- •Behavioral problems (e.g., depression) in epilepsy are common but usually of mild severity.
- •30 AED-sensitive items were discerned from the BDI-I, NDDI-E, and FPZ.
- •Items were classified into six scales, constituting the new screening tool “PsyTrack”.
- •PsyTrack subscale scores differed as a function of drug load and presence of AEDs with negative psychotropic effects.
- •Generally, monotherapy seems to be favorable in terms of behavioral adverse effects.
Posts Tagged behavior
[Abstract] Affective and behavioral dysfunction under antiepileptic drugs in epilepsy: Development of a new drug-sensitive screening tool
Behavioral problems and psychiatric symptoms are common in patients with epilepsy and have a multifactorial origin, including adverse effects of antiepileptic drugs (AEDs). In order to develop a screening tool for behavioral AED effects, the aim of this study was to identify behavioral problems and symptoms particularly sensitive to AED drug load and the presence/absence of AEDs with known negative psychotropic profiles.
Four hundred ninety-four patients with epilepsy were evaluated who had been assessed with three self-report questionnaires on mood, personality, and behavior (Beck Depression Inventory, BDI; Neurological Disorders Depression Inventory for Epilepsy extended, NDDI-E; and Fragebogen zur Persönlichkeit bei zerebralen Erkrankungen, FPZ). Drug-sensitive items were determined via correlation analyses and entered into an exploratory factor analysis for scale construction. The resulting scales were then analyzed as a function of drug treatment.
Analyses revealed 30 items, which could be allocated to six behavioral domains: Emotional Lability, Depression, Aggression/Irritability, Psychosis & Suicidality, Risk- & Sensation-seeking, and Somatization. Subsequent analysis showed significant effects of the number of AEDs on behavior, as in Emotional Lability (F = 2.54, p = .029), Aggression/Irritability (F = 2.29, p = .046), Psychosis & Suicidality (F = 2.98, p = .012), and Somatization (F = 2.39, p = .038). Affective and behavioral difficulties were more prominent in those patients taking AEDs with supposedly negative psychotropic profiles. These effects were largely domain-unspecific and primarily manifested in polytherapy.
Drug-sensitive behavioral domains and items were identified which qualify for a self-report screening tool. The tool indicates impairments with a higher drug load and when administering AEDs with negative psychotropic profiles. The next steps require normalization in healthy subjects and the clinical validation of the newly developed screening tool PsyTrack along with antiepileptic drug treatment.
[ARTICLE] Using Virtual Reality to Transfer Motor Skill Knowledge from One Hand to Another – Full Text
As far as acquiring motor skills is concerned, training by voluntary physical movement is superior to all other forms of training (e.g. training by observation or passive movement of trainee’s hands by a robotic device). This obviously presents a major challenge in the rehabilitation of a paretic limb since voluntary control of physical movement is limited. Here, we describe a novel training scheme we have developed that has the potential to circumvent this major challenge. We exploited the voluntary control of one hand and provided real-time movement-based manipulated sensory feedback as if the other hand is moving. Visual manipulation through virtual reality (VR) was combined with a device that yokes left-hand fingers to passively follow right-hand voluntary finger movements. In healthy subjects, we demonstrate enhanced within-session performance gains of a limb in the absence of voluntary physical training. Results in healthy subjects suggest that training with the unique VR setup might also be beneficial for patients with upper limb hemiparesis by exploiting the voluntary control of their healthy hand to improve rehabilitation of their affected hand.
Physical practice is the most efficient form of training. Although this approach is well established1, it is very challenging in cases where the basic motor capability of the training hand is limited2. To bypass this problem, a large and growing body of literature examined various indirect approaches of motor training.
One such indirect training approach uses physical practice with one hand to introduce performance gains in the other (non-practiced) hand. This phenomenon, known as cross-education (CE) or intermanual transfer, has been studied extensively 3,4,5,6,7,8,9 and used to enhance performance in various motor tasks 10,11,12. For instance, in sport skill settings, studies have demonstrated that training basketball dribbling in one hand transfers to increased dribbling capabilities in the other, untrained hand 13,14,15.
In another indirect approach, motor learning is facilitated through the use of visual or sensory feedback. In learning by observation, it has been demonstrated that significant performance gains can be obtained simply by passively observing someone else perform the task16,17,18,19,20. Similarly, proprioceptive training, in which the limb is passively moved, was also shown to improve performance on motor tasks 12,21,22,23,24,25,26.
Together, these lines of research suggest that sensory input plays an important role in learning. Here, we demonstrate that manipulating online sensory feedback (visual and proprioceptive) during physical training of one limb results in augmented performance gain in the opposite limb. We describe a training regime that yields optimal performance outcome in a hand, in the absence of its voluntary physical training. The conceptual novelty of the proposed method resides in the fact that it combines the three different forms of learning – namely, learning by observation, CE, and passive movement. Here we examined whether the phenomenon of CE, together with mirrored visual feedback and passive movement, can be exploited to facilitate learning in healthy subjects in the absence of voluntary physical movement of the training limb.
The concept in this setup differs from direct attempts to physically train the hand. At the methodological level – we introduce a novel setup including advanced technologies such as 3D virtual reality, and custom built devices that allow manipulating visual and proprioceptive input in a natural environmental setting. Demonstrating improved outcome using the proposed training has key consequences for real-world learning. For example, children use sensory feedback in a manner that is different from that of adults27,28,29 and in order to optimize motor learning, children may require longer periods of practice. The use of CE together with manipulated sensory feedback might reduce training duration. Furthermore, acquisition of sport skills might be facilitated using this kind of sophisticated training. Finally, this can prove beneficial for the development of a new approach for rehabilitation of patients with unilateral motor deficits such as stroke.[…]
[ARTICLE] Eslicarbazepine acetate as a replacement for levetiracetam in people with epilepsy developing behavioral adverse events – Full Text
Psychiatric and behavioral side effects (PBSEs) are a major cause of antiepileptic drug (AED) withdrawal. Levetiracetam (LEV) is a recognized first-line AED with good seizure outcomes but recognized with PBSEs. Eslicarbazepine (ESL) is considered to function similarly to an active metabolite of the commonly used carbamazepine (CBZ). Carbamazepine is used as psychotropic medication to assist in various psychiatric illnesses such as mood disorders, aggression, and anxiety.
The aim was to evaluate the psychiatric profile of ESL in people who had LEV withdrawn due to PBSEs in routine clinical practice to see if ESL can be used as a possible alternative to LEV.
A retrospective observational review was conducted in two UK epilepsy centers looking at all cases exposed to ESL since its licensing in 2010. The ESL group was all patients with treatment-resistant epilepsy who developed intolerable PBSEs to LEV, subsequently trialed on ESL. The ESL group was matched to a group who tolerated LEV without intolerable PBSEs. Psychiatric disorders were identified from case notes. The Hamilton Depression Scale (HAM-D) was used to outcome change in mood. Clinical diagnoses of a mental disorder were compared between groups using the Fisher’s exact test. Group differences in HAM-D scores were assessed using the independent samples t-test (alpha = 0.05).
The total number of people with active epilepsy in the two centers was 2142 of whom 46 had been exposed to ESL. Twenty-six had previous exposure to LEV and had intolerable PBSEs who were matched to a person tolerating LEV. There was no statistical differences in the two groups for mental disorders including mood as measured by HAM-D (Chi-square test: p = 0.28).
The ESL was well tolerated and did not produce significant PBSEs in those who had PBSEs with LEV leading to withdrawal of the drug. Though numbers were small, the findings suggest that ESL could be a treatment option in those who develop PBSEs with LEV and possibly other AEDs.
Epilepsy is a neurological condition with an enduring predisposition to generate seizures and is associated with cognitive, psychological, and social issues . Neuropsychiatric disorders are also more prevalent in people with epilepsy than in the general population  ; . There is, however, still ambiguity as to whether these comorbidities are the result of a direct link such as a genetic predisposition or structural cause leading to seizures and psychiatric problems or if seizures over time lead to psychiatric symptoms .
Treatment strategies in epilepsy need to be tailored to the individual and in particular, clinicians when choosing the appropriate antiepileptic drug (AED) medication need to pay attention not only to seizure patterns but also to a number of different parameters such as age, gender, comorbidities, and cognitive state.
Up to 75% of people with epilepsy may at some point have mental health issues. Antiepileptic drugs also have the potential to impact on mental health and cognition  ; , and treatment with some AEDs is associated with the occurrence of psychiatric and behavioral side effects (PBSEs) while other may have beneficial psychotropic effects ; ;  ; . The PBSEs are often overlooked in epilepsy management and, withdrawal of an AED occurs only if the impact of these symptoms is significant and usually a risk to self or others.
Understanding psychotropic effects of (AEDs) is crucial but knowledge is limited. Carbamazepine (CBZ)-purported mode of action is via the modulation of voltage-sensitive sodium channels. Apart from antiepileptic action, CBZ is also used as a mood stabilizer and has proven efficacy in affective disorders. Oxcarbazepine (OXB) is structurally related to CBZ and is a prodrug that is converted into licarbazepine. The active form licarbazepine is the S enantiomer, known as eslicarbazepine (ESL). The presumed mechanism of action is as for CBZ. Conversely, OXB has never been proven to work as a mood stabilizer. In view of similarities of the postulated mechanism of action but a better tolerability profile, OXB has been used “off label” in mood management.
Levetiracetam (LEV), a commonly prescribed AED in the UK, is associated with PBSEs including irritability, depression, and anxiety  ; . A study suggested that PBSEs occurred in around 17% of people exposed to commonly used AEDs. Nearly 1 in 5 study participants on LEV reported PBSEs to LEV. However for CBZ the reported PBSEs were significantly lower . The ESL did not figure in this study. Another study suggested that PBSEs with ESL were < 2.5%. While side effects such as irritability, anxiety, and aggressive behavior have been associated with other AEDs, rates of aggression and agitation were comparable between ESL and placebo . […]
Richard Pfau, who holds a doctorate in science education and an undergraduate degree in psychology, wrote Your Behavior: Understanding and Changing the Things You Do as a reaction to what he sees as the current state of psychology. In his own words, the psychology field today is “scattered and speculative”.
Pfau’s goal with Your Behavior is to synthesize work from various fields including psychology, sociology, anthropology, and biology into a coherent explanation of why we do the things we do, and to do so in a way that is accessible to both laypeople and professionals. Throughout the book, he draws from perceptual control theory (PCT) to help readers understand their own behavior and how to change it.
Pfau does an excellent job of ordering and organizing his work. He begins with establishing the reader as an “autopoietic being,” which includes the assertion that we are wired to survive. As such, he asserts that most of our behaviors are done to ensure survival and often occur without conscious thought.
Pfau examines the origins of behavior from the cellular level up to all possible environmental levels and discusses how the different levels interact with each other in a system that is not strictly linear.
In life, most of us have “references,” or things like goals, plans, or how we think things ought to be. We change our behaviors based on our perceptions of how congruent they are with our references. A basic example could be something as simple as putting on a jacket when it is cold. Our body’s reference is to maintain its optimum temperature and homeostasis. But it can also be much more complicated. For instance, the references a person may have in his or her political or religious beliefs may lead to behaviors to bring the references for those beliefs into being.
We behave in such a way that our perceptions give us feedback to ensure we are in congruence with our references, whether our behavior is or is not a conscious thing. At times, we may mistakenly attribute a behavior to one level when it is a result of a different level. We are in constant interaction with our environment in terms of our perceptions of our references. Pfau offers a truly intriguing look at human behavior.
The first ten chapters offer a comprehensive overview of perceptual control theory (PCT) and why people behave the way they do, which includes a look at both ourselves and others. Pfau has organized the book in a way so that the reader can delve as deeply as they want.
Each chapter begins with a brief overview and contains multiple boxed highlights that give examples of topics in the chapter, or more in-depth information about concepts. These were very helpful as refreshers of what concepts mean throughout the book. I do not recall ever coming across PCT or autopoiesis before reading Your Behavior.
Each chapter ends with a preview of the following chapter, which gives a sense of the intentional continuity of the educational process of this book. There is an extensive list of references for further reading at the end of each chapter, as well as endnotes that give further information on the covered material. The organization and presentation are very straightforward, well thought out, and excellently presented.
I am still debating Pfau’s critique of current behavioral theory. He says that the term “culture” is abstract, and therefore a statement such as “culture causes behavior” is meaningless or misleading, and cannot be verified. But just as humans evolve in the interplay with their environment to survive, cultures also evolve, and generally due to the shortness of our lives, cultures (our interplay with our environment in a systems way) evolve outside of our awareness.
I think it may come down to “abstract” versus “construct.” There are arguments that the self is a construct, which I don’t think is addressed in this work. While reading this, I became curious as to how PCT would address the self, and perhaps culture, as a construct.
After providing a very thorough understanding of PCT and why we and others behave the way we do, the final two chapters guide us through analyzing our own behaviors, and how to systematically change them.
Pfau calls upon the works of several individuals for this, but one that stood out to me was John Norcross, who has been involved in the transtheoretical model of change over the years. (Curiously, I didn’t find any reference to the model here.)
There are very useful appendices including checklists and forms with cues to help readers analyze and develop a way to change their own behavior. Pfau even discusses his own change process with weight and smoking.
This is a very comprehensive work that is clearly presented. Your Behavior is a good book for anyone interested in behavioral change with a theory backing it that encompasses a comprehensive system from the cellular level up.
This guest article appeared on PsychCentral.com: Your Behavior: Understanding & Changing the Things You Do and was originally posted on Psych Central by Richard H. Pfau and reviewed by Stan Rockwell, PsyD.
Richard H. Pfau (2017) Your Behavior: Understanding and Changing the Things You Do. Paragon House.
- Traumatic brain injury,
- Behavioral abnormalities,
- Sleep-wake disorder
When a traumatic brain injury occurs, according to the National Institutes of Health, several brain functions are disrupted causing various degrees of damage from mild to permanent.
Traumatic brain injury can be caused by blunt force trauma or by an object piercing the brain tissue.
Symptoms may be mild and temporary, moderate, or severe. Often, the injury requires brain surgery to remove ruptured blood vessels or bruised brain tissue.
Disabilities may arise depending on the extent of damage from the traumatic brain injury.
The following six brain functions suffer the most after a traumatic brain injury, according to the Mayo Clinic:
When an injury occurs at the base of the skull and damages the cranial nerves, the following complications may result:
- Facial muscle paralysis
- Eye nerve damage resulting in double vision
- Loss of sense of smell
- Vision loss
- Loss of facial sensation
- Problems with swallowing
A traumatic brain injury, depending on the severity of damage, can cause significant changes in cognitive and executive functioning abilities including the following:
- Mental processing speed
- Attention or concentration
- Problem-solving skills
- Multitasking abilities
- Task initiation or completion ability
Traumatic brain injuries can significantly disrupt and affect cognitive and communication skills and have lasting social implications. The following communication and social problems may result from a traumatic brain injury:
- Difficulty understanding speech or writing
- Difficulty with speech or writing
- Disorganized thoughts
- Conversational confusion and awkwardnes
Behavioral changes may be seen after a traumatic brain injury and may include the following:
- Lack of self-control
- Risky behavior
- Self-image issues
- Social difficulties
- Verbal or physical outbursts
Emotional changes may include the following:
- Mood swings
- Lack of empathy
- Insomnia and other sleep-related problems
- Self-esteem changes
Damage from a traumatic brain injury may greatly affect a person’s senses including:
- Ringing in the ears
- Problems with hand-eye coordination
- Blind spots or double vision
- Issues with taste or smell
- Tingling, pain, or itching of the skin
- Dizziness or vertigo
- Object-recognition difficulties
TBI Myths & Facts
- how old the person was at injury
- what part of the brain was injured
- how severe the injury was
Everyone’s brain injury is different and the recovery patterns are too. Getting our facts straight is a crucial first step in moving toward the best possible outcomes.
Let’s get our Facts Straight
Myth: Knowing which parts of the brain have been injured will tell you the specific challenges to expect.
By knowing the location of the injury to the brain, you may have some indication of the problems to expect but not to the point of being able to predict specifically what lies ahead. Injury to brain tissue may be much more extensive than just at the site of injury. Every response to brain injury is different.
Fact: With support, many people can change their behavior after a brain injury.
With proper support and therapeutic intervention, many people with brain injury have the ability to change their behavior, learn new things, and lead full and productive lives.
Fact: Many families report that the most challenging problems after brain injury are problems with cognition (learning and thinking) and behavior (emotions and actions).
Cognitive and behavioral problems tend to present the most challenges for families. The good news is that most of these problems can be addressed. You can find many types of support in this website.
Myth: The best way to help a person with brain injury is to assist them with tasks.
As a parent, sibling or spouse of an adult with brain injury, general wisdom suggests that you be there to assist when needed, but avoid offering assistance for activities that can be done independently. Overriding your family member’s efforts (such as jumping in to finish sentences or tasks) lessens a personal sense of dignity, respect and self-worth.
Myth: After a brain injury, a person’s basic emotional needs change.
People with brain injury have the same emotional needs as every other person: to feel loved, to feel useful, to feel needed, to be treated with respect and to exercise control over their lives.
Fact: Personality traits can intensify (become stronger) after a brain injury.
A mild mannered person may tend to become more mild mannered. An aggressive personality may tend to become more difficult and more aggressive after brain injury.
Fact: It is best for a person with a brain injury to be part of any discussion about his or her treatment, care or prognosis even if it will be upsetting.
There is general wisdom that even the most difficult or troubling information should be shared with an adult with a brain injury. Many believe that an adult with a brain injury needs to be a part of EVERY discussion concerning his or her care, treatment, or any plans to help solve personal challenges.
Myth: Most recoveries for brain injury show steady improvement up until 2 years when recovery is complete.
One should expect that there will be inconsistency during the recovery period. A person with a brain injury may be able to do something easily one day, then find the same thing difficult the next day. Although much of the recovery process occurs during the first two years, it is not necessarily complete in 2 years. Recovery can continue throughout a lifetime.
Fact: The amount of time the person with a brain injury remains in a coma is one of the factors that affects recovery.
The amount of time in a coma is one of many factors that will affect recovery. Other factors are
- severity of the injury,
- where in the brain the injury is located,
- early patterns of recovery,
- length of time a person is very confused or experiences amnesia,
- other injuries to the body, and
- the level of health before the injury.
Myth: It is helpful to tell your family member with brain injury that life will return to normal.
It is generally believed that one should not make promises about everything going back to what it was. Every recovery is different and only time will tell what the level of recovery will be. It is more likely that life will have a “new normal”.
Learn Something New
There is always something new to learn about brain injury. The Center on Brain Injury Research & Training provides updated information and useful trainings to help you improve your skills to support someone with a brain injury.
Visit cbirt.org for additional help and resources >
Source: TBI Myths & Facts
Identifying Behavior Problems
Head injury survivors may experience a range of neuro psychological problems following a traumatic brain injury. Depending on the part of the brain affected and the severity of the injury, the result on any one individual can vary greatly. Personality changes, memory and judgement deficits, lack of impulse control, and poor concentration are all common. Behavioral changes can be stressful for families and caregivers who must learn to adapt their communication techniques, established relationships, and expectations of what the impaired person can or cannot do.In some cases extended cognitive and behavioral rehabilitation in a residential or outpatient setting will be necessary to regain certain skills. A neuropsychologist also may be helpful in assessing cognitive deficits. However, over the long term both the survivor and any involved family members will need to explore what combination of strategies work best to improve the functional and behavioral skills of the impaired individual.
Even a person who makes a “good” recovery may go through some personality changes. Family members must be careful to avoid always comparing the impaired person with the way he/she “used to be.” Personality changes are often an exaggeration of the person’s pre-injury personality in which personality traits become intensified. Some changes can be quite striking. It may be, for example, the head injury survivor used to be easy going, energetic, and thoughtful and now seems easily angered, self-absorbed, and unable to show enthusiasm for anything. Nonetheless, try not to criticize or make fun of the impaired person’s deficits. This is sure to make the person feel frustrated, angry, or embarrassed.
Low-intensity transcranial electrical stimulation (tES) methods are a group of noninvasive brain stimulation techniques, whereby currents are applied with intensities typically ranging between 1 and 2 mA, through the human scalp. These techniques have been shown to induce changes in cortical excitability and activity during and after the stimulation in a reversible manner. They include transcranial direct current simulation (tDCS), transcranial alternating current simulation (tACS), and transcranial random noise stimulation (tRNS).
Currently, an increasing number of studies have been published regarding the effects of tES on cognitive performance and behavior. Processes of learning and increases in cognitive performance are accompanied by changes in cortical plasticity. tES can impact upon these processes and is able to affect task execution. Many studies have been based on the accepted idea that by increasing cortical excitability (e.g., by applying anodal tDCS) or coherence of oscillatory activity (e.g., by applying tACS) an increase in performance should be detected; however, a number of studies now suggest that the basic knowledge of the mechanisms of action is insufficient to predict the outcome of applied stimulation on the execution of a cognitive or behavioral task, and so far no standard paradigms for increasing cortical plasticity changes during learning or cognitive tasks have been established.
The aim of this review is to summarize recent findings with regard to the effects of tES on behavior concentrating on the motor and visual areas…
…When examining the responses to what appears to be injuries that are all serious in nature, it becomes apparent that some injuries are, indeed, more acute than others. Although an injury which is noticeable may on the surface seem more life changing, it cannot be argued that it is the injuries which are held within one’s mind that are the most devastating to a person’s being. Yes, they are all injuries to the body, but only those touching the brain have the capacity to change the “soul” of a person…