Brain damage as a family affair

Question 1

Name 5 aspects nature and severity of problems experienced by family members differ from family to family depend on

Answer 1

• type and severity of brain damage
• patients’ symptoms
• premorbid cohesiveness
• family attitudes about illness and responsibility
• financial and social support

Question 2

What are 2 reasons for families to often experience emotional abandoment and caretaker to feel often worn out?

Answer 2

• patients cannot provide emotional support

- others who could give comfort no longer come around or invite patient

Question 3

Name 5 patient behaviors likely to create family problems

Answer 3

1. Impaired social perception and social awareness
2. Impaired control
3. Dependency
4. Inability to learn from experience
5. Anxiety, depression and paranoia

Question 4

In what ways can control problems of patients show up? (3)

Answer 4

• Impulsivity (most reported anger outbursts)
• Restlessness and agitation
• Impatience

Question 5

What is a risk with a emotional dependent patient?

Answer 5

Getting into a vicious circle: the more the patients cling, the more obvious becomes the spouses’ impatience and dissatisfaction, and the more frantic the patients’ efforts to keep their spouses under their immediate surveillance control

Question 6

What are 4 ways a patient can be depend on the caretaker?

Answer 6

1. Emotional depencency (typically experienced as much more burdensome than physical dependency)
2. Dependency resulting from cognitive diffculties (e.g. memory or planning)
3. Dependence on physical care (easier to deal with because of most external options for help)
4. Dependence on financial support

Question 7

Sometimes caretakers get only little sympathy or support from physicians, friends, or relatives who do not live with the patients. What could be an explanation of this?

Answer 7

Many patients are able to exercise some control over their aberrant behavior, at least for short periods of time of in well-structured surroundings
-> chameleon-like character presented by some patients creates additional problems for family members whose complaints and distress are not understood by causal and infrequent observers who see the patients on their tenuously maintained best behavior

Question 8

What are 4 problems seen in caretakers who are the patient’s parents?

Answer 8

Although parental stress differs somewhat according to the age of the patient, the core problems are similar:

• responsibility for the care and well-being of the child will end only with death
• frequently marital conflicts result as parents disagree over who is to care the child and how
• fathers might feel neglected by the exhausted mothers who usually cope with the child
• not unusual for marriages to dissolve within a couple of years following onset of significant brain impairment in a child

Question 9

What are 3 problems seen in caretakers who are the patient’s minor child or sibling?

Answer 9

Reduction in parental attention and increase in responsibilities, shame, frustration and anger at having a ‘different’ family

• being ashamed to bring friends home
• being unable to participate in activities requiring a parent because the parent is occupied with the patient’s care
• Absence of good times the family had previous enjoyed (e.g. holiday abroad)

Question 10

What are 3 problems seen in caretakers who are the patient’s partner or spouse?

Answer 10

Spouses lose their chief companion and source of emotional support and affection at the very time that he or she is most needed

Healthy spouses’ feelings of responsibility and gratitude for the past relationship coupled with guilt and fears of social rejection

• make it difficult to consider divorce although the patients’ psychological impairments might preclude the establishment of anything like a normal marital relationship
• spouses usually become not only caretaker but also target of patients’ anger, fears, and frustrations
• depression in spouses is very common

Question 11

Name 4 treatment approaches for caregivers of patients with neurological damage

Answer 11

1. Education
2. Counseling
3. Emotional support
4. Support groups