Personality, Mood and Behavior Changes

1. Personality, Mood and Behavior Changes Prepared by: CiciliaEviGradDiplSc., M. Psi

2. Introduction • Personality changes can occur after any closed head injury, but it common in patients who have suffered severe or very severe head injuries • Can happen as direct result of damage to the brain … but it is possible that some late-appearing personality changes reflect the person’s reaction to the problems and frustrations associated with handicaps caused by the head injury

3. Anger and Aggression • An event or circumstances which would be considered as trivial or mildly irritating before the accident can trigger a major temper outburst  difficult to regain self-control • Rage as an epileptic activity in temporal lobe of the brain  instead of convulsive muscle spasm or lose of consciousness • Injury  impaired emotion and behavior control • Rate of violence increase between 1-5 years after the accident  loss of abilities and change in lifestyle • Altered sense of humor

4. Anxiety and Nervousness • Anxiety levels are greater in head-injured population  19% - 57% of the population • What happen? • Feelings  may feel tense, apprehensive, fearful or panic stricken, irritable, tired • Physiological symptoms  racing heart beat, headaches, painful muscles (neck and shoulders), shakiness/trembling, hyperventilation, gastric problems and sweating • Behaviors  talk quickly, easily startled, lack concentration, signs of irritability and impatience, tired, insecure, overly dependent, avoid soc life

5. Contd. • Causes of anxiety: • Damage to emotional centres of the brain (limbic system) • As emotional reaction  never recover, fear pr failures, PTSD

6. Childishness • About 60% of head-injured people reported by family showing childishness  in average of 2.5 years after the injury  but, dropped to 25% after 15 years of the injury • Related to reduced behavioral and emotional control, tendency to see things from their own perspective and the insecurity from lack of confidence due to changed abilities

7. Dislike of Company • Because they are very sensitive to noise and other stimulation and difficulty to cope with multiple inputs • They need to limit the amount of time of spending their time with large social group and preceding the time with rest (Dr Muriel Lezak)

8. Depressions and Unhappiness • Over 40% of the head-injured patients suffered a major episode of depression at some time during the first 12 months after the accidents  mild to severely injured patients • Can arise as direct consequences; or caused by the person’s reaction to the accident and its consequences • Signs  excessive crying, withdrawal, loss of pleasure and interest, low self-esteem, sleep and weight problems, marked lethargy and slowness

9. Contd. • Depression can caused irritability, lack of initiative, a difficulty in making even simple decisions, poor memory and concentration, and a feeling that life is not worth living • Fugue state  appears awake and alert and their behaviors seem normal  but later, they have no memory of the period during which they were in fugue state • Depression can be serious, painful and even life-threatening illness  need help and support

10. Impulsiveness • Do not necessarily consider all the options available to them, or the likely consequences of their actions • Some positive effects  more relaxed approach to matters  but they become reckless in every decision or action taken

11. Inflexibility and Stubbornness • No matter how strong the opposition or how cogent the reasoning  it’s very difficult to influence the inflexible brain-injured person once they have decided on a course of a action • Rigid expectation  can cause anger, conflicts, irritation and frustration

12. Jealousy and Possessiveness • By making angry or disparaging remarks about the other person, by bullying or by studiously ignoring them  objects of jealousy: other person’s good health, their personal relationships and the attention they receive or give to others • Possessiveness not restricted to relationship matters, but also into objects

13. Laughter, Crying – Uncontrollable • Suffer from frequent bouts of laughing or crying uncontrollably which are prompted neither by sad or amusing event nor by a happy or unhappy personal thought  known as pathological laughter or pathological crying • Their emotional behaviors do not reflect their actual feelings

14. Law-Breaking • The head-injured people who is unable to control their temper, sexual responses or impulses to relieve others of their money or possessions may find themselves trouble with the law • They have the knowledge of law, but they cant control their impulses  to the extreme of taking others’ lives

15. Listlessness • Adynamia having difficulty beginning or initiating an activity or a thought and tend to do and say very little unless encouraged or organized by someone else  need to be prompted into action by someone else • Being listlessly around the house, making no effort to occupy their time in a constructive or enjoyable fashion • Not lazy  but due to the damage to the region in the inner part of the frontal lobes which is responsible for initiating activities

16. Psychosis • Quite serious psychiatric symptoms appear after a head injury  their perception or interpretation of reality becomes grossly distorted  delusions and hallucinations, paranoid • Often begin during the period of post-traumatic amnesia, but can appear for the first time after the person is out of PTA • They are usually temporary and disappear as the person recovers

17. Self-Centred Behaviors • They view a situation entirely from their own point of view and according to how it affects them • Derives from executive and reasoning limitation • Executive  able to view from other’s perspective, but don’t think to do so • Reasoning lost reasoning skills to view an event from other point of view

18. Sexual Behavior – Changed, Inappropriate • Ignore unwritten rules on how to approach opposite sex and in what circumstances it is appropriate to make suggestions of a sexual nature • Unaware of the inappropriateness of their sexual comments, or maybe aware but unable to control their behaviors, preoccupied with sex and engage in excessive sexual activities  masturbating or exposing themselves in public • Some become disinterested in sex

19. Swearing and Verbal Abuse • Head injury victims sometimes swear excessively and in a way which shocks and offends others • Sometimes be assisted in special behavioral change techniques offered in rehabilitation programs

20. Positive Changes? • Happier, more communicative, more sensitive, stopped drinking, manage to keep one’s job, talkative, extroverted • Research by Dr Ranseen 120 patients over 2-year period  3.3% were judged to undergone a positive personality change by their relatives