INFORMACIONES PSIQUIÁTRICAS 246

16 Informaciones Psiquiátricas 2022 - n.º 246 to follow these group conversations and tend to remain silent or isolated. Relatives find difficult to realize the reason behind this retreat, get angry and frustrated, and confront the patient with the need to keep socially active. Social isolation and irritabi- lity are often the final behavioural presen- tation. A second example focuses on how poor working memory or poor short term memory will induce a change in leisure pre- ferences. With poor memory it is no longer possible to follow the plot of a film or the argument of a book, while watching sports, comedy and nature documentaries can still be enjoyed, as they demand less capacity for the conservation and manipulation of information. Similarly, inability to follow the sequence of actions required to com- plete a complex task (repair the car, plan a holiday) can easily lead to frustration, sad- ness and irritable behavior. Social cognition Cases with severe brain injury, marked so- cial difficulties and relative preservation of cognition pose the question of what kind of psychological functions underlie the social decline. The case of Phineas Gage is a clas- sical example that has been extensively stu- died 11 : following a severe frontal TBI there was a good motor and cognitive recovery but marked personality change and social decli- ne. Similarly, a number of neuropsychiatric disorders such as autism or schizophrenia display behavioural problems that do not seem to be fully explained by attention, exe- cutive or memory difficulties. Social cogni- tion was introduced as a concept that would include all the psychological processes that need to be invoked to explain adequate so- cial behavior, and that could therefore be used to understand behavioural disorders in the absence of cognitive deterioration. The boundaries and the content of this construct are not yet definitely settled, but theory of mind, social perception/knowledge and emotional processing are included in all the models proposed 12 ; empathy is another key concept that has a wide overlap with theory of mind. The literature on rehabilitation of social cognition in brain injury pursues at least three different strategies 13 : (1) restora- tion of cognitive abilities such as speed of information processing, executive function or memory under the hypothesis that social abilities always make use of these common cognitive processes, (2) rehabilitation of specific abilities such as facial recognition of emotions or empathy; (3) finally the in- terventions on social skills that address the final behavior directly. Inhibitory control and initiation These two distinct capacities are someti- mes incorporated in the models of executive function Norman and Shallice 14 listed five groups of functions included in their model of executive functions. One of them, ‘Stop- ping behavior’ is closely related with social disinhibition, while ‘initiation and dri- ve’ and ‘generative thinking’ play a role in initiating behavior. Inhibitory control is crucial in the unders- tanding of disinhibited behaviours such as inappropriate comments, impulsive shop- ping, lack of social manners or sexual ina- dequate remarks or approaches. The inability to delay a response and give time to think and consider the characteristics of the social scenarios and possible alternative respon- ses, results in a wide range of childish and disinhibited behaviours. José Ignacio Quemada