Behavioral Treatments.

The central nervous system is the source of all behaviors and emotions; it also mediates the individual's relationship with the environment. Consequently, when the central nervous system is disrupted by neurologic disease, there are frequently many concomitant emotional and behavioral disturbances, as well as conflicts with the environment and the people surrounding the patient. Patients are often unaware that these maladaptive interactions often determine the nature and quality of care that they receive from their caregivers. The aggressive or wandering brain-damaged patient often ends up in a secure facility, and the apathetic patient often becomes forgotten. Although psychopharmacologic agents can moderate some of the behavioral and emotional symptoms of brain damage, these medications have side effects such as sedation and falls, among others, and they often interfere with the metabolism of medications that patients are already taking. Behavior therapy is an excellent supplement to, if not alternative for, medications to control symptomatic behaviors associated with brain damage for the following reasons: 1) behavioral treatment is nonpharmacologic, and, therefore, there are no drug interactions or side effects in patients with neurologic illnesses; 2) behavioral treatments can be designed to treat specific symptoms, and, by mitigating them, improve the quality of life of the patient and the caregivers; 3) the success of behavioral treatments can usually be quantified as the target behaviors are pinpointed and measured before, during, and after the behavioral interventions; 4) behavioral treatments are usually cost effective, because they can be devised by psychologists, but administered by direct daily caregivers and family members; and 5) behavioral treatments administered by caregivers give the caregivers a sense of participation and control of the treatment. Reports of the effectiveness of behavioral treatments support their inclusion as an important complementary component in the care of individuals with neurologic disorders as well as the milieu of institutions that care for the brain damaged.

Early Change in Cognitive Performance Accompanying Bilateral ECT.

In order to characterize the onset and evolution of early cognitive changes that accompany bilateral electroconvulsive therapy (ECT), the performance of 13 ECT-treated and 16 psychiatric control patients on a battery of neuropsychological tests administered daily was compared. These tests included: Digit Symbol, spokes, letter cancellation, and short-term memory tests. While both groups improved on all tests, performance of ECT patients vs. controls on letter cancellation tests diverged significantly (p < 0.005) after three ECTs. The authors speculate that this finding reflects an alteration in attentional processes caused by bilateral ECT.