The Frontal Lobes and Neuropsychiatric Illness This page intentionally left blank The Frontal Lobes and Neuropsychiatric Illness Edited by Stephen P. Salloway, M.D., M.S. Paul F. Malloy, Ph.D. James D. Duffy, M.B., Ch.B. Washington, DC London, England Note: The authors have worked to ensure that all information in this book concerning drug dosages, schedules, and routes of administration is accurate as of the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice advance, however, therapeutic standards may change. For this reason and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of a physician who is directly involved in their care or the care of a member of their family. A product’s current package insert should be consulted for full prescribing and safety information. Books published by American Psychiatric Publishing, Inc., represent the views and opinions of the individual authors and do not necessarily represent the policies and opinions of APPI or the American Psychiatric Association. This book was developed and updated from material originally published as a special issue, “The Frontal Lobes and Neuropsychiatric Illness,” in The Journal of Neuropsychiatry and Clinical Neurosciences, Volume 6, Number 4, 1994. Copyright © 2001 American Psychiatric Publishing, Inc. ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper 04 03 02 01 4 3 2 1 First Edition American Psychiatric Publishing, Inc. 1400 K Street, N.W. Washington, DC 20005 www.appi.org Library of Congress Cataloging-in-Publication Data The frontal lobes and neuropsychiatric illness / edited by Stephen P. Salloway, Paul F. Malloy, James D. Duffy.-- 1st ed. p. cm. Includes bibliographical references and index. ISBN 0-88048-800-X (alk. paper) 1. Neurobehavioral disorders. 2. Frontal lobes--Pathophysiology. [DNLM: 1. Frontal Lobe--physiopathology. 2. Brain Diseases--physiopathology. 3. Mental Disorders--physiopathology. WL 307 F9348 2001] I. Salloway, Stephen. II. Malloy, Paul. III. Duffy, James D. RC386.2 .F76 2001 616.8’047--dc21 00-046472 British Library Cataloguing in Publication Data A CIP record is available from the British Library. About the cover: Top left: The medial orbitofrontal cortex–basal ganglia loop. Top right: T1-weighted midline sagittal magnetic resonance imaging scan showing marked segmental atrophy of the frontal lobe in a 56-year-old man with disinhibition and violent outbursts. Bottom left: Sagittal and axial PET scans showing decreased metabolism in the fronal lobes in depressed patients with Huntington’s disease (top) compared with nondepressed patients with Huntington’s disease (bottom). This book is dedicated to the memory of Per Mindus, M.D., whose premature death in 1998 deeply saddened us. Per participated in the development of this book from its inception. He was a tireless worker who pioneered the introduction of gamma knife capsulotomy, bringing relief and new hope to patients disabled by refractory obsessive-compulsive disorder. This page intentionally left blank Contents Contributors. ix PART 1 Introduction 1 The Frontal Lobes and Neuropsychiatric Illness . 3 Stephen P. Salloway, M.D., M.S., Paul F. Malloy, Ph.D., James D. Duffy, M.B., Ch.B. 2 The Significance of Frontal System Disorders for Medical Practice and Health Policy . 7 Barry S. Fogel, M.D., M.S. (Management) PART 2 Functional Organization of Prefrontal Lobe Systems 3 Frontal Subcortical Circuits: Anatomy and Function . 15 Michael S. Mega, M.D., Ph.D., Jeffrey L. Cummings, M.D. 4 The Orbitofrontal Cortex . 33 David H. Zald, Ph.D., Suck Won Kim, M.D. 5 Working Memory Dysfunction in Schizophrenia . 71 Patricia S. Goldman-Rakic, Ph.D. 6 Lateralization of Frontal Lobe Functions . 83 Kenneth Podell, Ph.D., Mark Lovell, Ph.D., Elkhonon Goldberg, Ph.D., A.B.C.N. 7 Consciousness, Self-Awareness, and the Frontal Lobes . 101 Donald T. Stuss, Ph.D., Terence W. Picton, M.D., Ph.D., Michael P. Alexander, M.D. PART 3 Prefrontal Syndromes in Clinical Practice 8 Regional Prefrontal Syndromes: A Theoretical and Clinical Overview. 113 James D. Duffy, M.B., Ch.B., John J. Campbell III, M.D. 9 Assessment of Frontal Lobe Functions . 125 Paul F. Malloy, Ph.D., Emily D. Richardson, Ph.D. 10 Diagnosis and Treatment of “Frontal Lobe” Syndromes . 139 Stephen P. Salloway, M.D., M.S. 11 Treatment Strategies for Patients With Dysexecutive Syndromes . 153 John J. Campbell III, M.D., James D. Duffy, M.B., Ch.B., Stephen P. Salloway, M.D., M.S. PART 4 Frontal Lobe Dysfunction in Neuropsychiatric Disorders 12 Frontal Lobe Dysfunction in Secondary Depression. 167 Helen S. Mayberg, M.D., F.R.C.P.C. 13 The Frontal Lobes and Schizophrenia . 187 A. Meyer-Lindenberg, M.D., Ph.D., Karen F. Berman, M.D. 14 The Frontal Lobes and Traumatic Brain Injury . 199 Marilyn F. Kraus, M.D., Harvey S. Levin, Ph.D. 15 The Frontal Lobes and Content-Specific Delusions. 215 Emily D. Richardson, Ph.D., Paul F. Malloy, Ph.D. 16 Neurosurgical Treatment for Refractory Obsessive-Compulsive Disorder: Implications for Understanding Frontal Lobe Function . 233 Per Mindus, M.D, Ph.D., Steven A. Rasmussen, M.D., Christer Lindquist, M.D., Ph.D., George Noren, M.D. Index . 247 Contributors Michael P. Alexander, M.D. Barry S. Fogel, M.D., M.S. (Management) Staff Scientist, The Rotman Research Institute, Baycrest Clinical Professor of Psychiatry, Harvard Medical Centre for Geriatric Care, University of Toronto, School, Boston, Massachusetts; Adjunct Professor of Toronto, Ontario, Canada; Associate Clinical Professor, Community Health, Brown Medical School, Neurology, Harvard Medical School, Behavioral Providence, Rhode Island; Attending Neurology Unit, Boston, Massachusetts Neuropsychiatrist and Behavioral Neurologist, Behavioral Neurology Group, Brigham and Womens Karen F. Berman, M.D. Hospital, Boston, Massachusetts Chief, Unit on Integrative Neuroimaging, Clinical Brain Disorders Branch, National Institute of Mental Elkhonon Goldberg, Ph.D., A.B.C.N. Health, Bethesda, Maryland Clinical Professor, Department of Neurology, New York University Medical Center, New York, New York John J. Campbell III, M.D. Director of Geriatric Psychiatry and Neuropsychiatry, Patricia S. Goldman-Rakic, Ph.D. Department of Psychiatry, Henry Ford Health System, Professor, Department of Neurobiology, Yale Detroit, Michigan; Medical Director, Kingswood University, New Haven, Connecticut Hospital, Ferndale, Michigan Suck Won Kim, M.D. Jeffrey L. Cummings, M.D. Associate Professor, Department of Psychiatry, Augustus Rose Professor of Neurology, Professor of University of Minnesota, Minneapolis, Minnesota Psychiatry and Biobehavioral Sciences, Director of the UCLA Alzheimer’s Disease Center, UCLA School of Marilyn F. Kraus, M.D. Medicine, Reed Neurological Research Center, Los Associate Professor of Psychiatry and Neurological Angeles, California Surgery, Stritch School of Medicine; Director, Neuropsychiatry Program, Loyola University Medical James D. Duffy, M.B., Ch.B. Center, Department of Psychiatry, Maywood, Illinois Medical Director, Huntington’s Disease Program, University of Connecticut Health Center; Associate Harvey S. Levin, Ph.D. Professor of Psychiatry, University of Connecticut Professor, Departments of Neurosurgery, Physical School of Medicine, Farmington, Connecticut; Director, Medicine, and Rehabilitation, Baylor College of Psychiatric Consultation Services, Hartford Hospital, Medicine, Houston, Texas Hartford, Connecticut Christer Lindquist, M.D., Ph.D. Consultant Neurosurgeon and Director, Cromwell Hospital Gamma Knife Centre, London, England; Associate Professor of Neurosurgery, Karolinska Hospital, Stockholm, Sweden ix x THE FRONTAL LOBES AND NEUROPSYCHIATRIC ILLNESS Mark Lovell, Ph.D. Terence W. Picton, M.D., Ph.D. Director, Sports Medicine Concussion Program, Staff Scientist, The Rotman Research Institute, Baycrest Department of Orthopedics, University of Pittsburgh Centre for Geriatric Care; Professor of Medicine Medical Center, Pittsburgh, Pennsylvania (Neurology) and Psychology, University of Toronto, Toronto, Ontario, Canada Paul F. Malloy, Ph.D. Associate Professor, Department of Psychiatry and Kenneth Podell, Ph.D. Human Behavior, Brown University; Director of Director, Division of Neuropsychology, Henry Ford Psychology, Butler Hospital, Providence, Rhode Island Health System, Detroit, Michigan Helen S. Mayberg, M.D., F.R.C.P.C. Steven A. Rasmussen, M.D. Professor, Psychiatry and Medicine (Neurology), Associate Professor of Psychology and Human University of Toronto; Sandra Rotman Chair in Behavior, Brown University; Medical Director, Butler Neuropsychiatry, Rotman Research Institute, Toronto, Hospital, Providence, Rhode Island Ontario, Canada Emily D. Richardson, Ph.D. Michael S. Mega, M.D., Ph.D. Assistant Research Professor, Associate Director, Assistant Professor of Neurology, UCLA School of Raimy Training Clinic, Department of Psychology, Medicine; Director, Memory Disorders Clinic, University of Colorado, Boulder, Colorado Laboratory of Neuroimaging, Reed Neurological Research Center, Los Angeles, California Stephen P. Salloway, M.D., M.S. Associate Professor of Neurosciences and Psychiatry A. Meyer-Lindenberg, M.D., Ph.D. of Human Behavior, Brown University School of Doctor of Medicine, Research Fellow, Unit on Medicine; Director of Neurology and the Memory Integrative Neuroimaging, Clinical Brain Disorders Disorders Program, Butler Hospital,