Ego-identity: Can it be reconstituted after a brain injury?
Cognitive alterations are frequently observed and studied in persons who present with psychiatric and neurological disorders. Recently an increased number of investigations on the self and attendant processes have interested psychologists, psychiatrists, and neuropsychologists, particularly when a person has suffered brain damage that upsets their daily function in economic, social, personal, behavioural, and emotional ways. At the same time, many theories have been developed to explain the observable changes in ego-identity of persons with brain injury as well as diverse rehabilitation programs centred on the re-establishment of the ego-identity changes. The present article focuses on: ( 1) the elucidation of the construct of self in current personality theoretical formulations; ( 2) the major negative effects of brain impairments on the cognitive, neurobehavioural, emotional, and personality functions of persons with brain injuries; ( 3) the conceptual underpinnings of Kurt Goldstein's views on the neuropsychological rehabilitation endeavour; ( 4) the illustration, using several clinical examples, that it is possible, following intensive neuropsychological rehabilitative interventions, to restore the shattered self of some brain-injured persons; and ( 5) the growing number of holistic programs of rehabilitation for brain-injured persons all over the world. In conclusion, the sequelae of brain injury not only imply alterations in neurological or cognitive process, but also involve changes in personality aspects. Nevertheless the number of holistic programs has increased, and a particular model of the holistic approach to the neuropsychological rehabilitation of persons with brain injury has been implemented in diverse countries such as Australia, Belgium, Denmark, England, Finland, France, Germany, Holland, Israel, Italy, South Africa, and the United States. Although each one of these programs has been modified to resolve the particular necessities and resources of the different countries, all of them implement Kurt Goldstein's ideas concerning the rehabilitation of persons with brain injuries
Use of the Internet for addiction education. Combining network therapy with pharmacotherapy
The authors prepared a course in addiction psychiatry for the Internet that combines a psychosocial and a medication modality for alcoholism; namely, network therapy and naltrexone. Responses of those who accessed the course revealed 679 counts (visits) at the Web Site. A group of 210 unique respondents, of whom 154 were psychiatrists, answered a demographic question set. Over half of these psychiatrists completed the course and evaluated it. The majority indicated that it helped them understand 'a good deal' about the management of alcoholism and the use of network therapy and naltrexone. This result suggests the feasibility of using the Internet as a vehicle for teaching in addiction psychiatry, an area where needs for training are often unmet
Managing diazepam abuse in an AIDS-related psychiatric clinic with a high percentage of substance abusers
Controversy over using benzodiazepines in a human immunodeficiency virus (HIV)-positive population to relieve sleep and anxiety has not been addressed in the literature. Serious problems with diazepam abuse emerged in a psychiatric outpatient clinic for a predominately HIV-positive and illicit drug-using population, which led to a review of patient characteristics and prescribing policies and to a systematic problem-solving effort. The patients originally prescribed diazepam were significantly more likely to be on methadone and have histories of intravenous drug use compared with the patients not on benzodiazepines. Thus, the patients asking for diazepam are likely to have histories of substance abuse and have a high potential for abusing the medication. The authors found that diazepam can be discontinued without causing a significantly greater drop-out rate in that group.
Incidence of suicidality in AIDS and HIV-positive patients attending a psychiatry outpatient program
Current suicidality and many other characteristics were assessed in 183-patients in the various stages of HIV infection who were referred to a specialized HIV-related psychiatric clinic. Intravenous drug use was the most common HIV risk factor. Patients with AIDS had significantly less current suicidal ideation than patients with AIDS-related complex and asymptomatic HIV positivity. The lower suicidality in AIDS patients was independent of age, gender, HIV risk group, and source of referral. Possible explanations of this association include denial, refocusing of life goals in AIDS patients, and psychological changes related to central nervous system impairment.