PSY 244 CLINICAL PSYCHOLOGY-I

1. PSY 244CLINICAL PSYCHOLOGY-I BAHAR BAŞTUĞ Assist. Prof. Dr.

2. Areas of Specialization: Clinical Neuropsychology, Geropsychology& Forensic Psychology

3. Lecture Preview • Clinical Neuropsychology • Geropsychology • Forensic Psychology

4. The clinical neuropsychology focuses on brain-behavior relationships, how brain functioning impacts behavior and problems. Neuropsychologists must be well experienced in neuroanatomy, neuropathology and clinical psychology. They assess a range of cognitive abilities such as executive or higher-order cognitive functions, sensory and motor functioning, memory skills, and abstract reasoning.

5. The clinical neuropsychology Most neuropsychologists work in hospital, rehabilitation, or clinic settings. Some specialize in working with children, a field referred to as child neuropsychology.

6. Some of the topics of interest to clinical neuropsychologists: head traumas, Alzheimer’s disease, stroke, dementia, epilepsy, seizures, tumors, alcohol, malingering, langauge problems, impairment due to injury, impairment due to chemotherapy, AIDS.

7. The clinical neuropsychology Neuropsychologists administer and interpret a wide variety of specialty test batteries such as the Luria-Nebraska Battery and Halstead-Reitan Neuropsychological Battery and the individual test such as the Benton Visual Recognition Test, Wechsler Adult Intelligence Test- IV (WAIS-IV), Stroop and the Wisconsin Card Sorting Test (WCST).

8. The clinical neuropsychology These tests provide information on the cognitive and psychological functioning of people with neuropsychological problems. Neuropsychologists provide consultation and rehabilitation services and conduct research into understanding, assessing, and treating these problems.

9. Epilepsy is a seizure disorder that is defined as excessive electrical discharging of brain cells in a sudden, temporary and recurrent manner. Seizures result in intense muscle spasms, a complete or partial loss of consciousness. Infections, metabolic abnormalities, and biochemical factors contribute to the development of a seizure. Psychological stress provokes seizures among those vulnerable to epilepsy.

11. Epilepsy affects about 1% of the population. Children are more likely to experienceepilepsy than adults; children under the ageof 5 and at puberty are the most vulnerable. Epilepsy is more likely to occur among lower SES. Etiology: Biopsychosocial factors: genetics, infections, SES, stress, nutrition, prenatal care contribute to the development of epilepsy.

12. Epilepsy Because of the epileptic seizures, attention, concentration, memory, problem solving, motor, and intellectual abilities can be impaired. In addition to neurological functioning, personality and mood are altered by seizures. People with epilepsy are at higher risk for the development of psychiatric problems such as anx, depr, psychosis, and antisocial behavior.

13. Epilepsy Neuropsychologists evaluate the cognitive and personalityfunctioning of patients with epilepsy. Neuropsychologists are asked to differentiate seizures from pseudoseizuredisorders and malingering.Some people present with seizures that are psychologically based (e.g., hysterical seizures) or intentionally feigne. Sometimes patients consciously or unconsciously fake having a seizure disorderfor medical attention, financial orother reasons.

14. Treatment of epilepsy reflects biopsychosocial perspectives. Anticonvulsant medication such as carbamazepine (Tegretol), Epdantoin and psychotropic medications such as benzodiazepines, antidepressants, and neuroleptics have been used to minimize the frequency, intensity, or duration of seizures. When medications don’t work and seizures are localized to the temporal lobe, a temporal lobectomy may be performed.

17. Brain Injuries Accidents causing brain injuries occur from accidents, falls, war wounds, sport injuries, gunshot wounds, and violent assaults. Concussions (jarring the brain) occur during accidents and impact brain functions such as memory, attention, concentration, and orientation. Strokes can impair language, motorskills, personality functioning, and other neurocognitiveabilities. Environmental toxins such as poisons, gas fumes, and metals such as mercury and lead can result in brain injuries.

18. Brain Injuries Neuropsychologists evaluate cognitiveand psychological functioning and develop rehabilitation programs for braininjured patients. According to the nature ofthe problem and the special needs of the patient and family, psychotherapy, group support, education, and medical treatment maybe involved. Brain injuries are common among soldiers, footballers and boxers.

19. Degenerative Diseases include Alzheimer’s disease, dementia, Parkinson’s disease, Huntington’s chorea, and infectious diseases such as syphilis. Gradual degeneration of neurological functioning results in problems in memory, attention, speech, judgment, and movement. Patients with degenerative diseases develop depr, anx, irritability, personality changes, and loss of social support. These patients needs sensitive care from others.

20. Dementia associated with Alzheimer’s disease (AD) is the most well-known degenerative disease. AD involves memory loss, failure to recognize well-known people and objects, difficulty in organizing and planning, suspiciousness, and language problems. It is expected to increase in future years due to the increase of aging population. It is more common among people with lower educational levels and women.

21. ADmay be due to genetically and environmentally caused brain atrophy and plaque formation and low levels of the brain neurotransmitters acetylcholine (ACh), serotonin (5-HT), and noradrenalin (NA).

22. Head trauma, malnutrition, drug and toxin exposure, viral infection, personality, and cultural factors may play a role in the AD. Neuropsychologists evaluate the cognitive and psychological functioning of these patients and assist in making a diagnosis.

23. Treatment of AD Psychologists offer services including psychotherapy, group support, psychoeducational instructions, behavior management, and consultation with physicians, nurses, and other caregivers. Treatment approaches include family members who have a caregiving burden and have a loss of a loved one.

24. Medicationincludes Aricept which alter the production of glutamate and acetylcholine.

26. http://www.psinema.org/index.php?c=3

29. Vascular dementia is another type of dementia. It is different from the AD. It is due to cerebral infarct or blood problems. It usually occurs after age 50.

30. In addition to dementia, epilepsy, and brain injuries, neuropsychology provide information of general psychological troubles. Depr is associated with neuropsychological dysfunction such as head trauma. Also, SCH is associated with structural and functional abnormailities in prefrontal cortex. fMRI, new diagnostic tool, become more common.

31. fMRI

32. Conclusion Neuropsychology is interested in how problems with brain impact behavior and psychological functioning. Neuropsychological disorders impact the patient and the patient’s family. Neuropsychologists can be helpful in assessment, treatment, rehabilitation and research about these disorders. Neuropsychology overlaps with health, child and forensic psychology.

33. Geropsychology The number of elderly people has increased due to industrialization. People who over the age of 65 is accepted as elderly people. Geropsychology is an important and fast-growing new specialty area of clinical psychology. Full-time geropsychologistswill be needed in Turkey and the world.

34. Geropsychology Many older people experience urinary incontinence,insomnia, anx, depr, mourning associated with a varietyof illnesses that impact their cognitivefunctioning such as ADand stroke. There is no enough socialsupport services orexperiences for elders. Geropsychologists provide prevention, assessment,consultation, and intervention servicesto help elders and their families dealwith the many problems. They provide treatment for depr,anx, assessing cognitive impairment, andhelp cope with the loss of physical and mentalfunctioning.

35. Degenerative Diseases AD Vascular dementia is the second most common type of dementia. Vasculardementia is a result of cerebrovascular disease.Bloodflow to the brain stop, it causes tissue damage. When this happenssuddenly, a stroke occurs.

37. Hypertension and atherosclerosis can create vascular dementia.

38. Atherosclerosis. Cholesterol deposits in the large arteries form plaque, restricting the flow of blood. This condition, called atherosclerosis, can result in stroke and heartattack.

39. Degenerative Diseases Cognitive and psychological changes are associated withthe physical brain changes. Cognitiveand psychological changes depend onboth the nature of the patient’s premorbidfunctioning and the specific areas ofthe brain that are affected. Risk of stroke and othervascular dementia increases with age.

41. Degenerative Diseases Parkinson’s disease is another degenerative brain disorder. It is due to the brain’s inability to adequately produce the neurotransmitter, dopamine (DA). The symptoms are involuntary tremors and muscle rigidity. About half of Parkinson’s disease patients develop dementiaduring the advanced stagesof the illness.

42. Parkinson’s Disease Michael J. Fox

43. Geropsychologistsconduct neuropsychological testing to assess the degree of cognitive and psychological damage and the strengths of patients. They participate in individual, family, and group psychotherapy and psychoeducationalactivities.

44. Psychiatric Issues in Older Adults Anx, depr, substance abuse, and mourning are common among theelderly. Diagnosing and treating these problemscan be difficult. Many of the psychologicalproblems experienced by elderly people could be related to comorbidmedical problems and medication side effects. Furthermore , we have no idea what is normal and not normalfor elderlypeople to experience, yet.

45. Anxiety About 15% ofelderly people experience ananx disorder. The anxisrelated to health, safety, and concerns aboutthe well-being of loved ones. PTSD iscommon among the elderly and is often associatedwith mourning regarding the loss ofa spouse or other closerelative or friends. Biopsychosocial approaches using medication, CBT, and supportive approaches are successfulfor dealing with anx. Geropsychologistsmust work with physicians and family members.

46. Depression Deprcan be deadly for elders. The suiciderate among elder men is the highest. Diagnosis and treatment can be difficult. Because elders aremore likely to report somatic problems than depressive symptoms. Depramong the elderlyis associated with mourning, comorbidmedical problems, and medication sideeffects.

47. Substance Abuse Elderlypersons experienceproblems with older adult onset alcoholabuse and prescription drug abuse. The mostcommon drugs used by the elderly include diuretics, cardiovascular medications, sedatives, analgesics, and laxatives. Olderpersons metabolize alcoholmore slowly, it leads to higher blood concentrations. Geropsychologistsmust be attentive to thepotential of substance abuse among elders.

48. Forensic psychology is defined as the “application of psychology to legal issues”. Forensic psychologists specialize in utilizing principles of human behavior to inform the judicial and legal systems. They are trained as clinical psychologists with a specialtyin forensic work. They conduct psychological evaluations with defendants and present their findings as an expert witness in court. They provideevaluations for child custody,or be asked to predict dangerousnessor determine if an individual is suitable tostand trial.

49. Forensic psychologists assist in documenting mental distress, pain and suffering, and brain injury in legal action. Injury may include physical accidents or psychological traumas associated with sexual harassment, rape, violence, discrimination, and others stressful experiences. Forensic psychologists work in legal cases: involuntary commitment, the insanitydefense, child custody, violence against women, and jury selection.

50. Involuntary Commitment The laws allow someone to be committed to a psychiatric hospital if they are in serious and immediate danger of hurting themselves or others. Some people may have suicidal or homicidal thoughts, some must be protected from harming themselves or others. But freedom is a basic human right. Depriving a person of this important right through forced is involuntary commitment to a psychiatric hospital.