[The psychopathology of the unawareness of cognitive impairments and behavioral limitations in traumatic brain-injured patients].

OBJECTIVE

To explore the unawareness of cognitive impairments and behavioral limitations using a psychopathological approach.

PATIENTS AND

SETTING

Fifteen patients with chronic severe TBI. Outpatient TBI rehabilitation programs in three different centers.

MAIN OUTCOME MEASURES: Case reports. The data from semi-structured interviews with the patients and their families, at least six months after the accident, were compared with data supplied by the Patient Competency Rating Scale (PCRS) and the Neurobehavioral Rating Scale-Revised (NRS-R).

RESULTS

Nine patients demonstrated unawareness of their limitations according to the PCRS (Group I), whereas six did not (Group II). Psychic phenomena specific to patients of group I were found. Some of these were specific to brain injury, such as the lack of representation of cognitive impairments and behavioral limitations or the difficulty to integrate the brain-injury into one's psychic space. Others were not specific to brain injury such as mourning process difficulties, personality characteristics, defense mechanisms. Several psychic phenomena coexisted in the same patient.

CONCLUSION

This study shows the complexity of unawareness of cognitive impairments and behavioral limitations and makes future clinical and theoretical definition indispensable.