INFORMACIONES PSIQUIÁTRICAS 246

Informaciones Psiquiátricas 2022 - n.º 246 11 decline of the concept of will since the end of the nineteenth century and has failed in the development of a rich psychopathology of emotions 3 . The result of these processes is an intellectualistic definition of mental illness. Psychopathology, the language used to describe psychological and behavioral alte- rations, has been organized following these three groups of phenomena: disorders of will, emotion and reasoning. Symptoms, such as delusions, obsessions or hallucinations repre- sent the derangement within the cognitive functions; sadness or elation are the proto- types of emotional disorders, while abulia, more recently apathy, compulsions and im- pulsivity represent volitional disorders. The consequence of adherence to this model is that basic symptomatology has to fit in one of these conceptual categories, and symptoms that seem to share emotio- nal, cognitive and volitional components are presented only with the more salient aspect (cognitive, emotional or volitional) as the only component of the symptom. Re- ality tends to be more complex and none of the classical neuropsychiatric symptoms can be fully described limiting the description exclusively to one of these psychological functions. Most symptoms in neuropsychia- try (and probably in general psychiatry as well), when looked at closely and described carefully, present a multiplicity of psycho- pathological faces to it. Irritability, one of the most frequent and neglected symp- toms in patients with stroke or TBI, is a good example. Craig et al (2008) designed ‘The irritability questionnaire’ on the basis of the following definition of irritability: ‘a mood that predisposes toward certain emo- tions (e.g. anger) certain cognitions (e.g. hostile appraisals) and certain actions (e.g. aggression)’. Even classical psychiatric symptoms such as delusions cannot be separated from non- cognitive psychological changes: Capgras delusion, for example, only appears after the patient experiences an abnormal lack of familiarity accompanying the perception of a very well-known face; the same applies to reduplicative paramnesia, the strange idea appears after, or simultaneously, with an unexpected sensation or emotion, the lack of an expected familiarity (or the abnormal presence of a novelty perception). Abnor- mal feelings of novelty or familiarity are necessary components of what initially is categorized as a delusion, a pure disorder of reasoning. Apathy, the main representation of a disorder of volition, is another good example; it often presents the poverty of ac- tions together with a lack of emotional life and with the abolition of the spontaneous generation of mental contents 5,6 . In regards to the psychopathology of ABI the first point to make is that psychotic symptoms (structured delusional ideas or repetitive hallucinations) play a minor role and that the classical affective disorders (retarded depression or mania) are also rare. On the other hand, mental changes, cogni- tive and non-cognitive are very prevalent and have enormous impact on quality of life of patients and families. Behavioural chan- ges, sometimes conceptualized as organic personality disorders, are the most frequent psychopathological challenge, particularly in TBI, followed by different forms of emo- tional and affective disorders, frequently encountered in patients with stroke; both types of problems are usually combined with cognitive changes (attention, memory, exe- cutive disorders) that often play a role in the generation of the behavioural changes. The rest of the chapter will describe these types of disorders in greater detail, ac- THE NEUROPSYCHIATRY OF ACQUIRED BRAIN INJURY