Depression, apathy and impaired self-awareness following severe traumatic brain injury: a preliminary investigation

Impaired Self-Awareness and Denial During the Postacute Phases After Moderate to Severe Traumatic Brain Injury

“…The question that emerged, however, was what magnitude of discrepancy constitutes a reliable behavioral maker of clinically significant ISA? While early work with this scale suggested that a 9- or 10-point discrepancy score of overestimating abilities (or conversely underreporting levels of difficulty) compared to significant other’s reports might signal a clinically significant ISA ( Prigatano et al, 1998 ), more recent work has suggested that a 20-point discrepancy score may provide the clearest classification of patients with clinically significant ISA after moderate to severe TBI ( Bivona et al, 2019 ).…”

“…Research on the relationship of executive dysfunction and ISA after TBI has produced mixed findings. While the number of categories achieved on the WCST does not separate patients with ISA versus those with no ISA after severe TBI using the PCRS, the number of perseverative errors does appear to separate these two groups (Ciurli et al, 2011;Bivona et al, 2019). Using the Self-Awareness of Deficits Interview (SADI) in studying ISA after TBI, Bogod et al (2003) report positive correlations with errors on the Stroop, Go-No-Go tasks and the self-order pointing test.…”

“…After following patients with a history of severe TBI and persistent and severe ISA over a 20-to 25-year period, it was suggested that a disparity of a least 20 points on the PCRS would provide one marker of clinically significant ISA (Prigatano, 2014). Using this criterion (Bivona et al, 2019) recently reported that 20% of postacute patients with a history of moderate to severe TBI meet this criteria of severe ISA that appears to be clinically significant. In a study from Netherlands (Smeets et al, 2017), 78 patients with a history of either TBI or cerebral vascular accidents (CVAs) were classified as overestimating, underestimating, or having accurate estimation of their competencies using the PCRS.…”

The Self-Awareness Multilevel Assessment Scale, a New Tool for the Assessment of Self-Awareness After Severe Acquired Brain Injury: Preliminary Findings

“…The PCRS ( Prigatano et al, 1986 ; Ciurli et al, 2010 ) is a 30-item self-report questionnaire that requires patients and their relatives to make an independent judgment of perceived degree of competency demonstrated in several behavioral, cognitive, and emotional situations. To assess declarative SA, it is important to consider both the patient self-report and the magnitude of the difference between patients’ report and the relative report of patients’ functional competency, that is, the PCRS discrepancy score (PCRS-DS) ( Prigatano et al, 1990 ; Prigatano, 2014 ; Bivona et al, 2019 ). Higher PCRS-DS mean higher ISA.…”

“…Impaired self-awareness (ISA) has been associated to apathy or anosodiaphoria ( Babinski, 1914 ; Tranel, 2002 ; Heilman and Harciarek, 2010 ; Gasquoine, 2016 ; Bivona et al, 2019 ), reduced subject’s compliance to treatment, worse functional outcome ( Lam et al, 1988 ; Pollens et al, 1988 ; Ezrachi et al, 1991 ; Prigatano and Leathem, 1993 ; Fleming et al, 1996 ; Sherer et al, 1998 , 2003 ; Prigatano and Wong, 1999 ; Bivona et al, 2014 ), and caregiver distress ( Prigatano, 2005 ). Thus, a careful and early assessment of ISA after sABI is an important clinical issue.…”