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Filipčíková M, Quang H, Cassel A, Darke L, Wilson E, Wearne T, Rosenberg H, McDonald S. Exploring neuropsychological underpinnings of poor communication after traumatic brain injury: The role of apathy, disinhibition and social cognition. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:433-448. [PMID: 36541559 DOI: 10.1111/1460-6984.12836] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Dysarthria, aphasia and executive processes have been examined for their role in producing impaired communicative competence post traumatic brain injury (TBI). Less understood is the role of emotional dysregulation, that is, apathy and disinhibition, and social cognition, that is, reading and interpreting social cues. METHODS & PROCEDURES In this study, we examined 49 adults with moderate to severe TBI and 18 neurologically healthy adults. We hypothesised that apathy and disinhibition would predict communication outcomes as would social cognition. We also predicted that apathy and disinhibition would influence social cognition. Communication outcomes were measured by the La Trobe Communication Questionnaire (LCQ) and the Social Skills Questionnaire-TBI (SSQ-TBI). Apathy and disinhibition were measured by the Frontal Systems Behavior Scale (FrSBe). We measured four aspects of social cognition: emotion perception and theory of mind using The Awareness of Social Inference Test (TASIT) and the Complex Audio-Visual Evaluation of Affect Test (CAVEAT), empathy using the Questionnaire of Cognitive and Affective Empathy (QCAE) and the Balanced Emotional Empathy Scale (BEES), and alexithymia using the Toronto Alexithymia Scale (TAS-20) and the Bermond-Vorst Alexithymia Questionnaire. OUTCOMES & RESULTS Consistent with predictions, the LCQ and SSQ-TBI were associated with disinhibition and the LCQ was also associated with apathy. The LCQ was associated with the full range of social cognition constructs although the SSQ-TBI was not. Finally, apathy and disinhibition predicted a number of social cognition measures. CONCLUSIONS AND IMPLICATIONS These results are discussed in relation to understanding the nature of communication disorders following TBI and how they are measured, as well as the interrelation between emotion dysregulation and social cognition. WHAT THIS STUDY ADDS What is already known on this subject The role of emotional dysregulation and social cognition in producing impaired communicative competence post traumatic brain injury (TBI) is not well understood. Although most adults with severe TBI have minimal or possibly no language impairment, they often struggle with functional communication in everyday situations. Many have been reported to be overtalkative, insensitive, childish and self-centred, displaying an inappropriate level of self-disclosure and making tangential and irrelevant comments. Conversely, some speakers with TBI have been noted to have impoverished communication, producing little language either spontaneously or in response to the speaker's questions and prompts. What this paper adds to existing knowledge We found that both apathy and disinhibition were strongly associated with the Latrobe Communication Questionnaire both empirically and conceptually, despite the LCQ being developed from a different, pragmatic orientation. Disinhibition was also associated with the Social Skills Questionnaire for TBI. We also found that poor social cognition scores predicted communication difficulties. Finally, we found that behavioural dysregulation itself, i.e., both apathy and disinhibition, predicted poor social cognition. What are the potential or actual clinical implications of this work? Our findings highlight the central role that apathy and disinhibition play in both communication and social cognition. These insights point to the importance of remediation to target behavioural and autonomic dysregulation as a means to improve everyday social function.
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Affiliation(s)
| | - Halle Quang
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Anneli Cassel
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Lilly Darke
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Emily Wilson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Travis Wearne
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Hannah Rosenberg
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Skye McDonald
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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Quang H, Wearne T, Filipcikova M, Pham N, Nguyen N, McDonald S. A Biopsychosocial Framework for Apathy Following Moderate to Severe Traumatic Brain Injury: A Systematic Review and Meta-analysis. Neuropsychol Rev 2023:10.1007/s11065-023-09620-4. [PMID: 38112938 DOI: 10.1007/s11065-023-09620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 09/19/2023] [Indexed: 12/21/2023]
Abstract
Apathy, the deficit of goal-directed behaviour, is well recognised as one of the most debilitating syndromes after moderate-to-severe traumatic brain injury (TBI). However, mechanisms underlying apathy, or at least factors associated with apathy, are sporadically reported. Based on a biopsychosocial framework, this systematic review and meta-analysis synthesised evidence regarding neurobiological, socio-environmental and individual factors associated with apathy. Our searches identified 21 studies satisfying inclusion and exclusion criteria. Results showed that the majority of work has focused on cognitive dysfunction, TBI-related factors, demographic variables and psychological correlates of apathy, while evidence for neural substrates and socio-cultural and premorbid aspects is scant. Overall, the current literature suggests that TBI-related and patient demographic factors did not contribute to apathy after TBI, whereas complex neurocognitive alterations, socio-environmental and cultural factors as well as patients' self-related factors may be important components. The evidence points to the multifaceted interplay of certain biopsychosocial contributors to apathy and suggests future investigations of more complex behavioural traits, cultural elements and pre-injury levels to better characterise the aetiology of this detrimental impairment after TBI.
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Affiliation(s)
- Halle Quang
- School of Health Sciences and Brain & Mind Centre, University of Sydney, Sydney, Australia.
- School of Psychology, University of New South Wales, High Street, Kensington, NSW, 2033, Australia.
| | | | - Michaela Filipcikova
- School of Psychology, University of New South Wales, High Street, Kensington, NSW, 2033, Australia
| | - Nhi Pham
- School of Psychology, Ho Chi Minh City University of Education, Ho Chi Minh City, Vietnam
| | - Nhi Nguyen
- Ho Chi Minh City University of Social Sciences and Humanities, Ho Chi Minh City, Vietnam
| | - Skye McDonald
- School of Psychology, University of New South Wales, High Street, Kensington, NSW, 2033, Australia
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Hogeveen J, Aragon DF, Rogge-Obando K, Campbell RA, Shuttleworth CW, Avila-Rieger RE, Yeo RA, Wilson JK, Fratzke V, Brandt E, Story-Remer J, Gill D, Mayer AR, Cavanagh JF, Quinn DK. Ventromedial Prefrontal-Anterior Cingulate Hyperconnectivity and Resilience to Apathy in Traumatic Brain Injury. J Neurotrauma 2021; 38:2264-2274. [PMID: 33787328 PMCID: PMC8328044 DOI: 10.1089/neu.2020.7363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Apathy is a common and impairing sequela of traumatic brain injury (TBI). Yet, little is known about the neural mechanisms determining in which patients apathy does or does not develop post-TBI. We aimed to elucidate the impact of TBI on motivational neural circuits and how this shapes apathy over the course of TBI recovery. Resting-state functional magnetic resonance imaging data were collected in patients with subacute mild TBI (n = 44), chronic mild-to-moderate TBI (n = 26), and nonbrain-injured control participants (CTRL; n = 28). We measured ventromedial prefrontal cortex (vmPFC) functional connectivity (FC) as a function of apathy, using an a priori vmPFC seed adopted from a motivated decision-making study in an independent TBI study cohort. Patients reported apathy using a well-validated tool for assaying apathy in TBI. The vmPFC-to-wholebrain FC was contrasted between groups, and we fit regression models with apathy predicting vmPFC FC. Subacute and chronic TBI caused increased apathy relative to CTRL, replicating previous work suggesting that apathy has an enduring impact in TBI. The vmPFC was functionally connected to the canonical default network, and this architecture did not differ between subacute TBI, chronic TBI, and CTRL groups. Critically, in TBI, increased apathy scores predicted decreased vmPFC-dorsal anterior cingulate cortex (dACC) FC. Last, we subdivided the TBI group based on patients above versus below the threshold for "clinically significant apathy," finding that TBI patients with clinically significant apathy demonstrated comparable vmPFC-dACC FC to CTRLs, whereas TBI patients with subthreshold apathy scores demonstrated vmPFC-dACC hyperconnectivity relative to both CTRLs and patients with clinically significant apathy. Post-TBI vmPFC-dACC hyperconnectivity may represent an adaptive compensatory response, helping to maintain motivation and enabling resilience to the development of apathy after neurotrauma. Given the role of vmPFC-dACC circuits in value-based decision making, rehabilitation strategies designed to improve this ability may help to reduce apathy and improve functional outcomes in TBI.
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Affiliation(s)
- Jeremy Hogeveen
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Denicia F. Aragon
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Kimberly Rogge-Obando
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Richard A. Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - C. William Shuttleworth
- Department of Neurosciences, and University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Rebecca E. Avila-Rieger
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
- Montefiore Medical Center, Bronx, New York, USA
| | - Ronald A. Yeo
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - J. Kevin Wilson
- Department of Neurosciences, and University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Violet Fratzke
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- College of Education, Clemson University, Clemson, South Carolina, USA
| | - Emma Brandt
- Department of Neurosciences, and University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Jacqueline Story-Remer
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Rosalind Franklin University, Chicago Medical School, North Chicago, Illinois, USA
| | - Darbi Gill
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Andrew R. Mayer
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- The Mind Research Network/LBERI, Albuquerque, New Mexico, USA
| | - James F. Cavanagh
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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McDonald S, Genova H. The effect of severe traumatic brain injury on social cognition, emotion regulation, and mood. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:235-260. [PMID: 34389120 DOI: 10.1016/b978-0-12-822290-4.00011-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This chapter provides a review of the emotional and psychosocial consequences of moderate to severe traumatic brain injury (TBI). Many of the disorders affecting socioemotional function arise from damage to frontotemporal systems, exacerbated by white matter injury. They include disorders of social cognition, such as the ability to recognize emotions in others, the ability to attribute mental states to others, and the ability to experience empathy. Patients with TBI also often have disorders of emotion regulation. Disorders of drive or apathy can manifest across cognitive, emotional, and behavioral domains. Likewise, disorders of control can lead to dysregulated emotions and behavior. Other disorders, such as loss of self-awareness, are also implicated in poor psychosocial recovery. Finally, this chapter overviews psychiatric disorders associated with TBI, especially anxiety and depression. For each kind of disorder, the nature of the disorder and its prevalence, as well as theoretical considerations and impact on every day functions, are reviewed.
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Affiliation(s)
- Skye McDonald
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.
| | - Helen Genova
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, NJ, United States
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Apathy following traumatic brain injury: A review. Neuropsychologia 2018; 118:40-47. [PMID: 29660377 DOI: 10.1016/j.neuropsychologia.2018.04.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 02/27/2018] [Accepted: 04/09/2018] [Indexed: 01/19/2023]
Abstract
Apathy is a common problem after traumatic brain injury (TBI) and can have a major impact on cognitive function, psychosocial outcome and engagement in rehabilitation. For scientists and clinicians it remains one of the least understood aspects of brain-behaviour relationships encompassing disturbances of cognition, motivation, emotion and action, and is variously an indication of organic brain disease or psychiatric disorder. Apathy can be both sign and symptom and has been proposed as a diagnosis in its own right as well as a secondary feature of other conditions. This review considers previous approaches to apathy in terms of relevant psychological constructs and those neural counterparts most likely to be implicated after TBI. Neurobehavioural disorders of apathy are characterised chiefly by dysfunction of executive control of goal-oriented behaviour or the neural substrates of reward-based and emotional learning. We argue that it is possible to distinguish a primary disorder of apathy as an organic neurobehavioural state from secondary presentations due to an impoverished environment or psychological disturbance which has implications for treatment.
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Gallais B, Gagnon C, Côté I, Forgues G, Laberge L. Reliability of the Apathy Evaluation Scale in Myotonic Dystrophy Type 1. J Neuromuscul Dis 2018; 5:39-46. [DOI: 10.3233/jnd-170274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Benjamin Gallais
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), CSSS de Jonquière, G7X 7X2 Saguenay, QC, Canada
- Centre de recherche Charles-Le-Moyne, Faculty of Medecine and Health Sciences, Université de Sherbrooke, QC, Canada
| | - Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), CSSS de Jonquière, G7X 7X2 Saguenay, QC, Canada
- Centre de recherche Charles-Le-Moyne, Faculty of Medecine and Health Sciences, Université de Sherbrooke, QC, Canada
| | - Isabelle Côté
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), CSSS de Jonquière, G7X 7X2 Saguenay, QC, Canada
- Centre de recherche Charles-Le-Moyne, Faculty of Medecine and Health Sciences, Université de Sherbrooke, QC, Canada
| | - Geneviève Forgues
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), CSSS de Jonquière, G7X 7X2 Saguenay, QC, Canada
- Département des sciences de la santé, Université du Québec à Chicoutimi, Saguenay, QC, Canada
| | - Luc Laberge
- Département des sciences de la santé, Université du Québec à Chicoutimi, Saguenay, QC, Canada
- ÉCOBES – Recherche et transfert, Cégep de Jonquière, Saguenay, QC, Canada
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Del Piccolo L, Finset A. Patients' autonomic activation during clinical interaction: A review of empirical studies. PATIENT EDUCATION AND COUNSELING 2018; 101:195-208. [PMID: 28869056 DOI: 10.1016/j.pec.2017.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate how patients' autonomic responses are related to verbal or non-verbal communication during clinical encounters. METHODS The SCOPUS database was searched to identify papers. Studies were included if measures of autonomic arousal were related to patients' emotions or patient-clinician interaction during clinical consultations such as psychotherapy, counseling or medical interviews. The search was conducted according to PRISMA criteria. The included studies were assessed using the 16 item quality assessment tool QATSDD. RESULTS A total of 24 publications were identified. The studies varied greatly in design and quality. However, a few trends could be observed across studies. Patients' expressions of emotions were associated with significant autonomic arousal. Clinician behavior affected arousal levels; and in a few studies, a patient centered way of presenting information was found to attenuate arousal level, interpreted as stress reduction. There was a general, but not consistent, trend in the reduction of arousal level over time within the consultation. Examples of individual differences in autonomic responses were found. CONCLUSION AND PRACTICE IMPLICATIONS Increased awareness of potential impact of clinician behavior on patient' arousal level may be helpful for clinicians, in particular how different communication styles may augment or attenuate arousal in response to stressors.
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Affiliation(s)
- Lidia Del Piccolo
- Section of Clinical Psychology, Faculty of Medicine, University of Verona, Italy.
| | - Arnstein Finset
- Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
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Ready RE, Mather MA, Santorelli GD, Santospago BP. Apathy, alexithymia, and depressive symptoms: Points of convergence and divergence. Psychiatry Res 2016; 244:306-11. [PMID: 27512920 DOI: 10.1016/j.psychres.2016.07.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/04/2016] [Accepted: 07/24/2016] [Indexed: 11/25/2022]
Abstract
This study determined convergence and divergence in the constructs of alexithymia, apathy, and depressive symptoms. Understanding of similarities and differences between these constructs will improve diagnostic accuracy for clinical and research purposes. Community-dwelling participants (N=622, M age=35.6 years, SD=13.1) completed online measures of alexithymia, depression, and apathy; 12.2% were alexithymic, 37.8% reported significant depressive symptoms, and 24.9% reported significant apathy. Exploratory Factor Analyses (EFAs) determined the best factor structure for the apathy, alexithymia, and depressive symptoms was comprised of three factors and accounted for 45.1% of item variance. The Depression, Apathy, and Alexithymia factors were defined most strongly by item content that is at the core of each construct. Depression was defined most highly by items assessing sadness, low self-esteem, and loneliness. The strongest item loadings for Alexithymia were difficulty identifying and describing feelings. Apathy was characterized by poor motivation, low interest, and lack of initiative. However, each of these core and defining features had significant cross-loadings on one of the other two factors. Negative affect shared variance with Apathy, low motivation shared variance with Depression, and difficulty describing and identify feelings shared variance with Depression and Apathy. Clinical and research implications are discussed.
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Affiliation(s)
- Rebecca E Ready
- Psychological and Brain Sciences, The University of Massachusetts, Amherst, MA, USA.
| | - Molly A Mather
- Psychological and Brain Sciences, The University of Massachusetts, Amherst, MA, USA
| | | | - Breanna P Santospago
- Psychological and Brain Sciences, The University of Massachusetts, Amherst, MA, USA
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Zakzanis KK, Grimes KM. Relationship among apathy, cognition, and real-world disability after mild traumatic brain injury. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 24:559-565. [DOI: 10.1080/23279095.2016.1225216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Kyrsten M. Grimes
- Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, Canada
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10
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Isacescu J, Danckert J. Exploring the relationship between boredom proneness and self-control in traumatic brain injury (TBI). Exp Brain Res 2016; 236:2493-2505. [PMID: 27215775 DOI: 10.1007/s00221-016-4674-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/11/2016] [Indexed: 12/21/2022]
Abstract
Characterized as an agitated state in which the individual is motivated to engage in their environment but all attempts to do so fail to satisfy, boredom represents a disengaged attentional state that is associated with negative affect and poor self-control. There have been anecdotal reports of increased levels of boredom post-traumatic brain injury (TBI). For the first time, we provide objective evidence that TBI patients do indeed experience higher levels of boredom proneness. Hierarchical regression analyses showed that the presence and severity of head injury were a significant positive predictor of levels of boredom proneness and a negative predictor of self-control. As with healthy controls, TBI patients showed a strong negative correlation between boredom proneness and self-control-those with lower levels of self-control exhibited higher levels of boredom proneness. This was despite the fact that our TBI patients reported higher overall levels of self-control (probably concomitant with their older mean age). The TBI patients also showed strong positive correlations between boredom proneness and measures of physical aggression and anger. Together, this suggests that patients with TBI may be more susceptible to increased levels of boredom proneness and other negative affective states that arise as a consequence of failures of self-control.
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Affiliation(s)
- Julia Isacescu
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - James Danckert
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
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Stéfan A, Mathé JF. What are the disruptive symptoms of behavioral disorders after traumatic brain injury? A systematic review leading to recommendations for good practices. Ann Phys Rehabil Med 2016; 59:5-17. [DOI: 10.1016/j.rehab.2015.11.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 12/01/2022]
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Prevalence, Comorbidities, and Correlates of Challenging Behavior Among Community-Dwelling Adults With Severe Traumatic Brain Injury. J Head Trauma Rehabil 2014; 29:E19-30. [DOI: 10.1097/htr.0b013e31828dc590] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lengenfelder J, Arjunan A, Chiaravalloti N, Smith A, DeLuca J. Assessing Frontal Behavioral Syndromes and Cognitive Functions in Traumatic Brain Injury. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 22:7-15. [PMID: 25529586 DOI: 10.1080/23279095.2013.816703] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jeannie Lengenfelder
- a Kessler Foundation Research Center , West Orange
- b Department of Physical Medicine and Rehabilitation , Rutgers University-New Jersey Medical School , Newark , New Jersey
| | - Aparna Arjunan
- c Kessler Foundation Research Center , West Orange , New Jersey
| | - Nancy Chiaravalloti
- a Kessler Foundation Research Center , West Orange
- b Department of Physical Medicine and Rehabilitation , Rutgers University-New Jersey Medical School , Newark , New Jersey
| | - Angela Smith
- c Kessler Foundation Research Center , West Orange , New Jersey
| | - John DeLuca
- a Kessler Foundation Research Center , West Orange
- b Department of Physical Medicine and Rehabilitation , Rutgers University-New Jersey Medical School , Newark , New Jersey
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14
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A Multidimensional Approach to Apathy after Traumatic Brain Injury. Neuropsychol Rev 2013; 23:210-33. [DOI: 10.1007/s11065-013-9236-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/26/2013] [Indexed: 12/14/2022]
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Block CK, West SE. Psychotherapeutic treatment of survivors of traumatic brain injury: Review of the literature and special considerations. Brain Inj 2013; 27:775-88. [DOI: 10.3109/02699052.2013.775487] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Psychometric properties and feasibility of instruments used to assess awareness of deficits after acquired brain injury: a systematic review. J Head Trauma Rehabil 2013; 27:433-42. [PMID: 21897287 DOI: 10.1097/htr.0b013e3182242f98] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unawareness of deficits after acquired brain injury (ABI) is often reported in the clinic. Several methods have been developed to measure a patient's awareness of deficits after ABI; however, no criterion standard currently exists to measure this phenomenon. OBJECTIVE To review all instruments for measuring awareness of deficits and evaluate their psychometric and conceptual properties as well as their feasibility. METHODS Systematic literature search for available awareness measurement instruments used in experimental ABI studies. Instruments were divided into the following 4 assessment methods: clinician ratings, structured interviews, performance-based discrepancy, and self-other rating discrepancy methods. The quality of the instruments was evaluated. RESULTS The literature search identified 39 instruments and 8 of these were selected. The following 3 instruments stood out in terms of quality: Self-Awareness of Deficits Interview, Patient Competency Rating Scale, and Awareness Questionnaire. CONCLUSION Although these quantitative instruments are useful tools in research, they have limited utility in the clinic because they only measure intellectual awareness. Therefore, in addition to these instruments, qualitative tools should also be used to gain a complete view of a patient's awareness problem.
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Lee YM, Park IH, Koo MS, Ko SY, Kang HM, Song JE. The Reliability and Validity of the Korean Version of Apathy Evaluation Scale and its Application in Patients with Schizophrenia. ACTA ACUST UNITED AC 2013. [DOI: 10.16946/kjsr.2013.16.2.80] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Young Min Lee
- Department of Psychiatry, Myongji Hospital, Goyang, Korea
| | - Il Ho Park
- Department of Psychiatry, Kwandong University College of Medicine, Gangneung, Korea
| | - Min Seong Koo
- Department of Psychiatry, Kwandong University College of Medicine, Gangneung, Korea
| | - Seon Young Ko
- Department of Psychiatry, Myongji Hospital, Goyang, Korea
| | - Hyun Mook Kang
- Department of Psychiatry, Myongji Hospital, Goyang, Korea
| | - Jung Eun Song
- Department of Psychiatry, Kwandong University College of Medicine, Gangneung, Korea
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Psychotherapeutic follow up of out patients with traumatic brain injury: Preliminary results of an individual neurosystemic approach. Ann Phys Rehabil Med 2012; 55:375-87. [DOI: 10.1016/j.rehab.2012.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 04/13/2012] [Accepted: 04/25/2012] [Indexed: 11/23/2022]
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Fleming JM, Winnington HT, McGillivray AJ, Tatarevic BA, Ownsworth TL. The Development of Self-Awareness and Relationship to Emotional Functioning During Early Community Reintegration After Traumatic Brain Injury. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.7.2.83] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractImpaired self-awareness may affect clients' emotional status, engagement in rehabilitation and community reintegration following traumatic brain injury (TBI). The study aimed to investigate the relationship between self-awareness, emotional distress and community integration in adults with TBI during the transition from hospital to the community. Thirty-four rehabilitation clients with TBI were assessed in the week before and 2 months after discharge home. Measures of self-awareness and emotional functioning were administered predischarge and repeated at follow-up along with a measure of community integration. Nonparametric tests were used to compare levels of self-awareness and emotional distress pre- and postdischarge, their interrelationships and association with community integration. Self-awareness significantly increased following discharge, and a trend towards increased depression was found. There were no consistent relationships found between level of self-awareness, emotional functioning, and community integration. The development of self-awareness in the immediate postdischarge phase suggests this is an important time for clinical interventions targeting compensation strategies and adjustment to disability.
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McDonald S, Rushby J, Li S, de Sousa A, Dimoska A, James C, Tate R, Togher L. The influence of attention and arousal on emotion perception in adults with severe traumatic brain injury. Int J Psychophysiol 2011; 82:124-31. [DOI: 10.1016/j.ijpsycho.2011.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 01/28/2011] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
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Cattran CJ, Oddy M, Wood RL, Moir JF. Post-injury personality in the prediction of outcome following severe acquired brain injury. Brain Inj 2011; 25:1035-46. [DOI: 10.3109/02699052.2011.607787] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Actigraphic Daytime Activity is Reduced in Patients With Cognitive Impairment and Apathy. Eur Psychiatry 2011; 28:94-7. [DOI: 10.1016/j.eurpsy.2011.04.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 04/08/2011] [Accepted: 04/18/2011] [Indexed: 11/19/2022] Open
Abstract
AbstractObjectivesApathy is a neuropsychiatric symptom in mild cognitive impairment (MCI) and dementia. This study examines correlations between Apathy Evaluation Scale (AES) ratings and actigraphic measures of daytime activity. The aim of this study is to determine the value of ambulatory actigraphy in the assessment of locomotor deficits as a correlate of apathy in geriatric patients with cognitive impairment.Patients and methodsIn this cross-sectional study a total of 82 participants were recruited, 32 patients with dementia, 21 patients with MCI and 23 elderly controls. Rating scales for apathy (AES) and depression (Beck Depression Inventory, BDI) were completed. To measure daytime activity a wrist-worn actigraph and an established protocol were used. A single measure of mean daytime activity per participant was calculated for further statistical analysis.ResultsIn the two groups of patients with MCI and dementia, apathy is associated with reduced daytime activity, independent of diagnosis (no group by apathy interaction). AES scores correlate significantly with daytime activity. Cognitive impairment reduces daytime activity (effect greater in dementia than in MCI). Daytime activity is negatively correlated with memory deficits.ConclusionAmbulatory actigraphy is a promising method to evaluate self-initiated action as a correlate of apathy in patients with cognitive impairment.
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Affiliation(s)
- Mary E Braine
- School of Nursing & Midwifery, University of Salford, Salford M6 6PU
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Müller U, Czymmek J, Thöne-Otto A, Von Cramon DY. Reduced daytime activity in patients with acquired brain damage and apathy: A study with ambulatory actigraphy. Brain Inj 2009; 20:157-60. [PMID: 16421064 DOI: 10.1080/02699050500443467] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PRIMARY OBJECTIVE Apathy is difficult to assess in clinical practice. Ambulatory actigraphy was used with the aim to measure locomotor activity during the daytime as a correlate of self-initiated action in brain-damaged patients with apathy. RESEARCH DESIGN Twenty-four patients with acquired brain damage and high levels of apathy or low levels of apathy as well as 12 healthy controls were investigated using a parallel group design. METHODS AND PROCEDURES Apathy was diagnosed after clinical observation and evaluated with the apathy evaluation scale. Locomotor activity was measured with a wrist-worn actigraph over 3 days. RESULTS High apathy patients showed significantly reduced locomotor activity and more episodes of inactivity (naps) during the daytime. Self-rated apathy correlated with daytime activity, nap frequency and cognitive (executive) deficits. CONCLUSIONS Ambulatory actigraphy is a promising method to evaluate self-initiated action in patients with apathy.
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Affiliation(s)
- Ulrich Müller
- Department of Psychiatry, University of Leipzig, Germany.
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Carota A, Bogousslavsky J. Stroke-related psychiatric disorders. HANDBOOK OF CLINICAL NEUROLOGY 2009; 93:623-651. [PMID: 18804672 DOI: 10.1016/s0072-9752(08)93031-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Antonio Carota
- Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland.
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Oddy M, Cattran C, Wood R. The development of a measure of motivational changes following acquired brain injury. J Clin Exp Neuropsychol 2008; 30:568-75. [DOI: 10.1080/13803390701555598] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Michael Oddy
- a Brain Injury Rehabilitation Trust, Horsham , Horsham, UK
- b University of Wales Swansea , Singleton Park, Swansea, UK
| | - Charlotte Cattran
- a Brain Injury Rehabilitation Trust, Horsham , Horsham, UK
- b University of Wales Swansea , Singleton Park, Swansea, UK
| | - Rodger Wood
- b University of Wales Swansea , Singleton Park, Swansea, UK
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Clarke DE, Van Reekum R, Patel J, Simard M, Gomez E, Streiner DL. An appraisal of the psychometric properties of the Clinician version of the Apathy Evaluation Scale (AES-C). Int J Methods Psychiatr Res 2007; 16:97-110. [PMID: 17623389 PMCID: PMC6878351 DOI: 10.1002/mpr.207] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This article examines the psychometric properties of the clinician version of the Apathy Evaluation Scale (AES-C) to determine its ability to characterize, quantify and differentiate apathy. Critical appraisals of the item-reduction processes, effectiveness of the administration, coding and scoring procedures, and the reliability and validity of the scale were carried out. For training, administration and rating of the AES-C, clearer guidelines, including a more standardized list of verbal and non-verbal apathetic cues, are needed. There is evidence of high internal consistency for the scale across studies. In addition, the original study reported good test-retest and inter-rater reliability coefficients. However, there is a lack of replication on these more stable and informative measures of reliability and as such they warrant further investigation. The research evidence confirms that the AES-C shows good discriminant, convergent and criterion validity. However, evidence of its predictive validity is limited. As this aspect of validity refers to the scale's ability to predict future outcomes, which is important for treatment and rehabilitation planning, further assessment of the predictive validity of the AES-C is needed. In conclusion, the AES-C is a reliable and valid measure for the characterization and quantification of apathy.
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Affiliation(s)
- Diana E Clarke
- Toronto Rehabilitation Institute and Department of Psychiatry, Baycrest Centre for Geriatric Care, Canada.
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Ownsworth T, Clare L, Morris R. An integrated biopsychosocial approach to understanding awareness deficits in Alzheimer's disease and brain injury. Neuropsychol Rehabil 2006; 16:415-38. [PMID: 16864480 DOI: 10.1080/09602010500505641] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Considerable emphasis has been placed upon cognitive neuropsychological explanations of awareness disorders in brain injury and Alzheimer's disease (AD), with relatively few models acknowledging the role of psychosocial factors. The present paper explores clinical presentations of unawareness in brain injury and AD, reviews the evidence for the influence of psychosocial factors alongside neuropsychological changes, and considers a number of key issues that theoretical models need to address, before going on to discuss some recently-developed models that offer the potential for developing a comprehensive biopsychosocial account. Building on these developments, we present a framework designed to assist clinicians to identify the specific factors contributing to an individual's presentation of unawareness, and illustrate its application with a case example.
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Affiliation(s)
- Tamara Ownsworth
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
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Fleming JM, Ownsworth T. A review of awareness interventions in brain injury rehabilitation. Neuropsychol Rehabil 2006; 16:474-500. [PMID: 16864483 DOI: 10.1080/09602010500505518] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Unawareness related to brain injury has implications for participation in rehabilitation, functional outcomes, and the emotional well-being of clients. Addressing disorders of awareness is an integral component of many rehabilitation programmes, and a review of the literature identified a range of awareness interventions that include holistic milieu-oriented neuropsychological programmes, psychotherapy, compensatory and facilitatory approaches, structured experiences, direct feedback, videotaped feedback, confrontational techniques, cognitive therapy, group therapy, game formats and behavioural intervention. These approaches are examined in terms of their theoretical bases and research evidence. A distinction is made between intervention approaches for unawareness due to neurocognitive factors and approaches for unawareness due to psychological factors. The socio-cultural context of unawareness is a third factor presented in a biopsychosocial framework to guide clinical decisions about awareness interventions. The ethical and methodological concerns associated with research on awareness interventions are discussed. The main considerations relate to the embedded nature of awareness interventions within rehabilitation programmes, the need for individually tailored interventions, differing responses according to the nature of unawareness, and the risk of eliciting emotional distress in some clients.
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Affiliation(s)
- J M Fleming
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
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Abstract
Disorders of diminished motivation occur frequently in individuals with traumatic brain injury. Motivation is an ever-present, essential determinant of behavior and adaptation. The major syndromes of diminished motivation are apathy, abulia, and akinetic mutism. Depending on their etiology, disorders of diminished motivation may be a primary clinical disturbance, a symptom of another disorder, or a coexisting second disorder. This article presents a biopsychosocial approach to the assessment and management of motivational impairments in patients with traumatic brain injury. The recognition and differential diagnosis of disorders of diminished motivation, as well as the mechanism and clinical pathogenesis, are discussed.
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Affiliation(s)
- Robert S Marin
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213, USA
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Lucas SE, M. Fleming J. Interventions for improving self-awareness following acquired brain injury. Aust Occup Ther J 2005. [DOI: 10.1111/j.1440-1630.2005.00485.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
We report on three males with prominent apathy as part of the symptom complex of depression or organic brain disease. Significant clinical responses were observed following treatment with bupropion, an antidepressant with dopamine (DA) reuptake activity. We present clinical evidence in support of the hypothesis that remission in these patients occurred as a consequence of bupropion-induced increases in central DA neurotransmission.
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Affiliation(s)
- C Corcoran
- Department of Psychiatry, Beaumont Hospital, Dublin, Ireland.
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Abstract
Recent research has greatly increased our understanding of the clinical phenomenology and etiology of apathy as a distinct clinical symptom and syndrome. Several rating scales have been developed that assist in making a diagnosis of apathy. Apathy has received increasing attention as an important source of functional disability that should be considered when assessing and treating patients with neurologic disease.
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Affiliation(s)
- J Duffy
- Psychiatric Consultation Services, University of Connecticut School of Medicine, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
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