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. 19-37). 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 14-year 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 In an informal survey, I also Revere, MA

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