Clinical Neuroscience Psychopathology and the Brain
SECOND EDITION
KELLY G. LAMBERT Randolph-Macon College • CRAIG H. KINSLEY University of Richmond
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NEW YORK OXFORD OXFORD UNIVEBS1TY PRESS 2011
Lambert, Kelly digitalisiert durch: Clinical neuroscience IDS Basel Bern 2011 Contents
Preface xxi
About the Authors xxxiii
PART ! Foundations of Clinical Neuroscience
CHAPTER 1: Emergence of Clinical Neuroscience 1 CONNECTIONS: Mara: Seeking Therapy 1 Jasmine: Seeking a Profession 2 Alex: Seeking Support 2
Status Reports on Psychiatry and Clinical Psychology 3 Research-Treatment Disconnect 5 Classifying Mental Disorders 8 Lessons Learned from the Multiple Personality Disorder Diagnosis 9
Exploring Various Windows of Mental Health 12 A CASE IN POINT: Diagnoses of Nadean Cool 13 Windows on Neurobiology 14 Neuroanatomy 15 Neurochemistry 16 Neurophysiology 17 Genetics Perspective 18 Developmental Perspective 20 Environmental Perspective 21 Evolutionary Perspective 22 Window Provided by Culture 24
What Lies Ahead 25 Multiple Perspectives 25 Contents
OLIVER SACKS: Educating the Public About Clinical Neuroscience 26 A Brain-Body Balance 28
Summary 28
CHAPTER 2: Research, Treatment, and Points of View: Historical Perspectives 31 CONNECTIONS: Barbers and Neurosurgeons 31
Emergence of the Brain as the Controlling Center of Behavior, Emotions, and Thought 33 Head, Heart, and Mind-Body Problem 33 Hippocrates: Heart of mental functions 33 Galen: Spirit of mental functions 34 Rene Descartes: Body meets mind 36 Localizing Functions in the Brain 37 BRAIN MATTERS: Mental lllness Loses Its Religion 38 Thomas Willis: Pioneer of brain functions 38 Franz Joseph Gall: Fiise and fall of phrenology 39 Paul Broca: Localization of language 41 Pioneers of Cellular Investigations in the Brain: The Architects 42 Camillo Golgi: Revealing neuronal structure with the perfect stain 42 Santiago Ramön y Cajal: Providing evidence for the neuron doctrine 43 Charles Scott Sherrington: Describing the Synapse 44 Pioneers of Cellular Investigations in the Brain: The Chemical Engineers 44 Otto Loewi: Dreaming of chemical communication 44 Edgar D. Adrian: Amplifying the electrical language of the neuron 45
Neurological Approaches to Mental lllness 46 Mental lllness Meets the Microscope 46 ERIC KANDEL: From Studying the History of Neuroscience to Becoming the History of Neuroscience 47 Jean-Martin Charcot: Birth of Neurology 48
Biological Therapies for Mental lllness 50 Early Biological Treatments 50 Electroconvulsive Therapy 51 The Drug Revolution 52 Psychosurgery 52
Importance of a Therapeutic Environment 55 Philippe Pinel and the Fall of the Asylum 55 Behaviorism: A Different Type of Therapeutic Environment 55 A GASE IN POINT: The Couple Who Needed Each Other Like a Hole in the Head 56 Beyond Behaviorism: Rethinking the Role of Mental Processes in Mental Health 58 Contents xi
Profiling the Pioneers of Clinical Neuroscience 60
Summary 60
Fundamentals: Establishing Homeostasis PART i I
CHAPTER 3: Macroanatomy and the Dynamic Brain 63 CONNECTIONS: Brain Plasticity in Evolutionary and in ffea/Time 63
Gross Structure and Function of the Nervous System 64 Organization of the Peripheral Nervous System 65 ANS and Homeostasis/Allostasis 66 Development of the CNS 67 Layers of protection 68 Ventricular system 69 Geography of the developing brain 69
CNS Structure and Function 70 Brain Stem 71 Medulla and basic survival 73 Cerebellum and motor control 73 Pons and Information transfer 74 Midbrain 74 Forebrain 75 Diencephalon: Regulating social and survival behaviors 76 Telencephalon and higher-order behaviors 78 Structures and functions of the cortex 79 Subcortical circuits: Limbic system and basal ganglia 81 Rhinencephalon: Smell and the brain 83 PAUL MACLEAN: Neural Investigator Paul MacLean's Pursuit of the Brain's Circuits 84 BRAIN MATTERS: Joking Around in the Laboratory 86 Spinal Cord 86 Cranial Nerves and Blood Suppiy 89 A GASE IN POINT: Katherine Sherwood 91
Summary 91
CHAPTER 4: Microanatomy and Neurotransmission 95 CONNECTIONS: Human and Mouse Genius 95
Microanatomy of the Neuron 97 Externa! Structure and Function of the Neuron 97 Cell membrane and its gateways 98 xii Contents
Dendrites: Extending the neuron's reach 100
Cell Body and Organelles: A Cellular Factory 101 Nucleus and executive function 102 Endoplasmic reticulum, ribosomes, and protein synthesis 103 Mitochondria and metabolism 103 Golgi apparatus and lysosomes: Packaging and recycling centers 104 Neuronal Cytoskeleton: Structure and Transport 104 Dynamic Elements of Neuronal Communication, Connection, and the Synapse 106 Axon: Information conductor 106 Terminal buttons: Getting the message across 106
Neuroglia 107
Generating an Action Potential 110 Electrochemical Activity at the Cell Membrane 110 Membrane Activity as Trigger of the Action Potential 113 Propagating the action potential 114 Refractory periods: The neuron recharges 115 A CASE IN POINT: Lorenzo Odone's Battle with Adrenoleukodystrophy 116 Integrating Information atthe Cell Membrane 117 Activity at the Synapse 118 Postsynaptic Potentials 119 Activity at the Receptor 120 BRAIN MATTERS: Epilepsy: Continued Intrigue and Lessons Leamed 122
Summary 124
CHAPTER 5: Neurochemistry and Psychopharmacology 127 CONNECTIONS: Coffee: Changing Our Culture and Our Nervous Systems 127
Neurochemicals 129 Small-Molecule Neurotransmitters 130 Acetylcholine 132 Catecholamines 134 Serotonin 137 BRAIN MATTERS: MDMA: Ecstasy or Agony for the Brain? 140 Anrtino Acid Transmitters 141 Excitatory amino acid 141 Inhibitory amino acids 142 Neuropeptides and Neurohormones 144 Endogenous Opioids 145 Oxytocin 146 Vasopressin 147 Contents xiii
A CASE IN POINT: Controversial Dietary Intervention for Autism: Karyn Seroussi's Struggle to Help Her Son 148
Neurochemistry of the Stress Response 149 Autonomie Stress Response 150 Hypothalamic-Pituitary-Adrenal Axis Response 150 Other Brain Areas Involved in the Stress Response 151 The hippocampus 151 Amygdala 152 Locus coeruleus 153
Foundations of Psychopharmacology 153
Summary 155
CHAPTER 6: Neurodevelopment Overthe Life Span 158 CONNECTIONS: Fate of the Aging Brain: Populär and Scientific Perspectives 158
Prenatal Brain Development 159 Emergence and Journey of the Brain's Neurons 160 Establishing and Fine-Tuning the Brain's Circuits 164
Postnatal Brain Development 167 Infancy and Childhood 167 Adolescence and Attention-Deficit/Hyperactivity Disorder 169 A CASE IN POINT: Relieving Ashlee's Seizure-Induced Wiggles 172
The Aging Brain 174 Normal Aging Processes 174 Neurodegenerative Decline: Alzheimers Disease 175
Development of Key Neurohormonal Circuits 176 Sexual Differentiation and Brain Development 177 BRAIN MATTERS: The Maternal Brain 178 Development of the Stress Response 180 Mom's impact on the developing stress response 181 Stress and aging 182 Sex differences in the stress response 183
Scientific Interventions with Developmental Neurobiology 183 Stem Cells 184 Mammalian Cloning 186
Summary 188 xiv Contents
PART Disruptions of Homeostasis: Representative Clinical Disorders
CHAPTER 7: Traumatrc and Chronic Brain Damage 191 CONNECTIONS: Educated Minds, Neural Reserves, and Recovery from Brain Injury 191
Overview of Chapter 193
Traumatic Brain Injury 194 Epidemiological Factors 194 Hypothesized Events Associated With the Aftermath of TBI 195 Primary effects 196 After the impact: Secondary factors related to sustained brain injuries 197
BRAIN MATTERS: The Perils of Using Your Head in the National Football League 199 Treatment and Recovery 199 A CASE IN POINT: Surviving a Life-Threatening Automobile Accident 200 Injuries necessitating surgical interventions 200 Pharmacological interventions 201 Discovering the impact of progesterone on TBI: A story of hard knocks 203 Cognitive rehabilitation 205 A Unique Behavioral Approach 206 BRAIN MATTERS: Gourmand Syndrome: TBI and Fine Dining 207 Environmental Enrichment and Recovery from TBI 207 Prevention of TBI: Impact of Safety Regulations and Legal Policies 210
Parkinson's Disease 211 Identification of Relevant Brain Damage 211 Treatment Strategies 211
BRAIN MATTERS: Striatal Neurons Hit the Dance Floor 215
Summary 215
CHAPTER 8: Disorders of Anxiety: Obsessive-Compulsive Disorder and Tourette Syndrome 218 CONNECTIONS: Common Denominators in Real-Life and Laboratory-Induced Compulsions? 218
Anxiety Disorders: An Overview 219 Obsessive-Compulsive Disorder 220 BRAIN MATTERS: Panic Disorder: A Faulty Brain Stem Surveillance System? 222 Tracing the Neurobiological Roots of OCD 223 Contents
OCD neuroanatomical circuit 223
A CASE IN POINT: Joseph Dee's Life with OCD 224 Additional evidence from neuroimaging studies 228 Neurochemistry of OCD 230 Evolutionary Perspectives: Fixed Action Patterns and Ritualistic Behavior 232 Animal modeis 233 Human modeis: Baseball rituals 233 Therapies for OCD 234 Psychopharmacological therapy 234 Neurosurgical treatment 236 Deep brain Stimulation 238 Cognitive-behavioral therapy 238
Tourette Syndrome 240 Tracing the Neurobiological Roots of Tourette Syndrome 240
A CASE IN POINT: Living with Tourette Syndrome 241 Role of the basal ganglia and associated neurochemistry 242 Possible environmental factors 243 Treatment for Tourette Syndrome 243 Psychopharmacological therapy 244 Behavioral and cognitive strategies 245
Summary 246
CHAPTER 9: Mood Disorders 248 CONNECTIONS: Foods and Moods 248
Mood Disorders: An Overview 250
Major Depression in Context 252 Sex Differences and Sociocultural Influences 252 Genetic Influences and Evolutionary Factors 253
Tracing the Neurobiological Roots of Depression 255 Depression's Neuroanatomical Circuit 255 Prefrontal cortex 255 Hippocampus and amygdala 256 A CASE IN POINT: Andrew Solomon's Noonday Demon 257 Cingulate cortex 258 Nucleus accumbens 259 Brain stem tracts 260 White matter 261 Neurochemistry of Depression 261 Serotonin (5-HT) 261 xvi Contents
Norepinephrine 265 Corticosteroids 266 Brain Plasticity 267 Brain structure and neurogenesis 267 BRAIN MATTERS: Animal Models of Depression 268 Role of BDNF in depression 269
Stress and Depression 270 Life's Losses 271 Sexual Abuse in Childhood 271 Seasonal Changes in Light 271
Treatment for Depression 272 Pharmacotherapy 272 BRAIN MATTERS: St. John's Wort 273 Serotonergic manipulation 274 Noradrenergic manipulation 276 Inhibiting CRH 276 Electroconvulsive Therapy 277 Repetitive Transcranial Magnetic Stimulation 278 Deep Brain Stimulation (DBS) 279 Cognitive-Behavioral Therapy 280
Bipolar Disorder 281 Tracing the Neurobiological Roots of Bipolar Disorder 282 Treatment for Bipolar Disorder 283
A CASE IN POINT: Kay Redfield Jamison 284
Summary 287
CHAPTER 10: Schizophrenia 290 CONNECTIONS: Home Movies, Childhood Behavior, and Schizophrenia 290
Overview of Schizophrenia 291 History, Descriptions, and Definitions 293 Contemporary Views of Schizophrenia 294 Views of a Schizophrenie Mind 294
Neurobiology of Schizophrenia 296 Genetic Factors 296 ACASE IN POINT: The Transformations of John Nash's Schizophrenie Mind 298 Neuroanatomy 301 Tuning in to the neural Substrates of auditory hallucinations 301 Cellular disorganization and alterations 303 Structural alterations in Schizophrenie brains 305 Contents xvii
Neurochemistry 307 Dopamine hypothesis of schizophrenia 307 Nondopaminergic neurochemical involvement in schizophrenia 310
Developmental Markers of Schizophrenia 311 Evidence from Minor Physical Anomalies 312 Sensory-Gating Deficits as a Common Denominator 312 Stress and Developmental Predisposition 313 BRAIN MATTERS: Animal Models of Schizophrenia 314 Viral Theory Controversy 315
Treatments for Schizophrenia 316 Somatic Therapies 316 Pharmacological Therapy 317 Neurocognitive Training 321 Psychosocial Therapy 322
Summary 322
CHAPTER 11: Drug Addiction 325 CONNECTIONS: Vulnerability to Addiction: Threatened Territories in North America and in the Laboratory 325
Drug Addiction in Context 326 Prevalence of Addiction 328 Addiction Across Cultures 329 Hereditary Influences on Addiction 329 Considering Addiction in the Context of Evolution 329
Tracing the Neurobiological Roots of Addiction 331 Neural Circuits Involved in Establishing Addiction 331 A CASE IN POINT: Running from Addiction 332 Role of the nucleus accumbens 333 Role of the OFC 336 Neurochemistry of Addiction 337 Dopamine: Primary fuel of addiction 337 Potential role of acetylcholine 340 Craving Response 340
BRAIN MATTERS: Substance Abuse and Behavioral Compulsion: Two Expressions of the Same Neurobiological System? 341 Craving as a conditioned response 342 Neural components of the craving response 342 Stress and Addiction 344 Therapy for Drug Addiction 346 Initial Step: Detoxification 347 XVIII Contents
Maintaining Abstinence 347 Vaccination: Therapeutic Shot in the Dark? 349 Behavioral Therapies for Addiction 351 Ethical Questions About New Addiction Therapies 353
Summary 354
PART IV Maintaining Homeostasis
CHAPTER 12: Stress and Coping 357 CONNECTIONS: Pacing and Prozac 357
Revisiting the Stress Response 358 Acute Stress Response 359 Chronic Stress Response 361 Stress and personality traits 362 BRAIN MATTERS: Eating and Stress 363 Stress ulcers 364 The Brain's Stress Circuit 365
Stress Responsivity Over the Life Span 367 Role of Mother-Infant Interactions 367 Aging-Related Effects of Stress 369 Effects of Sex Differences on Responses to Stress 370
Coping with Stress 371 Perception of Control 371 Research on control 372 Coping with lack of control 374 Social Support 374 Active Versus Passive Coping 379 Allostatic Load 382
Posttraumatic Stress Disorder 383 A CASE IN POINT: How Terry Anderson Survived as a Hostage 384 Tracing the Neurobiological Roots of PTSD 386 Treatment for PTSD 387
Summary 388
CHAPTER 13: Psychoneuroimmunology 391 CONNECTIONS: Species, Scents, and Sex 391
Fundamentals of the Immune System: The Body's Internal Security Agents 393 Contents
The Body's Most Wanted Invaders 393 Innate Immunity: The Immune System's Front-Line Defense 394 Acquired Immunity: Cells That Plan for the Future 396 Antibodies and B cells 397 T cells 397 Contrasting acquired immune defense strategies 400 Major Histocompatibility Complex and Information Dissemination 401 When Good Cells Turn Bad 402
Integrative Operations: Immune and Nervous System Communication 404 Conditioning the Immune System: A Serendipitous Discovery 404 Additional Pieces of the Neuroimmune Puzzle 405 Stress: Mediator Between the Immune and Neural Agencies 406 Sickness Behavior and Its Role in Maintaining Health 407 Fever 407 Loss of appetite 408 Role of cytokines 408
Putting the "Psych" in Psychoneuroimmunology 409 Psychological Factors Leading to Compromised Immune Function 410 A CASE IN POINT: Evan Händler 411 Psychological Factors Leading to Enhanced Immune Function 413
BRAIN MATTERS: Humor's Influence on Health: No Laughing Matter! 415
Summary 417
CHAPTER 14: Eating Regulation and Associated Disorders 420 CONNECTIONS: Increased Rates in Eating Out Accompany Increased Inches in Our Waistlines 420
Eating Regulation 422 Early Hunger Research Was Difficult to Swallow 422 Neurobiology of Hunger Regulation 424 Neurochemical Factors 425 Glucose 425 Cholecystokinin 426 Leptin 426 Neuropeptide Y 427 Environmental Factors 429
Evolutionary Theories of Hunger Regulation 430 Set-Point Theory 430 Preparatory Response Theory 431 Positive Incentive Theory 432 xx Contents
Sensory-Specific Satiety 433
Disorders of Eating Regulation 434 Obesity 434 Possible causes 435 Treatment 437 Children and obesity 438 BRAIN MATTERS: A Closer Look at Gastric Bypass Surgery 440 Anorexia Nervosa 440 Possible causes 441 Treatment 446 Bulimia Nervosa 447 Possible causes 447 A CASE IN POINT: Sara Hunnicutt's Bout with Anorexia Nervosa 448 Treatment 450
Digesting the Conflicting Theories of Eating Regulation 450
Summary 451
EPILOGUE 454 CONNECTIONS: Superman, Stem Cells, and the Senate 454
Ethics Buffeted on the Sea of Neuroscience 455 Neuroscience and Criminal Behavior 456 Brain areas influencing criminal behavior: The usual suspects 456 Neuroscience and the bürden of proof 459 Designer Brains, Designer Disorders 461
Genetics and Clinical Neuroscience: Basic Research, Basic Applications 464 A CASE IN POINT: Richard Restak's "Ted" 465
Looking to the Future Through the Lenses of Clinical Neuroscience 466 Integrating Mental Health Perspectives 467 Cleansing Our Views with Empirical Evidence: Remembering Past Lessons 470
Summary 472
Glossary G-1 References R-1 Name Index N-1 Subject Index S-1