Interdisciplinary rehabilitation of a patient with right brain injury and recurrent depression

Abstract

IntroductionRehabilitaton of concurrent psychiatric disorder and brain injury is a major challenge. E. underwent neurosurgery for right fronto-parietal astrocytoma. Before illness he was managing automatization of big companies, but was fired after the operation. E. felt into severe depression and anxiety with catastrofization of his illness, suicidal ideation. He resisted multiple prescriptions for SSRI, admitting a sect pretending to “treat” oncology by “psychological” methods. Half a year after operation he attended our center.Objectives and aimTo help E. return to paid employment.MethodsE. was evaluated by neurologists, psychiatrist, neuropsychologists. Current depressive episode appeared to be the second one with underlying schizoid and perfectionist characteristics. He had moderate text comprehension difficulties, confabulations, slight executive dysfunction. Neuropsychologist educated patient on his difficulties and developed compensatory strategies – an alternative to catastrofisation. After psychoeducational session E. agreed to receive fluvoxamine. However, he deformed the received information due to brain injury, so psychotherapy had only minor effects. Infra-low frequency neurofeedback at T4P4 and T4Fp2 sites was started to promote restoration of right brain functions. E. gradually did better, and 3 months later was able to complete CBT course along with relaxation training.ResultsImprovements in emotional status along with ability to cope with cognitive difficulties allowed E. to return to a job similar to the previous. Six month after the start of treatment medications are tapered off, E. has no signs of depression and only slight anxiety.ConclusionsInterdisciplinary holistic rehabilitation may be effective in concurrent psychiatric disorder and brain injury.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Screening Scales in Neuropsychological Rehabilitation: Opportunities, Requirements and Limitations

“…Ориентировка при подборе инструмента на требования и психометрические характеристики, не соответствующие задачам диагностики, в том числе -в реабилитационном процессе. Представляется важным подчеркнуть, что эти задачи -междисциплинарные (Varako et al, 2016), а потому, как будет показано ниже, определение психометрических характеристик такого рода методик не сводятся к способам проверки надежности, валидности и достоверности в классической психодиагностике (Бурлачук, 2008, Шмелев, 2002).…”