CABLEADO DE CORRIENTE CONTINUA

Sometimes, the rehabilitation program itself may be viewed as a punishment.

The rehabilitation team has to face verbal abuse and non co-operation by the patient. If rehabilitation-appropriate behavior is reinforced by family and team on the patient, then improvement is exponentially more.

Behavior problems may result from organic and inorganic causes. Organic causes means that the problem may be linked to pathology in the brain.

Examples of this are dementia, head injury, cerebral palsy, epilepsy and stroke.

But disabled people can undergo behavioral changes without any organic neurological lesion; e.g. amputees, paraplegics (Fig. 6.1).

PSYCHIATRIC PROBLEMS IN THE DISABLED Psychosis

This is a group of major mental illnesses.

• Organic Psychosis: This is a type of psychosis characterized by or associated with impaired brain tissue function. The patient exhibits clinical disturbances of consciousness, memory, intelligence and orientation.

• Functional Psychosis: This is a group of mental illnesses where the symptoms of psychosis are present even though there is no demonstrable disturbance of brain tissue.

Neurosis

This is a group of mental illnesses where the patient’s symptoms do not interfere with his capacity for insight and judgment; he is well-oriented to his

Figure 6.1: Primary and secondary factors in psychiatric illness

surroundings and his mental dysfunction is comparatively milder than psychosis. On the whole this group of patients suffers problems of a “minor”

nature.

• Anxiety Neurosis: Anxiety reaction is a state of chronic apprehension with recurrent symptoms of acute episodes of anxiety. Many people get anxious before an exam or an interview but when the client becomes hyperactive, his pulse is fast, his blood pressure shoots up, his sleep gets affected, and he cannot concentrate on the job at hand, then he or she could be suffering from anxiety neurosis.

• Phobic Neurosis: Unexplained and irrational morbid fears about animate or inanimate objects are known as phobias. Some people are scared of closed spaces (claustrophobia); while others cannot stand the sight of spiders (arachnophobia) or are terrified of heights (vertigo).

• Obsessive-compulsive Neurosis: Obsessions are persistent recurrences of unwelcome ideas. The ideas usually revolve around sex, dirt, or religion.

Some people are obsessed about starting for work at auspicious timings.

Others are obsessed about cleanliness and would not mind taking bath even a dozen times a day. They often are miserable and guilty about these obsessions and try to remove them from their mind without much success Compulsions are irresistible urges to carry out meaningless and irrational activities, if the patient does not carry out his impulse, he experiences discomfort and tension. We see people constantly checking if they have brought their keys, purse or tickets with them, or inspecting if their room is locked—these are compulsive disorders.

• Hysteria—conversion reaction: When the tension of the unconscious or subconscious mind manifests itself in to somatic symptoms the resulting illness is known as conversion reaction.

• Reactive depression: This type of depression occurs usually in persons of anxious, melancholic or obsessive personality. The illness is preceded by a physical, physiological or psychosocial stress situation like a death in the family, loss of job or prestige, financial stress, marital and sexual disharmony, etc. The patient suffers from insomnia, and feels better in the evening than in the morning. He is more comfortable when in company than alone.

• Temper Tantrums: This is one of the behavioral problems exhibited by some children who will scream to get their way done when frustrated. This may be accompanied by breath holding spells.

Boys are more likely to show temper, aggressive behavior and hyperactivity, while girls are more likely to be anxious, fearful, shy and clinging.

Delusion: It is a false or mistaken belief, which has for the patient the force of conviction and is firmly held despite all evidence to the contrary, e.g.

delusion of grandeur—a mere commoner believing that he is a king.

Hallucination: A hallucination is a perception through one of the senses, which does not correspond to any stimulus in the outside world. People have visual hallucinations of forms appearing in front of them, auditory hallucinations of voices speaking to them, and occasionally they complain of a feeling as if someone is touching them or strangulating them (tactile hallucination).

Illusion: An illusion is a perception, which although produced by an external stimulus, is misinterpreted by the patient in purely subjective terms.

The classic example is that of a person seeing a rope and mistaking it for a snake.

Behavioral Problems in the Disabled

Dementia: These are pathological conditions where behavior gets altered due to atrophy, age related changes or ischemia in the brain. Public figures may keep poking their ears or gesticulating to no one in particular on the platform of a political meeting. Shameless and inappropriate behavior, such as crude sexual advances to casual acquaintances or masturbation or micturition in public, may be the first sign of something very seriously wrong in a hitherto normal elderly and respected person.

Head Injury and Stroke: Some brain injured patients display disinhibited, aggressive, self-abusive or otherwise inappropriate behavior. They may also become depressed or withdrawn. In hemiplegia they may not be aware of the affected side, anosognosia, and may exhibit inappropriate emotions and

as emotional liability. The primary objective is the modification of inappropriate behaviors and the teaching of more effective means of communication and social interaction.

Assessment

Treat the patient with respect. Listen to him, and chart out a program and specify goals with his participation. The psychologist would have to monitor patient’s improvement in the program and reinforce staff and family behavior.

This is very important because the staff and family are in constant contact with the patient and need to be highly motivated to handle him.

Psychological Evaluation: It is essential to look at the mental framework of the patient to predict his prognosis. The better the persons coping skills are prior to the mishap the better the outcome. This is where the history taking skills of the examiner comes into play. He would have to delve into the past of the patient, the educational background, his nature, whether gregarious or withdrawn, details of the members of his family, his friends and their comprehension of the situation. This would have to be matched with the patient current behavior samples by keen and continuous observation. The reason for such elaborateness is because of the fact that future behavior is based on past behavior.

Tests for behavior assessment: Portland adaptability inventory is an instrument that measures degree of impairment in the areas of temperament, emotion, activities, social behavior and physical capabilities.

Halstead-Reitan Neuropsychological Battery: It is a fixed battery approach in that a specific set of tests is given to all patients. Here sets of seven standardized tests are administered which include Wechsler Intelligence scale, trial making test, sensory perceptual examination, and Reitan-Indiana Aphasia screening examination.

Behavior Disorders in Children

Behavior disorders are the result of complex interactions between the child and his environment.

“If a child’s behavior has a negative effect on its own adjustment or if it interferes with the lives of other people, then it is said that the child is behavior disordered.”

It is generally estimated that six to ten percent of school age children have noticeable behavior problems. The incidence is greater in boys than girls.

Characteristics of Children with Behavior Disorders Delay in social cognitive development:

• They do not learn from their own past experiences or the experiences of other children.

• They are not sensitive to the fact that their behavior affects others in a negative way.

• They are isolated from their peers.

• They lack a sense of right and wrong.

Low academic achievement: Most of these children are poor in academics, do not like school, and are poor in time bound tasks like finishing home work or assignments. They have a poor self image which interferes with learning and they resist change.

AUTISM

Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three that adversely affects a child’s educational performance. Autistic children generally engage in repetitive activities and stereotyped movements. There is lack of eye contact, resistance to change of daily routine and abnormal responses to sensory experiences.

It is generally accepted that autism is not a single entity but a series of behaviors.