Content uploaded by Michelle M Mielke
Author content
All content in this area was uploaded by Michelle M Mielke
Content may be subject to copyright.
A preview of the PDF is not available
Personality Changes in Brain Injury
... Several articles have described postinjury personality changes, [1][2][3][4] but few have investigated personality change using objective and valid personality measures. Only 3 studies [5][6][7] were identified that actually compared pre-and postmorbid personality after brain injury, and no studies investigated how personality change affects the immediate family. ...
... The authors reported a decrease from baseline to 12 months postinjury on the extraversion and openness scales, but this decrease was not statistically significant after controlling for multiple comparisons. 5 All conducted studies were based on relatively small samples. The assessments were conducted with different time intervals after the injury and included patients with mild to severe injuries. ...
... All 4 studies were based on small samples with limited statistical power; however, irrespective of statistical significance, they all suggest personality change on neuroticism and extraversion. We found associations between the presence of frontotemporal lesions and personality change on neuroticism, contrasting the results by Gracia-Garcia, 5 and Tate, 7 and colleagues. Kurtz 6 investigated if lesions in the left hemisphere were more associated with personality change than right hemisphere lesions, but this was not the case. ...
Objective
To investigate the prevalence of personality change after severe brain injury, to identify predictors of personality change, and to investigate whether personality change is associated with distress in family members.
Setting
A public sub-acute rehabilitation unit in Copenhagen, Denmark.
Participants
Twenty-two pairs of patients with TBI or NTBI and their SOs comprised the study sample.
Interventions
Not applicable.
Main Outcome Measures
A significant other (SO) completed the observer version of the NEO-FFI rating the patient at discharge from hospital and one year after the injury. The SOs were also asked to complete the anxiety and depression scales of the SCL-90-R, rating their own emotional condition and health-related quality of life (HRQoL) as assessed by the four mental scales of the SF-36.
Results
Of the sample 59.1% experienced personality change following acquired brain injury, and the most dominant changes were observed on the personality traits of Neuroticism, Extraversion and Conscientiousness. Changes in Neuroticism were most often observed in patients with frontal or temporal lesions. Generally, personality change in patients was not associated with more distress and lower HRQoL in family members but change in patient Agreeableness was associated with lower HRQoL on the Role Emotional scale.
Conclusions
Personality change was observed in the majority of patients with severe brain injury. Change in Neuroticism was associated with frontal and temporal lesions. Generally, personality change was not associated with more distress and lower HRQoL in SOs.
... TBI often leads to long-lasting emotional, physical, and cognitive changes and results in reduced functioning across multiple domains [5]. Personality changes observed in individuals post-TBI, including emotional lability, impulsivity, aggressiveness, and diminished selfawareness, are often more disabling than cognitive and/or physical changes [6][7][8][9]. Understandably, these changes impact interpersonal relationships, including marital status [10][11][12]. These behavioral shifts often lead to strain in marital relationships, as the uninjured spouse grapples with adapting to changes in their partner [13,12,14]. ...
Background
Traumatic brain injury (TBI) is a major cause of death and disability worldwide and often leads to long-lasting emotional, physical, and cognitive changes and results in reduced functioning across multiple domains. These changes often lead to strain in marital relationships, as the uninjured spouse grapples with adapting to changes in their partner.
Aims: The purpose of this study was to evaluate romantic relationship status after TBI at 6- and 12-months following injury and to identify predictor variables of these changes.
Methods
Ninety-seven TBI survivors were recruited while hospitalized at a tertiary care center in Quito, Ecuador, and followed at 6 and 12 months after their injury. Hierarchical linear modeling (HLM) was used to examine baseline predictors of linear romantic relationship probability trajectories across 6 and 12 months after injury. The final set of HLMs included each of the previously significant predictors from the first model, time, and interaction terms between time and the previously significant predictor.
Results
The first HLM showed that the probability of having a romantic relationship remained stable between 6 and 12 months after TBI. Individuals who were employed at baseline had higher romantic relationship probability trajectories than did those who had been unemployed. Older individuals had higher romantic relationship probability trajectories than younger individuals did, and women had higher romantic relationship probability trajectories than men did.
Conclusions
This is the first study to examine romantic relationship probability trajectories for an Ecuadorian adult population with TBI, and the data are highly valuable for understanding post-TBI outcomes in the region. These results can inform interventions and support systems to bolster marital resilience in the aftermath of TBI. Further research is warranted to explore the nuances of these relationships and to validate these findings in diverse populations.
... Alterations in mood, behaviour and changes in personality are often a concomitant of traumatic brain injury (TBI) (Garcia, Mielke, Rosenberg, Bergey, & Rao, 2011). There is in fact a threefold increased prevalence of changes in personality post-TBI. ...
The chapter explores the research done so far on neuropsychological deficits in major depressive disorder (MDD). The most prominent deficits have been reported in executive function and the cognitive control networks. These deficits have also been shown to affect various cognitive aspects of a patient, such as metacognitions and emotional regulation. They are also predictors of socio-occupational functioning and of recovering and relapse in patients. This makes it pertinent that these newer treatments for MDD account for these deficits and work on ameliorating them for long-term gains.
... Alterations in mood, behaviour and changes in personality are often a concomitant of traumatic brain injury (TBI) (Garcia, Mielke, Rosenberg, Bergey, & Rao, 2011). There is in fact a threefold increased prevalence of changes in personality post-TBI. ...
Background:
Following mild-moderate traumatic brain injury (TBI), an individual experiences a range of emotional changes. It is often difficult for the patient to reconcile with their post-injury persona, and the memory of pre-injury personhood is particularly painful. Insight into one's cognitive deficits subsequent to injury can lead to an existential crisis and a sense of loss, including loss of self.
Objective:
Restoration of cognitive functions and reconciliation with loss of pre-traumatic personhood employing a holistic method of neuropsychological rehabilitation in a patient suffering from TBI.
Methods:
Ms. K.S, a 25-year-old girl, presented with emotional disturbances following TBI. She reported both retrograde and anterograde amnesia. A multidimensional holistic rehabilitation was planned. Treatment addressed cognitive deficits through the basic functions approach. Cognitive behavioural methods for emotional regulation like diary writing helped reduce irritability and anger outbursts. Use of social media created new modes of memory activation and interactions. Compensatory strategies were used to recover lost skills, music based attention training helped foster an individualised approach to the sense of one's body and self.
Results:
As a result of these differing strategies, changes were reflected in neuro-psychological tests, depression score and the patient's self-evaluation. This helped generate a coherent self-narrative.
Conclusion:
Treatment challenges in such cases are increased due to patient's actual deficits caused by neuronal/biochemical changes. Innovative and multi-pronged rehabilitation strategies which involve everyday activities provided an answer to some of these problems. This method of rehabilitation may provide an optimistic context for future research.
... Previous research by Jokela et al. [45] highlighted that personality change on the Big Five was evident following the onset of different chronic illnesses (including respiratory disease), although was greater in magnitude for people with stroke. A longitudinal investigation of personality change after traumatic brain injury identified that levels of openness and extraversion significantly decreased between baseline (premorbid levels) and 12-months post-injury [69]. Further, a prospective longitudinal study by Leonhardt et al. [70] identified that participants with acquired brain injury (causes not specified) reported greater declines in extraversion and conscientiousness over time than healthy controls, whereas changes in extraversion did not differ from those reported by a clinical control group. ...
Purpose: To identify and appraise studies investigating the relationship between the Big Five personality factors and psychological well-being following stroke and evidence for personality change.
Methods: Systematic searches of six databases (PsychINFO, CINAHL, Ovid Medline, Cochrane, PubMed, and Web of Science) were conducted from inception to June 2017. Studies involving adult stroke samples that employed a validated measure of at least one of the Big Five personality factors were included. Two reviewers independently assessed the eligibility and methodological quality of studies.
Results: Eleven studies were identified that assessed associations between personality and psychological well-being after stroke (nine studies) or post-stroke personality change (two studies). A consistent finding was that higher neuroticism was significantly related to poorer psychological well-being. The evidence for the other Big Five factors was mixed. In terms of personality change, two cross-sectional studies reported high rates of elevated neuroticism (38–48%) and low extraversion (33–40%) relative to normative data. Different questionnaires and approaches to measuring personality (i.e., self vs. informant ratings, premorbid personality vs. current personality) complicated comparisons between studies.
Conclusions: People high on neuroticism are at increased risk of poor psychological well-being after stroke. Prospective longitudinal studies are needed to address the limited research on post-stroke personality change.
• Implications for rehabilitation
• High neuroticism is associated with poorer psychological well-being after stroke.
• Assessing personality characteristics early after stroke may help to identify those at risk of poor psychological outcomes.
Objective
To explore the incidence rate and the differences of clinical manifestations of organic personality disorders with varying degrees of craniocerebral trauma.
Materials and methods
According to the International Classification of Diseases-10, 1,027 subjects with craniocerebral trauma caused by traffic accidents were reviewed, the degrees of craniocerebral trauma were graded and those with personality disorder after craniocerebral trauma were diagnosed. The personality characteristics of all patients were evaluated by using the simplified Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI).
Results
The incidence rate of organic personality disorder after all kinds of craniocerebral trauma was 33.1%, while it was 38.7 and 44.2% in the patients after moderate and severe craniocerebral trauma, respectively, which was significantly higher than that in the patients after mild craniocerebral trauma (18.0%) (P < 0.05). Compared with the patients without personality disorder, the neuroticism, extraversion and agreeableness scores all showed significantly differences (P < 0.05) in the patients with personality disorder after craniocerebral trauma; especially the conscientiousness scores showed significant differences (P < 0.05) in the patients with personality disorder after moderate and severe craniocerebral trauma. The agreeableness and conscientiousness scores in the patients with personality disorder after moderate and severe craniocerebral trauma were significantly lower than that after mild craniocerebral trauma, and the patients with personality disorder after severe craniocerebral trauma had lower scores in extraversion than that after mild craniocerebral trauma.
Conclusion
The severity and area of craniocerebral trauma is closely related to the incidence rate of organic personality disorder, and it also affects the clinical manifestations of the latter, which provides a certain significance and help for forensic psychiatric appraisal.
Background:
Epidemiological studies examining associations between traumatic brain injury (TBI) and Alzheimer's disease and related dementias (ADRD) have yielded conflicting results, which may be due methodological differences.
Objective:
To examine the relationship between the presence and severity of TBI and risk of ADRD using a population-based cohort with medical record abstraction for confirmation of TBI and ADRD.
Methods:
All TBI events among Olmsted County, Minnesota residents aged > 40 years from 1985-1999 were confirmed by manual review and classified by severity. Each TBI case was randomly matched to two age-, sex-, and non-head injury population-based referents without TBI. For TBI events with non-head trauma, the Trauma Mortality Prediction Model was applied to assign an overall measure of non-head injury severity and corresponding referents were matched on this variable. Medical records were manually abstracted to confirm ADRD diagnosis. Cox proportional hazards models examined the relationship between TBI and severity with risk of ADRD.
Results:
A total of 1,418 residents had a confirmed TBI (865 Possible, 450 Probable, and 103 Definite) and were matched to 2,836 referents. When combining all TBI severities, the risk of any ADRD was significantly higher for those with a confirmed TBI compared to referents (HR = 1.32, 95% CI: 1.11, 1.58). Stratifying by TBI severity, Probable (HR = 1.42, 95% CI: 1.05, 1.92) and Possible (HR = 1.29, 95% CI: 1.02-1.62) TBI was associated with an increased risk of ADRD, but not Definite TBI (HR = 1.22, 95% CI: 0.68, 2.18).
Conclusion:
Our analyses support including TBI as a potential risk factor for developing ADRD.
Introduction:
Injuries from explosive devices can cause blast-force injuries, including mild traumatic brain injury (mTBI).
Objective:
This study investigated changes in personality from blast-force mTBI in comparison to blunt-force mTBI.
Methods:
Clinicians and significant others assessed US veterans who sustained pure blast-force mTBI (n = 12), as compared to those who sustained pure blunt-force mTBI (n = 12). Inclusion criteria included absence of any mixed blast-blunt trauma and absence of post-traumatic stress disorder. Measures included the Interpersonal Measure of Psychopathy (IM-P), the Big Five Inventory (BFI), the Interpersonal Adjectives Scale (IAS) and the Frontal Systems Behaviour Scale (FrSBe).
Results:
There were no group differences on demographic or TBI-related variables. Compared to the Blunt Group, the Blast Group had more psychopathy on the IM-P, with anger, frustration, toughness and boundary violations and tended to more neuroticism on the BFI. When pre-TBI and post-TBI assessments were compared on the IAS and FrSBe, only the patients with blast force mTBI had become more cold-hearted, aloof-introverted and apathetic.
Conclusion:
These results suggest that blast forces alone can cause negativistic behavioural changes when evaluated with selected measures of personality. Further research on isolated blast-force mTBI should focus on these personality changes and their relationship to blast over-pressure.
Previous item factor analyses and readability analyses suggested that 14 of the 60 items in the NEO Five-Factor Inventory might usefully be replaced. New analyses in high school (N=1959) and adult (N=1492) samples led to the selection of new items from the remaining pool of Revised NEO Personality Inventory items. The resulting scales showed modest improvements in reliability and factor structure, and equivalent validity. These new scales should be appropriate for most respondents age 14 and up. However, continued use of the current instrument is also reasonable for most applications.
To determine the frequency and nature of post-TBI personality disorders (PDs) in a community-based sample of individuals with TBI.
One hundred individuals with TBI were administered a structural clinical interview to determine Axis II psychopathology. METHODS OF PROCEDURES: The Structured Clinical Interview for DSM-IV Personality Disorders, Clinician Version (SCID II) was used to determine 12 Axis II personality disorders. SCID II questions were modified so that symptom onset could be rated as occurring pre-injury vs. post-TBI. Data were analysed using student T-tests, chi-square analysis and one way analyses of variance.
Pre-TBI PDs were diagnosed in 24% of the sample; antisocial PD and obsessive-compulsive PD were the most common diagnoses. Post-TBI, 66% of the sample met criteria for at least one PD, with PDs independent of TBI severity, age at injury, and time since injury. The most common post-TBI PDs were: borderline, avoidant, paranoid, obsessive-compulsive and narcissistic. Men were more likely to be diagnosed with antisocial PD and narcissistic PD. Individuals with pre-TBI PDs were at greater risk of acquiring additional psychopathology post-TBI. Personality traits endorsed by more than 30% of the sample post-TBI reflected loss of self-confidence, attempts to cope with cognitive and interpersonal failures and negative affect.
These findings argue against a specific TBI personality syndrome, but rather a diversity of personality disorders reflective of the persistent challenges and compensatory coping strategies developed by individuals post-TBI. Prospective need for clinical assessment, pro-active education and focused treatment approaches are discussed.
To test the hypothesis that changes in personality traits are evident after traumatic brain injury (TBI) using current models of normal adult personality variation.
Comparison of inception cohort and control group at two measurement occasions.
A large urban academic medical center.
Retrospective personality assessments were obtained from significant others of 21 TBI patients within 30 days of injury and at 6-month follow-up and from a control group of significant others of 25 persons without neurological history twice over a 6-month interval.
Five scales-Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness-from the revised NEO Personality Inventory (NEO PI-R), Form R, and an observer rating scale for retrospective estimates of change (REC).
Significant score changes were found for only one of the five trait domains in the patient sample; controls showed minimal changes overall. Patients' Extraversion scores declined to average levels at 6-month follow-up, diminishing premorbid differences between patients and controls on this dimension. Subjective change estimates made by raters after follow-up reflected perceptions of increased neuroticism in patients that were inconsistent with the serial NEO PI-R data the raters provided.
The absence of systematic changes in personality trait scores among the patients cautions against presuming that such changes account for the behavior of TBI patients.