Teleneuropsychology clinic development and patient satisfaction.

Objective: Telehealth offers the opportunity to address a growing need to improve access to specialty services, such as neuropsychology, particularly for older adults and those in rural areas. Initial research has examined the validity and acceptability of teleneuropsychology (teleNP) in research settings, but there is less information about teleNP implementation in clinical practice. Here we describe the development of a teleNP clinic and compare patient satisfaction to those completing in-person neuropsychological evaluations. Method: A teleNP clinic was developed at the VA Bedford Healthcare System to serve older Veterans with referral questions focused on cognitive aging concerns. Patients presented to affiliated VA satellite clinics and were connected to neuropsychology clinicians at the main hospital campus through synchronous video. An evaluation battery was compiled to closely approximate in-person evaluations. Trained staff members at the satellite clinic assisted with administration of select tasks. Patient satisfaction was evaluated using a self-report questionnaire and responses were compared to a group undergoing in-person neuropsychological evaluations. Results: Self-reported satisfaction was high for all aspects of the patient experience, with no significant difference found between teleNP (n = 67) and in-person (n = 64) groups. In particular, 90% of patients in the teleNP group and 98% of patients in the in-person group agreed or strongly agreed with the statement, "I was overall satisfied with this visit.". Conclusions: TeleNP is a feasible and acceptable alternative to traditional in-person neuropsychological evaluations in clinical practice focused on older adults. Future research should continue to validate evaluation measures used in telehealth settings, identify the populations that would benefit most from teleNP services, and explore the expansion of teleNP services.

"How to" operate a pediatric neuropsychology practice during the COVID-19 pandemic: Real tips from one practice's experience.

This paper aims to provide pediatric neuropsychologists with suggested processes and procedures to continue to provide neuropsychology services during the COVID-19 global pandemic. Our practice is located within an academic medical center/children's hospital, and setting-specific recommendations may not extend to all practices, though our hope is that others find guidance from our approach to providing pediatric neuropsychology evaluations when physical distancing is required. With consideration of ethics, equity, and assessment validity, we provide suggestions for a) modifying practices around seeing patients during COVID-19, b) tele-health for the pediatric neuropsychologist, c) safety standards and requirements, and d) working with special populations (e.g., Autism Spectrum Disorder, bilingual populations, immunocompromised patients, and acute inpatient assessment).

A case series illustrating the implementation of a novel tele-neuropsychology service model during COVID-19 for children with complex medical and neurodevelopmental conditions: A companion to Pritchard et al., 2020.

Objective: Despite a movement toward tele-based clinical services in other healthcare domains, implementation of these services within neuropsychology, particularly with pediatric populations, is limited. With the onset of social distancing due to COVID-19, the field of pediatric neuropsychology is encouraged to consider the utility of non-traditional, tele-neuropsychological assessments. In order to accommodate ongoing service needs for medically and neurodevelopmentally complex children, a novel three-tiered telehealth service model of care was developed and implemented in a large pediatric outpatient neuro/psychological clinic within an academic medical center.Method: In this article, we provide case examples that illustrate the clinical implementation of this three-tiered telehealth service model of care for serving children during this uncertain time.Conclusion: The primary aim of this article is to provide examples outlining how clinical service decisions were made in the application of this three-tiered model for children with complex medical and neurodevelopmental histories. This article is intended to serve as a guide for other pediatric neuropsychology providers considering tele-neuropsychological services for complex pediatric patients during social distancing.

A commentary for neuropsychologists on CDC's guideline on the diagnosis and management of mild traumatic brain injury among children.

Objective: In 2018, the Centers for Disease Control Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children. This commentary summarizes the key recommendations in the CDC Pediatric mTBI Guideline most relevant for neuropsychologists and discusses research gaps and topics that should receive attention in future iterations of the Guideline.Method: We described the methods used to develop the Guideline, which included a comprehensive Systematic Review. We also distilled and presented key practice strategies reflected in Guideline.Results: To optimize care of pediatric patients with mTBI, neuropsychologists should: use validated, age-appropriate symptom scales, assess evidence-based risk factors for prolonged recovery, provide patients with instructions on return to activity customized to their symptoms, and counsel patients to return gradually to nonsports activities after a short period of rest. Future iterations of the Guideline should encompass a review and guidance on care of patients with psychiatric and psychological difficulties, as well as the potential use of imaging to assess patients with persistent symptoms. Expanded research on mTBI among girls, children age 8 and under, and effective treatments for pediatric mTBI will be beneficial to inform care practices.Conclusions: Recommendations in the CDC Pediatric mTBI Guideline highlight multiple opportunities for neuropsychologists to take action to improve the care of young patients with mTBI and to advance research in the field. Multiple resources and tools are available to support implementation of these recommendations into clinical practice.

Neuropsychology and clinical health psychology in the UK Ministry of Defence.

Neuropsychological testing has been used in a wide range of applications across military settings, including the selection of personnel to engage in covert operations, battlefield assessment and rehabilitation following blast exposure, traumatic brain injury, other neurological conditions and assessment of malingering. Over recent decades, military psychologists have helped to shape the advances in assessing and remediating the psychological sequela that is associated with operationally related neurological and other physical injuries. This paper will present an overview of some of the neuropsychological and related services within the UK Armed Forces, which are provided to service personnel with traumatic brain and other physical injuries.

The Integrated Care Team Approach of the Department of Veterans Affairs (VA): Geriatric Primary Care.

Historically, integrated mental and behavioral healthcare in the Department of Veterans Affairs (VA) commenced with initiatives in geriatrics. Innovation and system-wide expansion has occurred over decades and culminated in a unified vision for training and practice in the VA medical home model: Patient Aligned Care Team or PACT approach. In one VA hospital, the integration of neuropsychological services in geriatric primary care is pivotal and increases access for patients, as well as contributing to timely and effective care on an interprofessional team. The development and innovative use of an algorithm to identify problems with cognition, health literacy, and mental and behavioral health has been pragmatic and provides useful information for collaborative treatment planning in GeriPACT, VA geriatric primary care. Use of the algorithm also assists with decision-making regarding brief versus comprehensive neuropsychological assessment in the primary care setting. The model presented here was developed by supervising neuropsychologists as part of a postdoctoral residency program in geropsychology. However, postdoctoral residency programs in neuropsychology, as well as neuropsychological clinics, can also use this model to integrate neuropsychological assessment and interventions in geriatric primary care settings.

Integration of Neuropsychological Services in a VA HIV Primary Care Clinic.

The Department of Veteran Affairs (VA) is the largest health care provider for individuals with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), with >28,000 Veterans with HIV/AIDS enrolled in care. Advances in medical treatment have improved the life-limiting effects of the disease, though many chronic symptoms persist. Comprehensive care is critical to manage the diverse constellation of symptoms. However, many patients face challenges to receiving optimal care due to limited resources, mistrust of health care providers, and/or co-occurring medical, psychiatric, and substance use disorders. The VA is a leader in developing integrated models of care to address these barriers. The inclusion of subspecialty mental health and substance abuse treatment in HIV care has been implemented across many VAs, with evidence of improved patient outcomes. However, neuropsychology has not traditionally been included, despite the fact that cognitive dysfunction represents one of the most ubiquitous complications of HIV/AIDS. Cognitive impairment is associated with myriad negative outcomes including medication non-adherence, reduced quality of life, and increased mortality. We contend that neuropsychologists are uniquely equipped to contribute to the comprehensive care of patients with HIV/AIDS. Neuropsychologists understand the range of factors that can impact cognition and have the requisite knowledge and skills to assess and treat cognitive dysfunction. Although we focus on HIV/AIDS, neuropsychologists often play critical roles in the provision of care for other infectious diseases (e.g., hepatitis C).

The trainee leadership blueprint: opportunities, benefits, and a call to action.

OBJECTIVE: Leadership experiences are vital not only to individual long-term career success but also the development, direction, and operation of higher spheres including professional organizations and the field of clinical neuropsychology itself. METHOD: The present paper presents a blueprint guide for neuropsychology trainees on available opportunities and resources for increasing their involvement in professional governance and developing leadership skills. First, we present a discussion of the benefits of leadership and professional service, including the acquisition of interpersonal skills and new professional competencies, the prospect of recognition and advancement, and the opportunity to participate in advocacy efforts. Then, we present an overview of existing opportunities for involvement, followed by the provision of specific, actionable items for trainees, mentors and leadership committees, and for neuropsychology organizations to ensure continued trainee engagement. CONCLUSIONS: These resources can serve as a guide for trainees and early career neuropsychologists seeking to acquire leadership proficiencies, and the recommendations aspire to promote advancement for trainees, professionals, and organizations alike.

Voices of leadership: wisdom from women leaders in neuropsychology.

OBJECTIVE: Inspired by panel discussions at various neuropsychology conferences, the aim of this paper is to share wisdom that women in neuropsychology acquired from their leadership experiences. METHOD: We identified 46 women leaders in governance and academic research through reviews of organizational websites and journal editorial boards, and requested their response to brief questions via email. Twenty-one leaders provided responses to three questions formulated by the authors. RESULTS: This paper summarizes the primary themes for the following questions: (1) What advice would you give to a woman neuropsychologist who is seeking to move into a leadership role? Responses included: increase visibility, make connections, know yourself, be confident, and gather information. (2) What leadership style(s) works best? No respondents endorsed a 'best' leadership style; however, they suggested that leaders should know their own personal style, be open and transparent, find a shared mission, and most importantly - use a collaborative approach. (3) What helps a woman earn respect as a leader in neuropsychology? Respondents recommended that leaders should: get involved in the work, demonstrate integrity, do your homework, be dependable, and keep meetings focused. CONCLUSIONS: It is the authors' intent that by gathering and distilling advice from successful women leaders in neuropsychology, more women may be catalyzed to pursue leadership roles in our profession.

Comparing mentorship and sponsorship in clinical neuropsychology.

OBJECTIVE: Mentoring is a well-known concept that is widely regarded as beneficial for personal and professional development. The concept of sponsoring is less recognized although it is considered critical by some for career advancement. The purpose of this study was to provide an initial exploration of differences between mentoring and sponsoring within neuropsychology and to learn what sponsors look for in protégés. METHOD: Twenty neuropsychologists with experience in mentorship and sponsorship were interviewed. Topics covered included the number of protégés they had mentored/sponsored, training received in mentoring/sponsoring, characteristics they look for in protégés, expectations of protégés, reasons they mentor/sponsor, and benefits of mentoring/sponsoring. RESULTS: On average, neuropsychologists interviewed had mentored 58 protégés and sponsored 40. None had ever received formal training in mentoring or sponsoring. Key characteristics needed for neuropsychologists to feel comfortable mentoring/sponsoring protégés were similar while those characteristics valued differed slightly with sponsored protégés valued for competence and getting things done and mentored protégés valued for interpersonal qualities. Reasons for and benefits of mentorship/sponsorship were similar, with rewarding feelings, satisfaction, and pride in the protégé's successes at the top of the list. CONCLUSIONS: Neuropsychologists who provide training are in the position to mentor and sponsor individuals; mentoring relationships often entail sponsorship and vice versa such that the two constructs may be considered part of a continuum. Improving knowledge and skills in mentorship and sponsorship will not only advance personal and professional development of protégés but will also positively impact mentors/sponsors and help shape the field of neuropsychology in deliberate ways.

Work-life integration in neuropsychology: a review of the existing literature and preliminary recommendations.

OBJECTIVE: The purpose of the current review paper is to identify and describe challenges to work-life integration in neuropsychology, and from this review extrapolate an initial set of recommendations and present a set of scenarios in which the recommendations might apply in the hopes of improving quality of life for current and prospective neuropsychologists. Specific areas of focus include diversity, early and mid-career transitions, and potential barriers to advancement in specific practice settings. METHOD: A broad review was conducted of extant literature on work-life integration. There is scant scientific literature in this area that is specific to neuropsychologists, or even psychology as a whole. Subsequently, the majority of this review was collected from more developed literatures in business and medical fields. The authors then provided recommendations based on experiences in their respective careers. Attempts were made to promote generalizability of recommendations for neuropsychologists in different settings. RESULTS: Evidence supports a potentially adverse impact on quality of life and overall life satisfaction when work and personal lives conflict. CONCLUSION: This manuscript identifies some of the potential risks when work and life responsibilities are not well integrated. It is anticipated this will serve as a catalyst for future studies on work-life integration in the field of neuropsychology, specifically.

Contributions to Understanding the Neuropsychology of Alcoholism: An INS Legacy.

Alcohol use disorder (AUD) has been a major cause of family, social, and personal strife for centuries, with current prevalence estimates of 14% for 12-month and 29% lifetime AUD. Neuropsychological testing of selective cognitive, sensory, and motor functions complemented with in vivo brain imaging has enabled tracking the consequences of AUD, which follows a dynamic course of development, maintenance, and recovery or relapse. Controlled studies of alcoholism reviewed herein provide evidence for disruption of selective functions involving executive, visuospatial, mnemonic, emotional, and attentional processes, response inhibition, prosody, and postural stability and brain systems supporting these functions. On a hopeful front, longitudinal study provides convincing evidence for improvement in brain structure and function following sustained sobriety. These discoveries have a strong legacy in the International Neuropsychological Society (INS), starting from its early days when assumptions regarding which brain regions were disrupted relied solely on patterns of functional sparing and impairment deduced from testing. This review is based on the symposium presentation delivered at the 2017 annual North American meeting of the INS in celebration of the 50th anniversary since its institution in 1967. In the spirit of the meeting's theme, "Binding the Past and Present," the lecture and this review recognized the past by focusing on early, rigorous neuropsychological studies of alcoholism and their influence on research currently conducted using imaging methods enabling hypothesis testing of brain substrates of observed functional deficits. (JINS, 2017, 23, 843-859).

Perception of ethical misconduct by neuropsychology professionals in Spain.

OBJECTIVE: To examine the prevalence of perceived ethical misconduct in clinical practice, teaching, and research in the field of neuropsychology in Spain. METHOD: Two hundred and fifteen self-identified mental health professionals who engage in neuropsychology practice in Spain completed an online survey from July to December of 2013. In the ethics section of the survey, participants were asked to identify if neuropsychologists they know who work in their country engaged in specific kinds of ethical misconduct. RESULTS: 41% reported receiving formal training in professional ethics. The clinical findings are as follows. The highest rate of perceived misconduct was found in the area of professional training and expertise, with an average of 40.7%, followed by research/publications (25.6%), clinical care (23.9%), and professional relationships (8.8%). Specifically, regarding training, over half of respondents (56.7%) know professionals who claim themselves to be neuropsychologists, even though they lack proper training or expertise and 46.0% know professionals in the field who do not have adequate training for experience to be working in the field. Regarding research/publications, 41.9% of respondents know professionals who appear as authors on publications where they have not made a significant contribution. Regarding clinical care, over one third of respondents endorse knowing professionals who (1) provide results of neuropsychological evaluations in such a way that patients or other professionals are not likely to understand (37.2%) and (2) do not have the skills or training to work with patients who are culturally different from them (34.9%). CONCLUSIONS: Less than half of survey respondents reported receiving ethics training. It is possible that introducing more or improved ethics courses into pre-graduate and/or graduate school curriculums, and/or requiring continuing ethics education certification may reduce perceived ethical misconduct among neuropsychological professionals in Spain.

[French Society for Biological Psychiatry and Neuropsychopharmacology and Fondation FondaMental task force: Formal Consensus for the management of treatment-resistant depression]. / Prise en charge des troubles dépressifs résistants : recommandations françaises formalisées par des experts de l'AFPBN et de la fondation FondaMental.

Major depression represents among the most frequent psychiatric disorders in the general population with an estimated lifetime prevalence of 16-17%. It is characterized by high levels of comorbidities with other psychiatric conditions or somatic diseases as well as a recurrent or chronic course in 50 to 80% of the cases leading to negative repercussions on the daily functioning, with an impaired quality of life, and to severe direct/indirect costs. Large cohort studies have supported that failure of a first-line antidepressant treatment is observed in more than 60% of patients. In this case, several treatment strategies have been proposed by classical evidence-based guidelines from internationally recognized scientific societies, referring primarily on: I) the switch to another antidepressant of the same or different class; II) the combination with another antidepressant of complementary pharmacological profile; III) the addition of a wide range of pharmacological agents intending to potentiate the therapeutic effects of the ongoing antidepressant medication; IV) the association with appropriate psychological therapies; and, V) the use of non-invasive brain stimulation techniques. However, although based on the most recently available data and rigorous methodology, standard guidelines have the significant disadvantage of not covering a large variety of clinical conditions, while currently observed in everyday clinical practice. From these considerations, formalized recommendations by a large panel of French experts in the management of depressed patients have been developed under the shared sponsorship of the French Association of Biological Psychiatry and Neuropsychopharmacology (AFPBN) and the Fondation FondaMental. These French recommendations are presented in this special issue in order to provide relevant information about the treatment choices to make, depending particularly on the clinical response to previous treatment lines or the complexity of clinical situations (clinical features, specific populations, psychiatric comorbidities, etc.). Thus, the present approach will be especially helpful for the clinicians enabling to substantially facilitate and guide their clinical decision when confronted to difficult-to-treat forms of major depression in the daily clinical practice. This will be expected to significantly improve the poor prognosis of the treatment-resistant depression thereby lowering the clinical, functional and costly impact owing directly to the disease.

Las secuelas invisibles del ictus / The invisible sequelae of stroke

No disponible

El proceso de envejecimiento de las personas con síndrome de Down: estudio multicéntrico para la detección de los cambios neuropsicológicos / No disponible

La mejora en la calidad de vida ha favorecido considerablemente el aumento de la esperanza de vida de las personas con síndrome de Down (SD), motivo por el cual es preciso describir las características neuropsicológicas que presenta su proceso de envejecimiento, con la finalidad de realizar una adecuada prevención y una intervención ajustada a las necesidades de cada persona. En esta investigación se ha realizado un estudio multicéntrico en el que han participado un total de 217 personas adultas con SD, administrando un screening cognitivo que permite obtener una valoración general y básica del estado cognitivo de los participantes. Los resultados nos indican que las personas adultas con SD de edades comprendidas entre los 38 y los 62 años presentan cambios neuropsicológicos significativos en las áreas de lenguaje, memoria y estado cognitivo general, en relación a las personas adultas con SD más jóvenes. En conclusión, el seguimiento en el proceso de envejecimiento favorece la detección temprana y la prevención del deterioro cognitivo, promoviendo así un envejecimiento activo y saludable

The improvement in the quality of life has significantly contributed to increase the life expectancy of people with Down syndrome (DS). It is necessary, then, to describe the neuropsychological characteristics during their aging process, in order to make a proper prevention and intervention adjusted to the needs of each person. This research has conducted a multicenter study with a total of 217 adults with DS participants. It was applied a cognitive screening which allows a general and basic assessment of cognitive status of participants. The results indicate that adults with DS between 38 and 62 years have significant neuropsychological changes in the areas of language, memory and general cognitive status compared to younger adults with DS. In conclusion, monitoring the aging process facilitates an early detection and prevention of cognitive decline, thus promoting active and healthy aging

Evaluación cognitiva en niños que presentaron gastrosquisis: estudio de casos y controles / Cognitive assessment in children who presented gastroschisis: a case-control study

Introducción. La gastrosquisis es una malformación de la pared abdominal que se corrige mediante cirugía y requiere cuidados hospitalarios especiales, como inmovilización, restricción alimenticia y separación de la madre durante tiempo variable, entre otros; para analizar las posibles repercusiones cognitivas se aplicó la prueba de Bayley III a 14 niños. Sujetos y métodos. Siete casos (nacidos con gastrosquisis) y siete controles, en los hospitales civiles de Guadalajara, en el período enero-abril de 2013. Resultados. Los casos no evidenciaron retraso en las evaluaciones relacionadas con la cognición, el lenguaje y la conducta motora, en tanto que en las asociadas a la conducta socioemocional y adaptativa las puntuaciones favorecieron al grupo control, lo que refleja que poseen mejores estrategias de adaptación e interacción respecto al grupo de casos. Conclusiones. La gastrosquisis no afectará el neurodesarrollo ulterior, por lo menos en este grupo que presentó esta única anormalidad y déficits explicables por sus circunstancias perinatales, sin que este pronóstico pueda generalizarse a otros casos con un cuadro clínico más grave, mayor duración de la estancia hospitalaria y comorbilidad asociada. De cualquier forma, es importante informar a los padres desde la etapa prenatal respecto a las consecuencias esperadas de esta patología (AU)

Introduction. Gastroschisis is a malformation of the abdominal wall that is corrected by surgery and requires special hospital care, such as immobilisation, dietary restriction and separation from the mother for a variable period of time, among others. To analyse the possible cognitive repercussions, the Bayley III test was administered to 14 children. Subjects and methods. The study was conducted with seven cases (born with gastroschisis) and seven controls, in civil hospitals in Guadalajara, over the period January-April 2013. Results. No evidence of retardation was found in the cases in the cognition, language and motor conduct assessments, whereas in those associated with socio-emotional and adaptive behaviour the scores favoured the control group. This shows that the latter have better adaptation and interaction strategies with respect to the cases group. Conclusions. Gastroschisis will not affect later neurodevelopment, at least in this group which presented only this abnormality and deficits that can be explained by their perinatal circumstances. Nevertheless, this prognosis cannot be generalised to other cases with a more severe clinical picture, a longer stay in hospital and associated comorbidity. In any case, it is important to inform the parents as of the prenatal stage about the expected consequences of this pathology (AU)

Perfil neuropsicológico en el síndrome opsoclono-mioclono-ataxia como forma de presentación de tumores neuroblásticos / Neuropsychological profile in opsoclonus-myoclonus-ataxia syndrome presenting as neuroblastic tumours

Introducción. Las mejoras sociosanitarias experimentadas en la sociedad occidental han incrementado de forma significativa la supervivencia de los pacientes con el síndrome opsoclono-mioclono-ataxia (SOMA). Sin embargo, diversos estudios han informado de déficits neurológicos, cognitivo-conductuales y de desarrollo persistentes en el 70-80% de estos pacientes. Pacientes y métodos. Se revisan los casos de tumores neuroblásticos diagnosticados en un período total de 13 años y seis meses (desde enero de 2000 a mayo de 2013) y su asociación a SOMA en el servicio de pediatría de un hospital general de tercer nivel. Además, se lleva a cabo la evaluación neuropsicológica exhaustiva de tres niños diagnosticados de SOMA. Resultados. Hemos objetivado déficits en inteligencia, atención, velocidad de procesamiento, memoria, lenguaje, habilidades visuoespaciales y visuoconstructivas, motricidad fina y funciones ejecutivas. Además, hemos comprobado alteraciones en el perfil psicológico. Conclusiones. Se aportan datos que enfatizan el papel del cerebelo en el procesamiento cognitivo complejo en población infantil, probablemente vinculado a alteraciones neuromadurativas de esta estructura motivadas por deficiencias del sistema inmunológico. Los resultados encontrados son interpretados en el marco conceptual de la neuropsicología Infantil y su interés por estudiar las relaciones cerebro-conducta en el contexto dinámico del desarrollo cerebral (AU)

Introduction. Sociosanitary improvements experienced in western society have significantly increased the survival of patients with opsoclonus-myoclonus-ataxia syndrome (OMAS). However, several studies have reported neurological, cognitivebehavioral and development persistent deficits in 70-80% of these patients. Patients and methods. We reviewed cases of neuroblastic tumors diagnosed in a total period of 13 years and six months (from January 2000 to May 2013) and its association with OMAS in the pediatric service of a general hospital of a third level. Furthermore, it conducts a full neuropsychological study in three children diagnosed with OMAS. Results. We objectified deficits in intelligence, attention, processing speed, memory, language, visuospatial and visuoconstructive skills, fine motor skills and executive functions. In addition, we found alterations in the psychological profile. Conclusions. Data emphasize the role of the cerebellum in complex cognitive processing in child population probably linked to neurodevelopmental deficits in this structure caused by deficiencies of the immune system. The results are interpreted in the framework of child neuropsychology and their interest in studying the brain-behavior relationships in the dynamic context of brain development (AU)

La comunicación como base en la seguridad del paciente / Communication as the basis to ensure patient safety

Presentamos el caso de un paciente que, como secuela de un accidente cerebrovascular, presenta afasia. Tanto la enfermería como el médico de familia tenían graves problemas de comunicación, por lo que se realizó un pictograma para mejorar la fluidez entre el paciente y los sanitarios. Tras familiarizarse con él, facilitó mucho la adecuada y correcta comunicación bidireccional y mejoró la seguridad de los cuidados (AU)

The present is a case of a patient with aphasia as a direct consequence of a stroke. Both the nursing staff and the family physician had serious communication problems so a pictogram was designed to improve fluency between patient and health workers. After becoming familiar with it, it greatly facilitated the appropriate and correct two-way communication and health care safety (AU)

Repercusiones funcionales y legales de un trastorno orgánico de la personalidad tras un infarto cerebral / Functional and legal repercussions of an Organic personality disorder following a stroke

El trastorno orgánico de la personalidad supone una alteración significativa de las formas habituales del comportamiento premórbido, afectando particularmente a la expresión de las emociones, necesidades e impulsos. Se presenta el caso de una mujer de 49 años de edad que, tras padecer un infarto cerebral, presentó una transformación de su personalidad y de sus valores previos. Anteriormente era una persona con múltiples miedos, cuidadosa, metódica en su vida diaria. Tras el infarto comenzó a presentar conductas de provocación y una mayor desinhibición e impulsividad, menor tolerancia a la frustración, así como mínima capacidad de planificación y resolución de problemas. Además, fue incapaz de conservar ningún trabajo y perdió las relaciones sociales. Se realizaron estudios de imagen (tomografía computarizada (TC) y resonancia magnética (RM)), electroencefalograma (EEG) y una evaluación neuropsicológica. Los resultados obtenidos son compatibles con un trastorno orgánico de la personalidad subtipo desinhibido, caracterizado clínicamente por la tendencia a la labilidad emocional, la desinhibición conductual y la falta de control de impulsos. El trastorno orgánico de la personalidad es una afectación crónica e irreversible que está influyendo en la capacidad de autogobierno de la paciente, y por ello deben valorarse los aspectos psiquiátrico-forenses pertinentes (AU)

The organic personality disorder causes a significant alteration of the habitual patterns of behavior displayed by the subject premorbidly, involving the expression of emotions, needs and impulses. We report the case of a 49-year-old woman who, after suffering a cerebral infarction, presented a transformation of her personality traits and previous values. She was previously a person with multiple fears, careful, methodical in her daily life. After the cerebral infarction she began to present conducts of provocation and major disinhibition, impulsiveness, minor tolerance to the frustration, minimal capacity of planning and resolution of problems. In addition, she was unable to preserve any work and lost the social relationships. Neuroimaging studies (CT, MR), EEG and a neuropsychological assessment were conducted. The obtained results are compatible with an Organic Personality Disorder disinhibited subtype, clinically characterized by emotional liability, disinhibited behavior and lack of impulses control. The organic personality disorder is a chronic irreversible disease that is affecting the self-government patient´s ability and therefore relevant forensic psychiatric aspects must be assessed (AU)