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Neuropsychiatric disorders are known as?
"Silent epidemic" consisting of anxiety, depression or PTSD
Could anybody experience a neuropsychiatric disorder?
Yes, but after ABI, can be more probable
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
Neuropsychiatric Disorders likely have increased?
Strongly associated with:
Functional impairment
Decreased social participation
Lower health-related quality of life
Neuropsychiatric Disorders are associated with?
Primary (Damage to Raphe nucleus) and secondary (Situational depression) etiologies
Neuropsychiatric disorder have limited evidence on?
Intervention efficacy, CBT and SSRIs need more evidence
Behavioral Dyscontrol
Tendency toward impulsive reactions toward internal/external stimuli
Behavioral Dyscontrol 3 Main Ideals
Agitation, Disinhibition, Aggression
Agitation
State of restlessness and increased psychomotor activity reflecting underlying emotions
Agitation involves?
Anxiety, insomnia, sundowning, depression, aggression as direct effect of brain injury, medical illness, adverse environment, psychosis
Agitation is often linked too?
Confused states early after injury
Leads to agitation, associated with rancho levels 4-6
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
Disinhibition
Inappropriate, nonaggressive responders reflecting an inability to appreciate behavioral norms
Could be socially inappropriate and non-aggressive forms
Physical Disinhibition
Unwanted sexual advances
Impulsivity (lack of insight or safety awareness)
Verbal Disinhibition
Poorly considered utterances (No filter)
Breaking rules of discourse (Interrupting, no active listening)
Egocentric perspective (Everything is all about them)
Disinhibition and Aggression are strongly correlated with?
TBI, not stroke. Stroke could be seen with impulsivity
Aggression
Verbal outburst or physical violence directed at objects or people
If agitated, you're more likely to have?
Aggression
Risk Factors of Aggression
Emotional dyscontrol, major depression, frontal lobe damage, and pre-injury aggression
Aggression Treatment Approaches
Valproate (mood stabilization), beta blockers, ritalin/adderall, SSRIs
Reactive Aggression
Triggered by modest or trivial stimuli like someone bumping into you
Nonreflective Aggression
Usually does not involve premeditation or planning (Automatic response)
NonPurposeful Aggression
Aggression serves no obvious long-term aims or goals (no trigger, verbal/physical aggression)
Explosive Aggression
Buildup is not gradual (Explode)
Periodic Aggression
Brief outbursts of rage and aggression punctuated by long periods of calm (temporal frequency, sometimes aggressive and sometimes calm)
Egotistic Aggression
After outbursts, patients are upset, concerned, and/or embarrassed, as opposed to blaming others or justifying behavior. They'll apologize after
All the characteristics of aggression are?
Non exclusive, there could be an event involving all
Mood Disorders
Sustained, pervasive shift in emotion or feeling, involves depression, anxiety and apathy
Depression
Depressed mood, decreased capacity for pleasure (anhedonia)
Depression is the most common?
Neuropsychiatric diagnosis after stroke and TBI
Risk Factors of Depression (Neurologic)
Frontal Pole (TBI), left injury lateralization (TBI), sertonergic dysfunction (TBI)
Demographic risk factors of Depression
Older age, female, less education, prior psychiatric disorder and stroke severity
Depression Treatment Approaches
SSRIs, Tricyclic antidepressants, and neuromodulation (Transcranial Magnetic Stimulation)
SSRIs are the first line in?
Depression and Anxiety diagnosis
Anxiety
Excessive worry, nervousness, or unease about an anticipated event or situation
Anxiety can be generalized or associated with?
PTSD
Anxiety Predictors due to stroke
Increased severity, premorbid depression, early anxiety post-stroke, cognitive impairment
Anxiety risk factors due to TBI
Older age, females, prior psychiatric disorders, longer LOC and shorter PTA (increased memory of traumatic event)
Anxiety often co-occurs with?
Depression
Anxiety Treatment
SSRIs and Benzos (Ativan and Xanax)
SSRIs and SNRIs can increase?
Anxiety, especially early in treatment
Apathy
Decrease in motivation. Often a non-motor symptom in Parkinson's
Areas affected in apathy?
MOFC, OFC, VL PFC, ACC and Amygdala
Apathy is co-morbid with?
Depression, due to dysfunctional reward network
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
Apathy Treatment
Dopamine Agonists, psychostimulants (ritalin/Adderall) due to dopamine deficiency and Acetylcholinesterase Inhibitors
Apathy Characteristics
Reduced initiative, needs prompting to start tasks, persists less in activities, less interested in events, blunted emotional responses and lack of concern
Apathy and Depression both involved?
Loss of pleasure, reduced energy, and physical/mental slowing
Depression Characteristics
Low mood, sadness, feeling of guilt, feelings of worthlessness, frequently co-morbid with anxiety disorder, suicidal ideation