The dynamic approach to neurodevelopmental psychiatric disorders: use of fMRI combined with neuropsychology to elucidate the dynamics of psychiatric disorders, exemplified in ADHD and schizophrenia

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Abstract

The paper discusses the application of fMRI in combination with neuropsychology to neurodevelopmental psychiatric disorders, exemplified on the case of attention deficit hyperactivity disorder (ADHD) in comparison with schizophrenia. The view is presented that ADHD, rather than being a compound of unrelated co-existing deficits, is a pervasive disorder of impulsiveness, which manifests at the motor, emotional, social and cognitive domain. Neuropsychology needs to refine the psychological measurements of these impulsivity symptoms and, in combination with fMRI, provide new insights into the interrelationship between brain and dysfunction and its bi-directional causalities. The suitability of the dynamic technique of functional MRI to assess the dynamic nature of developmental neuropsychiatric disorders is discussed. Brain activation can inform about strategy and compensatory mechanisms at a neuroanatomical level, which are not observable at a psychological level, providing insight into the underlying neurocognitive mechanisms of psychiatric disorders. Data are presented and discussed on opposing neurocognitive activation patterns for patients with ADHD and those with schizophrenia while performing a stop task. Comparisons between patient groups will be essential to address the specificity of neurocognitive mechanisms corresponding to specific neurodevelopmental psychiatric disorders.

Section snippets

Is ADHD a pervasive impulsivity disorder?

Attention deficit hyperactivity disorder (ADHD) is diagnostically defined by hyperactivity, impulsiveness and inattention [1]. From these, impulsiveness has been considered the core symptom of ADHD. This paper presents the view that ADHD is a generalised impulsivity disorder which expresses itself at the motor (hyperactivity), cognitive (impulsive cognitive style and lack of attentional control), emotional (uncontrolled temper) and social (social disinhibition) level. Impulsiveness is thus

Why is functional MRI a suitable tool to investigate the dynamics of developmental neuropsychiatric disorders?

Neurodevelopmental psychiatric disorders, as opposed to neurodegenerative disorders, are known to be dynamic and are very likely to be even more dynamic than currently assumed. Psychiatric disorders such as schizophrenia and depression, for example, are often triggered by life events, can manifest apparently spontaneously, and often follow a course of spontaneous remission. Only about a third of children with ADHD still meet criteria for ADHD in adulthood and about 30–50% of them grow out of

FMRI as an informant on strategy and compensation

fMRI as a window into the brain in vivo and ‘in action’ can give interesting insights into ‘how’ cognitive tasks are performed, i.e. it can tell about strategies and compensatory mechanisms that are not visible with neuropsychological tools alone. For example, patients with ADHD, schizophrenia and depression, although very different in their behavioural symptoms, all show longer reaction times in cognitive tasks and share similar attentional deficits, for example in the continuous performance,

References (82)

  • K. Rubia et al.

    Inhibitory dysfunction in hyperactive boys

    Behav. Brain Res.

    (1998)
  • K. Rubia et al.

    Frontalisation with age: mapping neurodevelopmental trajectories with fMRI

    Neurosci. Biobehav. Rev.

    (2000)
  • M.F. Rushworth et al.

    The left hemisphere and the selection of learned actions

    Neuropsychologia

    (1998)
  • J. Swanson et al.

    Cognitive neuroscience of attention deficit hyperactivity disorder

    Curr. Opin. Neurobiol.

    (1998)
  • E. Taylor et al.

    Hyperactivity and conduct problems as risk factors for adolescent development

    J. Am. Acad. Child Psychiatr.

    (1996)
  • E. Taylor

    Clinical foundations of hyperactivity research

    Behav. Brain Res.

    (1998)
  • American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. Washington: American...
  • R.A. Barkley

    Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD

    Psychol. Bull.

    (1997)
  • E.S. Barrat

    Impulsiveness and aggression

  • C.J. Bench et al.

    Changes in regional cerebral blood flow on recovery from depression

    Psychol. Med.

    (1995)
  • J.L. Bradshaw

    Developmental disorders of the Fronto-striatal system

    (2000)
  • J.D. Bremner et al.

    The effects of stress on memory and the hippocampus throughout the life cycle: implications for childhood development and aging

    Dev. Psychopathol.

    (1998)
  • G. Bush et al.

    Anterior cingulate cortex dysfunction in attention deficit hyperactivity disorder revealed by fMRI and the counting stroop

    Biol. Psychiatr.

    (1999)
  • A.H. Buss et al.

    A temperament theory of personality development

    (1975)
  • D.P. Cantwell

    Hyperactive children have grown up. What have we learned about what happens to them?

    Arch. Gen. Psych.

    (1985)
  • E.T. Carte et al.

    Neuropsychological functioning, motor speed, and language processing in boys with and without ADHD

    J. Abn. Child Psychol.

    (1996)
  • F.X. Castellanos et al.

    Quantitative morphology of the caudate nucleus in attention deficit hyperactivity disorder

    Am. J. Psychiatr.

    (1994)
  • F.X. Castellanos et al.

    Quantitative brain magnetic resonance imaging in attention-deficit hyperactivity disorder

    Arch. Gen. Psychiatr.

    (1996)
  • C.R. Cloninger

    A systematic method for clinical description and classification of personality variants

    Arch. Gen. Psychiatr.

    (1987)
  • A. Degl'Innocenti et al.

    Executive deficits in major depression

    Acta. Psych. Scand.

    (1998)
  • H.A.H. D'haenen

    Brain imaging in depression

  • R.A. Dykman et al.

    Selective and sustained attention in hyperactive, learning disabled, and normal boys

    J. Nerv. Ment. Diseases

    (1979)
  • J.L. Evenden

    Varieties of impulsivity

    Psychopharmacology

    (1999)
  • S.G.B. Eysenck

    The nature of impulsivity

  • P.A. Filipek et al.

    Volumetric MRI analysis comparing attention-deficit hyperactivity disorder and normal controls

    Neurology

    (1997)
  • H. Garavan et al.

    Right hemispheric dominance of inhibitory control: an event-related functional MRI study

    Proc. Natl. Acad. Sci. USA

    (1999)
  • J. Goldberg et al.

    Imaging of autism: lessons from the past to guide studies in the future

    Can. J. Psychiatr.

    (1999)
  • P.M. Grasby

    Imaging strategies in depression

    J. Psychopharm.

    (1999)
  • R.E. Gur

    Is schizophrenia a lateralized brain disorder?

    Schiz. Bull.

    (1999)
  • R.E. Gur et al.

    Laterality in functional brain imaging studies of schizophrenia

    Schiz. Bull.

    (1999)
  • L.J. Harris

    Early theory and research on hemispheric specialization

    Schiz. Bull.

    (1999)
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