中度和重度脑外伤患者的共情和自我意识

Q4 Medicine

Psiquiatria Biologica Pub Date : 2022-01-01 DOI:10.1016/j.psiq.2022.100354

Lisandro Vales

{"title":"中度和重度脑外伤患者的共情和自我意识","authors":"Lisandro Vales","doi":"10.1016/j.psiq.2022.100354","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Traumatic Brain Injury (TBI) is the most common cause of neurological disability in young patients. Empathy, an important factor of social cognition, allows a satisfactory interaction of the subject with his environment. Their deficits will suggest inadequate social perceptions, inappropriate answers, and social isolation. The ability to understand, be sensitive and represent the mental states of others, apparently would be related to the ability to represent our mental states, being fundamental to self-awareness.</p></div><div><h3>Materials and methods</h3><p>A descriptive and quantitative study was performed. Objective: to observe the relationship between self-awareness and empathy in moderate or severe TBI patients.</p><p>Patients: 31 Outpatients, aged between 16 and 45 years with a diagnosis of moderate or severe TBI, who attended the Neuropsychology Department of the Clinics Hospital (Montevideo – Uruguay).</p><p>Instruments: Patient Competency Rating Scale (PCRS) (self-awareness = PCRS of the patient - PCRS family), Interpersonal Reactivity Index (IRI) that assesses empathy, and the Lesion Pattern (PL) by accessing the Computational Axial Tomography (CT) report.</p></div><div><h3>Results</h3><p>Significant differences between the patient report and the family report after the TBI in the IRI Fantasy dimension (<em>p</em> = 0.0485), as well as in the IRI Perspective Taking dimension (<em>p</em> = 0.0090). 52% of patients present an impairment of self-awareness. Association between activities of daily living of self-awareness and fantasy of empathy (<em>r</em> = −0.63, <em>p</em> = 0.009). Significant behavior between personal distress of empathy (IRI) with high and low levels of self-awareness according to the median (<em>p</em> = 0.0207) (low levels of self-awareness are associated with less value in personal distress), and between self-awareness with patients with or without neurosurgery (<em>p</em> = 0,0295) (patients with surgery have less self-awareness).</p><p>Frontal (p = 0.0358, n = 24) and frontotemporal lesions (p = 0.0478, n = 24) have lower value in the fantasy dimension of empathy (IRI). Bilateral frontal (p = 0.0460, n = 24) lesions and rights (p = 0.0175), n = 24) have lower value in emotional self-awareness.</p></div><div><h3>Conclusions</h3><p>Patients who have suffered a moderate or severe TBI have a decrease in empathy and self-awareness. Neurosurgery, one of the most frequent interventions in the treatment of severe TBIs, can result in impaired self-awareness (ISA).</p><p>Patients with ISA have difficulties in managing their personal distress of the IRI (emotional dimension of empathy), losing the ability to perform a real examination of their emotional and behavioral states. We can also say that the difficulties in handling personal distress could be an obstacle to improving your self-awareness.</p><p>Fantasy (IRI), the cognitive dimension of empathy, is related to the self-awareness of the activities of daily life. The more fantasy, the patient “would be lost” more in the other person, implying difficulty in his capacity of self-awareness. A possible hypothesis about the relationship between self-awareness and empathy is proposed through Antonio Damasio's concept of extended consciousness.</p><p>The difficulties of self-awareness and empathy could have relevance in the problems of social functioning of these patients, and adversely affect the rehabilitation processes. From the therapeutic point of view, it could be useful for the treatment of these patients, to work on the self-evaluation of their internal states, trying to differentiate them from the others. Given the impact that TBI has on social cognition and social functioning, including these tests would be a valuable supplement with greater ecological value for a standard neuropsychological assessment, and a contribution to guide rehabilitation programs.</p><p>The neuropathology of TBI is complex and highly variable, combining focal and diffuse traumatic lesions. The heterogeneity of the lesions caused makes their study difficult and requires techniques with higher resolution than the CT used in this study. Despite its use, we were allowed to make some approximations. Frontal and frontotemporal lesions have a worse performance of the fantasy dimension of empathy (IRI), patients with bilateral frontal lesions and rights have a greater deterioration of emotional self-awareness.</p></div>","PeriodicalId":39337,"journal":{"name":"Psiquiatria Biologica","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Empatía y autoconciencia en los pacientes con traumatismo cráneo-encefálico moderado y severo\",\"authors\":\"Lisandro Vales\",\"doi\":\"10.1016/j.psiq.2022.100354\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>Traumatic Brain Injury (TBI) is the most common cause of neurological disability in young patients. Empathy, an important factor of social cognition, allows a satisfactory interaction of the subject with his environment. Their deficits will suggest inadequate social perceptions, inappropriate answers, and social isolation. The ability to understand, be sensitive and represent the mental states of others, apparently would be related to the ability to represent our mental states, being fundamental to self-awareness.</p></div><div><h3>Materials and methods</h3><p>A descriptive and quantitative study was performed. Objective: to observe the relationship between self-awareness and empathy in moderate or severe TBI patients.</p><p>Patients: 31 Outpatients, aged between 16 and 45 years with a diagnosis of moderate or severe TBI, who attended the Neuropsychology Department of the Clinics Hospital (Montevideo – Uruguay).</p><p>Instruments: Patient Competency Rating Scale (PCRS) (self-awareness = PCRS of the patient - PCRS family), Interpersonal Reactivity Index (IRI) that assesses empathy, and the Lesion Pattern (PL) by accessing the Computational Axial Tomography (CT) report.</p></div><div><h3>Results</h3><p>Significant differences between the patient report and the family report after the TBI in the IRI Fantasy dimension (<em>p</em> = 0.0485), as well as in the IRI Perspective Taking dimension (<em>p</em> = 0.0090). 52% of patients present an impairment of self-awareness. Association between activities of daily living of self-awareness and fantasy of empathy (<em>r</em> = −0.63, <em>p</em> = 0.009). Significant behavior between personal distress of empathy (IRI) with high and low levels of self-awareness according to the median (<em>p</em> = 0.0207) (low levels of self-awareness are associated with less value in personal distress), and between self-awareness with patients with or without neurosurgery (<em>p</em> = 0,0295) (patients with surgery have less self-awareness).</p><p>Frontal (p = 0.0358, n = 24) and frontotemporal lesions (p = 0.0478, n = 24) have lower value in the fantasy dimension of empathy (IRI). Bilateral frontal (p = 0.0460, n = 24) lesions and rights (p = 0.0175), n = 24) have lower value in emotional self-awareness.</p></div><div><h3>Conclusions</h3><p>Patients who have suffered a moderate or severe TBI have a decrease in empathy and self-awareness. Neurosurgery, one of the most frequent interventions in the treatment of severe TBIs, can result in impaired self-awareness (ISA).</p><p>Patients with ISA have difficulties in managing their personal distress of the IRI (emotional dimension of empathy), losing the ability to perform a real examination of their emotional and behavioral states. We can also say that the difficulties in handling personal distress could be an obstacle to improving your self-awareness.</p><p>Fantasy (IRI), the cognitive dimension of empathy, is related to the self-awareness of the activities of daily life. The more fantasy, the patient “would be lost” more in the other person, implying difficulty in his capacity of self-awareness. A possible hypothesis about the relationship between self-awareness and empathy is proposed through Antonio Damasio's concept of extended consciousness.</p><p>The difficulties of self-awareness and empathy could have relevance in the problems of social functioning of these patients, and adversely affect the rehabilitation processes. From the therapeutic point of view, it could be useful for the treatment of these patients, to work on the self-evaluation of their internal states, trying to differentiate them from the others. Given the impact that TBI has on social cognition and social functioning, including these tests would be a valuable supplement with greater ecological value for a standard neuropsychological assessment, and a contribution to guide rehabilitation programs.</p><p>The neuropathology of TBI is complex and highly variable, combining focal and diffuse traumatic lesions. The heterogeneity of the lesions caused makes their study difficult and requires techniques with higher resolution than the CT used in this study. Despite its use, we were allowed to make some approximations. Frontal and frontotemporal lesions have a worse performance of the fantasy dimension of empathy (IRI), patients with bilateral frontal lesions and rights have a greater deterioration of emotional self-awareness.</p></div>\",\"PeriodicalId\":39337,\"journal\":{\"name\":\"Psiquiatria Biologica\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Psiquiatria Biologica\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1134593422000045\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Psiquiatria Biologica","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1134593422000045","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

摘要

外伤性脑损伤(TBI)是年轻患者神经功能障碍的最常见原因。共情是社会认知的一个重要因素，它允许主体与环境进行满意的互动。他们的缺陷将表明不充分的社会认知、不恰当的答案和社会孤立。理解、敏感和表现他人心理状态的能力，显然与表现自己心理状态的能力有关，这是自我意识的基础。材料与方法进行描述性和定量研究。目的:观察中重度脑外伤患者自我意识与共情的关系。患者:31名门诊患者，年龄在16岁至45岁 之间，诊断为中度或重度脑外伤，就诊于门诊部医院(乌拉圭蒙得维的亚)神经心理科。工具:患者能力评定量表(PCRS)(自我意识 = PCRS患者- PCRS家族)，人际反应指数(IRI)评估共情，病变模式(PL)通过访问计算轴向断层扫描(CT)报告。结果颅脑损伤后患者报告与家属报告在IRI幻想维度(p = 0.0485)和IRI透视维度(p = 0.0090)上存在显著差异。52%的患者表现出自我意识受损。日常生活自我意识活动与共情幻想的关系(r = −0.63,p = 0.009)。自我意识水平高与低的共情个人痛苦(IRI)之间的显着行为(p = 0.0207)(低水平的自我意识与个人痛苦的价值较低相关)，以及自我意识与接受或未接受神经外科手术的患者之间(p = 0,0295)(手术患者的自我意识较低)。额叶区(p = 0.0358,n = 24)和额颞叶区(p = 0.0478,n = 24)共情幻想维度值较低。双侧额叶病变(p = 0.0460,n = 24)和右侧病变(p = 0.0175,n = 24)的情绪自我意识值较低。结论中重度脑外伤患者共情能力和自我意识下降。神经外科是治疗严重创伤性脑损伤最常见的干预措施之一，可导致自我意识受损(ISA)。ISA患者在处理IRI(共情的情感维度)的个人痛苦方面有困难，失去了对他们的情绪和行为状态进行真正检查的能力。我们也可以说，处理个人痛苦的困难可能是提高自我意识的障碍。幻想(IRI)是共情的认知维度，与日常生活活动的自我意识有关。幻想越多，病人就越会在对方身上“迷失”，这意味着他的自我意识能力存在困难。通过达马西奥的扩展意识概念，提出了一种关于自我意识与共情关系的可能假设。自我意识和共情的困难可能与这些患者的社会功能问题相关，并对康复过程产生不利影响。从治疗的角度来看，这对治疗这些病人很有用，对他们的内部状态进行自我评估，试图将他们与其他人区分开来。鉴于创伤性脑损伤对社会认知和社会功能的影响，包括这些测试将是一个有价值的补充，具有更大的生态价值的标准神经心理学评估，并有助于指导康复计划。创伤性脑损伤的神经病理是复杂和高度可变的，包括局灶性和弥漫性损伤。病变的异质性使其研究变得困难，需要比本研究中使用的CT更高分辨率的技术。尽管使用了它，我们还是可以做一些近似。额叶和额颞叶病变患者共情幻想维度(IRI)表现较差，双侧额叶和右侧病变患者情绪自我意识恶化更严重。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Empatía y autoconciencia en los pacientes con traumatismo cráneo-encefálico moderado y severo

Introduction

Traumatic Brain Injury (TBI) is the most common cause of neurological disability in young patients. Empathy, an important factor of social cognition, allows a satisfactory interaction of the subject with his environment. Their deficits will suggest inadequate social perceptions, inappropriate answers, and social isolation. The ability to understand, be sensitive and represent the mental states of others, apparently would be related to the ability to represent our mental states, being fundamental to self-awareness.

Materials and methods

A descriptive and quantitative study was performed. Objective: to observe the relationship between self-awareness and empathy in moderate or severe TBI patients.

Patients: 31 Outpatients, aged between 16 and 45 years with a diagnosis of moderate or severe TBI, who attended the Neuropsychology Department of the Clinics Hospital (Montevideo – Uruguay).

Instruments: Patient Competency Rating Scale (PCRS) (self-awareness = PCRS of the patient - PCRS family), Interpersonal Reactivity Index (IRI) that assesses empathy, and the Lesion Pattern (PL) by accessing the Computational Axial Tomography (CT) report.

Results

Significant differences between the patient report and the family report after the TBI in the IRI Fantasy dimension (p = 0.0485), as well as in the IRI Perspective Taking dimension (p = 0.0090). 52% of patients present an impairment of self-awareness. Association between activities of daily living of self-awareness and fantasy of empathy (r = − 0.63, p = 0.009). Significant behavior between personal distress of empathy (IRI) with high and low levels of self-awareness according to the median (p = 0.0207) (low levels of self-awareness are associated with less value in personal distress), and between self-awareness with patients with or without neurosurgery (p = 0,0295) (patients with surgery have less self-awareness).

Frontal (p = 0.0358, n = 24) and frontotemporal lesions (p = 0.0478, n = 24) have lower value in the fantasy dimension of empathy (IRI). Bilateral frontal (p = 0.0460, n = 24) lesions and rights (p = 0.0175), n = 24) have lower value in emotional self-awareness.

Conclusions

Patients who have suffered a moderate or severe TBI have a decrease in empathy and self-awareness. Neurosurgery, one of the most frequent interventions in the treatment of severe TBIs, can result in impaired self-awareness (ISA).

Patients with ISA have difficulties in managing their personal distress of the IRI (emotional dimension of empathy), losing the ability to perform a real examination of their emotional and behavioral states. We can also say that the difficulties in handling personal distress could be an obstacle to improving your self-awareness.

Fantasy (IRI), the cognitive dimension of empathy, is related to the self-awareness of the activities of daily life. The more fantasy, the patient “would be lost” more in the other person, implying difficulty in his capacity of self-awareness. A possible hypothesis about the relationship between self-awareness and empathy is proposed through Antonio Damasio's concept of extended consciousness.

The difficulties of self-awareness and empathy could have relevance in the problems of social functioning of these patients, and adversely affect the rehabilitation processes. From the therapeutic point of view, it could be useful for the treatment of these patients, to work on the self-evaluation of their internal states, trying to differentiate them from the others. Given the impact that TBI has on social cognition and social functioning, including these tests would be a valuable supplement with greater ecological value for a standard neuropsychological assessment, and a contribution to guide rehabilitation programs.

The neuropathology of TBI is complex and highly variable, combining focal and diffuse traumatic lesions. The heterogeneity of the lesions caused makes their study difficult and requires techniques with higher resolution than the CT used in this study. Despite its use, we were allowed to make some approximations. Frontal and frontotemporal lesions have a worse performance of the fantasy dimension of empathy (IRI), patients with bilateral frontal lesions and rights have a greater deterioration of emotional self-awareness.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Psiquiatria Biologica Medicine-Psychiatry and Mental Health

CiteScore

0.40

自引率

0.00%

发文量

期刊介绍： Es la Publicación Oficial de la Sociedad Española de Psiquiatría Biológica. Los recientes avances en el conocimiento de la bioquímica y de la fisiología cerebrales y el progreso en general en el campo de las neurociencias han abierto el camino al desarrollo de la psiquiatría biológica, fundada sobre bases anatomofisiológicas, más sólidas y científicas que la psiquiatría tradicional.