Descriptive Psychopathology: The Signs and Symptoms of ...

360 Section 3: Examination domainsTable 15.6. Personality changes after TBI 50Lateral orbital prefrontal injury (40%):* Irritability and episodic dyscontrol and unplannedviolence; tendency toward suspiciousness, emotional lability, restlessness and impulsiveness;self-destructive and unrealistic in plans; lacking insight; childishly self-centered, insensitivetoward others, overly talkative and exuberantDorsolateral prefrontal injury (10–30%): Lack of spontaneity and initiative, loss of drive,ambition and interests, sluggish, socially isolative, dysphoricNote:*Numbers in () are incidence figures.Table 15.7. 51 Features of frontal lobe personalityIrritable, insensitive toward the feelings of others with a loss of socialgraces, neglectful of appearanceInappropriately jocular, indifferent, placid, minimizes difficultiesImpulsive, unpredictable, impatient, increased rule-breaking, demanding,aggressive, “pseudopsychopathic”Reduced interests, more pleasant and sentimentalPersonality change associated with strokeLike TBI, stroke can result in changes in personality, particularly large or multiplestrokes in anterior brain regions. Changes are the same seen following TBI. 52“Frontal lobe” personalityPersons with frontal lobe disease commonly exhibit personality changes characterizedby disinhibition or apathy (Table 15.7). 53Patient 15.4 had personality changes associated with frontal lobe disease.He had little evidence of a defined mood disorder and his changed behaviorswere pervasive and persistent, as are personality traits.Patient 15.4A 63-year-old man was being treated at a psychiatric clinic following atraumatic brain injury. Brain imaging revealed atrophy in his left frontal lobe.During one of the visits, his wife became extremely angry with him andcomplained to the psychiatrist that since her husband’s injury it had becomeintolerable to live with him. A quiet person before the injury, he had become“a racist”. He frequently made socially inappropriate racial comments andused racial epithets. He also spoke loudly about women’s breasts.The patient exhibited no sustained irritability or euphoria. He had no pressureof speech or evidence of psychosis. His sleep and appetite were normal.