Neuropsych rehab of psychiatric disorders: neurocog. target systems affected in psychiatric disorders

3 overarching sections in this chapter

• Define the seven core neurocognitive target systems affected in psychiatric disorders using the RDoC framework.

• Classify the six tiers of holistic neuropsychological rehabilitation, ranging from molecular interventions to contextual supports.

• Differentiate between restorative, modulatory, and compensatory cognitive rehabilitation strategies.

Types of psychiatric disorders (3)

• Affective

• Psychotic

• Addictive

Affective disorders 2 categories w examples (1→2, 1→3)

• Mood

  • MDD

  • BPD

• Anxiety-related

  • GAD

  • OCF

  • PTSD

Psychotic disorders description (1→3)

• Loss of contact with reality

  • Hallucinations

  • Delusions

  • Disorganised speech/behaviour

7 neuropych targets for rehab of psychiatric disorders

• Memory + learning

• Attention + WM bias

• Executive functions

• Social function systems

• Positive valence systems

• Negative valence systems

• Arousal + regulatory systems

MAES PNA

Memory + learning how impaired, applied to mood, anxiety + SUDs

• Encoding + recall is disrupted by maladaptive associations

  • MDD → heightened recall of negative stimuli

  • Anxiety → focus on threat related memories

  • SUDs → strong environmental associations between cue + drug reward

MEMORY BIAS

Attention + WM how impaired (2)

• Attention is biased towards emotional (affective) or motivational (drug) cues

• Reductions in WM capacity impair attentional control + complex info processing

ATTENTIONAL BIAS

Executive function how impaired: particularly relevant domains w examples (2→2)

• Cognitive inflexibility (e.g. rumination in MDD)

• Response inhibition (difficult to maintain sobriety)

Social function systems how impaired + impact across all

• Impaired social cognition (e.g. emotion-recognition, ToM) → disrupts interpersonal relationships

Positive valence systems: description, examples (depression, SUDs)

• Regulates reward processing

  • MDD → blunted reward anticipation

  • SUDs → overactive response to drug-related cues

ABERRANT REWARD CIRCUITRY

Negative valence systems: description, example w affective disorders

• Regulates responses to threat, loss + punishment

  • In affective disorders → heightened punishment sensitivity → avoidance + helplessness

Arousal + regulatory systems: 2 examples

• Hyperarousal in anxiety-related disorders, SUDs

• Hypoarousal in MDD