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• 2 Advancing the profession of clinical neuropsychology with appropriate outcome studies and demonstrated clinical skills.

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• Professional identity of npsych

  The value of our work is ultimately judged by four individuals
  1. patient
  2. familie
  3. referral source
  4. payor of the services
  
  Patient satisfaction is often directly related to the perception that the clinical neuropsychologist took adequate time to carefully listen to his or her concerns and then acted on those concerns in a way that helped the patient.

• 6 College 3 Disorders of awareness: Anosognosia and related phenomena

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• Impaired Self-awareness (ISA)

  • Partial syndrome of unawareness of the disturbed function
    
  • Patients with ISA show some awareness of their impairments
  • May use both defensive and non-defensive approaches for coping with their limited awareness of an impaired function
    

• 7 College 4 Suicidality in patients with traumatic brain injury (TBI)

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• Prevalence of suicidality in persons with TBI

  Risk of death by suicide about 3-4 times greater than for the general population
  >> Concomitant cumulative suicide rate of 1% over the first 15 years post-injury
  Up to 18% of patients with TBI attempt suicide
  Clinically significant suicide ideation in about 22% of patients with TBI

• Potential neurological mechanisms underlying suicide in TBI patients

  Serotonergic hypofunction (particularly in basal orbital region of the prefrontal cortex) as significant marker of suicide risk
  Behavioural consequences of hyposerotonergic functioning are:
  

  • Reduction in inhibitory control, leading to increased aggression/impulsivity with elevation of risk for high lethality suicidal behaviour

• 8 College 5 Sexual Dysfunction

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• Temporal lobes: amygdala

  Sexual orientation, sexual disorders (eg, paraphilias), sexual drive (hypo/hypersexuality, impotence)

• Conceptual module for sexual dysfunction in MS (Foley & Iverson, 1992)

  Primary Sexual Dysfunction:Physiological impairments directly due to demyelinating lesions in the spinal cord and/or brain
  

  • decreased libido
  • Numbness or sensory paresthesias in the genitals
  • Loss of vaginal lubrication / erectile dysfunction
  • problems with arousal and orgasm

  Secondary Sexual Dysfunction:Non-sexual physical changes which affect the sexual response indirectly
  Tertiary Sexual Dysfunction: Psychological, social and cultural issues that may affect sexual functioning, e.g.

• Inappropriate Sexual Behaviour

  “Verbal or physical act of an explicit, or perceived, sexual nature, which is unacceptable within the social context in which it is carried out"
    Johnson et al. (2006)
  
  Examples:
  - making obscene gestures
  - exposing one's own body parts
  - frotteurism
  - masturbating in the public
  - touching body parts of another person

• 9 College 6 Brain damage as a family affair

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• Anxiety, depression and paranoia

  Anxiety :Families might see patients as inexplicably withdrawn, fearful, easily upset and moody. Families might be helpless to do anything.
  Depression: Patients’ depression particularly tends to erode family members’ self-esteem and enhance feelings of guilt and inadequacy
  Paranoia: might develop because of:
  
  
  •Lack of insight
  •Feelings of worthlessness because of incompetencies
  •Fears of rejection because of those incompetencies

• 10 Baird, Wilson,Bladin et al. Neurological control of human sexual behavior: Insight from lesion studies

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• Two reasons (Blumer and Walker) for little research into the neurological control of human sexual behavior

  1. Physicians are not routinely trained to explore the sex life of their partners
  2. There has been a stifling trend in research to investigate only what can be measured by objective methods.

• Cortical regions - frontal lobes

  Disinhibited sexual behaviour has been reported following damage to the frontal lobes, particularly the orbitofrontal region of the limbic system.
  1.Frontal leucotomy -some researchers reporting cases of hyper-sexualityand others describing no changes.
  2.Handling of the genitalia have been reported in patients with seizures arising from the frontal lobe> Historically, these movements : non-epileptic seizures or hysteria.