INFORMACIONES PSIQUIÁTRICAS 246

14 Informaciones Psiquiátricas 2022 - n.º 246 The same author compared subacute pa- tients (n=50) and two samples of chronic patients (2 to 4 years, n=54 and 5 to 8 years n=52). Patients were mainly severe TBI (80%). Relatives reported personality changes in 80% of the patients in the three samples; a minority of the changes qualified as positive: more communicative, emotiona- lly more expressive or less impulsive. In the three samples more than 90% of the patients presented psychopathological symptoms in the NPI with the same top three in the three different moments assessed: apathy, irrita- bility/lability and desinhibition. Sanchez-Cubillo 9 focused on the descrip- tion and measurement of disinhibited beha- viours in ABI. This research was carried out in a different hospital and city. The study included 93 patients attending a neurore- habilitation clinic, 70 TBI and 23 stroke, mean age of 36 and a majority of male subjects (72). 58 patients were diagnosed having an organic personality disorder (37 disinhibited type, 7 apathetic and 14 mixed type). The study included the development of a scale focused on the description of di- sinhibition. Out of the 31 items included in the scale the most prevalent were irri- tability, impulsivity, distractibility, lack of concern for future consequences and rigid behaviours. Despite the high prevalence of apathy as a symptom identified in the NPI and other neurobehavioural scales, a rela- tive low proportion of patients are classi- fied as OPD apathetic type. This probably reflects two facts: the high comorbidity of apathy and desinhibition and the salience of desinhibition when compared to apathy. Only the most severe cases of apathy, in the absence of aggressive or disinhibited beha- viours, attract the diagnosis of OPD apathe- tic type. Mimentza 10 focused upon the longitudinal analysis of the psychopathology of stroke patients. 45 stroke patients (mean age 60, 34 male) attending a neurorehabilitation inpatient clinic were assessed at different points in time. When assessed with the NPI three months after stroke none of them showed hallucinations or delusions, but 73% scored on depression, 58% on irrita- bility/lability and depression and 42% on apathy (see figure 1). Taking these three studies together we can confidently say that the most common behavioural changes in ABI are apathy, irri- tability, lability, desinhibition and de- pression. Each of these symptoms inclu- des a wide collection of overt behaviours (childishness, overtalktiveness, inappro- priate comments, lack of concern for others, lack of initiation, verbal abuse, hostile com- ments, crying) and a variety of subjective experiences (inner tension, sadness, indi- fference); limitation in the awareness of the behavioural changes and of psychological déficit is a very common accompanying phe- nomenon. Careful description of the clini- cal phenomena is a necessary initial step in clinical psychiatry; understanding symptom formation should follow in order to be able to design useful and rational the- rapeutic interventions. In the following paragraphs an attempt to list and discuss some of the psychological processes that lead to behavioural change are presented (see figure 2). It must be taken into accou- nt that the combined disruption of several of the processes will be more common than the isolated disorder of only one of them. José Ignacio Quemada