by Frontal lobe during normal development,which are not being suppressed in frontal lobe injury causes frontal release signs.WALKING/STEPPING REFLEX
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- 82. BABKIN REFLEXFrontal Lobe&schizophreniaREDUCEDNMDA GLUTAMATE RECEPTORS CAUSING COGNITIVE SYMPTOMSRESPONSIBLE FOR NEGATIVE SYMPTOMSANATOMICAL ABNORMALITY OF PREFRONTAL CORTEXMRI&PET SHOWS FUNCTIONAL DIFFERENCE IN BRAIN ACTIVITY IN FRONTAL LOBE,HIPPOCAMPUS,TEMPORAL LOBEPET SHOWS LESS FRONTAL ACTIVITY DURING WORKING MEMORY RELATED TO NEUROCOGNITIVE DEFECTS
- 83. ANTISOCOAL PERSONALITYORBITOFRONTAL INJURY-POORIMPULSE CONTROL&AGGRESSION
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- 85. NEUROIMAGING SHOWS REDUCEDPREFRONTAL CORTICAL SIZE DEPRESSIONLEFT DORSAL ANTEROLATERAL PREFRONTAL DYSFUNCTION
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- 87. MRI:SMALL CAUDATE NUCLEUS& FRONTAL LOBE
- 88. SPECT:DECREASED BLOOD FLOWTO FRONTAL CORTEXcontinuedOCDALTERED FUNCTION IN NEURO CIRCUIT
- 89. INCREASED BLOOD FLOW&METABOLISMIN FRONTAL LOBE
- 90. COMPULSIVE HOARDING:Compulsive hoarding or pathologicalhoarding or disposophobia is the excessive acquisition of possessions, even if the items are worthless, hazardous, or unsanitary.
- 91. DAMAGE TO RTMEDIAL PREFRONTAL CORTEX CAUSE HOARDINGDEMENTIACOGNITIVE IMPAIREMENT,MEMORY IMPAIREMENT,PERSONALITY CHANGES-THOUGHT TO BE DUE TO FRONTAL INVOLVEMENT
- 92. ADHDGENERAL REDUCTION OFBRAIN VOLUME ,BUT PROPORTIONALLY GREAT REDUCTION OF LT PREFRONTAL CORTEX
- 93. RECENT RESEARCH SHOWSFOLLOWING FOUR CONNECTED FRONTOSTRIATAL REGIONS PLAY A ROLE IN ADHD-lateral prefrontal cortex ,Dorsal anterior cingulate,caudate,Putamen
- 94. DELAYED DEVELOPMENT OFFRONTAL CORTEX,TAMPORAL LOBE&FAST MATURITY OF MOTOR CORTEX SEEN
- 95. THIS CONTRIBUTES SLOWBEHAVIOURAL CONTROL &ADVANCED MOTOR DEVELOPMENT LEADS TO FIDGETINESS,THAT IS CHARACTERISTIC OF ADHD
- 96. PET SHOS LOWPERFUSION AND METABOLISM OF FRONTAL AREAFRONTAL LOBOTOMY/LEUCOTOMYFIRST DEVELOPED BY EGAS MONIZ
- 97. DISORDERED THOUGHTS AREPREVENTED TO REACH HYPOTHALAMUS& THALAMUS FROM FRONTAL LOBE
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- 99. DISTRESS REDUCED,BUT BLUNTINGTHE EMOTIONS,PERSONALITY
- 100. NOT ROUTINELY PRACTICEDNOWEVOLUTIONSCIENTISTS THOUGHT THAT IMPORTANT HUMAN EVOLUTION AND DISTINCT COGNITION DUE TO LARGE FRONTAL LOBE IN HUMANS COMPARED TO OTHERS
- 101. SEMENDEFERI et alFOUND FRONTAL CORTEX RELATIVELY LARGE THAN LESSER APES AND MONKEYS BUT NOT THAN GREAT APES
- 102. TULVING DISCOVERED LEFTFRONTAL LOBE IMPORTANT IN SEMANTIC MEMORY RETRIEVAL (fMRI )
- 103. ANIMALS CANNOT USEFUTURE MEMORY DUE TO SMALL FRONTAL LOBE SIZEGAGE’S ACCIDENT
- 104. GAGE’S ACCIDENTIN1848 PHINEASGAGE A FOREMAN OF GANG BLASTING GROUP MET WITH BLAST ACCIDENT
- 105. A LARGE IRONROD PASSED ON SIDE OF FACE,PASSING BACK OF LT EYE,CAME OUT AT TOP OF HEAD
- 106. AS PER RATIUet al IT DAMAGED LT FRONTAL LOBE
- 107. NEUROLOGIST ANTONIO DAMASIOUSES GAGE TO ILLUSTRATE LINK BETWEEN FRONTAL LOBES AND EMOTION,PRACTICAL DECISION MAKING
- 108. BUT ANY THEORYON BASIS OF GAGE FACED DIFFICULTY THAT THE NATURE,EXTEND,DURATION OF INJURY’S EFFECT ON HIS MENTAL STATE ARE VERY UNCERTAIN
- 109. IN 1849 HENRYJACOB BIGELOW STATED THAT GAGE WAS QUITE RECOVERED IN FACULTIES OF BODY& MIND,THERE BEING INCONSIDERABLE DISTURBANCE OF FUNCTIONTHANK YOU