Psychosocial Impact of
Neuro--infections
Neuro
Bonnie-Kate Dewar
BonnieClinical Neuropsychologist
Institute of Psychiatry, Kings College London and
Re:Cognition Health www.recognitionhealth.com
Overview
What
do we mean by Psychosocial?
What
is the Psychosocial impact of
neurological infections?
Family, Social, Self
What
can be done to lessen the
Psychosocial impact?
Neuroinfective Illness
Encephalitis,
Meningitis, HIV, CJD
Cognitive changes
Memory, language, perceptual skills,
information processing, executive function.
Behavioural
Motor skills, frustration, anger, persistence
Emotional
changes
changes
Low mood, anxiety, sense of self
What do we mean by
Psychosocial impact?
Definition of Psychosocial
A
person centred approach
Difficulties
with ones community
integration which includes education,
occupation, family, peer and professional
relationships
Definition (cont.).
WHO
International Classification of
Functioning (2000)
Impairments
Disability/activity limitation
Handicaps/participation restriction
Psychosocial Adjustment
Multiple
dimensions
Direct factors
• Neuropsychological, neuropathology
Indirect factors
• Premorbid factors, cognitive appraisals (Kendall &
Terry, 1996).
• Problem or emotion focused coping style
• Environmental/social supports
What is the Psychosocial
impact of Neurological
Infection?
Family and Friends
Increased
reliance on family rather than
friends for social needs
Quality of significant/marital relationship
Sexuality
Parent
Parent--child relationships
Impact of child behavioural changes
Parental risk of stress, depression
Siblings
Social Roles
EDUCATION
Changes to academic skills
Changing needs
Social skillsskills-forming peer relationships
Lack of support/understanding from school
staff
WORK
COMMUNITY
ROLES
Social activities help us to make sense of who
we are (Gracey et al., 2008)
Emotional Well Being
Depression and anxiety disorders in ABI
Role of developing insight
Poor community reintegration
Reduction in perceived control and self efficacy
Elevated interpersonal sensitivity, depression,
phobic anxiety, obsessive compulsive
behaviours (Pewter et al., 2007)
Altered identity and sense of self
Continuity break in self narrative
How can we manage
the Psychosocial
impact of Neurological
Infection?
Family, Friends and Social Roles
Rehabilitation
BioBio-psycho
psycho--social approach (Williams & Evans, 2003)
Vocational and Community
‘Whatever it takes’ (Willer & Corrigan, 1994).
Education
Family and individual psychotherapy
Parenting skills (see Hooper et al., 2007)
Peer support
Individuals, carers, parents and siblings
Family, Friends and Social Roles
Training and support for schools
Role of social group membership
Sense of continued social identity
Self esteem, social support, guidance & advice
(Haslam et al., 2008)
Role of voluntary organisations
Involvement of affected individual
“A light in a very dark place” (Easton et al., 2007)
Advocacy, support, information
Lobbying for specialist services and support
Emotional Well Being
Psychological
Cognitive Behaviour Therapy framework
Behavioural experiments
Adaptations to accommodate cognitive
impairments
Possible
interventions
protective factors include
Social support
Functional family units
Identity and sense of self
Illness
as a ‘threat to self’ arising following
a traumatic event
Discrepancy
between
‘Who I was before my illness’,
‘Who I am now’ and…
Who ‘I’ might become?
Higher
levels of discrepancy associated
with higher emotional distress
“Am not Was”
Dewar & Gracey (2007) Case study of woman
post herpes simplex encephalitis
Sense of loss of self
Use of CBT & behavioural experiments
‘The Friendship Book’
Structured approach to problem solving
Experiential learning
Creating a new, integrated positive sense of self
An onon-going journey
Improving Psychosocial
Outcome after ABI
Gracey
et al, (2009)
Social, interpersonal and personal
discrepancies
Threat
failure to resolve discrepancy
poor psychosocial outcome
Resolve discrepancy
Continuity of self, development of new
meaning, consolidated through activity
Conclusion
Neuro
Neuro--infections
have a significant and
wide--ranging Psychosocial impact
wide
Role
for Rehabilitation
individual, family and community focus
Aim
to seek meaning for the individual
Thank you!