RESUMEN

The historical review of "psychiatric personality disorders" reveals the lack of convergence of those disorders with the organic personality disorder (OPD). Only the psychopathy concept has been used as a psychopathological phenotype for one of the groups of OPD, the so-called "pseudopsychopaths". These patients have been described from the beginning of the XXth century under the heading of "frontal lobe syndrome". It was only with the development of the psychiatric nosologies, towards the middle of the XXth century, that the term "organic personality disorder" started to be used. The accumulation of knowledge about the different prefrontal areas and the development of neuropsychological models that try to explain social behavior have opened new ways of understanding this syndrome. The orbitofrontal cortex has been identified as one of the key structures in behavioral and emotional regulation. Recognition of emotions in voices and faces, empathy, appreciation of humor, tasks that show "theory of mind" are some of the dimensions included in the examination of the non-cognitive functions of the prefrontal cortex

Asunto(s)

Trastornos Neurocognitivos/epidemiología , Trastornos de la Personalidad/epidemiología , Afecto/fisiología , Empatía , Humanos , Trastornos Neurocognitivos/fisiopatología , Trastornos de la Personalidad/fisiopatología , Corteza Prefrontal/fisiopatología

RESUMEN

INTRODUCTION: Attention disorders are a major problem after traumatic brain injury underlying deficits in other cognitive functions and in everyday activities, hindering the rehabilitation process and the possibility of return to work. Functional neuroimaging and neuropsychological assessment have depicted theoretical models considering attention as a complex and non-unitary process. DEVELOPMENT: Although there are conceptual difficulties, it seems possible to establish a theoretical background to better define attentional impairments and to guide the rehabilitation process. The aim of the present study is to review some of the most important pieces involved in the assessment and rehabilitation of attentional impairments. We also propose an appropriate model for the design of individualized rehabilitation programs. Lastly, different approaches for the rehabilitation are reviewed. CONCLUSIONS: Neuropsychological assessment should provide valuable strategies to better design the cognitive rehabilitation programs. It is necessary to establish a link between basic and applied neuropsychology, in order to optimize the treatments for traumatic brain injury patients. It is also emphasized that well-defined cognitive targets and skills are required, given that an unspecific stimulation of cognitive processes (pseudorehabilitation) has been shown to be unsuccessful.

Asunto(s)

Atención/fisiología , Lesiones Encefálicas , Trastornos del Conocimiento , Daño Encefálico Crónico/fisiopatología , Lesiones Encefálicas/patología , Lesiones Encefálicas/rehabilitación , Lesiones Encefálicas/terapia , Trastornos del Conocimiento/fisiopatología , Trastornos del Conocimiento/rehabilitación , Humanos , Pruebas Neuropsicológicas

RESUMEN

Introducción. Las alteraciones de la atención forman parte de los principales problemas que surgen tras un traumatismo craneoencefálico. Éstas pueden influir de forma directa en el funcionamiento de otros procesos cognitivos y en actividades de la vida diaria, y dificultar así el progreso de la rehabilitación y el retorno al trabajo. La evaluación neuropsicológica y la neuroimagen funcional están permitiendo el desarrollo de modelos teóricos que consideran la atención como un proceso complejo y no unitario. Desarrollo. A pesar de la dificultad conceptual, es posible establecer un marco teórico que permita delimitar las alteraciones de los pacientes y guiar el proceso de rehabilitación. El presente trabajo trata de recoger algunos de los aspectos básicos involucrados tanto en la evaluación como en la rehabilitación de las dificultades atencionales, y proponer un modelo que permite una aproximación a la elaboración de programas de evaluación y rehabilitación individualizados. Por último, se revisan distintos abordajes en la rehabilitación de los problemas de atención. Conclusión. La evaluación debe proporcionar bases explicativas y estrategias de utilidad para el desarrollo de programas de rehabilitación cognitiva. Es necesario establecer una relación entre una neuropsicología más orientada a proponer y verificar modelos cognitivos, y aquella dedicada a la aplicación de estos modelos en los programas de rehabilitación. Se pone de manifiesto la necesidad de programas dirigidos al entrenamiento de habilidades específicas, ya que una estimulación inespecífica y no dirigida (pseudorehabilitación) se ha mostrado inefectiva

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Introduction. Attention disorders are a major problem after traumatic brain injury underlying deficits in other cognitive functions and in everyday activities, hindering the rehabilitation process and the possibility of return to work. Functional neuroimaging and neuropsychological assessment have depicted theoretical models considering attention as a complex and non-unitary process. Development. Although there are conceptual difficulties, it seems possible to establish a theoretical background to better define attentional impairments and to guide the rehabilitation process. The aim of the present study is to review some of the most important pieces involved in the assessment and rehabilitation of attentional impairments. We also propose an appropriate model for the design of individualized rehabilitation programs. Lastly, different approaches for the rehabilitation are reviewed. Conclusions. Neuropsychological assessment should provide valuable strategies to better design the cognitive rehabilitation programs. It is necessary to establish a link between basic and applied neuropsychology, in order to optimize the treatments for traumatic brain injury patients. It is also emphasized that well-defined cognitive targets and skills are required, given that an unspecific stimulation of cognitive processes (pseudorehabilitation) has been shown to be unsuccessful

Asunto(s)

Humanos , Atención/fisiología , Lesiones Traumáticas del Encéfalo/patología , Lesiones Traumáticas del Encéfalo/rehabilitación , Lesiones Traumáticas del Encéfalo/terapia , Pruebas Neuropsicológicas , Lesión Encefálica Crónica/fisiopatología

RESUMEN

INTRODUCTION: The terms 'executive functioning' or 'executive control' refer to a set of mechanisms involved in the improvement of cognitive processes to guide them towards the resolution of complex problems. Both the frontal lobes, acting as structure, and the executive processes, acting as function, work with memory contents, operating with information placed in the diencephalic structures and in the medial temporal lobe. Generally, we can state that many works find an association between frontal damage and specific memory shortages like working memory deficit, metamemory problems, source amnesia, or difficulties in the prospective memory. DEVELOPMENT: This paper is a critical review of the working memory concept and proposes a new term: the attentional operative system that works with memory contents. Concerning the metamemory, the frontal lobes are essential for monitoring processes in general and for 'the feeling of knowing' kind of judgements in particular. CONCLUSIONS: Patients suffering prefrontal damage show serious problems to remember the information source. Thus, the information is rightly remembered but the spatiotemporal context where that information was learned has been forgotten. Finally, the prospective memory deals with remembering to make something in a particular moment in the future and performing the plan previously drawn up.

Asunto(s)

Trastornos de la Memoria/fisiopatología , Memoria/fisiología , Corteza Prefrontal/fisiología , Amnesia/fisiopatología , Atención/fisiología , Cognición/fisiología , Lóbulo Frontal/anatomía & histología , Lóbulo Frontal/patología , Lóbulo Frontal/fisiología , Humanos , Trastornos de la Memoria/patología , Recuerdo Mental/fisiología , Corteza Prefrontal/patología

RESUMEN

Introduction. The terms ‘executive functioning’ or ‘executive control’ refer to a set of mechanisms involved in the improvement of cognitive processes to guide them towards the resolution of complex problems. Both the frontal lobes, acting as structure, and the executive processes, acting as function, work with memory contents, operating with information placed in the diencefalic structures and in the medial temporal lobe. Generally, we can state that many works find an association between frontal damage and specific memory shortages like working memory deficit, metamemory problems, source amnesia, or difficulties in the prospective memory. Development. This paper is a critical review of the working memory concept and proposes a new term: the attentional operative system that works with memory contents. Concerning the metamemory, the frontal lobes are essential for monitoring processes in general and for ‘the feeling of knowing’ kind of judgements in particular. Conclusions. Patients suffering prefrontal damage show serious problems to remember the information source. Thus, the information is rightly remembered but the spatiotemporal context where that information was learned has been forgotten. Finally, the prospective memory deals with remembering to make something in a particular moment in the future and performing the plan previously drawed up (AU)

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Introducción. ‘Funcionamiento ejecutivo’ o ‘control ejecutivo’ hacen referencia a una serie de mecanismos implicados en la optimización de los procesos cognitivos para orientarlos hacía la resolución de situaciones complejas. Los lóbulos frontales como estructura y los procesos ejecutivos como función operan con contenidos de la memoria, trabajando estratégicamente con información que se halla en estructuras diencefálicas y del lóbulo temporal medial. En términos generales podemos afirmar que múltiples trabajos relacionan el daño frontal con déficit de memoria específicos como la afectación de la memoria de trabajo, los problemas de metamemoria, la amnesia de la fuente o las dificultades en la memoria prospectiva. Desarrollo. Se plantea una revisión crítica del concepto de memoria de trabajo para proponer el de sistema atencional operativo que trabaja con contenidos de la memoria. En lo referente a la metamemoria los lóbulos frontales son fundamentales para los procesos de monitorización en general y para los juicios tales como los de ‘sensación de que se conoce’ en particular. Conclusiones. Los pacientes con daño prefrontal muestran una desproporcionada afectación en la memoria para recordar la fuente de la información. Así la información es correctamente recordada, pero el contexto espaciotemporal en el que dicha información se adquirió ha quedado olvidado. Para terminar, la memoria prospectiva hace referencia al recuerdo de hacer algo en un momento concreto del futuro y la ejecución del plan previamente formulado (AU)

Asunto(s)

Humanos , Memoria/fisiología , Función Ejecutiva/fisiología , Procesos Mentales/fisiología , Corteza Prefrontal/fisiología , Amnesia/fisiopatología , Trastornos de la Memoria/fisiopatología , Memoria a Corto Plazo/fisiología

RESUMEN

Introducción. Las funciones ejecutivas incluyen una serie de componentes como son la capacidad implicada en la formulación de metas, las facultades empleadas en la planificación de los procesos y las estrategias para lograr los objetivos pretendidos. En un trabajo anterior, en el que se tomaba como base los modelos que han intentado esclarecer los procesos implicados en las funciones ejecutivas, planteamos un modelo integrador. Desarrollo. A partir de este modelo, en este artículo proponemos un protocolo de evaluación. Así, las funciones ejecutivas entendidas como solución de problemas requieren, en términos genéricos, procesos de selección de objetivos, planificación y monitorización (torre de Hanoi y mapa del zoo). Cada uno de estos subprocesos opera a través de la memoria de trabajo, tanto con la agenda visuoespacial como con el bucle articulatorio. El sistema ejecutivo central o sistema atencional supervisor (SAS) actúa cuando no existe una solución conocida y debemos crear una posible alternativa. Conclusión. En este sentido, el SAS podría contener las siguientes funciones: ampliación de la capacidad del bucle fonológico y de la agenda viusoespacial (tareas tipo Sternberg), manipulación y actualización de la información (paradigma n-back), manipulación y mantenimiento de la información (letras y números de la escala de memoria de Wechsler), trabajar simultáneamente en dos tareas cognitivas (tareas de ejecución dual), inhibición (paradigma de Stroop y go-no go) y alternancia de sets cognitivos (tareas tipo clasificación de cartas de Wisconsin). Una vez que este proceso de planificación se ha llevado a cabo se precisa tomar decisiones (paradigma del juego de cartas) y es el marcador somático el encargado de tal proceso (AU)

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Introduction. Executive functions include a variety of components such as the capacity implicated in goal formulation, the faculties employed in processes planning, and the strategies used to achieve the pretended objectives. In a previous work, taking as starting basis those models which have attempted to clarify those processes implicated in executive functions, we posed an integrative model. Development. Starting from this model, we now propose an assessment protocol. Thus, executive functions considered as problem solving, require in generic terms, objective selection, planning, and monitoring processes (tower of Hanoi and zoo map). Each of these sub-processes operate through the working memory both with the visospatial sketch and the phonological loop. The central executive system, or attentional supervisor system (ASS), acts when there is no known solution and we must create an alternative one. Conclusions. In this sense, the ASS could contain the following functions: amplification of the phonological loop and visospatial sketch capacity (Sternberg type tasks), information manipulation and actualisation (n-back paradigm), information manipulation and maintenance (Wechsler Memory Scale letters and numbers), simultaneously work in two cognitive tasks (dual execution tasks), inhibition (Stroop and go-no go paradigms), and cognitive sets alternation (Wisconsin Card Sorting Test). Once this planning process has been done, we must take a decision (gambling task paradigm), being the somatic marker in charge of this process (AU)

Asunto(s)

Protocolos Clínicos/clasificación , Trastornos del Conocimiento , Pruebas Psicológicas , Neuropsicología , Diagnóstico por Imagen , Escalas de Wechsler

RESUMEN

INTRODUCTION: Executive functions include a variety of components such as the capacity implicated in goal formulation, the faculties employed in processes planning, and the strategies used to achieve the pretended objectives. In a previous work, taking as starting basis those models which have attempted to clarify those processes implicated in executive functions, we posed an integrative model. DEVELOPMENT: Starting from this model, we now propose an assessment protocol. Thus, executive functions considered as problem solving, require in generic terms, objective selection, planning, and monitoring processes (tower of Hanoi and zoo map). Each of these sub-processes operate through the working memory both with the visospatial sketch and the phonological loop. The central executive system, or attentional supervisor system (ASS), acts when there is no known solution and we must create an alternative one. CONCLUSIONS: In this sense, the ASS could contain the following functions: amplification of the phonological loop and visospatial sketch capacity (Sternberg type tasks), information manipulation and actualization (n-back paradigm), information manipulation and maintenance (Wechsler Memory Scale letters and numbers), simultaneously work in two cognitive tasks (dual execution tasks), inhibition (Stroop and go-no go paradigms), and cognitive sets alternation (Wisconsin Card Sorting Test). Once this planning process has been done, we must take a decision (gambling task paradigm), being the somatic marker in charge of this process.

Asunto(s)

Protocolos Clínicos , Cognición/fisiología , Memoria/fisiología , Pruebas Neuropsicológicas , Desempeño Psicomotor , Algoritmos , Diagnóstico por Imagen , Humanos , Reconocimiento Visual de Modelos/fisiología , Solución de Problemas/fisiología

RESUMEN

OBJECTIVE: To describe how cognitive impairments contribute to the loss of communicative competence after traumatic brain injury (TBI), what instruments can be used to evaluate the pragmatic skills and which therapeutic approaches may be used to improve or compensate for this deficit. DISCUSSION: We present a detailed bibliographic review on the topic that shows how certain functions (namely, memory, attention and executive functions) interact with communication skills, both expressive and comprehensive. The pragmatic approaches for cognitive-communicative TBI impairments are allow to count typical difficulties that are described (difficulty with topic selection, turn-taking initiation, ability to respond or give indirect requests, ability to meet the informational needs of the listener, appropriateness of utterances within conversation, etc). Next a general outline of the assessment and treatment of is provided, including several strategies based on recovery and functional adaptation and compensation. CONCLUSIONS: Given the huge influence of communicative skills on social and vocational integration, it is crucial to obtain a better understanding of the interaction between cognitive functions and communicative skills. Therefore, we need to devise assessment protocols specifically designed for Spanish speakers as well as new therapeutic approaches to increase the life quality of this population. The specific approaches to improve narrative, procedural and conversational discourse must divide from the components of the pragmatic competence and promote the cooperative participation of the teamwork who attend to the patient.

Asunto(s)

Lesiones Encefálicas/fisiopatología , Trastornos del Conocimiento/fisiopatología , Atención/fisiología , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/patología , Lesiones Encefálicas/rehabilitación , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/terapia , Trastornos de la Comunicación/etiología , Trastornos de la Comunicación/fisiopatología , Trastornos de la Comunicación/terapia , Humanos , Memoria/fisiología , Ajuste Social

RESUMEN

INTRODUCTION: The executive functions are the high-level functions that have generated many studies. These functions comprise a whole range of cognitive abilities related to novelty problem solving. So, it includes: goal selection, planning, initiation of activity, self regulation and use of feedback. There are many papers about the definition of executive functions and about their deficits in different pathologies. However, there only exist a few works about the possibility of recovering these functions and the elaboration of programs of cognitive rehabilitation. AIM AND METHOD: The aim of this report is to review the main rehabilitation programs for executive functions and to adapt them to our culture and context from a theoretical practice perspective. In spite of the utility of these programs, we make a reflection on their limitations. In this sense, we emphasized the oversight of emotional aspects involved in decision making. Besides, new directions for the investigation in this area are pointed out.

Asunto(s)

Trastornos del Conocimiento/rehabilitación , Actividad Nerviosa Superior , Actividades Cotidianas , Adaptación Psicológica , Atención , Terapia Conductista , Daño Encefálico Crónico/psicología , Daño Encefálico Crónico/rehabilitación , Toma de Decisiones , Emociones , Humanos , Trastornos Mentales/rehabilitación , Solución de Problemas , Administración del Tiempo

RESUMEN

OBJECTIVE: We review the main aspects of functional recovery after brain injury as well as neuroimaging characteristics that make it relevant and useful to assess these changes. We also review some issues regarding recovery of motor and sensory functions, language and visuo spatial processes, and we discuss the methods used in this field, the difficulties found, and future implications. DEVELOPMENT: One of the main aspects in the study of the brain is the capacity to reorganize different functions in order to compensate for the deficits after a lesion in the central nervous system. The study of these adaptive processes is important in a clinical field as well as for basic research, as it is a clear example of brain plasticity. All the findings show how the study of the plastic phenomena or functional reorganization will allow us to better know how the brain works after a lesion. CONCLUSION: The use and combination of the new functional neuroimaging techniques gives the opportunity to register the reorganization of the brain with a high temporal and spatial resolution. It will give also an objective measure to assess the effectiveness of the rehabilitation programs. It will allow to identify different variables related to rehabilitation outcome and will guide effectively the selection of different rehabilitation approaches.

Asunto(s)

Lesiones Encefálicas/patología , Lesiones Encefálicas/rehabilitación , Diagnóstico por Imagen/métodos , Plasticidad Neuronal/fisiología , Recuperación de la Función/fisiología , Humanos , Lenguaje , Actividad Motora/fisiología , Sensación/fisiología

RESUMEN

INTRODUCTION AND OBJECTIVE: Cognitive deficits following lesions in parieto occipital areas tend to cause, among others, visuospatial and visuoperceptive alterations. The aim of this article is to examine the influence of others possible deficit over its rehabilitation. DEVELOPMENT: We discuss several patients who present visuospatial impairment after different brain injuries, not only those affecting the areas typically involved in these deficits, such as parieto occipital cortex. Rehabilitation was conducted on an individual basis in the brain injury unit of Beata Maria Ana hospital. Neuropsychological evaluation showed some difficulties not previously described together with these deficits, related to attention, working memory and executive functions, as well as topographic disorientation, lack of visuospatial coordination, distances perception disorders and difficulty to mentally rotate objects. The rehabilitation was AIMed not only at restoration but also compensation of visuospatial deficits, successfully achieved after treatment: patients were capable of returning to their daily activities, including their jobs. CONCLUSION: In patients with visuospatial deficits, a compressive neuropsychological evaluation seem to be essential to define the influence of the other cognitive domains over the rehabilitation of visuospatial problems. In particular, the reinforcement of processes related to attention control and executive functions could very important, give their contribution to the learning of compensatory strategies and assuming that those functions pay key role in the organization and supervision demanded for perceptual skills.

Asunto(s)

Atención , Lesiones Encefálicas/rehabilitación , Trastornos del Conocimiento/rehabilitación , Trastornos de la Percepción/rehabilitación , Percepción Espacial , Rehabilitación de Accidente Cerebrovascular , Percepción Visual , Adulto , Anciano , Anafilaxia/complicaciones , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/psicología , Isquemia Encefálica/complicaciones , Isquemia Encefálica/psicología , Isquemia Encefálica/rehabilitación , Trastornos Disruptivos, del Control de Impulso y de la Conducta/etiología , Trastornos Disruptivos, del Control de Impulso y de la Conducta/rehabilitación , Movimientos Oculares/fisiología , Hemianopsia/complicaciones , Humanos , Complicaciones Intraoperatorias/psicología , Complicaciones Intraoperatorias/rehabilitación , Masculino , Pruebas Neuropsicológicas , Lóbulo Occipital/irrigación sanguínea , Lóbulo Occipital/lesiones , Lóbulo Occipital/fisiopatología , Lóbulo Parietal/irrigación sanguínea , Lóbulo Parietal/lesiones , Lóbulo Parietal/fisiopatología , Reconocimiento Visual de Modelos , Recuperación de la Función , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/psicología , Vías Visuales/fisiopatología

RESUMEN

Medico-legal assessment of people who have suffered injuries in road traffic accidents must use Law 30/95 as a reference frame. Psychiatric and neuropsychological syndromes secondary to traumatic brain injury (TBI) are no exception and pose demanding challenges to physicians and psychologists. This paper analyzes descriptive and nosological difficulties face by psychiatrists and psychologists; their expert contribution includes translation of official diagnostic entities into categories published in the annex of Law 30/95. Our psychopathological repertoire was created in the 19th century and has hardly been revised since. The wide and varied types of neuropsychological impairments encountered in TBI have to be diagnosed within a very narrow range of DSM-IV and ICD-10 categories. The most common conflicts encountered in the medicolegal arena are revised: the differential diagnosis between dementia and combinations of organic personality disorder with cognitive impairment; differential diagnosis between spontaneous psychiatric illness (bipolar disorder, schizophrenia) and psychiatric syndromes secondary to brain injury (posttraumatic psychosis, organic bipolar disorder); differential diagnosis between concussional syndrome and organic personality disorder, cognitive impairment or organic affective disorder. Specific diagnostic guidelines are suggested for each of these clinical situations. Actas Esp Psiquiatr 2003;31(6):353-360

Asunto(s)

Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/psicología , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Trastornos Mentales/diagnóstico , Trastornos Mentales/etiología , Servicios de Salud Mental/legislación & jurisprudencia , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Humanos , Clasificación Internacional de Enfermedades , Pruebas Neuropsicológicas , España

RESUMEN

INTRODUCTION: There are many definitions in order to describe the consciousness. In the literature appear concepts such alertness, attention, knowledge, conscious experience, awareness of deficits, self awareness, theory of mind in relation with consciousness definition. This multiplicity conceptual lead to formulate a question: Do exist different levels of complexity in the consciousness that depend on neuroanatomics structures differentiated? METHOD: In this paper an approximation toward a taxonomy of consciousness is offered and five levels of complexity and its relation with cerebral structures differentiated are suggested. In the first place, it s consider the alertness state as a necessary condition to exist the consciousness and his relation with attentional states. In the second place, it s present the conscious experience that depends on synchronicity neural activity. On the other hand, the daily clinic work shows the possibility of the existence of a consciousness for each specific field of knowledge. In the fourth place, it s located the self awareness understood like the capacity to perceive to us with objectivity but maintaining a subjectivity sense. At last, the theory of mind refers to the ability for attribute to the others specific mental states. CONCLUSION: It s plan an analysis of the different models that have tried to give an answer to each one of complexity levels to attempt an approach based on the analytic science and not descriptive plane.

Asunto(s)

Encéfalo/fisiología , Estado de Conciencia/clasificación , Modelos Neurológicos , Atención , Concienciación , Encéfalo/anatomía & histología , Cognición , Humanos , Autoimagen

RESUMEN

Introducción. Conceptos tales como alerta, atención, conocimiento, experiencia consciente, conciencia del déficit, autoconciencia o teoría de la mente aparecen en la literatura relacionados con la definición de conciencia. Esta multiplicidad conceptual nos lleva a plantear una pregunta: ¿existen diferentes niveles de complejidad en laconciencia que dependen de estructuras neuroanatómicas diferenciadas? Desarrollo. En este artículo se ofrece una aproximación hacia una taxonomía de la conciencia y se sugieren básicamente cinco niveles de complejidad y su relación con estructuras cerebrales diferenciadas. Así, en primer lugar se plantea el estado de alerta como una condición necesaria para que se dé la conciencia, y se relaciona con estados atencionales. En segundo lugar se sitúa la experiencia consciente que dependería de pautas de actividad cerebral sincronizada. Por otra parte, la labor clínica cotidiana muestra la posibilidad de la existencia de una conciencia para cada dominio específico de conocimiento. En cuarto lugar, situamos la autoconciencia, entendida como la capacidad de percibir en términos objetivos manteniendo un sentido de subjetividad. Por último, la teoría de la mente hace referencia a la capacidad de atribuir estados mentales específicos a otros individuos. Conclusión. Se plantea un análisis de los diferentes modelos que han intentado dar respuesta a cada uno de los niveles de complejidad de la conciencia, y se define el contenido de cada nivel para intentar un acercamiento basado en la ciencia analítica y no centrado en el plano de la descripción del concepto (AU)

Asunto(s)

Humanos , Modelos Neurológicos , Autoimagen , Atención , Concienciación , Cognición , Estado de Conciencia , Telencéfalo

RESUMEN

INTRODUCTION: The new cognitive neuropsychology approaches have aroused an increasing interest in understanding the higher cognitive processes as well as the neural substrates linked to them. Particularly, the executive functions, reckoned to be essential to control the information processing and to co ordinate behaviour, have received preferential treatment from specialised literature on the subject. DEVELOPMENT: From obsessive compulsive disorder to schizophrenia, from Parkinson s disease to multiple sclerosis, there are many reports that show the affectation of these functions in all these morbid processes. On the other hand, the part that the prefrontal cortex plays in human behaviour in general, and in executive functions in particular, constitutes one of the most important fields of research of neurosciences nowadays. Thus, this cortical area appears closely linked to the executive processes, affecting different respects of the cognitive functions. Working memory, supervisory attentional system, somatic marker, information processing, behaviour planning, social judgement, are processes which have been related to the prefrontal cortex activity as a structure, and to the executive processes as a function. CONCLUSIONS: The aim of this article is to revise the concept of executive functions, and give rise reflections about the usefulness of the aforementioned concept and its practical applicability. It is essential that we understand the difference between structure and function, cognition and emotion, brain activity and behaviour, category and dimension, and between mind and brain, to achieve a more comprehensive approach to this concept of executive functions we all use, and many times find difficult to define and to understand.

Asunto(s)

Trastornos del Conocimiento/fisiopatología , Corteza Prefrontal/fisiopatología , Trastornos del Conocimiento/diagnóstico , Humanos , Trastornos de la Memoria/diagnóstico , Trastornos de la Memoria/fisiopatología , Red Nerviosa/fisiopatología , Pruebas Neuropsicológicas

RESUMEN

Introducción. Los nuevos modelos de la neuropsicología cognitiva han generado un creciente interés por comprender los procesos cognitivos superiores y los sustratos neurales asociados a dichos procesos de alto nivel. En particular, las denominadas funciones ejecutivas, consideradas como imprescindibles para controlar el procesamiento de la información y coordinar la conducta, han recibido un trato especial por parte de la literatura especializada en este tema. Desarrollo. Desde el trastorno obsesivo-compulsivo hasta la esquizofrenia, desde la enfermedad de Parkinson a la esclerosis múltiple, son numerosos los trabajos que indican la afectación de estas funciones en cualquier proceso mórbido. El papel que desempeña la corteza prefrontal en la conducta humana en general y en las funciones ejecutivas en particular es una de las más importantes áreas de investigación de las neurociencias en la actualidad. Así, esta región cortical aparece íntimamente unida a los procesos ejecutivos y afecta a diversos aspectos del funcionamiento cognitivo. Memoria de trabajo, sistema atencional supervisor, marcador somático, procesamiento de la información, planificación de la conducta y juicio social son procesos que se han ligado al funcionamiento de la corteza prefrontal como estructura y a los procesos ejecutivos como función. Conclusiones. Es propósito de este artículo realizar una revisión del concepto de funciones ejecutivas y plantear algunas reflexiones sobre la utilidad de dicho concepto y su aplicación práctica. Comprender la diferencia entre estructura y función, entre cognición y emoción, entre actividad cerebral y conducta, entre lo categorial y lo dimensional o entre mente y cerebro se nos antoja fundamental para lograr un mejor acercamiento a este concepto que todos utilizamos y que, en muchos momentos, tan difícil nos parece de comprender (AU)

Asunto(s)

Humanos , Corteza Prefrontal , Trastornos de la Memoria , Red Nerviosa , Trastornos del Conocimiento , Pruebas Neuropsicológicas

RESUMEN

INTRODUCTION: Personality change due to head injury is one of the most prevalent neuropsychiatric posttraumatic disorders and causes significant impairment in familial, social or occupational functioning. OBJECTIVES: To study the prevalence and clinical characteristics of personality changes secondary to severe closed head injuries, according to DSM-IV criteria. PATIENTS AND METHODS: Fifty-five patients (aged 15-65 years) with severe head trauma were studied during the chronic stage (11-3 months) with the following instruments: the Revised Iowa Collateral Head Injury Interview for the assessment of posttraumatic frontal symptoms, the Standardized Polyvalent Psychiatric Interview of Lobo et al, assessment of premorbid personality and its exacerbation, and the Scale of Aggressiveness of Yudofsky. RESULTS: Thirty-three patients (60% of the sample) fulfilled DSM-IV criteria for personality change due to head injury; two thirds of them were combined or mixed type, which consists in the association of two or more types specified in the DSM-IV. The most prevalent types were apathic, unstable, disinhibited, aggressive, which are related with lesions in prefrontal cortex. There were nine patients with 'unspecified' symptoms, such as 'inappropriate euphoria' and 'poor insight', and other symptoms related to executive dysfunction. CONCLUSIONS: One third of cases of personality changes were related to premorbid features; this fact argues against the exclusion of the criterium 'excerbation of premorbid personality traits' in DSM-IV. Only one third of posttraumatic personality changes can be classified according to DSM-IV and ICD-10 criteria. The high prevalence of symptoms related to deficit in self-awareness and executive dysfunction suggest the need of further investigations about nosology in this field.

Asunto(s)

Traumatismos Cerrados de la Cabeza/complicaciones , Trastornos de la Personalidad/etiología , Adolescente , Adulto , Anciano , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Trastornos de la Personalidad/diagnóstico , Pruebas de Personalidad , Índices de Gravedad del Trauma

RESUMEN

OBJECTIVE: To show the degree of detection of simulation, defined as the conscious, intentional production of false or exaggerated physical and psychological symptoms, motivated by external rewards such as payments by insurance companies and compensations. DEVELOPMENT: In forensic circles, a major problem is under consideration, namely recognition of the existence and nature of cognitive alterations after mild head injury (HI), since it is estimated that in 5-10% of the cases of mild HI there may be simulation of cognitive and emotional deficit, with further difficulty of differential diagnosis between simulation and the post-concussion syndrome. CONCLUSIONS: The forensic assessment of cognitive alterations following HI should include a clinical interview and neuropsychological evaluation. The former helps to determine the causal relationship between the traumatic accident and the resulting damage, continuance of symptoms and the existence or not of a premorbid pathological state. Although there is still not completely reliable, valid marker which permits one to be completely certain that the person is a simulator, neuropsychological evaluation permits suspicion of it in three aspects: 1. General indicators showing lack of internal consistence in the results of the person evaluated. 2. Specific tests to detect possible cases of simulation. 3. Profiles of responses which characterize possible simulators and neuropsychological evaluation tests.

Asunto(s)

Lesiones Encefálicas , Trastornos del Conocimiento , Psiquiatría Forense , Simulación de Enfermedad , Pruebas Neuropsicológicas , Síntomas Afectivos , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/fisiopatología , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/fisiopatología , Diagnóstico Diferencial , Evaluación de la Discapacidad , Humanos

RESUMEN

INTRODUCTION: Posconcussional syndrome is characterized by a heterogeneous group of somatic, cognitive and psychosocial symptoms, which occur in patients with head trauma, generally of mild severity. It is the neuropsychiatric postraumatic disorder more prevalent in the field of forensic medicine. DEVELOPMENT: Classical authors (Lishamn and Barraquer, for example) focused on controversial aspects of this syndrome, such as conceptual problems and etiology (organic versus functional). The objective of this report is to review the posconcussional literature in search of relevant aspects in forensic neuropsychology: conceptual aspects, epidemiology, etiology, clinical features, methodology for assessment, and its differential diagnosis with other postraumatic disorders, such as postraumatic stress disorder, adjustment disorder, anxiety disorder, mood disorders (major depressive disorder), substancerelated disorders, dementia due to head trauma, amnesic disorder, somatoform disorders, factitious disorder, malingering, chronic pain and chronic whiplash syndrome.

Asunto(s)

Síndrome Posconmocional/diagnóstico , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Diagnóstico Diferencial , Humanos , Trastornos del Humor/diagnóstico , Trastornos del Humor/etiología , Pruebas Neuropsicológicas , Síndrome Posconmocional/complicaciones , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/etiología , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/etiología , Encuestas y Cuestionarios

RESUMEN

INTRODUCTION AND OBJECTIVE: Establishment of the prognosis after traumatic brain damage is an important question for doctors, patients and their families, as well as for health organizations and insurers. The precision of the prognosis varies markedly according to the final objective of the prediction (mortality, severity and type of residual defects, return to work), apart from consideration of the many factors which may affect the clinical course after this type of lesion. Our study considers the current state of this question. DEVELOPMENT: We consider the main methodological difficulties in carrying out such studies and review the main variables affecting the prognosis in head injuries, divided into three general groups (severity and type of lesion, characteristics of the individual and variables depending on the context). Finally, we make general comments on the effect of multidisciplinary rehabilitation in relation to the functional prognosis and level of social and employment integration attained by the injured persons.

Asunto(s)

Lesiones Encefálicas/complicaciones , Factores de Edad , Amnesia/etiología , Daño Encefálico Crónico/epidemiología , Daño Encefálico Crónico/etiología , Lesiones Encefálicas/mortalidad , Lesiones Encefálicas/patología , Lesiones Encefálicas/psicología , Lesiones Encefálicas/rehabilitación , Trastornos del Conocimiento/etiología , Coma/etiología , Diagnóstico por Imagen , Escala de Coma de Glasgow , Humanos , Pruebas Neuropsicológicas , Terapia Ocupacional , Trastornos de la Personalidad/etiología , Pronóstico , Evaluación de Programas y Proyectos de Salud , Factores de Riesgo , Índice de Severidad de la Enfermedad , Apoyo Social , Factores de Tiempo