7A: Frontal Lobe Disorders

Question 1

Phineas Gage

Answer 1

a railroad foreman who had a railroad rod shoot through his prefrontal
cortex (and face) that survived and had drastic personality changes as a result. His case
influenced 19th-century thinking about the brain and the localization of its functions, and
was perhaps the first to suggest that damage to specific regions of the brain might affect
personality and behavior.

Question 2

Lobotomy

Answer 2

a procedure where ice picks are placed in the orbital sockets, up into the prefrontal cortex and wiggled around, destroying tissue, in order to treat a wide variety of mental illnesses

Question 3

Dorsolateral prefrontal cortex (DLPFC)

Answer 3

the highest cortical area responsible for
motor planning, organization, and regulation, which is involved in the integration of
sensory and memory information and the regulation of intellectual function and action
(executive function), and is also involved in working memory.

Question 4

Executive functions:

Answer 4

cognitive tasks such as working memory, cognitive flexibility, planning, inhibition, and abstract reasoning

Question 5

Working (short-term) memory

Answer 5

limited, active, transient traces of experiences
that happened in the very recent past (no longer than a few seconds ago). It’s the
“RAM” of human memory

Question 6

Frontal convexity syndrome

Answer 6

a disorder characterized by apathy, indifference, occasional outbursts, loss of self, stimulus-bound behavior, lack of planning,
psychomotor retardation, motor perseveration and programming deficits, poor word list
generation, poor abstraction and categorization, and working memory deficits

Question 7

Perseveration

Answer 7

persistent use of a specific strategy to solve a problem, despite the fact that the strategy is wrong or the rule of the task has changed

Question 8

Wisconsin Card Sorting Task

Answer 8

One example of a test that can reveal the
problems with executive function associated with DLPFC damage

Question 9

Anterior cingulate cortex (ACC)

Answer 9

part of cortex that subserves primarily executive functions related to emotional control and the reward system. It plays key roles in decision making, empathy, and reward anticipation, and it also is involved in autonomic functions like blood pressure and heart rate (together with the brain stem).

Question 10

Medial frontal syndrome

Answer 10

a syndrome characterized by akinetic mutism: a paucity of spontaneous movement and gesture, sparse verbal output, lower extremity weakness and loss of sensation, and incontinence (loss of bladder and bowel control). Caused by damage to the medial wall of the frontal lobe, usually including the anterior cingulate cortex. Treatment varies by patient: stimulants, L-Dopa (to increase dopamine)

Question 11

Orbitofrontal cortex

Answer 11

cortex that is involved in sensory integration, affective value of reinforcers, decision making, expectation, taste, flavor, and regulates planning behavior associated with sensitivity to reward and punishment

Question 12

Orbitofrontal syndrome

Answer 12

a syndrome caused by damage to the orbitofrontal cortex that
is characterized by disinhibited & impulsive behavior, inappropriate jocular affect
(laughing/excited mood), emotional lability (large/rapid shifts in emotions), poor
judgment and insight (understanding of self and disease), sexual disinhibition (wilder
sexual habits), lack of concern for others, and distractibility

Question 13

Antisocial personality disorder

Answer 13

A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture.
Antisocial personality disorder is a condition in which an adult has a long-term pattern
of manipulating, exploiting, or violating the rights of others. This disorder is thought to
be associated with criminal behavior in many cases. Related terms: psychopathic
personality disorder and sociopathic personality disorder. Dissocial personality
disorder is a term that has been proposed to cover all of these terms. There is no
recognized treatment.

Question 14

Conduct disorder

Answer 14

juvenile diagnosis that may turn into antisocial personality disorder in the adult; behaviors include bedwetting, animal abuse, pyromania, and general problems with authority

Question 15

Tourette’s syndrome

Answer 15

a syndrome in which patients exhibit multiple motor tics and at least one vocal tic, which change over time. Typical onset is during childhood, and it may be as common as 1 in 100 children. ~10% have coprolalia. Tourette’s frequently cooccurs with OCD, ADHD, and depression/anxiety.

Question 16

Motor and vocal tics

Answer 16

movements or vocalizations characteristic of Tourette’s syndrome that are stereotypic, temporarily suppressible, non-rhythmic, and often preceded by an unwanted premonitory urge (like a feeling of needing to sneeze).
Patients can sometimes suppress tics for a little while, but then will typically have
a rebound effect of more tics. Possible treatments target symptoms and include:
behavioral approaches (habit reversal training; cognitive behavioral therapy –
CBT), deep brain stimulation (of basal ganglia), and medications (antipsychotics
that decrease dopamine; antidepressants, blood pressure meds).

Question 17

Coprolalia

Answer 17

a condition associated with Tourette’s syndrome in which the
person has a vocal tic consisting of socially inappropriate exclamations. Only
10% of patients with Tourette’s have coprolalia (unlike the common media
portrayal).

Question 18

Causes of Tourette’s

Answer 18

Likely genetic cause that affects frontal lobe and basal ganglia
development. Decreased size of the caudate nucleus of the basal ganglia is
correlated with increased severity of symptoms. Tics worsen with stress.

Question 19

Treatments of Tourette’s

Answer 19

Behavioral- CBT, habit reverse training
DBS- can have dramatic symptom improvement, but is invasive
Medications- variable effect; Antipsychotics for tics, antidepressants, blood pressure medications

Question 20

Klüver-bucy syndrome

Answer 20

a syndrome characterized by placidity, diminished fear responses, inability to recognize emotional importance of an event, eating inappropriate objects, over-eating, hyper-orality, altered sexuality (compulsive sex drive, sex with inappropriate objects), visual agnosia, and hypermetamorphosis.

Question 21

Hypermetamorphosis

Answer 21

impulse to notice and react to everything within sight

Question 22

causes of Kluver bucy syndrome

Answer 22

thought to be caused by damage to the amygdala (fear response region)
of the limbic system and connections between limbic system and frontal cortex

Question 23

treatment for Kluver bucy syndrome

Answer 23

not very good, they target symptoms and include antipsychotic meds to decrease dopamine