Managing aggression in global amnesia following herpes simplex virus encephalitis: The case of E.B.

AIM: This article describes an integrative approach to the case of EB, a 33 year old male who presented with agitation, delusional ideation and global amnesia after contracting herpes simplex virus encephalitis (HSVE) while in a state prison in 2004. CASE STUDY: Although several prior case studies have described outcome following acute onset of HSVE, this case presents a unique challenge for rehabilitation in several respects. First, EB's pre-morbid history is complicated; in contrast with prior HSVE case studies that have typically involved individuals with a relatively high level of pre-morbid functioning, EB presents with limited educational attainment and a prior history of several incarcerations for violent offenses. Post-injury, his presentation includes significant verbal aggression, threats of harm toward others, physical posturing and occasional physical aggression toward his caretakers. Third, EB presents with a fixed delusion that others are constantly taking advantage of him. These features are present in the context of global amnesia and relatively intact cognitive functioning in other domains. Following a brief review of prior HSVE case studies, this study reviews the outcomes of various pharmacological, cognitive, behavioural and integrative interventions designed for management of EB's aggression and agitation.

Estimating premorbid intelligence: comparison of traditional and contemporary methods across the intelligence continuum.

The present investigation compared the North American Adult Reading Test (NAART), Wide Range Achievement Test-3 (WRAT-3) Reading subtest, Barona, and Oklahoma Premorbid Intelligence Estimate Best (OPIE) premorbid intelligence estimates in 64 chronic pain patients across three intelligence ranges. Results for the entire sample revealed that the NAART, Barona, and OPIE Best equations overestimated Wechsler Adult Intelligence Scale-Revised Full Scale IQ (WAIS-R FSIQ), while the WRAT-3 underestimated FSIQ. When the sample was divided into three intelligence ranges, the OPIE more accurately classified individuals with above average intelligence, while the WRAT-3 more accurately classified individuals with below average intelligence. Three methods (NAART, OPIE, and WRAT-3) provided relatively equivalent classifications of individuals in the average intelligence range. The Barona method tended to systematically under- and overestimate FSIQ across the intelligence continuum. These results suggest the potential utility of using different estimation methods for individuals in different IQ ranges, and speak to the need for development of estimation methods that incorporate current reading ability with best performance and demographic variables.

A review of cholinergic agents in the treatment of neurobehavioral deficits following traumatic brain injury.

Although traumatic brain injury (TBI) frequently results in significant handicap, empirical investigations of pharmacological treatment of the neurobehavioral sequelae of TBI are rare. This review presents evidence that supports hypotheses of a cholinergic mechanism underlying some neurobehavioral sequelae of TBI, as well as a critical review of the preliminary evidence supporting the efficacy of cholinergic agents in TBI. Despite numerous methodological limitations, preliminary evidence exists for the efficacy of cholinergic agents in ameliorating attention and memory deficits following TBI. The authors highlight the need for large, randomized, double-blind, placebo-controlled trials that include a broad range of cognitive and behavioral outcome measures.