Cases reported "Brain Damage, Chronic"

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1/8. Psychotherapeutic interventions with brain-injured children and their families: II. psychotherapy.

    Drawing on the case of a boy who was treated in an expressive psychotherapy process in childhood and followed for more than 15 years, the author explores a number of critical issues in the literature on psychotherapy with brain-injured children. These issues include: (1) the efficacy of psychotherapy with neurologically impaired children, (2) its relationship to other modes of treatment, (3) the nature of the therapeutic process, (4) the role of concomitant work with parents in treatment, and (5) the importance of follow-up contacts.
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keywords = psychotherapy
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2/8. Headlock: psychotherapy of a patient with multiple neurological and psychiatric problems.

    Psychodynamic psychiatrists seldom engage in psychotherapy with brain-injured patients because psychodynamic treatment typically depends on the patient's highly developed verbal skills, reflectiveness, tolerance of frustration, and capacity for abstract thinking and generalization--characteristics impaired by brain injury. The author describes the difficult but successful extended treatment of a young adult patient with preexisting attention-deficit hyperactivity disorder and personality disorders who had also abused alcohol and drugs and had suffered severe brain trauma. Treatment was characterized by a lengthy developmental process, the success of which depended on several factors, particularly the maintenance of the therapeutic alliance.
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keywords = psychotherapy
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3/8. psychotherapy in cases of brain damage: a possible mission.

    We present here a psychodynamic model for treating brain-injured patients. In contrast to the common assumption that brain-injured patients remain in an emotional vacuum, our model uses dream material to enable a direct access to the psychic inner life of the patient. It thus refutes the view that these patients can only benefit from supportive psychotherapy.
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keywords = psychotherapy
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4/8. metaphor as a diagnostic tool.

    A case study is reported wherein the patient's frequent use of metaphors was used as presumptive evidence that the patient had been misdiagnosed ten years earlier as having central nervous system disease. The ability to produce metaphors depends upon the capacity to condense several meanings into a word or two, and this in turn implies a rather active associative process. Concretism, not associative richness, characterizes central nervous system disease. The presumption as regards diagnosis was supported by subsequent data including the patient's response to psychotherapy.
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keywords = psychotherapy
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5/8. psychopathology in the light of brain injury: a case study.

    A case study of late onset psychopathology following brain injury is presented to illustrate the effects of cognitive and perceptual loss on personality functions. Based on Hughling Jackson's (1884/1958) notion of the duality of the symptom, we proposed a model of the development and process of psychopathology following brain injury, which views the development of the psychopathological behavior as a product of acquired cognitive and perceptual defects and ensuing compensatory strategies. For the present case study of paranoia, this involved defects in long-term memory, conceptual ability, and compensatory strategies of confabulation and self-referential orientation. Neuropsychological testing established defects in concept formation tasks including the Raven Progressive Matrices, the Leiter International Performance Scale, and the wisconsin Card Sorting test, as well as long-term memory defects where cognitive reorganization was needed. The paranoid process was understood as a product of disordered conceptual ability in interpersonal situations, and a self-referential conceptual classification system, which took time, and changed social relations, to emerge. The implications of this model for psychotherapy with brain injury is elaborated in our case study, in which psychotherapeutic intervention included training on interpersonal hypothesis formation.
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keywords = psychotherapy
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6/8. Pseudoseizure manifestations in two preschool age children.

    We report two patients with epilepsy with pseudoseizures at age 6 years. Both presented with intractable staring spells. Pseudoseizures were provoked and aborted by suggestion, leading to the diagnosis. In both patients, evidence of a neuropsychological disturbance was later found and psychotherapy started. Monitoring of intractable staring episodes is recommended prior to escalating antiepileptic drug levels or resorting to polytherapy. In addition, differentiation from other non-epileptic phenomena is necessary to initiate proper therapy.
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keywords = psychotherapy
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7/8. Behavioural psychotherapy of the frontal-lobe-injured patient in an outpatient setting.

    We present two cases of outpatient behavioural psychotherapy of frontal-lobe brain-injured adults. Unlike inpatient treatment of severely frontal-injured patients in which the hospital setting acts on the patient to modify behaviour, outpatient treatment teaches the self-motivated individual to use the structure and directiveness of behavioural psychotherapy to overcome his or her neuropsychological deficits. The literature describes two types of frontal syndromes: disinhibition and adynamia. Treatment of both types of syndromes is illustrated using case presentations. The therapeutic interventions for both syndromes are designed to exaggerate the link between stimulus and response to counter impaired processing of feedback. A six-stage behavioural psychotherapy model of the frontal-injured patient is outlined.
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keywords = psychotherapy
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8/8. Personality changes following brain injury as a grief response to the loss of sense of self: phenomenological themes as indices of local lability and neurocognitive structuring as psychotherapy.

    Both theoretical and empirical observations suggest that significant alterations in self-concept should occur following most closed head injuries because of diffuse synaptic modification within the temporofrontal regions; this loss of the sense of self should evoke a grief-like response sequence and should encourage paranormal/religious experiences during the subsequent months to years. The marked consistency between phenomenological experiences and the results of neuropsychological assessments of 56 adults who had sustained brain injuries supported this hypothesis. Subsequent reports by these patients indicated that clinical translation of posttraumatic experiences into rational neurobehavioral terms and interventions tailored for the individual's specific pattern of brain "dysfunction" may facilitate adaptation during the grieving period.
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keywords = psychotherapy
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