Comments & Controversies Comments & Controversies
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Comments & Controversies Brain injury: More clues to symptom validity I appreciate Current Psychiatry’s asked these injured individuals to emphasis on sharpening one’s psy name their favorite movie and actor. chiatric diagnostic skills (“Neuro The Godfather: Part II and/or the film’s cognitive impairment: Feigned, actors Robert De Niro, Al Pacino, and exaggerated, or real?” Current James Caan were chosen by 85% of Psychiatry, August 2007, p. 1937). patients from a certain generation. I have found a few additional ques One possible reason for this choice tions may help validate symptoms of was suggested by a 14year veteran neurocognitive impairment during of the Canadian Forces, who felt that a psychiatric interview. These ques the motion picture allowed one to tions were developed as a result of fantasize about striking out at others my informal survey of individuals without harming oneself. Positive an with head injuries, usually months swers to 1 or more of these questions after the injury. suggested symptom validity. Ask about a patient’s job. Sig The psychologist’s documenta nificant changes in employment sta tion of an organic cause of the neuro tus—such as job loss or changes in job cognitive impairment compared responsibilities or how others relate favorably to an abnormal finding on to the individual in the workplace— a computerized brain mapping electro usually occur in the first 6 months af encephalogram (EEG). The recent ter an injury. computerization of multiple EEGs will Has the patient thought about or allow physicians to identify abnormal obtained a gun permit? In response patterns of electrical activity and sug to their perceived weaker status, gest a diagnosis. A finding of 2 stan many patients acquired weapons. dard deviations from average may I have no knowledge if these guns indicate neurocognitive impairment. were misused. Leonard R. Friedman, MD Revere, MA In an informal survey, I also Current Psychiatry To comment on articles in this issue or other topics, send letters in care of Erica Vonderheid, 8 November 2007 CURRENT PSYCHIATRY, 110 Summit Avenue, Montvale, NJ 07645, [email protected] or visit CurrentPsychiatry.com and click on the “Contact Us” link..