INFORMACIONES PSIQUIÁTRICAS 246

18 Informaciones Psiquiátricas 2022 - n.º 246 tral stimuli and prompts a defensive way of thinking. While the ‘cognitive revolution` helped to develop conceptual models of memory, language, attention or executive functions, the ‘emotional revolution’ has not arrived yet and we lack the conceptual so- phistication that might help to understand the emotional and affective difficulties after brain injury. Added to the difference between disorders of affect and emotion, we shall see disor- ders of a variety of ‘contents’ of affects or emotions. Within the realm of emotions the- re is, at present, a widely accepted catego- rization of six basic emotions: fear, anger, sadness, happiness, surprise and disgust 18 . The same categories have not been proposed for affect. Psychopathology invites clini- cians to systematically assess the dimension sadness-elation, but we often encounter other forms of affective disorders such us persistent irritability, generalized anxiety or apathy. It is less common to consider abnor- mal absence or presence of familiarity (deja vu, jamais vu) as an affective disorder. The same could apply to the abnormalities in the experience of trust or certainty. Taking these limitations into account we shall sum- marize the literature on affective disorders after brain injury. Post-stroke depression is the best known affective disorder in brain injury; it has been extensively studied in the last four decades 19 . Up to then, depression following stroke was interpreted as an emotional re- action to the brain lesion. Golstein´s ‘ca- tastrophic reaction’ was a concept that fo- llowed this psychogenic view. Folstein et al 20 started to argue that depression could be a direct consequence of the brain di- sorder. Establishing the prevalence has not been easy because of the heterogeneity of samples (hospitalized, outpatient, commu- nity), the different scales and diagnostic tools used, the different moments of as- sessment and the exclusion of aphasics and demented patients. On the whole it is con- sidered that one third of the patients with stroke will present significant depressive symptoms 21 . Robinson & Spalleta 19 establis- hed that 21% suffered minor depression and 19% presented major depression. House et al 22 presented a much lower incidence stu- dying a community sample. The differential diagnosis of post-stroke depression includes ‘fatigue’, a poorly understood and frequently underdiagnosed syndrome that is present in up to half of all stroke survivors 23 .Patients describe a subjective experience of lack of energy, or the need to exert a high level of effort in order to complete ordinary tasks, in the absence of sadness. Pathological laughing and crying are the paradigm of the disorders of the expression of emotions. These syndromes can be found in a variety of neuropsychiatric conditions including stroke 24 , multiple sclerosis, trau- matic brain injury or pseudobulbar palsy. Minor stimuli provoke important emotional reactions that the patient judges as dispro- portionate and out of his control. Psychosis Psychosis is an uncommon complication of brain injury. Samples are very heteroge- neous in a number of dimensions: diagnos- tic criteria and length of follow-up are two of the most important. Davison and Bagley 25 published the monograph entitled ‘Schizo- phrenia like psychoses associated with orga- nic disorders of the central nervous system’. They reviewed 14.385 cases with traumatic brain injury from 8 different series and the incidence of psychosis reported ranged from José Ignacio Quemada