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The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC,Gabbard GO. 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org

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Slide show includesTopic Headings

Tables and Figures

Key Points

Neuroanatomy for the PsychiatristKatherine H. Taber, Ph.D., F.A.N.P.A.,

Robin A. Hurley, M.D., F.A.N.P.A.

The American Psychiatric Publishing

TEXTBOOK OF PSYCHIATRYFifth EditionEdited by Robert E. Hales, M.D., M.B.A., Stuart C. Yudofsky, M.D., Glen O. Gabbard, M.D.

2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org

CHAPTER 5


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CHAPTER 5 Topic Headings

CEREBRAL CORTEXFrontal LobeTemporal LobeParietal LobeOccipital LobeBasal ForebrainSUBCORTICAL AREAS

SUBCORTICAL AREASBasal Ganglia

Caudate Nucleus

PutamenGlobus PallidusSubstantia Nigra

Limbic SystemHippocampal Formation and

Parahippocampal Cortex AmygdalaMammillary BodiesT halamus

Hypothalamus

PonsCerebellum

CONCLUSION


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CHAPTER 5 Tables and Figures

Figure 51. Planes of section.

Figure 52. Anatomic orientations and directions.

Figure 53. Major divisions of the brain.

Figure 54. Lobes of the cerebral cortex.

Figure 55. Major gyri and sulci of the cerebral cortex.

Figure 56. Functions of the cerebral cortex.

Figure 57. Brodmann areas.

Figure 58. Variability in Brodmann areas.

Figure 59. Major subcortical structures.

Figure 510. Basal forebrain.Figure 511. Sectional anatomyaxial atlas: dorsal frontal and parietal cortices.

Figure 512. Sectional anatomyaxial atlas: cingulate cortex.

Figure 513. Sectional anatomyaxial atlas: dorsal occipital and parietal cortices, caudate.

Figure 514. Sectional anatomyaxial atlas: insular cortex, basal ganglia, thalamus.

Figure 515. Sectional anatomyaxial atlas: orbital cortex, basal forebrain, hippocampus, midbrain.

Figure 516. Sectional anatomyaxial atlas: orbital cortex, hippocampus, amygdala, midbrain.

Figure 517. Limbic lobes.

Figure 518. Circuit of Papez.

Figure 519. Prefrontal cortexsurface anatomy and circuits.

Figure 520. Prefrontal cortexsectional anatomy.

Table 51. Summary of functional anatomy pertinent to psychiatry

Summary Key Points


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FIGURE 51. Planes of section.

Figure 51 shows the planes of sections of the brain.

S ource. U sed with permission from Mid-Atlantic Mental Illness Research, Education, and Clinical Center.


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FIGURE 52. Anatomic orientationsand directions.

Figure 52 illustrates the terms used to describe directions and anatomic orientations of the brain.

Several sets of terms are used to describedirections in the brain. Some of them areinvariant, whereas others are named relativeto a particular axis. Superiorinferior,anteriorposterior, and mediallateral do not

change. Rostralcaudal and dorsalventralare relative.

S ource. U sed with permission from Mid-Atlantic Mental IllnessResearch, Education, and Clinical Center.


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FIGURE 53. Major divisions of the brain.

Figure 53 shows the major divisions of the brain.

T he major divisions of the brain are color-coded onto magnetic resonance images to provide overallorientation. Origins of these divisions during development are presented in summary form.



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FIGURE 53. (continued)



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FIGURE 54. Lobes of the cerebral cortex.

Figure 54 shows the lobes of the cerebral cortex.

T he highly infolded surface layer of the brain, the cerebral cortex, is thelargest single division of the humanbrain. Anatomists commonly dividethe cerebral cortex into four sectionsor lobes: frontal, temporal, parietal,and occipital. In addition, someconsider the limbic areas of thecortex to comprise a fifth lobe,whereas others include these areas inthe frontal and temporal lobes anddiencephalon. T hese five lobes arecolor-coded onto both magneticresonance images and drawings of the medial, lateral, and inferior (bottom) views of the brain. Note thatthe medial and posterior inferior surfaces of the temporal lobe canonly be seen on the drawings of themedial and inferior surfaces of thebrain. T his is because the brain stemand cerebellum (see Figure 53)have been omitted from the drawings.

S ource. U sed with permission from Mid-Atlantic MentalIllness Research, Education, and Clinical Center.

(continued)


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FIGURE 55. Major gyri and sulci of the cerebral cortex.

Figure 55 shows the major gyri and sulci of the cerebral cortex.

An outfolding of thecerebral cortex is calleda gyrus (plural is gyri ), aninfolding is called asulcus (plural is sulci ).Some very large sulci arecalled fissures. Althoughall normal brains containmany gyri and sulci, theycan vary considerably inboth extent and location.

S ource. U sed with permission fromMid-Atlantic Mental Illness Research,Education, and Clinical Center.

(continued)


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S ource. U sed with permission from Mid-Atlantic Mental Illness Research,Education, and Clinical Center.


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FIGURE 56. Functions of the cerebral cortex.

Figure 56 shows the functions of the cerebral cortex.

S ource. U sed with permission from Mid-Atlantic Mental Illness Research, Education, and Clinical Center. (continued)


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FIGURE 57. Brodmann areas.

Figure 57 presents a general mapping of the Brodmann areas.

In the early part of the twentieth century,Brodmann defined cortical areas based onfeatures such as the size, shape, anddistribution of neurons (cytoarchitecture).

An approximation of these areas isprovided in these illustrations. Versions of this system are still widely used (Zeki

2005). Although useful, it is important toalways keep in mind that Brodmanns workwas based on analysis of a single brain.Brains vary greatly in size, shape, andfolding patterns. Research has shown thatthere is a wide range in the extent of aspecific Brodmann area when comparedacross individuals (see Figure 58). T hus,such maps should be used only as

extremely general guides.S ource. U sed with permission from Mid-Atlantic Mental IllnessResearch, Education, and Clinical Center.


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FIGURE 58. Variability in Brodmann areas.

Figure 58 presents a simplified variability map for Brodmann area 17 (primary visual cortex).

Multiple studies have compared the extent of particular Brodmann areas across individuals (Amunts et al. 2000,2004; U ylings et al. 2005). T here is considerable variability, even in areas dedicated to essential sensoryfunctions, such as primary visual cortex (Brodmann area 17). Individuality is even greater in areas subservingmore complex functions. Variability (or probability) maps have been created by transforming each studied braininto a common anatomic space, so that the areas can be superimposed. T his illustration is a simplification of published variability maps for Brodmann area 17 (primary visual cortex), which borders the calcarine sulcus inthe occipital lobe. T he colors indicate the number of individual brains (out of 10 brains) that overlapped.



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FIGURE 59. Major subcortical structures.

Figure 59 shows the major subcortical structures, color-coded to match the sectional axial atlaspresented in Figures 511 through 516.

An illustration of the major subcortical structures is color-coded to match the axial atlas (Figures 511 through 516).



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FIGURE 510. Basal forebrain.

Figure 510 shows the basal forebrain.

T he basal forebrain area (basal nucleus of Meynert, nucleus of the diagonal band, septal nuclei) containsmany cholinergic neurons. T he general location of this important region and its projections to cortical andsubcortical areas are indicated on sagittal ( left image ) and coronal ( right image ) magnetic resonanceimages.



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FIGURE 511. Sectional anatomyaxial atlas: dorsal frontal andparietal cortices.

Figures 511 through 516 present a sectional axial atlas, color-coded to the major subcorticalstructures depicted in Figure 59.

Axial T 1-weighted magnetic resonance imagewith major gyri, sulci, and lobes labeled.



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FIGURE 512. Sectional anatomy

axial atlas: cingulate cortex.

Axial T 1-weighted magnetic resonanceimage with major gyri, sulci, and lobeslabeled.



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FIGURE 513. Sectional anatomyaxial atlas: dorsal occipital andparietal cortices, caudate.

Axial T 1-weighted magneticresonance image with major gyri,sulci, and lobes labeled.



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FIGURE 514. Sectional anatomyaxial atlas: insular cortex, basalganglia, thalamus.

Axial T 1-weighted magnetic resonanceimage with major gyri, sulci, and lobeslabeled.



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FIGURE 515. Sectional anatomyaxial atlas: orbital cortex, basalforebrain, hippocampus, midbrain.

Axial T 1-weighted magnetic resonance imagewith major gyri, sulci, and lobes labeled.

S ource.U

sed with permission from Mid-Atlantic Mental IllnessResearch, Education, and Clinical Center.


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FIGURE 516. Sectional anatomyaxial atlas: orbital cortex,hippocampus, amygdala, midbrain.

Axial T 1-weighted magnetic resonance image

with major gyri, sulci, and lobes labeled.S ource. U sed with permission from Mid-Atlantic Mental IllnessResearch, Education, and Clinical Center.


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FIGURE 517. Limbic lobes.

Figure 517 shows the limbic lobes, color-coded to match the summary of subcortical structures(see Figure 59) and the sectional axial atlas (see Figures 511 through 516).

T he location and names of the structures that make up the outer (surface of brain) and inner (deepstructures) limbic lobes are illustrated on schematic diagrams of the medial surface of the right cerebralhemisphere. Structures are color-coded to match the summary of subcortical structures (see Figure 59)and the sectional axial atlas (see Figures 511 through 516).



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FIGURE 518. Circuitof Papez.

Figure 518 shows the circuit of Papez, color-coded to match the summary of subcortical structures(see Figure 59) and the sectional axial atlas (see Figures 511 through 516).

A schematic diagram of theemotion and memory circuit of Papez is color-coded to matchthe summary of subcorticalstructures (Figure 59) and thesectional axial atlas (Figures511 through 516). T helocation and extent of theanterior cingulate cortex ( light gold ) is indicated on a sagittalmidline drawing of the brain.T he locations of the remainingstructures are shown on acoronal magnetic resonanceimage.

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FIGURE 518. (enlarged)



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FIGURE 519. Prefrontalcortexsurface anatomyand circuits.

Figure 519 depicts thesurface anatomy and circuitsof the prefrontal cortex.

In psychiatry, the prefrontal cortexis generally divided into threeprincipal areas, each havingreciprocal connections withsubcortical structures that formcorticosubcortical circuits. T hesecircuits are formed by chains of neurons with cell bodies in graymatter structures (both cortical andsubcortical) connected by theaxons that form the white matter.Recently, the evidence supporting asimilar reciprocal circuit to thecerebellum has been strengthened,although the functions of this circuitare still controversial.

S ource. U sed with permission from Mid-AtlanticMental Illness Research, Education, and ClinicalCenter.


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The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC,Gabbard GO. 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org 28

FIGURE 520. Prefrontalcortexsectional anatomy.

Figure 520 shows thesectional anatomy of theprefrontal cortex.

T he frontal lobe circuits are crucial tomany higher-order behaviors, includingmemory, planning, and sociallyappropriate behavior. T hese circuitsare believed to be segregatedthroughout their course, with injury atany point producing a characteristicsyndrome (e.g., injury to thedorsolateral prefrontal cortex or to thedorsomedial thalamus could bothproduce deficits in executive function).In the white matter and at the varioussubcortical nuclei, the pathways arevery close together. Brain injury (e.g.,stroke, ischemia, trauma) may involvemore than one circuit, resulting in amixture of deficits.



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TABLE 51. Summary of functional anatomy pertinent to psychiatry

Table 51 presents a summary of functional anatomy pertinent to psychiatry.

(continued)S ource. Nolte 2002; T ranel 2002.


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TABLE 51. (continued)

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CHAPTER 5 Key Points

T he dorsolateral prefrontal region is important for cognition, executive

function, and focused attention.T he orbital prefrontal region is important for social conduct, insight, judgment,and mood.T he mesial region of the temporal lobe contains the hippocampus, theparahippocampus, and the amygdala.T he hippocampal complex is the key to memory formation and storagefunctions.T he parietal lobe is important for sensation, speech production/conduction,and deficit recognition.T he basal ganglia are critical for suppression/modulation of involuntarymovements and contribute to memory, cognition, behavior, and mood.T he thalamus is the key relay station for memory, emotion, cognition,behavior, motor, and sensory functions.T he hypothalamus modulates physiological response to emotional stimuli,temperature control, sleep, water metabolism, hormone secretion, satiety,and circadian rhythms.

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T he pons contains the locus coeruleus (norepinephrine production) and

portions of the reticular formation (alertness).T he cerebellum is important for equilibrium and fine motor coordination andis associated with cognition.

CHAPTER 5 Key Points (continued)

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