Pyschosocial Issues

Question 1

dual diagnosis

Answer 1

the relationship of a set of symptoms, including behaviors, which are or resemble symptoms of a known psychiatric disorder

2 diagnoses create disabling conditions as comorbidity creates additional stressors

Question 2

how does the onset of psychiatric symptoms following brain injury negatively impact recovery?

Answer 2

causes caregiver stress, may lead to premature termination of rehabilitation
patient discharged too early, crisis events occur
negatively impacts return to community and independence

Question 3

T/F: those with severe brain injuries have higher rates of depression

Answer 3

FALSE: those with severe injuries found to have lower rates of depression, suggesting self-awareness plays a role in depression

Question 4

what is the most common Axis I disorder for TBI patients

Answer 4

major depressive disorder

Question 5

what are the most common Axis II disorders for TBI patients

Answer 5

avoidant, paranoid, schizoid personality disorders

Question 6

pre-morbid alcoholism is linked to post injury ____

Answer 6

depression

Question 7

depression alone tends to relate to ___ hemisphere injury

while co-occurring depression and anxiety tends to relate to ____ hemisphere injury

Answer 7

depression - left hemi

depression + anxiety - right hemi

Question 8

major depressive episode criteria

Answer 8

2+ weeks of loss of interest/ depressed mood accompanied by at least 4 additional symptoms:
change in appetite, weight gin, decreased energy, feeling of worthlessness, suicidal ideation

Question 9

2 risk factors associated with developing major depressive disorder (MDD) following TBI

Answer 9

socioeconomic status

premorbid psychiatric pathology

Question 10

manic episode criteria

Answer 10

1+ week of noticeably elevated, expansive, or irritable mood with at least 3 additional symptoms: 
extremely amplified self-esteem
decreased desire for sleep
grandiose ideas
distractibility 
risk activities

Question 11

bipolar affective disorder 1 and 2 criteria

Answer 11

bipolar 1 - 1+ manic episodes

bipolar 2 - 1+ depressive episode followed by 1+ hypomanic episode

Question 12

cyclothymic disorder

Answer 12

subtype of bipolar disorder, chronic fluctuating mood disturbance including both depressive and hypomanic states

Question 13

panic disorder criteria

Answer 13

repeated panic attacks followed by worry about future attacks or changes in behavior related to the panic attack, accompanied by at least 4 somatic symptoms:
sweating, palpitations, trembling, nausea, chest pain, dizzy, chills, hot flashes

repeated panic attacks make individual anxious about more panic attacks which causes rise to level of panic disorder

Question 14

schizophrenia criteria

Answer 14

6+ months characterized by minimum of 1-month phase of symptoms such as delusions, hallucinations, incoherent speech, catatonia, avolition

Question 15

organic personality disorder

Answer 15

traditional diagnosis for individuals who develop personality disorder following TBI

Question 16

most frequently reported personality disorders following TBI

Answer 16

avoidant, paranoid, schizoid

Question 17

frontal lobe syndrome and diagnosis methods

Answer 17

presents with symptoms of other psychiatric disorders including depression, psychosis, mood disorders, etc. Unable to regulate emotions due to damage.

diagnose with EEG, neuropsychological testing, MRI scans

Question 18

pseudobulbar affect (PBA)

Answer 18

aka emotional incontinence - prone to sudden, inexplicable, often inordinate episodes of crying or laughing. Commonly misattributed to psychiatric disorders. Individuals cannot understand why they are displaying such emotions

associated with TBI, stroke, Parkinson’s, MS, dementia

Question 19

consumption of alcohol and illegal drugs and the use of prescription drugs exceeding the prescribed amount or use of another person’s prescription drugs

Answer 19

substance misuse

Question 20

continued substance use despite health, psychological, or social consequences

Answer 20

substance use disorder

Question 21

use of substances in a manner associated with higher risk of physical, mental, or social consequences and therefore represents public health concern

Answer 21

hazardous use (of substances)

Question 22

criteria of high-risk drinking for men and women (who are healthy)

Answer 22

men - 4+ drinks per day or 14 drinks in a week

women - 3+ drinks per day or 7 drinks in a week

Question 23

CAGE standardized assessment tool for alcohol abuse

Answer 23

C - “have you ever felt you should Cut down on drinking?”
A - “have people Annoyed you by criticizing your drinking?”
G - “have you ever felt Guilty about your drinking?”
E - “have you ever had a drink first thing in the morning to steady your nerves (Eye opener)?”

Question 24

four quadrant model of substance misuse/abuse

Answer 24

describes various settings where people with TBI and substance misuse could receive treatment
quadrants divided by whether TBI and substance misuse are severe:
Quad I (lower left): acute medical setting, primary care
Quad II (lower right, severe TBI): TBI rehabilitation 
Quad III (upper left, severe misuse): substance use disorder treatment setting
Quad IV (upper right): specialized TBI and SUD services

Question 25

T/F: all persons receiving TBI rehabilitation should be screened for risk of substance misuse

Answer 25

TRUE. All patients should be provided with education regarding harms associated with substance abuse after TBI

Question 26

T/F: approximately 25% of people receiving SUD treatment have a history of at least 1 TBI

Answer 26

FALSE: actually 50%

Question 27

what are 3 principles important for SUD providers providing treatment to persons with limited cognitive abilities?

Answer 27

assist individuals to compensate for unique learning style
provide direct feedback regarding inappropriate behavior
be cautious when making inferences about motivation based on observed behaviors (ex- unawareness deficits may be due to brain damage and not denial)