ABSTRACT
OBJECTIVE: To compare the incidence of sleep and pain complaints in symptomatic traumatic brain injury (TBI) (mild vs moderate/severe) and neurologic populations. DESIGN: Case-control study. SETTING: Outpatient neuropsychology service at a university-affiliated tertiary care center. PATIENTS: A consecutive sample of mild (n = 127) and moderate to severe (n = 75) patients with TBI and a general neurologic (non-TBI) group (n = 123) referred for neuropsychological assessment. MAIN OUTCOME MEASURES: Patient report of sleep and/or pain problems. RESULTS: TBI subjects had significantly more insomnia (56.4% vs 30.9%) and pain complaints (58.9% vs 22%) than non-TBI subjects (p < .0001). For both subject groups, the presence of pain increased insomnia approximately twofold. Poor sleep maintainance was the most common sleep problem. In those subjects without pain, TBI patients reported more sleep complaints that non-TBI patients (p = .05). Mild TBI patients reported significantly (p < .0001) more pain than patients with a moderate to severe injury (70% vs 40%). In TBI subjects without pain, there were significantly more insomnia complaints in mild than in moderate to severe injuries (p < .01). CONCLUSIONS: TBI patients with persistent cognitive complaints have more sleep and pain concerns than general neurologic patients. Pain is strongly associated with sleep problems. Aggressive evaluation and treatment of pain and sleep problems in the TBI, especially mild TBI, population appears warranted and may contribute to increased disability. The etiology of greater sleep and pain problems in the mild than in the more severe TBI patients requires further study.
Subject(s)
Brain Injuries/physiopathology , Pain/physiopathology , Sleep Initiation and Maintenance Disorders/physiopathology , Adult , Brain Injuries/classification , Brain Injuries/psychology , Case-Control Studies , Chi-Square Distribution , Demography , Female , Humans , Injury Severity Score , Male , Middle Aged , Nervous System Diseases/physiopathologyABSTRACT
100 disability claimants of the Social Security Administration referred for neuropsychological evaluation and 40 undergraduate college students asked to simulate brain damage were administered a measure for the detection of malingering, an abbreviated version of the Hiscock Forced-choice Procedure, and other neuropsychological tests. Half of each group was administered the Hiscock Procedure at the beginning of the battery; the other half was administered this test last. For both groups, the results indicated poorer performance on the earlier administration of the abbreviated Hiscock Forced-choice Procedure. Formal measures for detection of malingering should be an integral and early part of any neuropsychological evaluation in which the subject has a financial incentive to perform poorly.
Subject(s)
Brain Damage, Chronic/diagnosis , Disability Evaluation , Malingering/diagnosis , Neuropsychological Tests/statistics & numerical data , Social Security , Adult , Brain Damage, Chronic/psychology , Female , Humans , Male , Malingering/psychology , Mental Recall , Middle Aged , Psychometrics , Reproducibility of Results , Retention, PsychologyABSTRACT
A group of 50 disability claimants referred by the Social Security Administration for neuropsychological screening were administered a 36-item, forced-choice, digit-recognition method of detecting malingering to assess effort and motivation to perform well. This abbreviated form of the 1989 Hiscock and Hiscock Forced-choice Procedure has been shown to be quite easy even for individuals with severe organic brain dysfunction. A perfect performance of 36 correct on this digit-recognition task is obtained by most individuals with moderate to severe brain damage. A performance of less than 90% correct is due more likely to poor effort or even malingering rather than brain damage. In this sample, 18% (n = 9) obtained scores of less than 90% correct, i.e., < 33, which calls into question the reliability and validity of test data obtained. An additional 20% (n = 10) obtained intermediate scores of 33 to 35 correct. These intermediate scores are more difficult to interpret although at least some proportion of those scores reflects poor motivation. The results over-all indicate that nearly one-fifth of potential disability claimants produced invalid and uninterpretable neuropsychological test protocols and an additional one-fifth obtained protocols that should be well scrutinized for evidence of poor effort as well. Neuropsychologists conducting disability evaluations are urged to use measures designed specifically to assess effort and motivation.
Subject(s)
Brain Damage, Chronic/diagnosis , Cognition Disorders/diagnosis , Disability Evaluation , Neuropsychological Tests/statistics & numerical data , Adult , Brain Damage, Chronic/psychology , Brain Damage, Chronic/rehabilitation , Cognition Disorders/psychology , Cognition Disorders/rehabilitation , Eligibility Determination/legislation & jurisprudence , Female , Humans , Male , Malingering/diagnosis , Malingering/psychology , Middle Aged , Psychometrics , Rehabilitation Centers , Reproducibility of ResultsABSTRACT
A patient with a postoperative posterior right hemisphere lesion underwent neuropsychological testing during a major depressive episode, and again following remission of the depression. Qualitative visuoconstructive deficits typical of right hemisphere damage were present when the patient was depressed, but were absent following treatment of the depression. Verbal intelligence, cooperation, and vigilance were normal. The case suggests that depression may accentuate focal cognitive signs of fixed lesions in the absence of global impairment of function.
Subject(s)
Brain Diseases/psychology , Cognition Disorders/psychology , Depressive Disorder/psychology , Postoperative Complications/psychology , Adult , Brain Diseases/complications , Brain Injuries/complications , Brain Injuries/psychology , Cognition Disorders/diagnosis , Depressive Disorder/complications , Depressive Disorder/drug therapy , Desipramine/therapeutic use , Humans , Intracranial Arteriovenous Malformations/surgery , Male , Neuropsychological Tests , Wechsler ScalesABSTRACT
Nonmedical social-setting detoxication (SSD) is proposed as a safe, cost-effective program which emphasizes referral to long-term treatment. An examination of patient characteristics, program safety, utilization and cost, referral rate, and patient-staff interaction at one SSD program indicated the viability of the SSD model.
