INFORMACIONES PSIQUIÁTRICAS 246

Informaciones Psiquiátricas 2022 - n.º 246 17 Apathy is the paradigm of the disorder in the initiation of action. The definition of apathy includes the reduction in expected self-initiated behaviours, together with an empoverishment in generative thinking and blunted affect. The relationship of these three groups of phenomena, behavioural, cognitive and affective, is far from clear. It can be argued that the core drive to action depends upon the preservation of a lively affective state or the capacity to generate and experience emotions. Alternatively we can place the generation of ideas as the primary function, or it can be hypothesized that both functions are necessary in the generation of social behavior, and that the absence or disorder of one or the other will give rise to a subtype of apathy. These are questions still open to research. Insight and awareness This cognitive ability is also incorporated in the more comprehensive models of execu- tive functions. It is defined as the capacity to monitor and modify one’s own behavior. Awareness can be applied to a very wide range of functions, from body functioning (sensory and motor control) to insight into one’s actions and feelings. Unilateral ne- glect, denial of left hemiplegia or of blind- ness (Anton´s syndrome), unawareness of expressive aphasia, of behavioural change or of amnesia are some of the clinical pre- sentations of the disorders of awareness in brain injury. Most of the models 15,16,17 propo- se that the understanding of unawareness includes a basic level that is related to the access to basic information but also other levels related to awareness of the implica- tions of the deficit in everyday life and to mechanisms of psychological denial. Whate- ver the source or type of unawareness might be, it is not difficult to realize that these disorders will give rise to behavioural chan- ges and social conflicts. Carers will often try to protect the patients from unneces- sary risks that will often not be accepted by patients. Driving and returning to work are only two of the common situations that lead to conflicts. Disorders of affect and emotion Psychiatrists focus their efforts on the description of affective disorders whi- le psychologists tend to study the nature of human emotions and the ways in which their recognition and regulation can be dis- torted in different groups of patients. What are the differences, if any, between affecti- ve states and emotions? Both sets of phe- nomena belong to the non-cognitive part of our psychic life, together with others such as drive, motivation or desire. The literature tends to differentiate bet- ween emotions being a brief reaction (se- conds or minutes) to external stimuli that elicit a specific facial expression and gene- rate an adaptive behavioural response, and affective states, a long-lasting state (days or weeks), unrelated to external stimuli that biases thinking and does not always help with social adaptation. Neither of the definitions gives information on the speci- fic nature of the experience which is where both concepts overlap. Let us take the case of fear (emotion) that can be a brief res- ponse to an external threat that disappears soon after the external situation changes, or, fear (affect) can be a more long-lasting state that biases the interpretation of neu- THE NEUROPSYCHIATRY OF ACQUIRED BRAIN INJURY