The relationship between coping styles and affective/behavioural symptoms among individuals with an acquired brain injury.

PRIMARY OBJECTIVE: To evaluate the impact of combined Axis I and II emotional profiles, demographic and psychosocial variables on coping responses in an Acquired Brain Injury (ABI) population using the Personality Assessment Inventory (PAI) and the Coping Response Inventory (CRI). RESEARCH DESIGN: This was a retrospective study examining the relationship between coping styles with affective, demographic and psychosocial variables using a multi-dimensional profile analysis. METHODS AND PROCEDURES: Participants completed the PAI and CRI during a regular clinical visit at the ABI Program (n = 100). Profile data was divided into seven established sub-types and analysed with coping responses. Traumatic (TBI; n = 78) and non-traumatic (n = 24) brain-injured individuals comprised the sample. MAIN OUTCOMES AND RESULTS: Previous findings were confirmed showing that highly symptomatic patients primarily use negative coping strategies. Also, affective symptoms, gender, relationship status, perceived stress and psychosocial supports mediate the use of different negative coping responses. Interesting, anxiety-based symptoms were associated with positive responses similar to asymptomatic ABI patients. CONCLUSIONS: Coping strategies adopted by brain-injured individuals are mediated by Axis I and II symptoms as well as psychosocial support, stress, marital status and gender. As a result, this has implications for developing treatment strategies.

Immune activation and neuropsychiatric symptoms in HIV infection.

This study examined the role of biological processes in the development of specific neuropsychiatric complications in HAART-naive adults with HIV/AIDS. Depressive symptoms were modestly associated with elevated IL-6 mRNA expression (r(s)=0.40, p<0.05) even after removing the influences of other subjective complaints (pr=0.39, p<0.05). Elevated serum neopterin was strongly associated with depressive symptoms in individuals taking antidepressants (r(s)=0.83, p<0.001), though the association was nullified in those not on antidepressants (r(s)=-0.25, p>0.05). Mean neopterin levels were higher in the depressed as compared with nondepressed group but only for those taking antidepressants (F=45.66, df=1, 11, p<0.001). Neuropsychological impairment was not associated with the biological markers. These findings suggest that systemic immune markers (like neopterin) may be useful in differentiating treatment-resistant individuals at greater risk of developing chronic depression.

A case of foreign accent syndrome resulting in regional dialect.

BACKGROUND: Foreign Accent Syndrome (FAS) is a rare acquired syndrome following neurological damage that results in articulatory distortions that are commonly perceived as a "foreign" accent. The nature of the underlying deficit of FAS remains controversial. We present the first reported Canadian case study of FAS following a stroke. We describe a stroke patient, RD, who suffered an acute infarction to the left internal capsule, basal ganglia and frontal corona radiata. She was diagnosed as having FAS without any persistent aphasic symptoms. Family, friends, and health care professionals similarly described her speech as sounding like she had a Canadian East Coast accent, a reported change from her native Southern Ontario accent. METHOD: An investigation of this case was pursued, incorporating neuroimaging, neuropsychological and speech pathology assessments, and formalized linguistic analyses. RESULTS: Linguistic analyses confirmed that RD's speech does in fact have salient aspects of Atlantic Canadian English in terms of both prosodic and segmental characteristics. However, her speech is not entirely consistent with an Atlantic Canadian English accent. INTERPRETATION: The fact that RD's speech is perceived as a regional variant of her native language, rather than the "generic foreign accent" of FAS described elsewhere, suggests that the perceived "foreignness" in FAS is not primarily due to dysfluencies which indicate a non-native speaker, but rather due to very subtle motor-planning deficits which give rise to systemic changes in specific phonological segments. This has implications for the role of the basal ganglia in speech production.

Weight loss and biomedical health improvement on a very low calorie diet: the moderating role of history of weight cycling.

In this study, the authors examined biomedical consequences of participation in a professionally delivered, multifaceted very low calorie diet (VLCD) program and whether the degree of benefit associated with treatment was moderated by history of weight cycling. The authors monitored body weight and biomedical health indicators in 66 severely obese outpatients on a VLCD liquid fast. Participants remained on the VLCD for a median of 55 (range 9 to 247) days. Treatment was associated with significant pre-to-post improvements on body weight, systolic and diastolic blood pressure, triglycerides, and cholesterol. History of weight cycling (independent of age) was inversely related to the magnitude of absolute pre-to-post treatment changes in systolic and diastolic blood pressure, as well as to the rate of weight change. More intensive, longer term, and explicit maintenance components, especially aimed at individuals with multiple weight loss-regain episodes, may be necessary to facilitate weight loss and attain optimal health benefits from VLCDs.

Psychiatric disturbances after traumatic brain injury: neurobehavioral and personality changes.

Traumatic brain injuries (TBI) are frequently accompanied by psychiatric disturbances, which can include striking to relatively minor alterations in personality, behavior, and emotional regulation. The persistence of these neurobehavioral syndromes often leads to deleterious effects on recovery and rehabilitation outcomes. A recent surge of studies has emerged in the past several years to quantify the extent of psychiatric disorders in TBI and to describe differential clinical presentations. Various pre- and post-injury factors also have been hypothesized to contribute to the development and maintenance of psychiatric symptoms in survivors of brain injuries. The identification of high-risk individuals with distinct neuropathophysiological and psychosocial features permits the development of multidisciplinary and tailored approaches to the assessment, prevention, and management of the negative effects of personality and behavioral changes in TBI. This article summarizes the most recent research in these areas and highlights the gaps that need to be filled in subsequent future.

Subtypes of emotional and behavioural sequelae in patients with traumatic brain injury.

This study examined patterns of emotional and behavioural sequelae in 300 individuals who sustained a traumatic brain injury (TBI). Participants were obtained through the Adult Acquired Brain Injury Program at Chedoke Hospital in Hamilton, Ontario, based on the following inclusionary criteria: (1) single incident of TBI; (2) no history of additional neurological diseases; (3) time postinjury < or =8.5 years; (4) WAIS-R FSIQ >85 and/or estimated reading skills above grade 5 level; and (5) valid Minnesota Multiphasic Personality Inventory (MMPI) profiles (i.e., F<90, L<66, and K<66). MMPI profiles of these individuals, in randomly split samples of 150 per group, were subjected to a three-step cluster analytic approach. A six-cluster solution was adequately replicated across samples and across clustering techniques. The identified subtypes included profiles indicative of: (1) no concerns or normal functioning; (2) mild somatic and pain concerns; (3) mild internalizing difficulties; (4) marked disinhibition and externalizing behavioural difficulties; (5) marked internalizing difficulties; and (6) marked somatic, internalizing, and externalizing behavioural disturbances. Members of the Externalized subtype were significantly younger in age than those in the other five subtypes, and more likely to be single than those in the Internalized subtype. Individuals in the Internalized subtype tended to be married, have longer times postaccident, and lower WAIS-R Verbal Intelligence Quotients than those comprising the Normal subtype.