A Clinician's Rating Scale for Evaluating Impaired. Self-Awareness and Denial of Disability After Brain Injury

Prigatano, George P.; Klonoff, Pamela S.

doi:10.1076/clin.12.1.56.1721

Cited by 119 publications

(118 citation statements)

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“…26 Freud viewed the lack of awareness as a defense mechanism that serves to protect the individual from anxiety. 19 In 1955, Weinstein and Kahn observed that there might be different types of anosognosia, though they failed to find a specific neurologic function or territory that was associated with anosognosia. 19 Prigatano and Koloff 19 observed that patients with denial demonstrated some knowledge about their illness, showed resistance and anger when receiving feedback about their condition, and struggled when trying to work with new information about themselves.…”

Section: What Are the Psychological Reactions To Stroke And When Do Tmentioning

confidence: 99%

“…Patients with anosognosia seemed oblivious to their illness and showed surprise when unable to perform simple tasks. 19 Ghika-Schmid and colleagues 6 found that denial was correlated with decreased fear, which was associated with a delay in seeking medical care and with poor outcome. Therefore, it is important to help patients overcome their fear of illness so that they may seek the help they need.…”

Section: What Are the Psychological Reactions To Stroke And When Do Tmentioning

confidence: 99%

“…10,13,20,22 Psychological reactions to stroke are in large measure determined by an individual's premorbid thought processes, personality, and coping mechanisms (i.e., the thoughts and behaviors employed by a person in an effort to manage a stressful situation). 8,19,30 Individuals who are predisposed to feeling distressed and who tend to be highly emotional in reaction to stress are more likely to interpret or to appraise their condition as overly stressful and to feel that they lack control over it. 30 The ability to cope with the illness, therefore, depends both on the appraisal of the event as stressful and on the capacity to utilize effective strategies in changing one's relationship to the situation and regarding it as manageable.…”

Section: Which Patients Are More Likely To Develop Adverse Psychologimentioning

confidence: 99%

“…2 Denial. Denial and anosognosia are terms that have often been used interchangeably since they were first applied to the medically ill. 6,19,25,26 Anton and Pick first described the phenomenon of denial in 1898, and in 1914, Babinski coined the term anosognosia (to describe braininjured patients with hemiplegia who did not acknowledge their illness). 27 Since then, anosognosia has been used to describe patients with various neurologic disorders who lack awareness and insight into their disability.…”

Section: What Are the Psychological Reactions To Stroke And When Do Tmentioning

confidence: 99%

“…11,18 Denial of physical impairment can also lead to catastrophic reactions: when denial fails, anger arises. 17,19 Inappropriate or uncontrollable laughing or crying (also referred to as pseudobulbar affect) can be triggered by a stimulus that is related, yet disproportionate, to the behavior it elicits. 10 The condition occurs in 20% to 30% of stroke survivors and can be associated with intrusive thoughts about the stroke and with feelings of helplessness and hopelessness 20,21 or in response to a stimulus that has little or no emotional value and that does not induce a subjective experience of emotion (e.g., a patient may cry but not feel sad).…”

Section: What Are the Psychological Reactions To Stroke And When Do Tmentioning

confidence: 99%

See 4 more Smart Citations

The Recognition and Management of Psychological Reactions to Stroke

Chriki¹,

Bullain²,

Stern³

2006

Prim. Care Companion CNS Disord.

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ROUNDS IN THE GENERAL HOSPITALPrimwho is likely to cope poorly with physical impairments? Have you wondered how you can distinguish psychological reactions from neuropsychiatric and neurologic reactions? If you have, then the following case vignette (of a man who developed poststroke depression) should provide the forum for answers to these and other questions related to the psychological sequelae of stroke and comorbid neuropsychiatric syndromes. Cerebrovascular accidents (CVAs) disable thousands of people each year and are a major cause of death in this country. 1 CVAs lead to physical limitations in daily living and to psychological disorders, expressed in alterations to an individual's behavior and emotion. 2 However, in the recovery process after stroke, many patients and their caregivers focus on the patient's physical disabilities and fail to appreciate that the psychological complications of stroke can hinder a patient's recovery. Psychological reactions to stroke are manifested in myriad ways in the days, months, and years after a stroke. [2][3][4][5][6][7] Although not every patient develops intense emotional responses to stroke, those who do often have risk factors that make them more vulnerable to psychological consequences. 3,4,[8][9][10][11] Attention paid to those patients who may benefit from psychotherapeutic treatments as well as from psychotropic medications can facilitate effective treatment.The patient we present sustained a stroke and had severe psychological reactions to it. We will highlight symptom recognition, review the risk factors for distress and dysfunction, and discuss the treatment of psychological reactions to stroke. Case VignetteMr. B, a previously healthy, right-handed, 60-year-old man, suffered a CVA in his sleep. A sudden noise awakened him; his head ached, and he realized that he could barely move his right arm. Despite this, he managed to call for an ambulance. On arrival at the emergency room, his vital signs revealed a heart rate of 120 beats per minute, a respiratory rate of 26 breaths per minute, and a blood pressure reading of 172/112 mm Hg. The physical examination revealed decreased muscle tone, 1/5 muscle strength, and hyperreflexia in the right arm. A noncontrast computed tomography scan of Mr. B's head confirmed the diagnosis of stroke. Results of the rest of his examination were within normal limits. After 4 days in the hospital, Mr. B was discharged to his home and began a course of physical therapy as arranged by his family practitioner. Mr. B struggled to carry out the basic activities of daily living (ADLs); he had difficulty dressing himself and preparing his own food, and he was unable to write.

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