As transformações do cotidiano de familiares cuidadores de sujeitos acometido por Lesão Encefálica Adquirida em idade produtiva / Daily life changes of family caregivers of subjects affected by Acquired Brain Injury in productive age / Las transformaciones del cotidiano de familiares cuidadores de sujetos acometidos por Daño Cerebral Adquirido en edad productiva

Introdução: Lesões Encefálicas Adquiridas (LEA) provocam importantes mudanças no sujeito acometido e em seus familiares. Objetivo: Este estudo foi refletir sobre as transformações no cotidiano de familiares cuidadores de sujeitos com LEA em idade produtiva, analisando, especialmente, o impacto do afastamento do trabalho desses sujeitos lesionado encefálicos na percepção de seus familiares. Método: Trata-se de um estudo descritivo com abordagem qualitativa. A coleta de dados foi realizada entre junho e dezembro de 2014, por meio de busca ativa, em serviços públicos de reabilitação em Fisioterapia, Fonoaudiologia e Terapia Ocupacional de um município de médio porte do interior gaúcho. Participaram deste estudo 27 cuidadores, destes 26 eram cuidadores familiares e um cuidador formal (excluído do estudo por não contemplar o seu objetivo). Resultados: Os dados foram analisados pelo método de Análise de Conteúdo e estão apresentados em duas categorias: 1) Familiar cuidador: um novo papel a ser desempenhado; 2) Percepção do familiar cuidador sobre o afastamento laboral do sujeito com LEA e sua repercussão no cotidiano familiar. Conclusão: A LEA trouxe para os familiares cuidadores sentimentos de medo e angústia no ato de cuidar, assim como desgaste físico; também trouxe dificuldades financeiras e o isolamento social dos familiares cuidadores de sujeitos com LEA.

Introduction: Acquired Brain Injury (ABI) causes major changes for the affected subject as well as for their relatives. Objective: The objective of this study was to reflect on the changes in daily life of family caregivers of ABI subjects in productive age, analyzing, especially, the impact of the absence from work of brain injured subjects on the perception of their relatives. Method: This is a descriptive study with qualitative approach. Data collection was carried out between June and December 2014, through active search in public rehabilitation services in Physical Therapy, Speech Therapy and Occupational Therapy of a medium-sized inland city in the state of Rio Grande do Sul. A total of 27 caregivers participated in this study, 26 of them were family caregivers and only one was a formal caregiver (excluded from the study since it did not contemplate our objective). Results: Data were analyzed using the Content Analysis method and are presented into two categories: 1) Family caregiver: a new role to play; 2) Perception of family caregiver on absence from work of ABI subject and its repercussion to family life. Conclusion: ABI brought to family caregivers feelings of fear and anguish in the act of caring, as well as physical exhaustion; it also brought financial difficulties and social isolation to family caregivers of subjects with ABI.

Introducción: Daños Cerebrales Adquiridos (DCA) provocan importantes cambios en el sujeto acometido y en sus familiares. Objetivo: Esta investigación buscó reflexionar sobre las transformaciones en el cotidiano de familiares cuidadores de sujetos con DCA en edad productiva, analizando, especialmente, el impacto del alejamiento laboral de esos sujetos que sufrieron daños cerebrales en la percepción de sus familiares. Método: Se trata de una investigación descriptiva con abordaje cualitativa. La recopilación de datos fue realizada entre junio y diciembre del 2014, por medio de busca activa, en servicios públicos de rehabilitación en Fisioterapia, Fonoaudiología y Terapia Ocupacional en una ciudad de mediano porte en el interior del Rio Grande del Sur. Participaron de esta investigación 27 cuidadores, donde 26 eran cuidadores familiares y un cuidador formal (en exclusión de la investigación por no contemplar su objetivo). Resultados: Los informaciones fueron analizadas por el método de Análisis de Contenido y están presentados en dos categorías: 1) Familiar cuidador: el desempeño de un nuevo rol; 2) Percepción del familiar cuidador sobre el alejamiento laboral del sujeto con DCA y la repercusión en el cotidiano familiar. Conclusión: El DCA trajo a los familiares cuidadores sentimiento de miedo y angustia en el acto de cuidar, así como desgaste físico; también desencadenó dificultades económicas y aislamiento social de los familiares cuidadores de personas con DCA.

Validity and screening properties of three depression rating scales in a prospective sample of patients with severe traumatic brain injury

Objective: To evaluate the validity and utility of the Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS) as screening tools for depression after severe traumatic brain injury (TBI). Methods: Forty-six consecutive survivors of severe TBI were evaluated at a median of 15 months after injury. Receiver operating characteristic (ROC) analysis was performed using HAM-D, BDI, and HADS as predictors, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) as gold standard. Results: The area under the curve (AUC) for HAM-D was 0.89, and the optimal cutoff point was 7 (sensitivity 92.9%, specificity 78.1%); for the BDI, the AUC was 0.946 and the optimal cutoff point was 14 (sensitivity 92.3%, specificity 96.7%); for the HADS, the AUC was 0.947 and the optimal cutoff point was 9 (sensitivity 100%, specificity 80.7%); and for the HADS depression subscale, the AUC was 0.937 and the optimal cutoff point was 6 (sensitivity 92.9%, specificity 83.9%). There were no statistically significant differences among the AUCs. Conclusion: Our findings support a high validity and utility for the HAM-D, BDI, and HADS as screening tools for depression in patients with severe TBI, without major changes in standard cutoff points. .

Correlative factors for organic psychotic symptoms in patients following traumatic brain injury / 法医学杂志

OBJECTIVE@#To investigate the correlative factors for organic psychotic symptoms following traumatic brain injury (TBI).@*METHODS@#In the current study, 391 subjects who had undergone forensic identification of the organic mental disorders due to TBI were included, both the demographic and post-traumatic information collected. The relevant data were statistically analyzed in those confirmed as organic psychotic syndrome according to Chinese Classification of Mental Disorders 3rd version (CCMD-3).@*RESULTS@#Fifty-two subjects (13.3%) were identified as organic psychotic symptoms. The chi-square test showed that the detectable organic psychotic symptoms were associated with the marriage status, damage nature, injury severity and treatment, and the multivariate logistic regression analysis revealed good fitness of treatment and injury severity with the regression model (OR = 0.044, 95% CI: 0.017-0.114; OR = 2.145, 95% CI: 1.201-3.832, respectively).@*CONCLUSION@#The risks of organic psychotic symptoms following TBI can be involved in the alternative of craniotomy for the cases with trauma and moderate brain injury.

Reappraisals of mental disabilities due to traffic accidents: a retrospective analysis of 51 cases / 法医学杂志

OBJECTIVE@#To discuss the causes for changes of opinions in reappraisals of mental disabilities due to traffic accidents.@*METHODS@#Fifty-one reappraisals of mental disorders due to traffic accidents from October 2009 to October 2011 in the Institute of Forensic Science, Shaoxing Seventh People's Hospital, were retrospectively analyzed.@*RESULTS@#In the reappraisals, the opinions about disability grade changed in 30 cases (58.82%), including 8 cases increased and 22 cases decreased. According to the causes of changing the opinions, there were 8, 10 and 2 cases related to different understandings of appraisers in the severities of mental disorders, subjective judgements and certain psychiatric symptoms, respectively. Also, there were 10 cases related to different appraisal time.@*CONCLUSION@#Appraisals of mental disabilities should grasp the appraisal time, decrease the changes of opinions due to the differences of appraisers and correctly understand the orders of rules and clauses.

Evaluating on recognition impairment after traumatic brain injury with WCST / 法医学杂志

OBJECTIVE@#To explore the value of Wisconsin Card Sorting Test (WCST) in evaluating the recognition impairment after traumatic brain injury (TB1).@*METHODS@#WCST and Wechsler Adult Intelligence Scale Revised in China (WAIS-RC) were adopted to assess the cognitive function in 186 patients with brain injury (experimental group) and 180 healthy volunteers (control group), respectively. The cognition between the experimental group and the control group was compared. The correlation between WCST and IQ was analyzed. The correlation between age, education level, the severity of TBI and the executive function were also analyzed.@*RESULTS@#(1) The performances of WAIS-RC and WCST in the experimental group were significantly worse than that of the control group. (2) There were significantly negative correlation between the performance of total errors, percentage of preservative errors, percentage of random errors, response number on first category and IQ (P < 0.05). While there were significantly positive correlation between the categories completed, percentage of conceptual level and IQ (P < 0.05). (3) There was significantly negative correlation between percentage of conceptual level and the severity of TBI. While there were significantly positive correlation between percentage of preservative errors, percentage of random errors, response number on first category and the severity of TBI.@*CONCLUSION@#WCST could be an important method in evaluating cognition of patients with brain injury.

The investigation of event-related brain potentials in malingered neurocognitive deficit / 法医学杂志

In the fields of judicial psychiatric identification, about 40%-60% of the people maybe exaggerate their injury for personal profit. Though some psychological tests are effective in identification, they are limited in cunning liars. This article summarizes previous experimental mode, results and effects of event-related potential (ERP) in detecting cognitive malingering. ERP technology can be highly sensitive and specific. It is a kind of objective physiological index and is a promising technology in detecting cognitive malingering.

Frequency of brain injury in a forensic psychiatric population

OBJETIVO: Cada vez mais, nos últimos anos, estudos em pacientes individuais e em populações demonstram que os traumatismos craniencefálicos (TCE) determinam inúmeros sintomas psiquiátricos, com significativas alterações que podem influenciar os diagnósticos, os prognósticos, os tratamentos e com evidentes implicações psicossociais, incluindo as jurídicas e previdenciárias. O objetivo deste estudo foi o de 1) Detectar numa população psiquiátrica forense a existência de TCE antes do acometimento de delitos; 2) Verificar se houve reconhecimento desses traumatismos por parte dos peritos da instituição. MÉTODO: Foram analisados 3.323 prontuários de pacientes submetidos a exames periciais no Instituto Psiquiátrico Forense "Dr. Maurício Cardoso" de Porto Alegre, entre 1995 e 1999. RESULTADOS: Na população estudada, foram encontrados 133 TCE ocorridos antes dos delitos, sendo 39 leves e 94 moderados e graves. Do total dos casos encontrados, não foram considerados 111 casos, muitos deles com alterações motoras, cognitivas, psíquicas e sensoperceptivas. CONCLUSÃO: O expressivo número de pacientes que sofreu TCE antes dos delitos cometidos e que não foi considerado pelos peritos (neurologistas e psiquiatras) da instituição forense é forte indicativo do pouco conhecimento das conseqüências desses traumatismos. Considerando a relevância dos aspectos psicossociais envolvidos, novos estudos necessitam ser realizados junto a populações psiquiátricas de maneira a aprimorar o conhecimento a respeito das conseqüências desses traumas.

Reabilitaçäo psicossocial da criança com traumatismo cranioencefálico: conseqüências na afetividade e no emocional / Psychossocial rehabilitation of brain injured children, considering physical, cognitive deficits and affective/emotional aspects

As autoras colocam em pauta a reabilitação psicossocial da criança com traumatismo cranioencefálico, em suas diferentes facetas, considerando-se os déficits físicos, cognitivos e os aspectos afetivos/emocionais. Destacam a posição que os pais ocupam no momento de crise e as conseqüências posteriores no âmbito emocional. Ressaltam a violência que ocorre com as crianças e com os pais, decorrentes de normas culturais e sociais. Concluem, enfatizando a responsabilidade partilhada entre pais, crianças e sociedade com respeito à questão da prevenção.

Reabilitaçäo psicossocial da criança com traumatismo cranioencefálico: consequências na afetividade/emocional / Psychosocial rehabilitation of child with cranioencephalic traumatism: affectity/emotional consequences

Os autores colocam em pauta a reabilitaçäo psicossocial da criança com traumatismo cranioencefálico, em suas diferentes facetas, considerando-se os déficits físicos, cognitivos, e aspectos afetivos/emocionais. Destacam a posiçäo que os pais ocupam no momento de crise e as consequências posteriores no âmbito emocional. Ressaltam a violência que ocorre com as crianças e com os pais, decorrentes de normas culturasi e sociais. Concluem, enfatizando a responsabilidade partilhada entre pais, crianças e sociedade com respeito à questäo da prevençäo.

Trastornos psíquicos de los traumatismos craneales / Psychic disorders of skull traumas

Se describen en general las circunstancias en que aparecen los traumatismos craneoencefálicos. Precisa la diferencia entre contusión y conmoción y los cuadros clínicos de ambas, así como las complicaciones psiquiátricas de las que estudia: 1) los trastornos de conciencia; 2) los estados confusionales postraumáticos y su evolución y 3) las secuelas no confusionales , tales como estados deficitarios, epilepsias, síndrome subjetivo común y neurosis postraumáticas, precisando su evolución y tratamiento

Estudio de las alteraciones cognitivas en los traumatizados de cráneo a través de la escala de inteligencia de Wechsler / Cognitive disorders in head injured patients by means of the Wechsler intelligence scale

Se analizan los resultados obtenidos por un grupo de pacientes traumatizados de cráneo en la escala de inteligencia de Wechsler - Bellevue. Se concluye que el rendimiento del grupo es significativamente inferior al promedio normal. La evaluación sucesiva de los pacientes a través de dos aplicaciones de la prueba con un lapso de 3 meses entre ambas, muestra que esta diferencia va disminuyendo a medida que aumenta el tiempo transcurrido desde el accidente