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Cognitive function in psychiatric practise

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Cognitive function
in psychiatric practice
Divisi Biology Psychiatry
Divisi Psychogeriatry
Divisi Forensic Psychiatry
Cognition

Is a process of making sense of sensory
inputs, of remembering events and
procedures , of making generalizations,
analogies, and explanations, and of
developing means of communications.
Arciniegas & Beresford 2001
Cognition 2

Cognition to the essential process by things are
known :
- perception
reasoning
- attention
planning
- memory
judgement
- recognition
- language
- imagination
Cognition 3


all the process associated with thinking
In Psychiatry : self-concept
belief
Brain functions
Working memory

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
Working memory  interface between new
information and existing knowledge
Serves to keep the representation of the task
active and to link perception to action
Provides the continuity between past
experience and present actions and involves
rehearshals and manipulation of information
Basic cognition

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Arousal
Attention
Language
Memory
Praxis
Recognition
Arciniegas & Beresford, 2001
Basic cognition
Fungsi kognitif

Hecker : 9 domain fungsi kognitif
- berbahasa (language)
- daya ingat (memory)
- pemusatan perhatian dan konsentrasi
(attention & concentration)
- menilai/tilikan (judgement/ insight)
- daya abstraksi (abstract thought)
- praxis
- visuospatial
- berhitung (calculation)
- memberi alasan (reasoning)
Psychiatry FKUA
Case of Phineas Cage
Phineas Cage 2

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Behavior Changes :
- childish
- capricious
- obstinate
Poor judgment
Retain : largely intellectual function
motivation
Complex cognition
3 essential area :

Executive function

Social intelligence

Motivation
Complex cognition
Executive function


Mediated by the dorsolateral prefrontal circuit
Functions :
analyze the problem
planning
problem solving : alternative solutions
consequences
decision making
expression
Executive dysfunctions

Deficit in planning and regulation of behavior

Deficient in problem solving

Maintenance of set and mental flexibility
 frontal impairment
Executive dysfunction

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Dysexecutive  conceptual disorganization 
incoherent and chaostic behavior
Hypometabolism di dorsolateral prefrontal
cortex
Test : Planning – organization –
consequences – decision making
Social intelligence

Mediated by the lateral orbitofrontal circuit

Functions : social awareness
social skills
Social Awareness

Empathy

Developing Others

Service Orientation

Organizational Awareness
Social Skills

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
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
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Influence
Communications
Conflict Management
Leadership
Change Catalyst
Building Bonds
Teamwork and Collaboration
Social functioning

Social competence
- social-emotional skills needed in
interpersonal interaction and
relationship

Social adjustment and integration
-Involvement in social and community
activities (work/school, leisure events)
Social adjustment

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Basic roles : self care – house keeping
Complex roles : work, community
responsibilities
Verbal memory and vigilance measures outcome
community functioning, social problem solving
and acquisition of psychosocial skills.
motivation

And conscious experience of emotion are
mediated by the anterior cingulate circuit.

Motivation : direction
intensity
persistence
Achieving
specific goals
Motivation impairment

Apathy / abulia

Becareful emotional disorders
- depression : negativistic behavior
anhedonia
Cognitive and psychiatry
Through life-cycle
 Children : learning disorders
 Teenagers : post trauma capities
substance abuse
 Adult
: career (recruitment & promotion)
criminal pooling
 Elderly : behavior changes
legal issues
Cognitive functions
in clinical setting


Competencies related to health care decisions.
A valid informed consent :
- follow the information (attention & concentration)
- understand the meaning (comprehension)
- make other alternative solutions & consequences
( judgment & memory)
- make the decision (reasoning & abstract thinking)
- express the thought concept.
Dilemma in clinical setting
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Last will : do not resuscitate
Testamentary competence
Elderly guardianship / curatelle
Treatment refusal
Medical team as a decision maker
cognitive functions
Cognitive function
in Forensic Psychiatry

Evaluating competencies

Criminal pooling
- antisocial behaviors in personality disorder,
- as a symptom of psychiatric disorder

Malingering
Civil Competency
(Ralph Slovenko)
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Competency of a professional
Competency of a witness
Competency to make a will
Competency to contract
Competency regarding medical care
Competency of a minor consent to
treatment
Weiner & Hess,2006
Psychopathic as a symptom?
malingering
Cognitive function
in psychogeriatry

Diagnostic on psychiatric problems

Elderly competencies in legal processes

Curatelle
Last will
Executive function
Memory
Judgment
Reasoning
Abstract thinking
Consequences
Cognitive rehearsals
Third party confrontations
Violence against older people
WHO/INPEA 2002

Curatelle : social cognition ? Personality disorder?

Includes : physical, sexual, psychological and financial
abuse.

Perceive abuse including :
- neglect ( social exclusion, and abandonment)
- violation (human, legal and medical right)
- deprivation(choices, decisions,status, finances
and respect)
Cognitive function
in Industrial Psychiatry

Recruitment

Promoting

Mental health in organizations
Competence as an employee

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The legal standard for measuring incompetence is related to :
- vocational
- social
- educational
- other circumstances (Slovenko,2006)
Note : burn out!
Cognitive function
in Clinical Psychiatry

Diagnosis and treatment in Schizophrenia

Dx : Concept formation
- attention
- working memory
- executive function
Tx : Cognitive rehabilitation in
Schizophrenia

Cognitive function in psychotherapy
Cognitive impairment

Change in social and family position

Need intensive caretaking and prompt cognitive
rehabilitation

Neuropsychology Test : retain competencies
Functional measures

Social interaction

Behavior (include incompliance  holistic)

Degree of concern (vs neglect)

Demonstrate their whishes through non verbal
means
Counseling cognitive dysfunction

Adjustment issues
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Education

Competence building

Problem solving
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Realistic goal setting
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Family intervention
Cognitive rehabilitation

Reinforcing remaining strength

Developing useful compensatory strategies

Family/caregiver psychoeducation
Note : language dysfunction
Word Game
WORD GAME 2
Shopping List
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