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Task 2: Consequences of PFC brain damage during brain development…
Task 2: Consequences of PFC brain damage during brain development
Adulthood
Intellectual abilities
preserved
Social conventions
preserved
Moral rules
preserved
Social knowledge
accessible at factual level (e.g. ...)
Sensitivity to future consequences of decisions
disrupted
Decision-making
disrupted
Autonomic response to punishment contingencies
disrupted
Responsiveness to behavioral interventions and social behavior
disrupted
Early childhood
(<16 months)
Social & moral reasoning
disrupted
Generating appropriate responses to social situations
disrupted
Acquisition of complex social conventions and moral rules
disrupted
Planning and executing multi-step procedures
disrupted
Moral dilemmas approached from egocentric perspective of avoiding punishment (characteristic of 10y old)
More severe behavioral defects: aggression impulsive rather than goal-directed
Sensitive period for developing the underlying mechanisms involved in acquisition and development of social and moral reasoning
Assessments
Wisconsin Card Sorting Task / Tower of Hanoi
Tests of normal intellectual abilities
No abnormalities
Gambling Task
Test of real-life decision-making, uncertainty of rewards/punishments associated with response options
Failure to choose the options with low immediate reward but with positive long-term gains. Keep choosing options that provide immediate high rewards with higher long-term loss. No SCR to risky responses. No anticipatory response.
Behav. & Emo. Consequences / Psychopathology
PSYCHOPATHOLOGY
Major Depression
Symptoms
Most frequently: fatigue, distractibility, irritability
Psychomotor slowness
Information processing deficits
Moderating factors
Current SES
Premorbid characteristics (e.g. alcohol use, educational level)
Age at time of injury (positively correlated with severity of symptoms)
Cause
In the acute post-TBI stage it may be related to the neuropathology of the injury
Maladaptive psychological response to disability, psychological vulnerability, lack of self-awareness of disability, social disruption and secondary gain may contribute to the maintenance or delayed onset of chronic problems
Premorbid coping liabilities (e.g. lack of personal, financial and social resources) negatively influence the ability to adjust to post-injury changes
Identity crises following the inability to resume the pre-morbid life and the lack of adequate occupational, social and physical rehabilitation services
Generalized Anxiety Disorder
prevalence is increased and patients remain at elevated risk over several years following the injury
Biological connection
Mixed evidence for biological gradient, strong support for temporal relationship
GAD, as well as panic disorder and PTSD following TBI are, however, associated with a disruption to brain anxiety circuits
PTSD
Increased prevalence
First thought that PTSD and TBI were none overlapping, as the loss of consciousness and disruption to cognitive functioning are thought to protect PTSD (would prevent the formation of traumatic memories and a post-trauma psychological reaction). However, PTSD can occur after TBI even when consciousness and memory is significantly disturbed
Moderating factors
Pre-injury history of psychiatric disorders biggest predictor
Biological connection
The extension of TBI damage to subcortical structures may be a critical factor for the development of PTSD. This is still unclear though
Cause
It may represent a generalized reaction to the stress of coping with post-injury cognitive and environmental changes, rather than be a singular effect of neurophysiological consequences
BEHAVIOR
Social difficulties
Independence, interpersonal relationships, work
Social and emotional adjustment
Reduced QoL
Personality changes
Agitation, aggression, confusion
at acute recover stage
Susceptible for
long-term personality changes, mania, psychosis
COGNITION
IQ
Low-average to average range 10 years after TBI
Impaired attention, memory, academic failure
Impaired emotionally and decision-making
early TBI vs. late TBI
(e)TBI
(< 8y)
Performance IQ
Poorest intellectual ability
at all time points
Little evidence of recovery
Processing speed
(l)TBI
(8-12y)
Verbal comprehension
Processing speed