Non-Motor Impairments after ABI (Behavior, Emotion, Motivation)

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49 Terms

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Neuropsychiatric disorders are known as?

"Silent epidemic" consisting of anxiety, depression or PTSD

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Could anybody experience a neuropsychiatric disorder?

Yes, but after ABI, can be more probable

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Neuropsychiatric Disorders: Prevalence

33-50% of patients after stroke, 65% of patients with one diagnosis and 40% with two diagnosis after TBI

Diagnoses could be depression and anxiety

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Neuropsychiatric Disorders likely have increased?

Strongly associated with:

Functional impairment

Decreased social participation

Lower health-related quality of life

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Neuropsychiatric Disorders are associated with?

Primary (Damage to Raphe nucleus) and secondary (Situational depression) etiologies

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Neuropsychiatric disorder have limited evidence on?

Intervention efficacy, CBT and SSRIs need more evidence

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Behavioral Dyscontrol

Tendency toward impulsive reactions toward internal/external stimuli

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Behavioral Dyscontrol 3 Main Ideals

Agitation, Disinhibition, Aggression

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Agitation

State of restlessness and increased psychomotor activity reflecting underlying emotions

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Agitation involves?

Anxiety, insomnia, sundowning, depression, aggression as direct effect of brain injury, medical illness, adverse environment, psychosis

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Agitation is often linked too?

Confused states early after injury

Leads to agitation, associated with rancho levels 4-6

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Agitation can be associated with ?

Long-term behavioral presentation

Can be shown in rancho level 4, especially if you don't go pass the level

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Disinhibition

Inappropriate, nonaggressive responders reflecting an inability to appreciate behavioral norms

Could be socially inappropriate and non-aggressive forms

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Physical Disinhibition

Unwanted sexual advances

Impulsivity (lack of insight or safety awareness)

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Verbal Disinhibition

Poorly considered utterances (No filter)

Breaking rules of discourse (Interrupting, no active listening)

Egocentric perspective (Everything is all about them)

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Disinhibition and Aggression are strongly correlated with?

TBI, not stroke. Stroke could be seen with impulsivity

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Aggression

Verbal outburst or physical violence directed at objects or people

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If agitated, you're more likely to have?

Aggression

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Risk Factors of Aggression

Emotional dyscontrol, major depression, frontal lobe damage, and pre-injury aggression

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Aggression Treatment Approaches

Valproate (mood stabilization), beta blockers, ritalin/adderall, SSRIs

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Reactive Aggression

Triggered by modest or trivial stimuli like someone bumping into you

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Nonreflective Aggression

Usually does not involve premeditation or planning (Automatic response)

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NonPurposeful Aggression

Aggression serves no obvious long-term aims or goals (no trigger, verbal/physical aggression)

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Explosive Aggression

Buildup is not gradual (Explode)

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Periodic Aggression

Brief outbursts of rage and aggression punctuated by long periods of calm (temporal frequency, sometimes aggressive and sometimes calm)

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Egotistic Aggression

After outbursts, patients are upset, concerned, and/or embarrassed, as opposed to blaming others or justifying behavior. They'll apologize after

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All the characteristics of aggression are?

Non exclusive, there could be an event involving all

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Mood Disorders

Sustained, pervasive shift in emotion or feeling, involves depression, anxiety and apathy

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Depression

Depressed mood, decreased capacity for pleasure (anhedonia)

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Depression is the most common?

Neuropsychiatric diagnosis after stroke and TBI

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Risk Factors of Depression (Neurologic)

Frontal Pole (TBI), left injury lateralization (TBI), sertonergic dysfunction (TBI)

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Demographic risk factors of Depression

Older age, female, less education, prior psychiatric disorder and stroke severity

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Depression Treatment Approaches

SSRIs, Tricyclic antidepressants, and neuromodulation (Transcranial Magnetic Stimulation)

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SSRIs are the first line in?

Depression and Anxiety diagnosis

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Anxiety

Excessive worry, nervousness, or unease about an anticipated event or situation

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Anxiety can be generalized or associated with?

PTSD

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Anxiety Predictors due to stroke

Increased severity, premorbid depression, early anxiety post-stroke, cognitive impairment

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Anxiety risk factors due to TBI

Older age, females, prior psychiatric disorders, longer LOC and shorter PTA (increased memory of traumatic event)

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Anxiety often co-occurs with?

Depression

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Anxiety Treatment

SSRIs and Benzos (Ativan and Xanax)

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SSRIs and SNRIs can increase?

Anxiety, especially early in treatment

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Apathy

Decrease in motivation. Often a non-motor symptom in Parkinson's

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Areas affected in apathy?

MOFC, OFC, VL PFC, ACC and Amygdala

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Apathy is co-morbid with?

Depression, due to dysfunctional reward network

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What are the different types of Apathy?

Cognitive apathy: Lack of interest in planning, problem-solving, or initiating tasks

Behavioral apathy: Failure to act unless prompted (won’t self-initiate ADLs or therapy tasks)

Emotional apathy: Flattened affect, reduced emotional reactivity

Social apathy: Withdrawal from relationships or social interaction

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Apathy Treatment

Dopamine Agonists, psychostimulants (ritalin/Adderall) due to dopamine deficiency and Acetylcholinesterase Inhibitors

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Apathy Characteristics

Reduced initiative, needs prompting to start tasks, persists less in activities, less interested in events, blunted emotional responses and lack of concern

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Apathy and Depression both involved?

Loss of pleasure, reduced energy, and physical/mental slowing

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Depression Characteristics

Low mood, sadness, feeling of guilt, feelings of worthlessness, frequently co-morbid with anxiety disorder, suicidal ideation