Clinical Neuropsychology and Psychopharmacology

Comprehensive practice flashcards in vocabulary style covering neuropsychological assessment, brain injuries, neuroanatomy, psychopharmacology, cognitive rehabilitation, and cultural competencies based on the lecture notes.

Clinical Neuropsychology vs. Experimental Neuropsychology

Clinical neuropsychology applies knowledge of brain-behaviour relationships to assess, diagnose, treat, and rehabilitate individuals with brain dysfunction, whereas experimental neuropsychology investigates brain damage to understand normal brain functioning, cognitive processing, and behavioural output.

The Four Pillars of Neuropsychological Assessment

The integrated assessment framework consisting of clinical interview, behavioural observation, standardized psychometric testing, and questionnaires or collateral informant reports.

Acquired Brain Injury (ABI)

An umbrella term describing any damage to the brain that occurs after birth, defined by the timing of the injury rather than a specific cause, and encompassing both traumatic and non-traumatic etiologies.

Traumatic Brain Injury (TBI)

Damage to brain tissue resulting from external mechanical forces, including blunt impacts, rapid acceleration or deceleration, and penetrating objects.

Glasgow Coma Scale (GCS)

An acute physiological scoring system assessing depth of consciousness across eye opening, verbal response, and motor response, scored from a minimum of $3$ to a maximum of $15$.

Post-Traumatic Amnesia (PTA)

The clinical recovery period following a brain injury extending from the initial insult until continuous memory and full orientation to time, place, and person are reliably regained.

TBI Severity Classification Framework

The diagnostic categorization of traumatic brain injuries using acute markers: Mild ($\text{GCS } 13\text{--}15$, $\text{PTA } < 24\,\text{hours}$), Moderate ($\text{GCS } 9\text{--}12$, $\text{PTA } 1\text{--}7\,\text{days}$), Severe ($\text{GCS } 3\text{--}8$, $\text{PTA } 1\text{--}4\,\text{weeks}$), and Very Severe ($\text{GCS } 3\text{--}8$, $\text{PTA } > 4\,\text{weeks}$).

Diffuse Axonal Injury (DAI)

A widespread traumatic brain injury mechanism caused by rotational, acceleration, and deceleration forces that stretch and twist axons, commonly affecting subcortical white matter, the corpus callosum, and the upper brainstem.

Coup-Contrecoup Injury

A dual-site brain injury pattern where primary contusion occurs at the point of physical impact (coup) and secondary contusion occurs on the diametrically opposite side of the brain (contrecoup) as it rebounds against the rigid inner skull.

Australian Alcohol Consumption Guidelines

National health guidelines recommending healthy adults consume no more than $4$ standard drinks on any single day and no more than $10$ standard drinks per week to reduce lifetime injury and disease risk.

Wernicke Encephalopathy

An acute, reversible neuropsychiatric medical emergency caused by thiamine ($\text{vitamin B}_1$) deficiency, classically presenting with the triad of acute confusion or altered mental state, oculomotor signs (nystagmus, ophthalmoplegia), and cerebellar gait ataxia.

Korsakoff Syndrome

A chronic, persistent amnestic syndrome typically following inadequately treated Wernicke encephalopathy, characterized pathologically by mammillary body hemorrhage and atrophy, and clinically by severe anterograde amnesia with confabulation.

Confabulation

The spontaneous generation or retelling of fabricated, distorted, or misinterpreted memories about oneself or past events without the conscious intention to deceive, reflecting the brain filling memory gaps.

Alcohol-Related Cognitive Impairment (ARCI)

A diffuse fronto-subcortical pattern of cognitive decline linked to chronic alcohol neurotoxicity, characterized by executive dysfunction, psychomotor slowing, inefficient memory retrieval, and visuospatial impairment.

Delirium Tremens (DTs)

A severe, life-threatening complication of alcohol withdrawal emerging $48\text{--}96\,\text{hours}$ after cessation, presenting with delirium, extreme autonomic hyperactivity, tremors, agitation, confusion, and vivid hallucinations.

Parkinsonism

A clinical motor syndrome defined by the mandatory presence of bradykinesia accompanied by either a resting tremor, muscle rigidity, or both.

Bradykinesia

The progressive slowness and reduction in amplitude or speed of voluntary movements during continuous, repetitive motor performance.

Huntington's Disease

An autosomal dominant neurodegenerative genetic disorder caused by a pathogenic CAG trinucleotide repeat expansion in the HTT gene on chromosome 4, producing early striatal degeneration and a clinical triad of chorea, cognitive decline, and psychiatric disturbance.

Chorea

Involuntary, brief, irregular, non-stereotyped, and unpredictable movements that continuously flow randomly from one body region to another.

Mini-Mental State Examination (MMSE)

A brief, 30-point global cognitive screener widely used in dementia assessments, with a clinical cutoff score of $< 24/30$ indicating impairment, but limited by heavy verbal weighting, poor executive sensitivity, and floor effects in severe dementia ($< 10/30$).

Montreal Cognitive Assessment (MoCA)

A 30-point screening measure sensitive to mild cognitive impairment (MCI) and early Alzheimer's disease (cutoff score $< 26/30$), evaluating executive functioning, visuospatial skills, memory, language, and attention, with a 1-point educational correction for $\le 12$ years of schooling.

Addenbrooke's Cognitive Examination–III (ACE-III)

A 100-point comprehensive cognitive screening instrument evaluating attention, memory, verbal fluency, language, and visuospatial abilities, utilizing recommended cutoff thresholds of $88/100$ (high sensitivity) or $82/100$ (high specificity).

Kimberley Indigenous Cognitive Assessment (KICA)

A specialized, culturally validated cognitive screening tool designed for older Aboriginal and Torres Strait Islander Australians living in rural, remote, and urban communities, minimizing Western educational bias.

Rowland Universal Dementia Assessment Scale (RUDAS)

A 30-point multicultural cognitive screening measure designed to minimize the confounding effects of language diversity, cultural learning, and formal education on baseline cognitive performance.

Campinha-Bacote Model of Cultural Competence

A structural model depicting cultural competence as an ongoing, non-linear developmental process consisting of five core constructs: cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire.

Hall's Cultural Framework

A communication framework distinguishing between high-context cultures, where information is largely embedded within shared relationships and physical context, and low-context cultures, where communication relies predominantly on explicit, direct verbal statements.

Neuraxis Bend in Humans

The approximate $90^\circ$ anatomical bend at the midbrain-diencephalic junction caused by upright bipedal posture, which alters directional orientation so that 'dorsal' points upward in the brain but backward in the spinal cord.

Primary Brain Vesicles

The early developmental divisions of the neural tube: the prosencephalon (forebrain, which further divides into telencephalon and diencephalon), mesencephalon (midbrain), and rhombencephalon (hindbrain, which further divides into metencephalon and myelencephalon).

Spina Bifida

A congenital neural tube defect resulting from incomplete fusion of the spinal column at the lower back during embryonic neurulation, which can cause motor paralysis, bowel or bladder dysfunction, and cognitive learning difficulties.

Anencephaly

A fatal neural tube defect characterized by the failure of the anterior neural tube to close between gestational days $23\text{--}26$, resulting in the congenital absence of major portions of the brain, cranial vault, and scalp.

Meninges

The three protective connective tissue membranes encasing the brain and spinal cord: the outer fibrous dura mater, the intermediate avascular web-like arachnoid mater, and the delicate, vascularized inner pia mater.

Precentral Gyrus

The cortical structure located on the posterior frontal lobe that contains the primary motor cortex, organized somatotopically as the motor homunculus to plan, initiate, and execute voluntary motor commands.

Cingulate Gyrus

A prominent C-shaped cortical band situated immediately superior to the corpus callosum that coordinates emotional responses, pain affect, motivation, and autonomic behavioural integration within the limbic system.

Olfactory Bulb

The subcortical limbic structure that processes incoming smell signals directly from nasal chemoreceptors, representing the only sensory pathway that bypasses the thalamic sensory relay station.

Pituitary Gland

The endocrine 'master gland' located in the sella turcica directly below the hypothalamus, synthesizing and releasing systemic hormones into the bloodstream in response to hypothalamic signals.

Pons

A major prominence on the brainstem situated between the midbrain and medulla oblongata that relays motor information from the cerebral cortex to the cerebellum and houses nuclei regulating autonomic respiration and sleep.

Action Potential Phases

The sequential electrical cycle of a neuron: resting membrane potential ($-70\,\text{mV}$), threshold depolarization ($-55\,\text{mV}$), rapid $Na^+$ influx depolarization to $+30\,\text{mV}$, $K^+$ efflux repolarization, hyperpolarization, and the refractory period.

Excitatory Postsynaptic Potential (EPSP)

A graded electrical depolarization of the postsynaptic membrane driven by an influx of positive ions ($Na^+$ or $Ca^{2+}$), shifting the membrane potential closer to the firing threshold.

Inhibitory Postsynaptic Potential (IPSP)

A graded electrical hyperpolarization of the postsynaptic membrane driven by an influx of negative ions ($Cl^-$) or an efflux of positive ions ($K^+$), shifting the membrane potential further from the firing threshold.

Pharmacodynamics vs. Pharmacokinetics

Pharmacodynamics describes what a drug does to the body (receptor binding, mechanisms, efficacy), whereas pharmacokinetics describes what the body does to the drug (Absorption, Distribution, Metabolism, Excretion - ADME).

Therapeutic Index (TI)

A quantitative measurement of a drug's relative safety calculated as the ratio between the lethal dose in 50% of subjects and the effective dose in 50% of subjects ($\text{TI} = \frac{LD_{50}}{ED_{50}}$).

Receptor Agonist

A chemical agent or drug that binds to a specific receptor site and activates it, mimicking the physiological action of an endogenous neurotransmitter to trigger a full biological response.

Receptor Antagonist

A drug that binds to and occupies a receptor site without activating it, physically preventing endogenous neurotransmitters from binding and blocking subsequent biological responses.

Partial Receptor Agonist

A drug that binds to and activates a receptor with submaximal efficacy relative to a full agonist, acting as an activator in deficient states and a competitive inhibitor in high-ligand states.

Reuptake Inhibitor

A pharmacological agent that blocks presynaptic transporter proteins, preventing the reabsorption of neurotransmitters back into the presynaptic terminal and increasing their concentration in the synaptic cleft.

Blood-Brain Barrier (BBB)

A specialized semi-permeable physiological barrier composed of tight junctions between capillary endothelial cells and astrocytic foot processes, restricting systemic toxins and pathogens from entering brain parenchyma.

Monoamine Oxidase Inhibitors (MAOIs)

First-wave antidepressant medications that block mitochondrial monoamine oxidase enzymes from metabolizing serotonin, noradrenaline, and dopamine, carrying a risk of severe hypertensive crisis when combined with dietary tyramine.

Tricyclic Antidepressants (TCAs)

First-wave three-ring antidepressant drugs (e.g., imipramine, amitriptyline) that block the reuptake of serotonin and noradrenaline but produce significant anticholinergic side effects and lethal cardiotoxicity in overdose.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Third-wave antidepressant medications (e.g., fluoxetine, sertraline, escitalopram) that selectively block the serotonin transporter (SERT) to elevate synaptic serotonin availability, with therapeutic onset requiring $2\text{--}6\,\text{weeks}$.

Serotonin Syndrome

A toxic clinical condition caused by excess central and peripheral serotonergic stimulation, characterized by cognitive confusion, agitation, autonomic instability (hyperthermia, tachycardia), and neuromuscular hyperactivity (myoclonus, hyperreflexia).

Lithium

A primary mood stabilizer used for over $50$ years to treat acute bipolar mania and prevent mood relapse (effective in $60\%\text{--}80\%$ of cases), requiring regular serum monitoring due to its narrow therapeutic window and risks of renal and thyroid dysfunction.

Sodium Valproate

A first-line anticonvulsant and mood stabilizer for acute mania and rapid-cycling bipolar disorder that acts by inhibiting voltage-gated sodium/calcium channels and enhancing GABAergic inhibition, carrying significant teratogenic risks.

Clozapine

A second-generation atypical antipsychotic indicated for treatment-resistant schizophrenia that does not produce extrapyramidal symptoms, but requires mandatory haematological monitoring due to the risk of life-threatening agranulocytosis (occurring in approximately $0.4\%$ of patients).

Dopamine Hypothesis of Schizophrenia

The neurobiological theory proposing that positive psychotic symptoms arise from hyperactive dopamine $D_2$ receptor activity in the mesolimbic pathway, while negative and cognitive symptoms stem from hypodopaminergic activity in the prefrontal cortex.

Glutamate Hypothesis of Schizophrenia

The neurobiological theory proposing that schizophrenia symptoms are driven by hypofunction of NMDA-type glutamate receptors, supported by observations that NMDA antagonists (ketamine, PCP) reproduce positive, negative, and cognitive symptoms in healthy individuals.

Depot Antipsychotics

Long-acting, slow-release intramuscular injections administered every $2\text{--}4\,\text{weeks}$ to improve medication adherence in individuals with schizophrenia experiencing cognitive disorganization or poor illness insight.

D-Cycloserine (DCS)

A partial agonist at the glycine-binding site of the NMDA glutamate receptor investigated as a pharmacological augmentation strategy to enhance fear extinction learning during exposure-based cognitive behavioural therapy.

Time Pressure Management (TPM)

An evidence-based compensatory cognitive rehabilitation strategy for mental slowness that trains patients to recognize task time pressure, create strategic pre-plans, and implement tactical coping steps to handle information overload.

Making the Most of Your Memory

A 6-week manualized group cognitive rehabilitation program (2 hours weekly) combining psychoeducation, internal compensatory strategies, and external memory aids to improve functional memory in acquired brain injury.

Long-Term Memory Taxonomy

Squire's (1991) cognitive structural model dividing long-term memory into declarative/explicit memory (conscious recall of episodic events and semantic facts) and nondeclarative/implicit memory (procedural skills, priming, conditioning, and habits).

Non-Fluent/Agrammatic Primary Progressive Aphasia (nfvPPA)

A frontotemporal language syndrome characterized by effortful, dysfluent speech with prominent word-finding pauses, agrammatism in language production, and impaired comprehension of syntactically complex sentences.

Holistic Neuropsychological Formulation

The clinical framework developed by Fish, Betteridge & Winegardner (2018) that maps brain pathology, cognitive deficits, physical symptoms, and affective changes alongside premorbid identity, values, and social support to formulate functional goals.

Dementia with Lewy Bodies (DLB)

A neurodegenerative disease characterized pathologically by cortical and nigral alpha-synuclein neuronal inclusions (Lewy bodies), and clinically by progressive cognitive decline, fluctuating attention, recurrent formed visual hallucinations, REM sleep behaviour disorder, and spontaneous parkinsonism.

Frontotemporal Dementia (FTD)

A group of neurodegenerative syndromes characterized by progressive atrophy of the frontal and temporal lobes, including behavioural-variant FTD (marked by disinhibition, apathy, loss of empathy, and hyperorality) and primary progressive aphasias.

Vascular Dementia (VaD)

A heterogeneous dementia syndrome caused by cerebrovascular pathology and ischemia, characterized clinically by prominent executive dysfunction, psychomotor slowing, and patchy memory retrieval deficits that benefit from recognition cues.