Enhanced emotional reactions in chronic head trauma patients.

Abstract

SUMMARY The emotional characteristics of head injury patients referred for neuropsychological testing were examined as a function of the time since injury. Patients referred more than 6 months from injury were more emotionally distressed on the MMPI and Katz Adjustment Scale (relatives form) compared to those tested 6 months or earlier. The more chronic head trauma patients were more anxious and depressed, more confused in their thinking, and more socially withdrawn compared to the acute patient group. These differences in emotional functioning appeared to be independent of level of neuropsychological impairment and the initial length of coma. Premorbid personality and increased awareness of impaired functioning with the passage of time are discussed as possible mediators of enhanced emotional distress in some chronic head injury patients.Cognitive deficits following significant craniocerebral trauma have been shown to improve with the passage of time. The rate and eventual level of recovery is known to be related to the severity of injury.'-3 Emotional recovery following such injuries may parallel improvements in cognitive functioning,3 but in some cases emotional functioning may actually deteriorate with the passage of time.4 It has been our impression that increased emotional distress often parallels the patient's increased awareness of cognitive, social and vocational limitations, which occur as overall cognitive confusion lessens. Premorbid personality characteristics5 6 also seem to relate to heightened psychopathology in some chronic patients. It is becoming increasingly more apparent that emotional and personality adjustment following head injury can have a significant effect on rehabilitation outcome.78The purpose of the present study was to compare the degree of emotional distress in chronic and acute head injury patients. It was predicted that patients referred for neuropsychological evaluation longer than 6 months after trauma would exhibit greater emotional distress than those tested 6 months or less from the time of injury. As the degree of emotional Address for reprint requests: David J Fordyce, Ph.D., Depart-ment of Clinical Neuropsychology, Presbyterian Hospital, Northeast 13th and Lincoln Blvd.,

Role of premorbid factors in predicting safe return to driving after severe TBI

“…In fact, by no means could we directly assess premorbid personality or verify whether close relatives evaluations reflected, for instance, real pre-TBI driving style. Prior research has shown that reports from caregivers on patients' functioning were more predictive of patients' fitness to drive than patients' self ratings [21,39]. Other findings suggested that relatives' own personality structure could impact upon their perception of the effects of brain injury on patients [90].…”

“…Driving requires planning, concentration, inhibition of distractors, foresight, anticipation, problem-solving capacities, the ability to interpret rapidly complex arrays of multimodal stimuli, and prompt, effective, and calm reactions. Some post-TBI subjects display a hidden deficit in one or more of these domains and may have loss of emotional control under certain circumstances [35][36][37][38][39][40][41][42][43][44]. Others may also be unaware of 198 P. Pietrapiana et al…”

Assessment of neuropsychologic impairments after head injury: Interrater reliability and factorial and criterion validity of the Neurobehavioral Rating Scale–Revised

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Other frequent problems observed early postinjury and later concern the regulation of survival-oriented behavior, manifested in disinhibitory behavior (overeating, defensive behavior, changes in sexual behavior) [17][18][19][20][21] and of emotional state (indifference, irritability, excitation, incongruity of affect, emotional lability). [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] In addition, a deficit in one or the other aspect of intentional, or goal-oriented behavior is also frequent, affecting appropriate understanding of the social environment and perception of oneself, goal formulation or identification of needs, determination and organization of steps and means of attaining the goal or satisfying the needs (planning), execution of the plan, and verification of its appropriateness in relation to the goal or needs. 22,[38][39][40][41][42][43] Problems in the regulation of intentional behavior also affect social...…”

Neuropsychological rehabilitation after closed head injury in young adults.

“…It is not surprising, therefore, that these patients often show enhanced emotional and motivational disturbances over time. 4 While some of these problems may reflect disturbed neurophysiology,5 others seem to be related to problems in coping with residual deficits. Clearly, both cognitive and personality disturbances, whatever the aetiology, are related to one another in traumatic head injury patients6 and are predictive of failure to return to work.…”