Neuropsychology, the patient\u27s experience, and the political forces within our field

This article emphasizes the importance of both scientific and phenomenological approaches to the practice of clinical neuropsychology. Paying attention to patients experiences while they receive neuropsychological services is stressed because this aspect is often neglected in the training of clinical neuropsychologists. Finally, the reality of \u27hostile\u27 forces within the politics of neuropsychology is considered briefly. Neuropsychologists need to consider three major issues that are important to our field and to the National Academy of Neuropsychology. First, neuropsychology is a scientific enterprise that deserves continued efforts at scholarship and clinically relevant research. The second issue concerns how scientific information is applied to patient care and the need for clinical neuropsychologists to understand both personal suffering and empirical data. The third issue is more delicate. It concerns the political forces in our field and my related personal observations. Copyright (C) 1999 National Academy of Neuropsychology

Denial, anosodiaphoria, and emotional reactivity in anosognosia

A central flaw in models of anosognosia is to consider metacognitive awareness and affective regulation and responsiveness as separate functional modular subsystems. This line of reasoning leads to an “either or” conceptualization of the probable causes of implicit awareness in anosognosic patients. Neuroscience research and clinical observations of patients suggest that anosognosia is often associated with a change in the affective status of the individual as well as a change in their explicit verbal descriptions of themselves. Studying anosognosic patients over time and including measures of psychological denial and anosodiaphoria are necessary when interpreting markers of implicit awareness

Neuropsychological functioning of recidivist alcoholics treated with disulfiram: A follow-up report

Does disulfiram have a deleterious effect on neuropsychological functions? Neuropsychological test performance of 15 chronic alcoholics before and after being placed on disulfiram was compared with a similar group of 9 milieu-treated alcoholics also tested twice. Results indicated that (1) both groups showed a high incidence of significant neuropsychological impairment prior to either disulfiram or milieu treatment; (2) on second testing, both groups showed improved neuropsychological test performance. Disulfiram-treated alcoholics generally did not show increased neuropsychological impairment after being maintained on low dosages of this drug for 2 weeks. Certain results, however, suggest that the effect of disulfiram on short-term memory should be investigated. © 1980 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted

Anosognosia and patterns of impaired self-awareness observed in clinical practice

Disturbances of self-awareness are observed in a wide variety of patients. While group studies can provide useful information concerning potential mechanisms underlying these complex disturbances, experienced clinicians, such as Babinski, recognized the potential value of repeated observations on individual patients to insure the reliability of findings and to aid in diagnosis. This paper describes patterns of impaired self-awareness (ISA) that are observed in clinical practice that suggest a model for clinical classification. Repeated observations are reported on four patients ranging from anosognosia for hemiplegia (AHP), ISAassociated with bilateral cerebral dysfunction with frontal lobe involvement, and apparent denial of disability (DD). A patient who presents with denial of ability (DA) is also studied for comparison purposes. When coupled with brain imaging findings, the nature of the patients\u27 subjective responses to feedback regarding their functional capacities, speed of finger tapping in the left, nondominant hand, and their capacity to express and perceive affect suggests different clinical correlates in these four conditions

Cognitive and Behavioral Dysfunction in Children With Hypothalamic Hamartoma and Epilepsy

Hypothalamic hamartoma (HH) syndrome comprises the clinical triad of epilepsy, developmental retardation, and central precocious puberty. A predominant opinion has been that the acquired cognitive and behavioral disorders observed in children with this syndrome are a direct effect of their seizure activity. A review of the recent literature suggests that this opinion needs to be revised because it is only partially supported by the data. The size of the HH and its anatomic attachment/location, in addition to the seizure history, appear to contribute to the cognitive and behavioral disturbances in children with HH. Small sample sizes and the inability to use standard neuropsychological testing scales in more severely affected HH patients complicate the study of causality. The present literature, however, suggests that multiple factors contribute to the cognitive and behavioral problems of these children. © 2007 Elsevier Inc. All rights reserved

The importance of the patient\u27s subjective experience in stroke rehabilitation

Kaufman\u27s observation that the patients\u27 reactions to their impairments and disabilities need to be addressed in stroke rehabilitation has been shown to be an accurate and perceptive statement. In this article, 3 levels of stroke rehabilitation are outlined, and the importance of focusing on the third level (the level of subjective experience) is emphasized. Identifi cation of the patients\u27 subjective experience allows one to understand what is most frustrating to them. After addressing those frustrations, patients are more eager to engage the rehabilitation process. Within the context of this rehabilitation process, helping patients clarify what their subjective or phenomenological state is as it relates to their stroke is crucial in having them not only engage the rehabilitation process, but ultimately fi nd meaning in life in the face of their stroke. This can be a diffi cult task because patients often do not have the words to clarify what their inner psychological experiences are following a stroke. Helping to provide guidelines for this can result in a meaningful experience for both the patient and the therapists involved in their care. © 2011 Thomas Land Publishers, Inc.