The document discusses managing neurobehavioral issues in clients with brain injuries. It covers topics like post-traumatic amnesia, aggression, mood disorders, psychosis, and sexually inappropriate behaviors. It describes developing unwanted behaviors after brain injury and how to conduct functional assessments to understand the purpose and function of behaviors. The summary emphasizes using reinforcement and antecedent-based strategies to modify behaviors while avoiding punishment when possible due to safety risks.
The Hidden Agenda: Cognitive processes in addictiondrfrankryan
1. The document discusses cognitive processes like attentional biases and impaired executive function as latent vulnerability factors that can increase drug craving and relapse risk in addiction.
2. Treatment should focus on modifying these cognitive processes through strategies like cognitive rehabilitation, impulse control training, and reversing cognitive biases.
3. Translating cognitive psychology findings into effective clinical applications is challenging but treatments combining cognitive and behavioral approaches may be most effective in addressing addiction at both implicit and explicit cognitive levels.
Implicit cognitive processes in the addiction clinicdrfrankryan
The document discusses implicit cognitive processes in addiction treatment. It argues that implicit processes underlie involuntary aspects of addiction and are potential targets for modification through existing and new treatments. Specifically, it suggests that addressing implicit biases and improving executive control can enhance treatment outcomes by reducing cue reactivity and preoccupation with drug cues. A number of cognitive and behavioral techniques are proposed that aim to increase cognitive control and reverse automatic tendencies, such as cognitive bias modification and implementation intentions.
Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyenepicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Johan Vlaeyen. In this talk, Dr Vlaeyen discusses the mechanisms, assessment and treatment of fear avoidance in patients with chronic pain. Edinburgh, UK. www.nbpa.org.uk
Unfrying Your Brain- Tonmoy Sharma, CEO of Sovereign HealthDr. Tonmoy Sharma
Tonmoy Sharma, CEO of Sovereign Health Group, reveals how we must view addiction, and how we can reverse serious cognitive deficits that often go undetected in addiction treatment. Sharma also reviews the need for measurement-based care, and outlines in great detail, how the addiction-treatment industry can evolve to better meet the needs of our patients.
Ed Sum presented on managing functional overlay in patients with multiple sclerosis. He explored conceptual models of functional neurological symptoms and discussed interventions like cognitive behavioral therapy and physiotherapy. He presented a case study of a patient named "Kay" who experienced numerous neurological symptoms in addition to her MS diagnosis, which were determined to have a functional component related to stressors in her life. Sum emphasized the importance of diagnosis, education, and multidisciplinary interventions for patients presenting with functional neurological disorder.
Counseling Strategies Action & Maintenance
By: Linda L. Barclay PH.D. LPCC/S LICDC
CHD 635
Chemical Dependency
"Recovery from addictions requires lifestyle changes"
"Recovery from addictions requires developing and working with relapse prevention or maintenance plans."
Cognitive behavioural therapy (CBT) leads to significant improvements in functioning and quality of life for chronic pain conditions like low back pain. Several studies show CBT is as effective or more effective than other therapies or medications for issues like reducing catastrophizing thoughts, pain levels, and disability. While evidence is limited, online CBT and web-based interventions show promise in improving outcomes for chronic low back pain. Overall, CBT aims to help patients better manage their pain by changing maladaptive thoughts and behaviors.
The document discusses the management of acute stress disorder. It begins by presenting a case of a student experiencing symptoms of acute stress disorder including body aches, fatigue, indigestion, decreased sleep and concentration. It then provides the diagnostic criteria for acute stress disorder, risk factors, and empirically supported intervention strategies including psychological first aid, cognitive behavioral therapy, and pharmacologic management. It stresses monitoring patients and referring those with prolonged reactions affecting daily life.
The Hidden Agenda: Cognitive processes in addictiondrfrankryan
1. The document discusses cognitive processes like attentional biases and impaired executive function as latent vulnerability factors that can increase drug craving and relapse risk in addiction.
2. Treatment should focus on modifying these cognitive processes through strategies like cognitive rehabilitation, impulse control training, and reversing cognitive biases.
3. Translating cognitive psychology findings into effective clinical applications is challenging but treatments combining cognitive and behavioral approaches may be most effective in addressing addiction at both implicit and explicit cognitive levels.
Implicit cognitive processes in the addiction clinicdrfrankryan
The document discusses implicit cognitive processes in addiction treatment. It argues that implicit processes underlie involuntary aspects of addiction and are potential targets for modification through existing and new treatments. Specifically, it suggests that addressing implicit biases and improving executive control can enhance treatment outcomes by reducing cue reactivity and preoccupation with drug cues. A number of cognitive and behavioral techniques are proposed that aim to increase cognitive control and reverse automatic tendencies, such as cognitive bias modification and implementation intentions.
Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyenepicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Johan Vlaeyen. In this talk, Dr Vlaeyen discusses the mechanisms, assessment and treatment of fear avoidance in patients with chronic pain. Edinburgh, UK. www.nbpa.org.uk
Unfrying Your Brain- Tonmoy Sharma, CEO of Sovereign HealthDr. Tonmoy Sharma
Tonmoy Sharma, CEO of Sovereign Health Group, reveals how we must view addiction, and how we can reverse serious cognitive deficits that often go undetected in addiction treatment. Sharma also reviews the need for measurement-based care, and outlines in great detail, how the addiction-treatment industry can evolve to better meet the needs of our patients.
Ed Sum presented on managing functional overlay in patients with multiple sclerosis. He explored conceptual models of functional neurological symptoms and discussed interventions like cognitive behavioral therapy and physiotherapy. He presented a case study of a patient named "Kay" who experienced numerous neurological symptoms in addition to her MS diagnosis, which were determined to have a functional component related to stressors in her life. Sum emphasized the importance of diagnosis, education, and multidisciplinary interventions for patients presenting with functional neurological disorder.
Counseling Strategies Action & Maintenance
By: Linda L. Barclay PH.D. LPCC/S LICDC
CHD 635
Chemical Dependency
"Recovery from addictions requires lifestyle changes"
"Recovery from addictions requires developing and working with relapse prevention or maintenance plans."
Cognitive behavioural therapy (CBT) leads to significant improvements in functioning and quality of life for chronic pain conditions like low back pain. Several studies show CBT is as effective or more effective than other therapies or medications for issues like reducing catastrophizing thoughts, pain levels, and disability. While evidence is limited, online CBT and web-based interventions show promise in improving outcomes for chronic low back pain. Overall, CBT aims to help patients better manage their pain by changing maladaptive thoughts and behaviors.
The document discusses the management of acute stress disorder. It begins by presenting a case of a student experiencing symptoms of acute stress disorder including body aches, fatigue, indigestion, decreased sleep and concentration. It then provides the diagnostic criteria for acute stress disorder, risk factors, and empirically supported intervention strategies including psychological first aid, cognitive behavioral therapy, and pharmacologic management. It stresses monitoring patients and referring those with prolonged reactions affecting daily life.
Mode Deactivation Therapy (MDT) was developed as an alternative to standard Cognitive Behavioral Therapy for treating adolescents with behavioral and complex comorbid problems. MDT incorporates principles from CBT, DBT, ACT, and FAP. It is based on Beck's theory of modes and aims to overcome limitations of CBT by assessing and reconstructing adolescents' core beliefs using modes. MDT uses mindfulness, acceptance, and validation techniques to help adolescents manage fears, triggers and core beliefs that lead to maladaptive behaviors. A key part of MDT is developing therapeutic relationships and family support systems to encourage new coping skills and reduce anxiety.
Treatment Issues and Relational Strategies for Working with Complex PTSD and ...Daryush Parvinbenam
By: Daryush Parvinbenam M.A., M.Ed., LPCC-S, LICDC
Prevalence of Childhood Trauma: "50-60% of women seeking health services have experienced childhood sexual abuse. Up to 75% of women seeking mental health services has experienced childhood sexual abuse. Children of mothers who were sexually abused are twice as likely to experience childhood sexual abuse."
This research report summarizes a study examining the neural effects of cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD). The study involved 21 adults with GAD and 11 healthy controls. Participants underwent functional MRI while viewing facial emotions before and after CBT (or a comparable waiting period for controls). Results showed that before treatment, those with GAD had blunted responses in brain regions involved in emotion processing when viewing happy faces, and greater connectivity between the amygdala and insula. After CBT, individuals with GAD showed attenuated activation in the amygdala and anterior cingulate in response to threat-related faces, as well as heightened insular responses to happy faces. The findings provide evidence
1. The document provides a lesson plan on behavior therapy that introduces the topic, defines behavior therapy, and explains the principles of conditioning behavior, including classical conditioning, operant conditioning, and modeling.
2. It then describes techniques of behavior therapy in detail, focusing on systematic desensitization which involves relaxation training, constructing an anxiety hierarchy, and desensitizing stimuli from least to most anxiety-provoking while relaxed.
3. The goal of behavior therapy is to reduce or eliminate maladaptive behaviors through principles of learning and conditioning, using techniques like systematic desensitization to treat conditions like phobias, OCD, and anxiety disorders.
Understanding fatigue and an introduction to the FACETS programmeMS Trust
This presentation by Alison Nook and Vicky Slingsby, Occupational Therapists at the Dorset MS Service, explores fatigue in multiple sclerosis, the most common MS symptom. It looks at how fatigue can be managed with energy effectiveness techniques and introduces FACETS (Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle),
Facing our demons: Do mindfulness skills help people deal with failure at work?anucrawfordphd
The document summarizes research on whether mindfulness skills help people cope with failure at work. Three studies were conducted among university students to test if mindfulness interventions facilitated more adaptive coping behaviors. The results showed that for individuals reporting high levels of perceived stress, mindfulness predicted less avoidance coping and greater approach coping. Specifically, brief mindfulness inductions led to less avoidance coping. Additionally, a mindfulness acceptance induction led to greater approach coping. Thus, the research suggests mindfulness can help people cope more adaptively with stress and failures, especially for those experiencing high stress.
This document discusses attitudes, theories of attitude formation and change, and behavior modification therapy (BMT). It defines attitudes as predispositions involving thoughts, feelings, and behaviors. Major theories discussed include Heider's balance theory, Festinger's cognitive dissonance theory, and the Yale attitude change approach. BMT techniques are described that are based on classical conditioning principles like systematic desensitization and flooding, operant conditioning using reinforcement, and cognitive therapies aimed at changing thoughts. Factors influencing attitudes include beliefs, social factors, personal experiences, and institutions.
1) The study examined whether coping strategies mediate the relationship between personality traits (Big Five factors) and psychological distress.
2) Results found several Big Five factors (agreeableness, conscientiousness, neuroticism) were correlated with psychological distress and certain coping strategies (wishful thinking, self-criticism, social withdrawal).
3) Further analysis showed these coping strategies (wishful thinking, self-criticism, social withdrawal) partially mediated the relationships between some Big Five factors (agreeableness, conscientiousness, neuroticism) and psychological distress.
Stress and Crisis - plays important role to deteriorate the physical and mental health of a person, so one should know how to manage it by knowing the condition, causes, sign and symptom and its intervention.
1) The study examined whether symptom change in computerized cognitive behavioral therapy (cCBT) for depression is mediated by changes in cognitive skills, and whether dorsolateral prefrontal cortex (DLPFC) activity as measured by pupil reactivity moderates this process.
2) The results found that symptom change was partially mediated by acquisition of cognitive skills, and that pupil reactivity moderated the effect of treatment on skill acquisition, such that those with low-moderate pupil reactivity showed greater skill improvements.
3) For participants with low-moderate pupil reactivity, skill change mediated subsequent reductions in depression symptoms, but this was not seen for those with high pupil reactivity, providing evidence that pupil reactivity
1) The document discusses the use of psychosocial interventions (PSI) for patients with severe mental illness, including techniques from cognitive behavioral therapy.
2) It presents a case study of a patient named Andrea who was admitted to an acute psychiatric ward and describes how staff overcame obstacles to engage Andrea and her family using PSI approaches.
3) Key aspects of the PSI used included flexible time for the nurse to build rapport with Andrea, assessing her symptoms and medication side effects, involving her family by addressing needs and devising a crisis plan, and explaining the stress vulnerability model to provide support and communication.
Chronic stress can lead to depression through several pathways in the body and brain. The stress response involves the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, which elevate cortisol and catecholamine levels. Over time, prolonged activation of these systems due to stress can result in allostatic load, damaging the body and brain through effects on inflammatory and immune responses. This dysregulation of stress mediators is associated with increased risk of depression as well as medical conditions like heart disease and metabolic syndrome. Meditation may help reduce stress's harmful impacts through effects on the brain's opioid and stress response systems.
1) Dr. Oziel Menendez consulted with colleagues regarding treating two brothers, Erik and Lyle Menendez, after they confessed to murdering their parents.
2) During treatment, concerns arose about threats made by Lyle against Dr. Menendez and his staff. Dr. Menendez took security precautions and the brothers were eventually arrested after audio tapes of their sessions were provided to police.
3) This led to a 1991 court case, Menendez v. Superior Court, regarding the admissibility of the audio tapes in the brothers' criminal trial for murdering their parents.
1) Preliminary results from the Norwegian TF-CBT study show that TF-CBT was more effective than TAU in reducing children's PTSD, depression, and anxiety symptoms.
2) Parental emotional reactions and post-trauma cognitions may mediate treatment outcomes. Parents in both groups reported less distress and depression over time, and changes in parental distress were related to child outcomes. Changes in children's post-trauma cognitions also predicted symptom reduction.
3) A stronger therapeutic alliance was associated with better outcomes for children receiving TF-CBT but not TAU, suggesting alliance may be an active ingredient in TF-CBT specifically.
psychosocial intervention for children and adolescents with depressionpraful kapse
Psychosocial intervention is an approach that acknowledges the psychological and social factors that influence an individual's well-being. It includes psychoeducation, cognitive and behavioral strategies, social skills training, sleep hygiene, interpersonal therapy, and group therapy. A case study describes a 12-year-old boy presenting with depression who was assessed and received cognitive behavioral therapy targeting negative thoughts, as well as social skills training and group therapy. Research shows cognitive behavioral therapy can have immediate and long-term positive effects on reducing depressive symptoms.
This document summarizes Peter Fonagy's presentation on psychotherapy for emerging borderline personality disorder. It discusses what is known about treating BPD in adolescence, including evidence for DBT, MBT, ERT, HYPE, and pharmacotherapy. It also summarizes results from RCTs comparing MBT to treatment as usual, finding that MBT was more effective in reducing self-harm, depression, BPD traits, and improving mentalization and attachment. The document considers whether BPD can be validly diagnosed in adolescence and reviews prevalence studies showing similar rates to adults.
LRI05 - Self Help for Distress in Cancer - Is It Time For An RCT [Oct 2005]Alex J Mitchell
This is an academic presentation from 2005 outlining the case for a randomized controlled trial of a self-help programme to help people deal with distress and depression following the diagnosis of cancer
Psychological Assessment For Implantable Therapies Dr Peter Murphyepicyclops
Psychological assessment is recommended for patients undergoing spinal cord stimulation (SCS) therapy based on evidence that it leads to better outcomes. A brief psychological evaluation can identify potential mental health issues like depression or anxiety that are common in chronic pain patients and associated with poorer prognoses. It also aims to ensure patients have realistic expectations of SCS and a plan for managing their pain should the treatment not achieve the desired level of relief. While certain personality traits alone may not predict outcomes, evaluations can help optimize patient selection and preparation for SCS.
1) The document discusses the importance of considering an individual's genetics, learning history, current environment, and biological factors when conducting a functional behavior assessment (FBA), regardless of whether they have a psychiatric diagnosis.
2) It emphasizes that the goal of an FBA is to objectively define, measure, and understand the functions or reinforcers maintaining problematic behavior in order to develop effective behavioral interventions.
3) Medications can impact behavior in various ways by altering sensitivity to reinforcement or punishment, but their effects must be considered in the context of each individual's unique contingencies of reinforcement as understood through an FBA.
Dr Andrea Grubb Barthwell: Neuroscience for Non-scientists: The Brian Targets...iCAADEvents
The American Society of Addiction Medicine (ASAM) defines substance use disorders (SUD) as primary, chronic diseases of brain reward, motivation, memory, and related circuitry.
Without treatment or engagement in recovery activities, this is reflected as an individual who is pathologically pursuing reward and/or relief by substance use and other behaviours, despite consequences.
As we develop strategies and treatments to prevent use and intervene on early use, knowledge of the neuroscience can improve our ability to respond effectively, and with compassion.
Each of the medication development targets and psychological strategies employed in the treatment of SUD are tied to specific organ systems, most generally the pathways in the brain.
Since many of the areas of the brain that are involved with mental disorders overlap those affected by chronic drug use, medications that treat symptoms of anxiety and mood are also useful in changing the incentives and patterns of use.
Andrea G Barthwell, MD, DFASAM will present the neuroscience needed to understand SUDs and medications that work on these systems.
Mode Deactivation Therapy (MDT) was developed as an alternative to standard Cognitive Behavioral Therapy for treating adolescents with behavioral and complex comorbid problems. MDT incorporates principles from CBT, DBT, ACT, and FAP. It is based on Beck's theory of modes and aims to overcome limitations of CBT by assessing and reconstructing adolescents' core beliefs using modes. MDT uses mindfulness, acceptance, and validation techniques to help adolescents manage fears, triggers and core beliefs that lead to maladaptive behaviors. A key part of MDT is developing therapeutic relationships and family support systems to encourage new coping skills and reduce anxiety.
Treatment Issues and Relational Strategies for Working with Complex PTSD and ...Daryush Parvinbenam
By: Daryush Parvinbenam M.A., M.Ed., LPCC-S, LICDC
Prevalence of Childhood Trauma: "50-60% of women seeking health services have experienced childhood sexual abuse. Up to 75% of women seeking mental health services has experienced childhood sexual abuse. Children of mothers who were sexually abused are twice as likely to experience childhood sexual abuse."
This research report summarizes a study examining the neural effects of cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD). The study involved 21 adults with GAD and 11 healthy controls. Participants underwent functional MRI while viewing facial emotions before and after CBT (or a comparable waiting period for controls). Results showed that before treatment, those with GAD had blunted responses in brain regions involved in emotion processing when viewing happy faces, and greater connectivity between the amygdala and insula. After CBT, individuals with GAD showed attenuated activation in the amygdala and anterior cingulate in response to threat-related faces, as well as heightened insular responses to happy faces. The findings provide evidence
1. The document provides a lesson plan on behavior therapy that introduces the topic, defines behavior therapy, and explains the principles of conditioning behavior, including classical conditioning, operant conditioning, and modeling.
2. It then describes techniques of behavior therapy in detail, focusing on systematic desensitization which involves relaxation training, constructing an anxiety hierarchy, and desensitizing stimuli from least to most anxiety-provoking while relaxed.
3. The goal of behavior therapy is to reduce or eliminate maladaptive behaviors through principles of learning and conditioning, using techniques like systematic desensitization to treat conditions like phobias, OCD, and anxiety disorders.
Understanding fatigue and an introduction to the FACETS programmeMS Trust
This presentation by Alison Nook and Vicky Slingsby, Occupational Therapists at the Dorset MS Service, explores fatigue in multiple sclerosis, the most common MS symptom. It looks at how fatigue can be managed with energy effectiveness techniques and introduces FACETS (Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle),
Facing our demons: Do mindfulness skills help people deal with failure at work?anucrawfordphd
The document summarizes research on whether mindfulness skills help people cope with failure at work. Three studies were conducted among university students to test if mindfulness interventions facilitated more adaptive coping behaviors. The results showed that for individuals reporting high levels of perceived stress, mindfulness predicted less avoidance coping and greater approach coping. Specifically, brief mindfulness inductions led to less avoidance coping. Additionally, a mindfulness acceptance induction led to greater approach coping. Thus, the research suggests mindfulness can help people cope more adaptively with stress and failures, especially for those experiencing high stress.
This document discusses attitudes, theories of attitude formation and change, and behavior modification therapy (BMT). It defines attitudes as predispositions involving thoughts, feelings, and behaviors. Major theories discussed include Heider's balance theory, Festinger's cognitive dissonance theory, and the Yale attitude change approach. BMT techniques are described that are based on classical conditioning principles like systematic desensitization and flooding, operant conditioning using reinforcement, and cognitive therapies aimed at changing thoughts. Factors influencing attitudes include beliefs, social factors, personal experiences, and institutions.
1) The study examined whether coping strategies mediate the relationship between personality traits (Big Five factors) and psychological distress.
2) Results found several Big Five factors (agreeableness, conscientiousness, neuroticism) were correlated with psychological distress and certain coping strategies (wishful thinking, self-criticism, social withdrawal).
3) Further analysis showed these coping strategies (wishful thinking, self-criticism, social withdrawal) partially mediated the relationships between some Big Five factors (agreeableness, conscientiousness, neuroticism) and psychological distress.
Stress and Crisis - plays important role to deteriorate the physical and mental health of a person, so one should know how to manage it by knowing the condition, causes, sign and symptom and its intervention.
1) The study examined whether symptom change in computerized cognitive behavioral therapy (cCBT) for depression is mediated by changes in cognitive skills, and whether dorsolateral prefrontal cortex (DLPFC) activity as measured by pupil reactivity moderates this process.
2) The results found that symptom change was partially mediated by acquisition of cognitive skills, and that pupil reactivity moderated the effect of treatment on skill acquisition, such that those with low-moderate pupil reactivity showed greater skill improvements.
3) For participants with low-moderate pupil reactivity, skill change mediated subsequent reductions in depression symptoms, but this was not seen for those with high pupil reactivity, providing evidence that pupil reactivity
1) The document discusses the use of psychosocial interventions (PSI) for patients with severe mental illness, including techniques from cognitive behavioral therapy.
2) It presents a case study of a patient named Andrea who was admitted to an acute psychiatric ward and describes how staff overcame obstacles to engage Andrea and her family using PSI approaches.
3) Key aspects of the PSI used included flexible time for the nurse to build rapport with Andrea, assessing her symptoms and medication side effects, involving her family by addressing needs and devising a crisis plan, and explaining the stress vulnerability model to provide support and communication.
Chronic stress can lead to depression through several pathways in the body and brain. The stress response involves the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, which elevate cortisol and catecholamine levels. Over time, prolonged activation of these systems due to stress can result in allostatic load, damaging the body and brain through effects on inflammatory and immune responses. This dysregulation of stress mediators is associated with increased risk of depression as well as medical conditions like heart disease and metabolic syndrome. Meditation may help reduce stress's harmful impacts through effects on the brain's opioid and stress response systems.
1) Dr. Oziel Menendez consulted with colleagues regarding treating two brothers, Erik and Lyle Menendez, after they confessed to murdering their parents.
2) During treatment, concerns arose about threats made by Lyle against Dr. Menendez and his staff. Dr. Menendez took security precautions and the brothers were eventually arrested after audio tapes of their sessions were provided to police.
3) This led to a 1991 court case, Menendez v. Superior Court, regarding the admissibility of the audio tapes in the brothers' criminal trial for murdering their parents.
1) Preliminary results from the Norwegian TF-CBT study show that TF-CBT was more effective than TAU in reducing children's PTSD, depression, and anxiety symptoms.
2) Parental emotional reactions and post-trauma cognitions may mediate treatment outcomes. Parents in both groups reported less distress and depression over time, and changes in parental distress were related to child outcomes. Changes in children's post-trauma cognitions also predicted symptom reduction.
3) A stronger therapeutic alliance was associated with better outcomes for children receiving TF-CBT but not TAU, suggesting alliance may be an active ingredient in TF-CBT specifically.
psychosocial intervention for children and adolescents with depressionpraful kapse
Psychosocial intervention is an approach that acknowledges the psychological and social factors that influence an individual's well-being. It includes psychoeducation, cognitive and behavioral strategies, social skills training, sleep hygiene, interpersonal therapy, and group therapy. A case study describes a 12-year-old boy presenting with depression who was assessed and received cognitive behavioral therapy targeting negative thoughts, as well as social skills training and group therapy. Research shows cognitive behavioral therapy can have immediate and long-term positive effects on reducing depressive symptoms.
This document summarizes Peter Fonagy's presentation on psychotherapy for emerging borderline personality disorder. It discusses what is known about treating BPD in adolescence, including evidence for DBT, MBT, ERT, HYPE, and pharmacotherapy. It also summarizes results from RCTs comparing MBT to treatment as usual, finding that MBT was more effective in reducing self-harm, depression, BPD traits, and improving mentalization and attachment. The document considers whether BPD can be validly diagnosed in adolescence and reviews prevalence studies showing similar rates to adults.
LRI05 - Self Help for Distress in Cancer - Is It Time For An RCT [Oct 2005]Alex J Mitchell
This is an academic presentation from 2005 outlining the case for a randomized controlled trial of a self-help programme to help people deal with distress and depression following the diagnosis of cancer
Psychological Assessment For Implantable Therapies Dr Peter Murphyepicyclops
Psychological assessment is recommended for patients undergoing spinal cord stimulation (SCS) therapy based on evidence that it leads to better outcomes. A brief psychological evaluation can identify potential mental health issues like depression or anxiety that are common in chronic pain patients and associated with poorer prognoses. It also aims to ensure patients have realistic expectations of SCS and a plan for managing their pain should the treatment not achieve the desired level of relief. While certain personality traits alone may not predict outcomes, evaluations can help optimize patient selection and preparation for SCS.
1) The document discusses the importance of considering an individual's genetics, learning history, current environment, and biological factors when conducting a functional behavior assessment (FBA), regardless of whether they have a psychiatric diagnosis.
2) It emphasizes that the goal of an FBA is to objectively define, measure, and understand the functions or reinforcers maintaining problematic behavior in order to develop effective behavioral interventions.
3) Medications can impact behavior in various ways by altering sensitivity to reinforcement or punishment, but their effects must be considered in the context of each individual's unique contingencies of reinforcement as understood through an FBA.
Dr Andrea Grubb Barthwell: Neuroscience for Non-scientists: The Brian Targets...iCAADEvents
The American Society of Addiction Medicine (ASAM) defines substance use disorders (SUD) as primary, chronic diseases of brain reward, motivation, memory, and related circuitry.
Without treatment or engagement in recovery activities, this is reflected as an individual who is pathologically pursuing reward and/or relief by substance use and other behaviours, despite consequences.
As we develop strategies and treatments to prevent use and intervene on early use, knowledge of the neuroscience can improve our ability to respond effectively, and with compassion.
Each of the medication development targets and psychological strategies employed in the treatment of SUD are tied to specific organ systems, most generally the pathways in the brain.
Since many of the areas of the brain that are involved with mental disorders overlap those affected by chronic drug use, medications that treat symptoms of anxiety and mood are also useful in changing the incentives and patterns of use.
Andrea G Barthwell, MD, DFASAM will present the neuroscience needed to understand SUDs and medications that work on these systems.
The document provides an overview of anxiety disorders and nursing strategies. It discusses types of anxiety disorders like panic disorder, obsessive compulsive disorder, generalized anxiety disorder, post-traumatic stress disorder, agoraphobia, social phobia, and specific phobias. For panic disorder, it outlines nursing strategies like slow breathing exercises and lifestyle modifications. For obsessive compulsive disorder, it discusses exposure therapy and response prevention. The presentation aims to educate on signs and symptoms, causes, and evidence-based treatments for different anxiety disorders.
This chapter explores causal factors and viewpoints in abnormal psychology. It discusses biological, psychosocial, and sociocultural factors that can influence abnormal behavior. Biologically, factors include genetics, brain chemistry, physical trauma, and deprivation. Psychosocially, early life experiences like trauma, parenting styles, and relationships can impact development. Socioculturally, one's environment and culture can influence which disorders manifest and how they are experienced. An integrated biopsychosocial model acknowledges the complex interactions between biological, psychological, and social causal influences.
This chapter explores causal factors and viewpoints of abnormal psychology. It discusses biological, psychosocial, and sociocultural perspectives on the development and maintenance of abnormal behavior. Some key topics covered include diathesis-stress models, genetics, early life experiences, cognitive and learning theories, and the influence of culture and society. An integrated biopsychosocial approach is presented as the current dominant viewpoint.
The document summarizes and critiques three current psychological treatment practices: exposure therapy, exposure response therapy, and electroconvulsive therapy. Exposure therapy is used to treat PTSD but can increase risks of violence, depression, substance abuse, and panic attacks with prolonged use. Exposure response therapy involves exposing patients with OCD to fears while stopping compulsive behaviors, but the document questions if less confrontational therapies may be better. Electroconvulsive therapy uses electric currents to induce seizures for treatment-resistant depression but can cause side effects like confusion, memory loss, and complications; the document argues future researchers may view it as barbaric due to its extreme methods.
The document discusses several definitions of abnormality including statistical deviation from norms, failure to function adequately, and deviation from ideal mental health. It also evaluates these definitions. Mental disorders like phobias, depression, and OCD are explained using behavioral, cognitive, and biological approaches and the effectiveness of treatments like CBT, flooding, and drug therapy are evaluated.
There are two main types of therapy: psychotherapy which uses psychological techniques to treat mental health issues, and biomedical therapy which uses medications and medical interventions. Psychoanalysis developed by Sigmund Freud is based on understanding repressed unconscious conflicts through techniques like free association, dream interpretation, and analysis of transference in therapy. Modern therapies are generally shorter-term and more goal-oriented than traditional psychoanalysis. Behavioral therapy uses principles of conditioning to change maladaptive behaviors, while cognitive-behavioral therapy integrates cognitive and behavioral techniques. Psychotherapy has been shown to be more effective than no treatment, and the specific type of therapy is generally less important than the therapeutic relationship.
This document provides information on behavior management, including definitions, influences on behavior, and prevention strategies. It defines behavior and discusses the physiological, environmental, psychological, and social factors that can influence it. Challenging behaviors are those seen as inappropriate, and they vary between individuals and societies. Such behaviors are often a form of communication, expressing needs that are not being met. Prevention is key to managing behaviors, through understanding triggers, maintaining routines, adapting environments, and using communication strategies like respecting personal space and using a calm tone during escalation. The overall document offers guidance on assessing and addressing problem behaviors.
The document discusses Mode Deactivation Therapy (MDT), an evidence-based treatment for adolescents. It provides details on the theoretical constructs of MDT, including that MDT views psychopathology as arising from "modes", which are networks of cognitive, affective, motivational and behavioral components that are activated in response to specific problems or demands. MDT aims to deactivate maladaptive modes by balancing perceptions, physiological responses, and behaviors in therapy sessions. The document also provides data on populations that have been treated with MDT and compares MDT to other therapies.
This document discusses depression in older adults, including barriers to treatment, treatment goals and modalities, and considerations for providers and patients. It describes common psychotherapies and pharmacotherapies used to treat depression at different phases. The goals are to resolve current episodes, prevent relapse and recurrence, and improve quality of life and functioning. Barriers include inadequate treatment, lack of accessible care, and limited specialty mental health use.
The document discusses stress, health, and coping. It defines stress and identifies common stressors like life changes, daily hassles, and catastrophes. It describes the biopsychosocial model of health and explains how biological, psychological, and social factors interact to influence health. Stress can indirectly impact health through unhealthy behaviors and directly impact the body through changes in functions. The general adaptation syndrome describes the body's three stage response to stress. Stress influences the immune system and chronic stress tends to suppress immunity. Psychological and social factors like perceived control, social support, and coping strategies also impact how stress affects health.
The document discusses stress, health, and coping. It covers the biopsychosocial model of health and defines stress. It describes different types of stressors like life changes, daily hassles, and catastrophes. It also discusses the endocrine and immune system responses to stress as well as the general adaptation syndrome. Finally, it examines factors that influence stress and coping such as social support, explanatory style, and problem-focused versus emotion-focused coping strategies.
New directions in the psychology of chronic pain managementepicyclops
Lecture followed audience discussion on contextual cognitive behaviour therapy and acceptance and commitment therapy in the management of chronic pain from the West of Scotland Pain Group on Wednesday 5th December 2007. The speaker is Lance M. McCracken PhD, of the Pain Management Unit at the Royal National Hospital for Rheumatic Diseases & University of Bath, Bath UK.
www.wspg.org.uk
Further reading:
DAHL, J., & LUNDGREN, T. (2006). Living beyond your pain using acceptance and commitment therapy to ease chronic pain. Oakland, CA, New Harbinger Publications.
http://www.worldcat.org/oclc/63472470
HAYES, S. C., STROSAHL, K., & WILSON, K. G. (1999). Acceptance and commitment therapy an experiential approach to behavior change. New York, Guilford Press.
http://www.worldcat.org/oclc/41712470
MCCRACKEN, L. M. (2005). Contextual cognitive-behavioral therapy for chronic pain. Progress in pain research and management, v. 33. Seattle, IASP Press.
http://www.worldcat.org/oclc/57564664
Stress occurs due to events beyond our control like frustrations, other people's behavior, work, health issues, and misunderstandings. The severity of the anxiety and emotional response to stress depends on how severe the stress is and an individual's ability to handle stress. Psychological interventions target stress through rational thinking and being flexible. The response to stress involves changes in neurophysiology and hormones like cortisol. There are three components to the psychological response to stress: an emotional response with physical symptoms, a coping strategy, and defense mechanisms. Coping strategies like problem solving or reducing emotions can be healthy or maladaptive like substance abuse. Defense mechanisms are unconscious responses used in stressful situations like repression, denial, or projection. Stress can lead
1) Applied behavior analysis (ABA) is a scientific approach for modifying behaviors that uses principles of learning theory. ABA breaks tasks into small steps and uses techniques like positive reinforcement to teach skills.
2) ABA is used to help people with intellectual or developmental disabilities by systematically introducing skills in small steps and rewarding correct responses while ignoring incorrect ones.
3) Cognitive behavioral therapy (CBT) techniques can also help patients adjust to chronic illness by addressing thoughts, monitoring triggers, and changing distressing beliefs. Supportive psychotherapy provides comfort and helps patients cope.
OCD is an anxiety disorder characterized by recurrent obsessions and/or compulsions. It affects approximately 3% of the population worldwide and typically emerges between ages 20-24. While the exact cause is unknown, biological factors like abnormalities in brain circuits and serotonin levels are implicated. Treatment involves cognitive-behavioral therapy such as exposure response prevention and medication like SSRIs. Nursing management focuses on assessing coping abilities, role functioning, and providing psychoeducation on relationships between anxiety, thoughts, and behaviors.
This document provides an overview of a training on child trauma assessment. It introduces the goals of bringing trauma-informed practices to systems serving children. It discusses the importance of cultural and linguistic competence when working with diverse populations. It also covers topics like the brain-behavior connection, the impact of traumatic stress and neglect on child development, and social communication challenges that may arise from complex trauma.
The document provides an overview of a training on child trauma assessment. It discusses the importance of cultural and linguistic competence when working with traumatized children. It then covers topics like the brain-behavior connection, the impact of traumatic stress and neglect on child development, and how children respond to trauma. The training aims to introduce trauma-informed practices to better serve traumatized children and their families.
Similar to The Agitated Client and More: Managing Neurobehavioral Issues in Clients with Brain Injury (20)
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Role of Mukta Pishti in the Management of Hyperthyroidism
The Agitated Client and More: Managing Neurobehavioral Issues in Clients with Brain Injury
1. The Agitated Client and More: Managing Neurobehavioral Issues in Clients with Brain Injury NRH / ReMed / BIA of DC Joint Conference 10/27/11 Scott Peters, MS, OTR/L
20. Comparing Terminology (Trepacz and Kennedy, 2005) Coma Stupor Delirium Amnestic Disorder Recovery Post Traumatic Amnesia Post Traumatic Agitation Time Post Injury
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52. Brief Review and Concluding Thoughts Stable Activity Pattern Establish Medical Stability Behavioral Stability PTA Aggression Mood Disorders Diminished Motivation Post Traumatic Psychosis Sexually Aberrant Behavior
Neurobehavioral Changes among brain injury survivors remains significantly problemmatic for families, caregivers and rehabilitation professionals. Studies have shown that increased irritability and aggressive behaviors are frequent and persistant sequelae of aquired brain injury. Approached this topic from a perspective of the types of clients that ReMed has worked with over the past 25 years that fall into the category of behavioral clients. Issues of aggression, depression, anxiety, mood instability, sexual disinhibition, amotivation, PTA with resultant confusion are generally evident in the individuals that are referred to us. Usually these issues have been treated in a hospital setting or an outpatient setting yet they continue to persist leading to concerns about safety, family capacity to handle their loved ones, etc. The mission of providing services to this very challenging populations has been a consistent component of ReMed’s mission for the past 25 years. I am the clinical director of ReMed’s Short Term and Intensive Residential Services. I have been involved in programming for TBI survivors with Neurobehavioral issues for the 19 years that I have been with ReMed. I am an OT by training so I had to rely on really smart clinicians that ReMed has always been committed to hire and retain to help me understand effective approaches to address the challenging sequelae of our clients. In preparation fo the this presentation I attempted to review literature summarized from the past quarter of a century since ReMed has been around. I will be presenting you, an experienced group of professionals, with information related to Neurobehavioral changes following TBI.
Pos Rf candy for answering, paycheck, etc… Neg Rf bringing umbrella, headphones at library, etc… Pos Punish aversive stimuli, circling no on schedule Neg Punish Time-Out, loss of privileges, etc...
These terms are loosely used and have often been used interchangeably. Delirium can be caused by a wide variety of medical, pharmacological and postoperative conditions. From 10% to 30% in general hospital patients (Fann 2000). Some surgical populations even greater (as much as 50% in elderly hip patients) (Williams et al. 1985). Post Traumatic Amnesia also defined as a “period of clouded consciousness which precedes the attainment of full orientation and continuous awareness in persons recovering from head injury. Also “characterized primarily by a failure of amnestic processes (Mandelberg 1975). Katz (1992) recognized the confusional state embedded in PTA. Stuss et al.1999 called it postraumatic confusional state. PTA is generally considered during the time of recovery continuum after coma, emerging from stupor, including delirium and amnestic disorder
Patients may progress without going through the stages in a regimented manner. Delirium may have a hypoactive, hyperactive or mixed motoric presentation. These presentations may include behavioral symptoms including yelling, punching and mood lability. Post traumatic agitation overlaps with the hyperactive type of delirium. In a study conducted by Tate et al. 2000 of severly brain injured patient, it was found that disorientation subsided before amnesia in 94% of the cases. Therefore, as delirium resolves, orientation improves and some form of memory impairment could persist. In a study of behavioral disturbances after TBI showed that restlessness and agitation resolved in all patients before the resolution of PTA (indicating that there is a restlessness phase to delirium.
These symptoms can have an abrupt onset, fluctuating course and it is usually reversible.
Drug Intoxication: Anticholinergics, histamine antagonists, opiods, barbituates, etc. Drug Withdrawal: alchohol, benzodiazipines, barbiturates Metabolic: dehydration, hepatic or renal insufficiency, hyper – hypoglycemia Infection: abcess, encephalitis, etc. Endocrine: hypothyroidism, Seizures: ictal and postictal states Cancer: metastases, brain tumor Vascular: stroke, TIA, shock, MI, etc, Environmental: heat stroke, toxins, carbon monoxide
Environmental Structuring: Safety Management : one to one’s, items in room, falls risk, wander risk Sensory Stimulation Level: low stim as possible, structure number of visitors, amount of information given, etc. Environment: orienting materials posted, review of orienting materials, clock, calendar, pictures, video from family, logbook, calming / soothing activities (music, TV, games) Staff Approach: critical (reassuring, soothing, redirecting, reorienting); consistent information delivered in a consistent manner, specific approaches trialed for care needs; pick your battles (shower, toilet, medications) Neuroleptics: Haldol, side effect of sedation, TD Dopamine blocking effects of Haldol may negatively impact cognitive rehab efforts (Feeney et al. 1982; Gualtieri 1991) because dopaminergic medications enhance memory (Gualtieri 1991). Atypicals: side effect profiles more tolerable. Clozapine (Ratey et al. 1993), olanzapine (Edell and Tunis 2001; Kinon et al. 2001; Meehan et al. 2001, 2002; Wright et al. 2001) and risperidone (Czobor et al. 1995) have been effective in reducing aggression related to their effects on seratonin receptors. Benzodiazepines can worsen delirium and further impair cognition so are usually avoided.
Norepinephrine: Major NE tracts in the brain are vulnerable to TBI. Studies have shown that elevations of plasma Norepinephrine are evident (Clifton et al. 1981;Hamill et al. 1987). Animal studies suggest that NE enhances aggressive behavior. Humans who have exhibit aggressive or impulsive behaviors have been shown to have increased NE metabolite (G.L. Brown et al. 1979). Serotonergic neurons originate in the pons and upper brainstem and project to the frontal cortex. Changes in serotonin activity have been found in patients with TBI. Animal studies suggest lowered levels of serotonin have been associated with increased aggression including studies of predatory aggression. Studies have confirmed the role in decreased serotonin in the expression of aggression and impulsivity in humans (Kruesi et al.1992; Lonnoila and Virkkunen 1992) particularly as it applies to self destructive acts. Dopamine systems are prominent in mesolimbic systems and mesocortical regions. Elevated serum dopamine levels have been correlated with severity of injury and poorer outcomes (Hamill et al. 1987). Increases in dopamine may lead to aggression in several animal models (Eichelman 1987). Cholinergic complex is found in the basal forebrain area. Elevated acetylcholine has been found in fluid obtained from intraventricular catheters or lumbar punctures in patients after TBI (Grossman et al. 1975). Acetylcholine has been found to increase aggressive behaviors. GABA is an inhibitory neurotransmitter found throughout he brain. Currently no studies have examined GABA levels after brain injury but it is expected that injured neurons would produce less GABA. Increasing GABA via benzodiezapines results in reduced aggressive behavior in animals (Eichelman 1987).
Neuropsychiatric Problems: Learning Disabilities Attentional Deficits] Behavioral Problems Personality Disorders Preinjury History of Substance Abuse: associated with aggressive behavior 6 months after TBI (Tateno et al. 2003) Coexisting anxiety and depression: associated with increased aggression and irritability (Hibbard et al. 1998; Tateno et al. 2003) 56% of TBI with Depression demonstrated verbal and physical aggression compared with 22% of TBI clients who did not have a mood disorder
Alcohol: most commonly associated with aggression (intoxication and withdrawal). Positive BAL when injured – longer periods of agitation as compared to those with no BAL (Sparadeo and Gill 1989) Intoxication following ABI results in dysregulation of behaviors Stimulating Drugs (Cocaine and Amphetamines): may produce severe anxiety and aggression, may lead to manic state and paranoid ideation in latter stages Steriods: prednisone, cortisone and anabolic steriods Antidepressants: may contribute to agitation in early stages of treatment (our experience with long term behavioral clients) Antipsychotics: may induce agitation through anticholinergic side effects, agitation accompany akathesia Analgesics: opiates and other narcotics, contribute to intoxication and withdrawal states Anticholinergic Drugs: including over the counter sedatives associated with delirium and central anticholinergic syndrome
Studies have shown an increase in hostility, irritability and aggression interictally (Mendez et al. 1987; Robertson et al . 1987)
No medication has been approved by FDA for treatment of aggression… must use medications approved for other uses. Antipsychotics: in acute phase employed for the sedative effects, neuroleptics risk of side effects (tardive dyskinesia or akathisia). Studies in acute phase suggest that decreasing dopamine may prolong periods of PTA. Consider atypicals. For chronic aggression consider if also treating psychotic symptoms Sedatives and Hypnotics: use of benzodiazapines in management of acute aggression (amplify’s inhibitory neurotransmitter GABA. Negative impact on memory function, coordination and balance. Antianxiety: seratonin is a key neurotransmitter in the modulation of aggressive behavior (Gaultieri 1991a, 1991b; Levine 1988). Some instances more aggressive with antianxiety meds (buspar, Klonopin) Anticonvulsants: studies indicate carbamazepine effective (Yudofsky et al. 1998); valproic acid (Geracioti 1994; Giakas et al. 1990; Mattes 1992); Gabapentin has also been found to be beneficial (Hermann et al. 2000; Roane et al. 2000) Antimanic: lithium has been widely used and has been found to be effective. Our experience with long term lithium use (kidney failure), replace with other agents (atypicals) Antidepressants: studies have shown antidepressants that act preferentially (Elavil) or specifically (Prozac) on seratonin have been found to be effective. Trazadone found to be effective in treatment of aggression (Yudofsky et al.1998). Our experience is that use of antidepressants can be tricky. Put in place a mood stabilizer first to buffer against manic side effects. Stimulants: some studies about the use of dopaminergic medications on treatment of agitation and aggression. Amantadine and Methylphenidate. We are very wary. Antihypertensives: several studies about the use of beta blockers (Propranolol, Nadolol and Pinolol) (Yudofsky et al. 1998).
Depressive disorders and anxiety are frequent complications among patients with TBI. Variability of frequency in study results due to lack of uniformity in the psychiatric diagnosis and reliance on rating scales or relatives reports rather than structured interviews of the patients and established diagnostic criteria ie DSM – IV - TR (American Psychiatric Association 2000). Hibbard et al. 1998: 61% - used a structured interview and DSM- IV criteria sample size 100 adults with TBI evaluated 8 years (on average) after trauma. Kruetzer et al. 2001: 42% - sample size of 722 outpatients who were on average 2.5 years after brain injury Koponen et al. 2002: 26% - sample size 60 TBI patients who were followed for an average of 30 years Data suggests that there is a significant risk for ongoing depression following TBI
Suicidal ideation, suicide attempts and completed suicides occur more frequently in patients with TBI compared with non brain injured control subjects (Oquendo et al. 2004; Silver et al.2001; and Engberg 2001)
Anxiety : studies conducted to determine frequency and types of anxiety disorders following TBI. Likely that a combination of factors including neuroanatomic correlates between TBI and anxiety disorders, psychosocial consequences of disability and a biologic vulnerability for anxiety. In a study by Fann et al. 2000 evaluated 50 consecutive TBI patients (university TBI program, average 3 years post, mostly mild TBI) found 24% had GAD with patients also having major depressive disorder. However it was noted that 34% had a history of GAD (difficult to determine if GAD was because of TBI). Another study by Salazar et al. 2000 evaluated 120 consecutive active duty military members with moderate to severe TBI. 10% had generalized anxiety at baseline and 15% at one year. Therefore study suggests that anxiety is common but link between TBI and anxiety is unclear. Areas implicated in the neurobiology of anxiety include diffuse brain injury, frontal and temporal structures (Levin and Krauss 1994) including the hippocampus and the amygdala (Bigler 2001). These are consistent with TBI. Physiologic response includes increased levels of cortisol and catecholamines to ready for “fight or flight” response and cortisol to negatively impact the hypothalamus and pituitary attempts to shut down the stress response. The amygdala and hippocampus are located close to the temporal lobes. Frontal and temporal lobes are often affected by trauma and due to the close proximity of the amygdala, amygdala and hippocampus is often involved in TBI related anxiety disorders. Injuries to these structures may predispose patients to the development of anxiety symptoms following TBI. PTSD: required for this diagnosis is experience of a traumatic event that later evokes physiological reactivity, emotional distress upon reminders of the event, and reexperiencing phenomena (e.g. flashbacks, nightmares and intrusive thoughts of the traumatic event. Anxiety has been described in the literature for some time, PTSD is more unclear (controversial) with the issue of neurogenic amnesia for the event protecting the patient from developing memories and future symptoms of flashbacks and nightmares. Studies have shown TBI patients who developed PTSD typicially had brief or no LOC. In a study by Sbordone and Liter (1995) compared individuals with PTSD with another group who had PCS. None with PTSD had LOC while 24 of 28 with PCS had LOC and could not give a detailed account of the trauma. No individual had both PTSD and PCS leading the authors to conclude that the two do not occur simultaneoulsy. Summary of the studies suggest that PTSD after TBI does occur but may be modified by the brain injury. Intrusive memories are less common than in non – TBI populations and in less severely injured individuals with TBI. Can develop PTSD related to memories of events following the injury (respond to a story of the event, photograph of the accident, seeing injuries associated with the event. PTSD can also be related to events immediately before the LOC and traumas reactivated from earlier life events. Neuroimaging studies suggest that in non TBI patients, involvement of the limbic structures including amygdala, hippocampus suggest vulnerability to PTSD following TBI (Bigler 2001). Mania and hypomnia: has been reported in a number of organic disorders such as thyroid disorders, uremia, Vitamin B12 deficiency as well as brain tumors, central nervous systems dysfunction, stroke (Cummings and Mendez 1984) and TBI (Bamrah and Johnson 1980). Shukla et al. 1987 reported on 20 patients who developed manic syndromes following TBI. They found a significant association between mania and post traumatic seizures but no association with a family history of bipolar disorder among 85 first degree relatives. Jorge et al. 1993 studied manic syndromes in 66 TBI patients. Six patients (9%) developed secondary mania. Manic episodes lasted approximately 2 months but expansive mood had a mean period of 5.7 months. Secondary mania was not related to severity of brain injury, degree of physical or intellectual impairment, level of social functioning or history (family or personal) of psychiatric history. Did appear to be related to presence of basopolar temporal lesions.
Literature suggests there is a lack of adequately controlled clinical studies to provide a solid scientific basis for neuropsychiatric treatment. Continue to employ anecdotal cases and clinical experience to guide treatment decisions Tricyclics have important anticholinergic effects that may interfere with cognitive and memory functions and may lower the seizure threshold. However nortryptaline (Pamelor) is a reasonable choice with close monitoring blood levels and toxic effects. SSRI’s: selective seratonin reuptake inhibitor appears to have less adverse side effect profile. This includes citalopram (Celexa), sertraline (Zoloft), paroxetine (Paxil) venlafaxine (Effexor), fluoxetine (Prozac). Commonly used in TBI populations to treat anxiety symptoms. One study showed a 50% improvement in depressive symptoms in the treatment of 15 TBI patients diagnosed with major depression after TBI (Fann et al. 2000). Side effects can include apathy and sexual dysfunction. Psycho – Stimulants: dextroamphetamine (Dexadrine) and methylphenidate (Ritalin) (Zasler 1992). Must monitor closely for side effects (anxiety, dysphoria, irritability, insomnia, mania). Amantadine has been found to have some positive effects for treatment of motivational deficits. Aricept (Donepenzil) empirical evidence of the beneficial effects on cognitive functioning, motivation and general well being. Our experience has also included Provigil to promote wakefulness (sleep disorder such as narcolepsy) Anxiolytics: Buspirone (Buspar) can be considered, a seratonin 1A agonist. Ancedotal reports suggest that Buspar may have positive effects with aggression and agitiation. May be good as an add on med with panic disorders. Avoid the use of Benzodiazipines due to excessive sedation, negative impact on cognition (attention and memory) and the risk for abuse / dependence issues if used for extended periods. Mood Stabilizers / Anticonvulsants: may be helpful in the treatment of anxiety related to manic symptoms or agitation related to TBI. Limited evidence in the literature about the effectiveness of Depakote and Neurontin for anxiety although Lamictal (Lamotrigine) may benefit patients with PTSD. Anticonvulsants may be a reasonable treatment for anxiety associated with aggression. ECT Electroconvulsant therapy: may be considered if intractible depression that does not respond to other efforts. Recent experience with two clients that came to us with having been previously treated with ECT. Both cases did not have great outcomes with us. Issue was long standing history of depression / suicidal ideation, rigid thinking (from TBI) and recent emotional activation. Recent Case Individual came in with preinjury history of depression and sustained TBI secondary to an assault. Symptoms included anxiety, depression, cognitive impairment including attention, concentration and memory. Had been psychiatrically hospitalized for depression. Current medications were Prozac, Klonopin and Seroquel. Suspicion of alcohol abuse. Goal was to return to some form of employment. Plan: Discontinue Klonopin via a gradual schedule. Klonopin considered sedating, addicting and contributing to cognitive suppression. Replace the Seroquel as sleep agent due to antihistiminic affect. (She could not get going until afternoon due to hangover effect). Went with Ambien CR. Treat anxiety as a symptom of depression by more aggressively treating the depression with “broad spectrum coverage”. Prozac targets Seratonin. Wellbutrin targets Dopamine and Strattera targets Norepnephrine. Or switching Prozac to Cymbalta with targets both Seratonin and Nor epinephrine. Then may consider adding a mood stabilizer.
Apathetic Syndrome / Disorders of Diminished Motivation: akinetic mutism, abulia, apathy is a continuum of motivational loss This is very complicated topic. There are many factors that can influence motivation including medical states, emotional states, psychiatric states etc. It is important to consider the etiology of this syndrome to direct treatment planning efforts. The mechanism of motivation has been a topic of research. A model that has been proposed suggests a presence of a “core circuit” (Marin 1996b) that is a subsystem of the forebrain and includes anterior cingulum, nucleus accumbens, ventral pallidum and ventral tegmental area. The other limbic system structures amygdala, hippocampus, prefrontal cortex provides continuous modulation of the core circuit on the basis of motivational significance of the internal and external environment. Neurochemical mechanisms include the essential role of Dopamine systems in mediating responses to reward, novelty and elements of motivational behavior (McAllister 2000). Other biochemical changes include glutamate, acetylcholine etc. Conditions associated with DDM: Frontal Lobe damage Right Hemisphere Damage (right middle cerebral artery infarct) Cerebral White Matter (multiple sclerosis) Basal Ganglia (Parkinson’s Disease, Huntington’s Disease) Diencephalon: Wernicke – Korsakoff Syndrome Amygdala: Kluver – Bucy Syndrome Medical Disorders: hypothyroidism, Lyme Disease, Chronic Fatigue Syndrome Drug Induced: Neuroleptics, SSRI’s, chronic marijuana dependence Amphetimine or cocaine withdrawal Socio environmental: role change, institutionalism
Pharmacology: Diagnose and treat conditions that may be contributing (hypothyroidism, parkinsons) Reduce or eliminate meds that may be negatively affecting motivation (Neuroleptics, SSRI’s) Treat depression in most effective manner Stimulants: Ritalin, etc Activating Antidepressants: Buspar, Parnate (MAO inhibitor), Dopamine Agonists: Amantadine, Bromocryptine, Levadopa Other psychotropics: Provigil, Aricept, Razadyne Environmental: set up the environment for optimum success. Set up for interaction, participation, stimulation and pleasure. Minimize social isolation, maximize lighting, orienting materials, consistency of approach, structured day, stimulating activities. Supportive Counseling / Therapies: counseling, supportive completion of ADL’s, physical activity that is goal directed, cognitive remediation (computer stimulation), recreational therapy Behavioral Interventions: functional trials to systematically determine client’s response to stimulation. Identify optimum environmental structure, time of day, reward preference, interaction style, prompt, etc.
Early writings about head injury and resultant psychopathology (Adolf Meyer 1904 termed it “traumatic insanity”.
Literature suggests that psychosis may follow a TBI months or years later. In one study (Buckley et al. 1993) in a series of case reports with patients with schizophrenia and premorbid TBI the onset of psychosis was 1, 9, 7, 16 and 11 years after the TBI occurred.
Location of Injury: studies using CT scan evidence have shown left temporal and parietal regions (Sachdev et al. 2001). Primary sites of lesion are frontal and temporal cortices with secondary sites to be the hippocampus Severity of Injury: degree of severity is related to risk of posttraumatic psychosis. ie duration of unconsiousness, extent of damage on CT scan and degree of cognitive deficits. Recent study suggested that for patients with a family history of bipolar disorder or schizophrenia, risk of psychosis was unrelated to severity. Inherent Vulnerability to Psychosis: previous psychopatholigical disturbances have been reported in 83% or individuals who develop psychosis after TBI (Violon and De Mol 1987). Sachdev et al. 2001 reported that genetic vulnerability, having a first degree relative with a psychotic disorder, was found to be among the strongest predictors of who would develop psychosis following TBI. Gender: no clear role of gender in risk for PTP (selection of study, veterans, etc) IQ / Cognition: recent studies differ in findings (Fujii and Ahmed 2001) found no differences in IQ while Sachdev et al. 2001) found patients with PTP had more neurological deficits including lower IQ, worse verbal and non verbal memory, greater impairments in language. Socioeconomic Status: (Fujii and Ahmed 2001) found no differences in level of education Prior Neurological Disorder: (Fujii and Ahmed 2001) found significant more neurological pathology than in brain injured control groups including prior brain injury (14/25), siezures (3/25), learning disability (3/25), birth complications (2/25), ADHD (1/25) Post Traumatic Epilepsy: earlier studies suggested a that temporal lobe epilepsy greater risk for psychosis. More recent studies (2001) did not find a link between epilepsy and and post traumatic psychosis
Pharmacology: side effects with Neuroleptics is tardive dyskinesia, sedation, extrapyramidal symptoms
Findings: of the 445 clients with TBI, 6.5% were identified as having committed some form of sexual offense In all 128 individual offenses were committed. The most common was touching (combining Frotteurism and Toucherism) at 64.8%. Next was exhibitionism at 22.7% and overt sexual aggression at 9.4%. Only two clients had a prior history. The four main victim groups were staff, strangers, other people with TBI and family members. Staff members were twice as likely to be targets. Touching was the most common behavior exposed to staff. Children were victims in 15 of the 128 offenses (11.7%)