Seasonal affective disorder following brain injury

Article Abstract:

Seasonal affective disorder (SAD) is a mood disorder characterized by seasonal bouts of depression that often develop during the fall or winter and remit by the following spring or summer. No reports have been made of head injury or cerebral pathology in relation to SAD. However, affective (mood) disorders are frequently associated with cerebral damage. For instance, mania has been found in patients with lesions of the right cerebral hemisphere. A report is presented of a 45-year-old SAD patient with recurrent winter depression and summer hypomania (enhanced excitability), who also had a clear-cut intracerebral pathology involving the right limbic area of the brain. When the patient was 17, she had an artery bleed of the right cerebral hemisphere, resulting in minor paralysis of the left side. At age 31, she had a child, followed by another cerebral bleed. Tomography revealed lesions of the right frontal and temporal lobes. The first depressive episode occurred within two months after childbirth and persisted for almost a year before treatment with a tricyclic antidepressant. The woman improved, but had depressive episodes for the next four years. A brief trial of lithium led to greater improvement. She then began showing marked seasonal variations in mood, energy, socialization and sleep, leading to a suicide attempt in 1984. Treatment with lithium was resumed, and again, she responded well. This patient is of particular interest because her SAD is associated with structural brain damage. The site of her lesion is similar to that found in patients suffering from mania after brain injury. It is suggested that bipolar affective disorder and its seasonal variant (SAD) may be linked to an abnormality in the right hemisphere of the brain. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Complications and side effects, Seasonal affective disorder, Brain damage

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Ordering thoughts on thought disorder

Article Abstract:

A review of research focusing on the role of frontal lobe impairment in thought disorder is presented. Frontal lobe lesions have been shown to lead to various communication disorders, including the inability to monitor personal behavior or to note and use errors; difficulty in turning thoughts or ideas into action; and the inability to generate, maintain, and change focus (sets) or to generate and plan sequential behavior. The inability to establish and maintain sets is thought to contribute to poverty of speech and speech content, and to other deficit (negative) aspects of thought disorder. Whereas, the inability to change sets or detach from an action or idea is thought to lead to the persistent repetition of words and thoughts, a trait commonly found in schizophrenia and in mania. Generating, maintaining, and changing sets and the ability to manage sequences (e.g., converting ideas to speech) are all abilities which are dependent upon frontal lobe functions. A distinction between patients with thought disorder and patients with aphasia (speech disorder) is that thought-disordered patients do not realize that they are making communication errors, while aphasics tend to become frustrated by the inability to say what they mean. Cortical-subcortical loops between the pre-frontal cortex and thalamus are now believed to play an important part in language production. It is posited that when the loop becomes dysfunctional, a disconnection syndrome results in formal thought disorder, along with the ensuing lack of executive planning and editing ability. Since schizophrenic and manic patients evidence fluctuations over time in degree of thought disorder, it is further posited that undetermined factors must influence loop activation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Frontal lobes

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Marital adjustment and obsessive-compulsive disorder

Article Abstract:

Obsessive-compulsive disorder (OCD) has been treated with some success with behavioral techniques, specifically by exposure to the problematic situations and response prevention in the patient's real world. Homework assignments may be just as effective as treatment involving exposure to stimuli in the presence of a therapist. For patients who are married, spouse-aided exposure has been found to be more effective than exposure not including the spouse when treating agoraphobia, which involves extreme anxiety and panic attacks in certain situations. Fifty patients with OCD were divided into two groups: self-exposure and partner-assisted exposure. In both groups, patients received homework assignments between sessions. Patients were assessed before treatment at their initial interview, again prior to treatment after a five-week waiting period, and at the conclusion of the five-week treatment period. It was found that marital problems were unrelated to outcome of treatment and that partner-assisted treatment was no more effective than treatment involving only the patient. Treatment had no overall effects on the marital relationship, and partners' levels of anxiety, anger, and marital satisfaction improved equally under both conditions. Although there appear to be no reasons to deny the participation of spouses in the treatment of patients with OCD, there is no need to coerce their participation either. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Marital psychotherapy, Couples therapy, Obsessive-compulsive disorder, Obsessive compulsive disorder

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