Emotional and psychosocial problems after brain injury

Abstract

Emotional and psychosocial disorders of brain-damaged patients have a strong impact upon the outcome of the rehabilitation. However, owing to methodological difficulties, and to the intrinsic complexity of such disorders, these issues have received only a limited amount of interest. The aim of this paper is to try to disentangle some of the major factors underlying these disturbances, making a schematic distinction between three main categories:(1) neurological factors; (2) psychological (or psychodynamic) factors;(3) psychosocial factors. Emotional disorders stem directly from neurological factors when they result from the disruption of specific neural mechanisms subserving the modulation and control of emotional and social. behaviour. Patients with severe traumatic head injury are, in general, the more prototypical instances of this category, as in them the lesion usually involves some of the most important cortical components of the limbic system. According to some authors, poststroke depression should also be included in this category. Psychological or psychodynamic factors, on the other hand, consist of those personal attitudes towards the disability that result from an implicit or explicit awareness of the defect and of its implications as to the future quality of life of the patient. These factors are linked to the personality of the patient, to their life-style and to their whole system of values. Finally, psychosocial factors can be considered as the interconnected set of consequences that the handicap, resulting from the functional impairment, will produce on the patient's social activities and on their network of social relationships. An important component of this category consists of the burden that the cognitive and personality change produced by the lesion represents for the close relatives of the patient, of their reaction to this burden, and of the influence that these reactions can have on the process of recovery.

Emotional distress and awareness following acquired brain injury: An exploratory analysis

“…Each question has four possible responses, which are scored on a scale from 0-3. Based on normative data, anxiety and depression ratings can be classified as: normal (0-7), mild (8-10), moderate (11)(12)(13)(14)(15) and severe (16)(17)(18)(19)(20)(21). Anxiety and depression subscales can be aggregated to provide an overall score.…”

“…Psychological models of awareness focus on the role of denial of disabilities as a protection against the impact of the reality of disability and loss of pre-injury status [11]. Such models propose that an increase in awareness of difficulties would be accompanied by increased emotional distress [12].…”

Caracterización y efectividad de programas de rehabilitación neuropsicológica de las funciones ejecutivas en pacientes con daño cerebral adquirido: una revisión

“…Estos programas incluyen la iniciativa y la motivación necesaria para desenvolverse en la vida cotidiana, ya que es frecuente encontrar pacientes con problemas para iniciar conductas y/o falta de iniciativa para participar en actividades externas (Gainotti, 1993). A partir de estos planteamientos se han diseñado programas que tienen como objetivo relacionar conductas entre sí, buscando que los pacientes las asocien y que las inicien de forma autónoma (Arango & Parra, 2008).…”

The ESDQ: A New Method of Assessing Emotional and Social Dysfunction in Patients Following Brain Surgery

“…Of the many changes and impairments associated with brain damage, it is the emotional changes that are often seen as the most disabling for the individual in the long-term (Andrewes, Hordern, & Kaye, 1998;Grant & Alves, 1987;Hanks, Temkin, Machamer, & Dikmen, 1999;Malia, Powell, & Tarrode, 1975). Nevertheless despite the importance of assessment in this area, Gainotti (1993) and others have commented, that many studies have suffered from a lack of availability of adequate measures of emotional dysfunction appropriate to a braindamaged patient population. Some of the theoretical inconsistencies between cognitive neuroscience research (Davidson, 2001) and self-reports by brain-damaged patients (e.g., Carson et al, 2000) may be due, in part, to the use of inappropriate measures and also the general tendency to concentrate on depression at the expense of other important areas of emotional dysfunction.…”