Module 6

What is the definition of cognitive neuropsychology in relation to delusions?

Combination of both cognitive psychology and neuropsychology with emphasis on understanding the mind

What is the definition of cognitive neuropsychiatry in relation to delusions?

Applications of cognitive neuropsychology methods to understand/explain disorders of higher-level cognition

What is a delusion?

a false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary

What are the 5 common types of delusions?

-Capgras delusion
-Fregoli delusion
-Cotard delusion
-Somatoparaphrenia
-Delusion of alian control

Once established, a ______________ is very ____________ to change

delusion; resistant

A delusion is culturally ____________

unusual

What are monothematic delusions?

Only concern a single topic

What type of delusion is often caused by neurological damage?

Monothematic delusions

What is a positive associated with monothematic delusions?

Due to its parameters as a single topic delusion, it pinpoints the cause of the delusion

T/F - encapsulated beliefs do not interact with the rest of a patients beliefs

Yes

What is the basic distinction of Capgras Delusion syndrome?

It is the belief that someone emotionally close to you has been replaced by an imposter

Who coined the term capers delusion syndrome?

Capgras & Reboul-Lachaux, 1924

T/F - capers delusion is a monothematic delusion

True, other beliefs are normal

False beliefs of Capgras delusion are ____________

encapsulated

Are patients with capers delusion syndrome aware of their delusion?

No- they more commonly believe they suffer from from ODD

T/F- Capgras Delusion syndrome is rare

False

CDS CASE STUDY: (Alexander, Stuss & Benson, 1979) - 44Y male, road accident victim had damage to where?

-Bilateral lesions in frontal lobes
-Extensive right hemisphere damage
-Auditory delusions prior to accident in times of stress

CDS CASE STUDY: (Alexander, Stuss & Benson, 1979) - 44Y male reported what delusion 2yrs post vehicle accident?

That he had 2 families

CDS CASE STUDY: (Alexander, Stuss & Benson, 1979) - 44Y male reported what differences in his delusional family?

-Wives had the same name and similar appearance
-5 children had same names but delusional family all one year younger
-Claimed the change occured one month post accident when new wife picked him up from the hospital
-positive emotive towards both wives

Consistent features of Capgras: Delusion often -

specific to one person or set of persons

Consistent features of Capgras: Patient is convinced that although the person is -

identical to the original personal in everyday, but they are different

Consistent features of Capgras: Belief is resistant to -

Criticism, however patients can recognise the idea is absurd

Consistent features of Capgras: False person is never -

mistaken for someone else or given a different name

Consistent features of Capgras: Patient cannot explicitly identify the-

differences between the current and true person

Consistent features of Capgras: Delusion tends to occur-

in familiar contexts

Consistent features of Capgras: Patients adapt well to -

the imposter

CDS occurs in parallel to what three medical disorders?

-psychiatric illness
-Organic illnesses
-Neurological damage

4% of CDS patients also have?

psychosis - mostly paranoid schizophrenia

20-30% of CDS patients also have?

Alzheimer's disease

What neurological damage is concurrent to CDS?

Epilepsy, tumors, head injury, multiple sclerosis, Parkinsons' disease

Oedipal interpretation

if one's mother is not actually ones mother but an imposter then sexual feelings towards her don't allow patients to feel guilty

Joseph (1986): Cerebral hemisphere disconnection hypothesis

-Each hemisphere independently processes visual information about faces
-CD occurs when the two sets of information fail to integrate

Staton et al (1982): failure to update patient's mental representations

CD due to mismatch between what is currently seen and the memory representation

How does Hirstein & Ramachandran (1997) explain CD? 1 of 4

-CD due to failure to process information between the face-processing components of the temporal lobe and limbic system

How does Hirstein & Ramachandran (1997) explain CD? 2 of 4

CD = failure to integrate ongoing memories of a person across episodes

How does Hirstein & Ramachandran (1997) explain CD? 3 of 4

Damage prevents patient from integrating current encounter with person the the stored 'file' on that person so it creates a new file

How does Hirstein & Ramachandran (1997) explain CD? 4 of 4

Limbic activation (emotion) acts as a glow to help link successive episodes with that person

In normal dual route (Bauer,1984) face processing, the ventral route is responsible for what?

Seeing a face allows you to recognise a familiar person

In normal dual route (Bauer,1984) face processing, the dorsal route is responsible for what?

affective response to the face

In normal dual route (Bauer,1984) face processing, prospagnosia is responsible for what?

damage to the ventral pathway

In normal dual route (Bauer,1984) face processing, Capgras Delusion is responsible for what?

damage to the dorsal pathway

How does damage to the dorsal pathway effect cognitive processes?

Lack of affective response leads to conflict within the person they adopt a rationalisation strategy = Capgras delusion

Ellis et al (1997) determined the normal cognitive neuropsychological response to familiar faces is?

-stronger autonomic response (SCR) than unfamiliar faces

Ellis et al (1997) determined the cognitive neuropsychological response of Capgras patients to familiar faces is?

-weak autonomic responses irrelevant if the face is known or not

T/F - Capgras patients cannot recognise faces

False

Ellis et al (1997) determined what disconnection of Capgras patient's cognitive neuropsychology?

Disconnection between the face recognition and limbic system

What weaknesses are identified with Ellis et al (1997) study on the cognitive neuropsychological differences in Capgras patients?

This study only used famous faces in the familiar faces conditions

Bonifacci, Borlimi & Ottaviani (2007) Studied YY, a 20y woman with Capgras for who?

Her father

CASE STUDY YY: demonstrated what SCR response for pictures of family and strangers?

No SCR difference between family and strangers but could correctly identify if they were known or unknown

Bree et al (2000) - Affective response model

structures within the dorsal route guide actions, not the recognition of objects

According to Breen et al (2000), structures within the dorsal route guide actions, not -

the recognition of objects

Breen et al (2000) Face recognition occurs via?

the ventral pathway

Breen et al (2000) the ventral pathway facilitates what?

affective responses to faces are provided by ventral limbic structures including the amygdala

What does the Breen et al (2000) model fail to explain?

How the lack of affective response from the limbic system becomes a delusion

How did Ellis & Lewis (2001) modify the affective response model for CDS?

They propose the delusional belief is a specific hypothesis to explain the belief there is something different about a familiar person

What is the first factor in Coltheart et al (2011) two-factor theory?

Capgras patients lack autonomic response to a familiar face

What is the second defecit in Coltheart et al (2011) two-factor theory?

Damage to the right lateral prefrontal cortex

According to Ellis and colleagues; What is the role of the right hemisphere in Capgras delusion?

Damage to the right hemisphere impairs face perception

According to Colheart and colleagues; What is the role of the right hemisphere in Capgras delusion?

Right hemisphere damage impairs belief evaluation

Lucchelli & Spinnler (2007) propose that Capgras is what?

A cross-modal disorder for the failure of a person, not face recognition

Evidence suggests that when a patient is directly and explicitly analysing the evidence about their delusion, what occurs?

Skepticism

Breen et al concluded treatment of Capgas involves what?

CBT

Patients experiencing Fregoli delusions experience what?

The belief that known people are following them in disguise so they are not recognisable

What is the delusion syndrome responsible for the belief that unfamiliar faces are actually known faces in disguise?

Fregoli delusion

According to Coltheard et al (2011) two-factor theory, what is the first factor of Fregoli delusion

Arousal responses to faces is herperactive

According to Coltheard et al (2011) two-factor theory, what is the second factor of Fregoli delusion

An impaired belief evaluation system

Patients with Cortard delusions believe what?

That they are deceased

CASE STUDY: Young et al (1992) PATIENT W1 28Y male injured in a motorbike accident. Had issues recognising faces, buildings and places and reported feelings of derealisation. Where did CT scans determine damage?

Right hemisphere temporo-parietal region and some bi-lateral damage to frontal lobes

Delusional misidentification syndromes concern the belief that -?

a person, place or object has been somehow changed or altered

Cognitive neuropsychology =

integration of cognitive psychology and neuropsychology with emphasis on understanding the mind

Capgras delusion =

The belief that someone emotionally close to you has been replaced by an imposter

Fregoli Delusion =

People I know are following me around but in disguise so I cannot recognise them

Cortard delusion =

The belief that you are dead

Cognitive neuropsychiatry =

The application of cognitive neuropsychology methods to explain disorders of higher-level cognition

Delusion =

False belief based on incorrect inference about an external reality that is maintained even though contrary evidence is provided

Monothematic delusion =

False belief about about a single topic or issue

Encapsulated belief

Belief isolated or separated from the rest of a persons beliefs

Patients with cotard delusion present with what symptoms?

significantly diminished autonomic responses for all stimuli (face, voice etc)

What is the difference between cortard delusion and pure autonomic nervous system failure?

Patients with pure autonomic failure receive no emotional response from all sensory modalities and still believe they are alive

Ellis and Lewis (2001) Model explains cotard delusion how?

Patients exhibit recognise faces with a lowered autonomic response. Because they 'seem' familiar, the patient = I must be dead

Ramachandran & Blakeslee (1998) Affective deficit model argues against what other model?

Ellis & Young Attribution model

How does Ramachandran & Blakeslee (1998) Affective deficit model differentiate between cortard and capgras delusions?

Cortard is associated with more extreme deficit in autonomic under activity for all stimuli - not just faces = capgras

A patient who says 'something is different about my wife' may likely have what?

capgras delusions

A patient who says 'everything is different about my wife' may likely have what?

cortard delusions

Coltheard et al (2011) Two-factor theory explanation: what is the first factor?

an under-arousal for emotional stimuli

Coltheard et al (2011) Two-factor theory explanation: what is the second factor?

Damage to the right lateral prefrontal cortex = weakened belief evaluation system

What are 4 types of delusions about the self?

1 - Mirror self misidentification
2 - Reverse intermetamorphosis
3 - Somatoparaphrenia
4 - Alian control delusion

Breen et al (2000) PATIENT FE CASE STUDY: 87Y male hospitalised post stroke. What symptom did he present with post discharge?

Occasional nocturnal hallucinations

Breen et al (2000) PATIENT FE CASE STUDY: 87Y male hospitalised post stroke. What happened 12 months after FE moved residence?

Failed to recognise his reflection - it was someone else following him

Breen et al (2000) PATIENT FE CASE STUDY: 87Y male hospitalised post stroke. Was the patient stressed about someone else in the mirror?

No, only stressed when he saw this other person in bed with his wife. No other signs of paranoia

Breen et al (2000) PATIENT FE CASE STUDY: 87Y male hospitalised post stroke. FE was diagnosed with what?

Mirrored-self misidentification

Breen et al (2000) PATIENT FE CASE STUDY: 87Y male hospitalised post stroke. What was the functionality of his left hemisphere?

Functional including functional language and memory

Breen et al (2000) PATIENT FE CASE STUDY: 87Y male hospitalised post stroke. What was the functionality of his right hemisphere?

Functionally impaired for copying, drawing and visual memory

Breen et al (2000) PATIENT FE CASE STUDY: 87Y male hospitalised post stroke. Did he demonstrate any evidence that he could identify himself in a mirror?

Covert behavioural evidence - when asked if the person in the mirror was bald he would tilt his own head to show bald spot in the mirror

Breen et al (2000) PATIENT FE CASE STUDY: 87Y male hospitalised post stroke. Whas his face recognition system impaired?

Yes, some inconsistance recognising famous faces

What is reverse inter metamorphosis?

The belief that you have psychologically and physically changed into another person

Breen et al (2000) PATIENT RZ CASE STUDY: 40Y female believed she was her father or grandfather. How was this demonstrated?

-Only responded to her fathers name
-gave his histry when asked
-gave her fathers age
-saw her father in the mirror

Breen et al (2000) PATIENT RZ CASE STUDY: 40Y female, did she have any history of psychosis?

Schizophrenia at 23y

Anosognosia for motor and somatosensory neurological deficits in delusions for ownership of own limbs is also what?

Somatoparaphrenia

Gerstmann (1942) CASE STUDY: patients delusions for the side of their body correlated with what?

contralateral of the side of the brain with damage