Dissociation of depression from apathy in traumatic brain injury: A case report

Costa, Raquel Quimas Molina da; Porto, Fábio Henrique de Gobbi; Marrocos, Rogério Paysano

doi:10.1590/S1980-57642013DN70300014

ABSTRACT

Although not evident clinically, lesions to the prefrontal cortex cause great social and functional impairment to patients. The anterior cingulate cortex is intimately involved with motivational behavior and after injury to this area the onset of an apathetic state can be observed. This paper describes the case of a patient with traumatic brain injury to the prefrontal lobe presenting with a depressive syndrome associated with apathetic symptoms. After appropriate treatment for depression, intense apathy was revealed, an irreversible sequelae of the traumatic brain injury, constituting the main barrier to the patient's return of lifestyle and independence.

Key words:
apathy; depression; traumatic brain injury.

RESUMO

Apesar de não se destacarem ao olhar clínico, as lesões do córtex pré-frontal acarretam grande prejuízo funcional e social aos pacientes. O córtex do cíngulo anterior está intimamente envolvido com o comportamento motivacional e o que se observa após um dano a esta região é a instalação de um estado apático. Este trabalho visa relatar o caso de um paciente com lesão traumática do lobo pré-frontal que apresentou uma síndrome depressiva associada a sintomas apáticos. Após tratamento adequado da depressão foi possível perceber intensa apatia, sequela irreversível do traumatismo crânio encefálico, que se constituiu como principal obstáculo ao retorno do estilo de vida e independência do paciente.

Palavras-chave:
apatia; depressão; lesão encefálica traumática.

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REFERENCES

Cummings JL, Miller BL. The Human Frontal Lobes. 2nd ed., Guilford Press; 2007.
Starkstein SE, Leentjens FG. The nosological position of apathy in clinical practice. J Neurol Neurosurg Psychiatry 2008;79:1088-1092.
Marin R. Apathy: a neuropsychiatric syndrome. J Neuropsychiatry Clin Neurosci 1991;3:243-254.
Mesulam MM. From sensation to cognition. Brain 1998;121:1013-1052.
Guimarães HC, Paes P, Fialho A. Brazilian caregiver version of the Apathy Scale. Dement Neuropsychol 2009;3:321-326.
Jorge ER, Robrinson G, Moser D. Major depression following traumatic brain injury. Arch Gen Psychiatry 2004;61:42-50.
Hama S, Yamashita H, Yamawaki S, Kurisu K. Post-stroke depression and apathy: Interactions between functional recovery, lesion location, and emotional response. Psychogeriatrics 2011;11:68-76.
Schwartzbold M, Diaz A, Martins E. Psychiatric Disorders and Traumatic BrainInjury. Neuropsychiatr Dis Treat 2008;4:797-816.
Starkstein SE, Mayberg HS, Preziosi TJ, et al. Reliability, validity and clinical correlate of apathy in Parkinsons's disease. J Neuropsychiatry Clin Neurosci 1992;4:134-139.
Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology 2000;55:1621-1626.
Hall RC. Global assessment of functioning. A modified scale. Psychosomatics 1995;36:267-275.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry1960;23:56-62.
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the cognitive state of patients for clinician. J Psychiatr Res 1975;12:189-198.
American Psychiatric Association. 2000. Diagnostic and statistical manual of mental disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association.
Jorge M. Manual Diagnóstico e Estatístico de Transtornos Mentais. 4th ed., Artmed; 2003.
Hanna-Pladdy B. Dysexecutive syndromes in neurologic disease. J Neurol Phys Therapy 2007;31:119-127.
Robinson RG, Szetel B. Mood change following left hemispheric brain injury. Ann Neurol 1981;9:447-453.
Lipsey R, Robinson R, Pearlson G. Mood change following bilateral hemisphere brain injury. Br J Psychiatry 1983:266-273.
Nicholl J, LaFrance WC. Neuropsychiatric sequelae of traumatic brain injury. Semin Neurol 2009;29:247-255.
Khan MAU, Briones DF, Brower RD, Briones M. Disability from "soft" neuropsychiatric sequelae due to frontal lobe injury. South Med J 2009;102:829-831.

Publication Dates

Publication in this collection
Jul-Sep 2013

History

Received
05 May 2013
Accepted
04 Aug 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Cummings JL, Miller BL. The Human Frontal Lobes. 2nd ed., Guilford Press; 2007.

[2] Starkstein SE, Leentjens FG. The nosological position of apathy in clinical practice. J Neurol Neurosurg Psychiatry 2008;79:1088-1092.

[3] Marin R. Apathy: a neuropsychiatric syndrome. J Neuropsychiatry Clin Neurosci 1991;3:243-254.

[4] Mesulam MM. From sensation to cognition. Brain 1998;121:1013-1052.

[5] Guimarães HC, Paes P, Fialho A. Brazilian caregiver version of the Apathy Scale. Dement Neuropsychol 2009;3:321-326.

[6] Jorge ER, Robrinson G, Moser D. Major depression following traumatic brain injury. Arch Gen Psychiatry 2004;61:42-50.

[7] Hama S, Yamashita H, Yamawaki S, Kurisu K. Post-stroke depression and apathy: Interactions between functional recovery, lesion location, and emotional response. Psychogeriatrics 2011;11:68-76.

[8] Schwartzbold M, Diaz A, Martins E. Psychiatric Disorders and Traumatic BrainInjury. Neuropsychiatr Dis Treat 2008;4:797-816.

[9] Starkstein SE, Mayberg HS, Preziosi TJ, et al. Reliability, validity and clinical correlate of apathy in Parkinsons's disease. J Neuropsychiatry Clin Neurosci 1992;4:134-139.

[10] Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology 2000;55:1621-1626.

[11] Hall RC. Global assessment of functioning. A modified scale. Psychosomatics 1995;36:267-275.

[12] Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry1960;23:56-62.

[13] Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[14] Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the cognitive state of patients for clinician. J Psychiatr Res 1975;12:189-198.

[15] American Psychiatric Association. 2000. Diagnostic and statistical manual of mental disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association.

[16] Jorge M. Manual Diagnóstico e Estatístico de Transtornos Mentais. 4th ed., Artmed; 2003.

[17] Hanna-Pladdy B. Dysexecutive syndromes in neurologic disease. J Neurol Phys Therapy 2007;31:119-127.

[18] Robinson RG, Szetel B. Mood change following left hemispheric brain injury. Ann Neurol 1981;9:447-453.

[19] Lipsey R, Robinson R, Pearlson G. Mood change following bilateral hemisphere brain injury. Br J Psychiatry 1983:266-273.

[20] Nicholl J, LaFrance WC. Neuropsychiatric sequelae of traumatic brain injury. Semin Neurol 2009;29:247-255.

[21] Khan MAU, Briones DF, Brower RD, Briones M. Disability from "soft" neuropsychiatric sequelae due to frontal lobe injury. South Med J 2009;102:829-831.

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