New insights for coping with personality changes in acquired brain injury

PUBLIC RELEASE DATE:

25-Jun-2014

Contact: Daphne Watrin d.watrin@iospress.com 31-206-883-355 IOS Press

Amsterdam, NL, June 25, 2014 Individuals with brain injury and their families often struggle to accept the associated personality changes. The behavior of individuals with acquired brain injury (ABI) is typically associated with problems such as aggression, agitation, non-compliance, and depression. Treatment goals often focus on changing the individual's behavior, frequently using consequence-based procedures or medication. In the current issue of NeuroRehabilitation leading researchers challenge this approach and recommend moving emphasis from dysfunction to competence.

"Behavior dysfunction may be best construed as a sentinel rather than a cause. It signals that a person is beyond his or her personal capacities and needs contextually relevant supports," says Guest Editor Harvey E. Jacobs, PhD, a noted clinician practicing in Richmond, Virginia. "The purpose of this special issue is to move beyond the person and the brain and to understand more clearly how our behavior, especially those involved in service delivery or caregiving, directly or through our systems, diagnostic and treatment perspectives, cultures, and perceptions, directly affects behavior associated with ABI, with an emphasis on competence over dysfunction."

Eminent experts have contributed a series of insightful reviews.

Randall D. Buzan, Jeff Kupfer, Dixie Eastridge, and Andres Lema-Hincapie note that accepting post-injury personality changes is complicated by tacit assumptions about the nature of personality, free will, and the relationship between the mind and the brain. They challenge the Western Dualistic model of mind and body by reviewing the constructional nature of perception and the neurologic bases of affect, morality, empathy, and sense of self, and propose embodiment theory as one viable solution to the mind body dilemma.

Hal S. Wortzel and David B. Arciniegas draw attention to the substantial changes in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Diagnosis is now based retrospectively on the severity of posttraumatic cognitive impairments and their effects on everyday function, as compared to the initial severity of TBI. They conclude that this approach is likely to improve the evaluations of persons with TBI by mental health professionals, including differential diagnosis.

TBI initiates a cascade of neuromodulatory damage that blurs distinctions between physical and psychological medicine, say Nadia E. Webb, Brittany Little, Stephanie Loupee-Wilson, and Elizabeth M. Power. They point out that monitoring endocrine function is critical to avoid misdiagnosing and mistreating clinical symptoms such as depression, fatigue, diminished concentration, irritability, and overall cognitive decline. Wider adoption of consensus guidelines on the detection and monitoring of endocrine abnormalities post-TBI may diminish the severity of functional impairment and improve quality of life.

Ryan McQueen and Gregory J. O'Shanick note that acute rehabilitation following neurotrauma has evolved over the past 30 years to include the common use of drugs to promote synaptogenesis and improve recovery potential. However, little guidance exists for similar strategies in post-acute or community re-entry phases ABI. They draw on the existing scientific literature, models of pharmacologic intervention in promoting stability in other disease states, and their own collective clinical experience to provide a potential structure to create a stable physiologic platform to facilitate proactive behavioral intervention.

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New insights for coping with personality changes in acquired brain injury