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Tayim N, Barbosa P, Panicker J. Hypersexuality in neurological disorders: A systematic review. BMJ MENTAL HEALTH 2024; 27:e300998. [PMID: 38777563 PMCID: PMC11116864 DOI: 10.1136/bmjment-2024-300998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Hypersexuality (HS) accompanying neurological conditions remains poorly characterized despite profound psychosocial impacts. Objective We aimed to systematically review the literature on HS in patients with neurological disorders. Study selection and analysis We conducted a systematic review to identify studies that reported HS in neurological disorders. HS was defined as a condition characterized by excessive and persistent preoccupation with sexual thoughts, urges, and behaviors that cause significant distress or impairment in personal, social, or occupational functioning. Data on demographics, assessment techniques, associated elements, phenotypic manifestations, and management strategies were also extracted. Findings The final analysis included 79 studies on HS, encompassing 32 662 patients across 81 cohorts with neurological disorders. Parkinson's disease was the most frequently studied condition (55.6%), followed by various types of dementia (12.7%). Questionnaires were the most common assessment approach for evaluating HS, although the techniques varied substantially. Alterations in the dopaminergic pathways have emerged as contributing mechanisms based on the effects of medication cessation. However, standardized treatment protocols still need to be improved, with significant heterogeneity in documented approaches. Critical deficiencies include risks of selection bias in participant sampling, uncontrolled residual confounding factors, and lack of blinded evaluations of reported outcomes. Conclusions and clinical implications Despite growth in the last decade, research on HS remains limited across neurological conditions, with lingering quality and methodological standardization deficits. Key priorities include advancing assessment tools, elucidating the underlying neurobiology, and formulating management guidelines. PROSPERO REGISTRATION NUMBER CRD42017036478.
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Affiliation(s)
- Natalie Tayim
- Department of Psychology, Doha Institute for Graduate Studies, Doha, Qatar
| | - Pedro Barbosa
- Movement Disorders Group, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil
| | - Jalesh Panicker
- Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, London, UK
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2
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Kelly G, Simpson G. The Behaviour Support Elements Checklist: Profiling intervention elements in community-based behaviour support for sexualised behavior after acquired brain injury. Brain Inj 2023; 37:551-561. [PMID: 36867020 DOI: 10.1080/02699052.2023.2184494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND The challenges associated with behavior dysregulation post acquired brain injury (ABI) are well documented. In a previous publication, we described a case series in which sexualized behavior post-ABI was reduced using multi-element behavior support interventions. In this publication, we describe the intervention elements used, as summarized using a one-page recording tool: The Behavior Support Elements Checklist (BSEC). INSTRUMENT The BSEC contains three categories indicating the target for change: the individual with ABI, their support network members, or other environmental aspects. Each category lists a number of elements being used in the routine practice of a community-based behavior support service. RESULTS In total, 173 intervention elements were recommended, averaging seven per participant. Elements from all three categories were routinely incorporated into interventions, but changes to the (category) environment were rated by clinicians as most effective in changing behavior; some elements (e.g., meaningful activities) were considered more effective than others (e.g., ABI education). CONCLUSIONS The BSEC could assist service agencies and researchers to record and analyze clinician practices to improve service delivery, detect professional development needs, and steer resource allocation. Although the BSEC reflects the context in which it was constructed, it could readily be adapted to other service contexts.
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Affiliation(s)
- Glenn Kelly
- Private practice, Melbourne, Australia.,Concept Psychology Services, Melbourne, Australia
| | - Grahame Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Sydney, Australia.,John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney LHD, Sydney, Australia.,Sydney School of Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Kelly G, Brown S, Gillett L, Descallar J, Simpson GK. Can behaviour support interventions successfully treat inappropriate sexual behaviour after acquired brain injury in community settings? A case series ( N = 24). Neuropsychol Rehabil 2020; 32:407-428. [PMID: 33081575 DOI: 10.1080/09602011.2020.1830807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Inappropriate sexual behaviours (ISX) are challenging clinical sequelae of acquired brain injury (ABI). Limited evidence exists about treatment approaches, with few case studies published to date. This study reports an exploratory clinical trial of community-based behaviour support interventions as a treatment approach to ISX after ABI. From routine referrals to a state-wide service specializing in challenging behaviours after ABI, a cohort (n = 24) displaying ISXs were selected. The interventions addressed multiple behavioural domains, and used a variety of approaches including environmental change, psychoeducation, and specific behavioural techniques. These approaches targetted change in the person with ABI, support personnel, or other environmental domains. Behaviour data were collected using the Overt Behaviour Scale (OBS) at baseline, closure and follow-up. Visual inspection and multilevel models were used to analyse the data. For the sample as a whole, there was a significant decline in ISXs from baseline to closure that was maintained at follow-up. Results at an individual level are also presented. Specificity of the intervention was demonstrated by comparison with concurrent challenging behaviours (aggression, perseveration, absconding) which showed no significant change over the same three time points. The results demonstrate the potential efficacy of community-based behaviour support interventions in treating ISXs after ABI.
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Affiliation(s)
| | | | - Lauren Gillett
- Department of Neurology, Liverpool Hospital, Sydney, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Sydney, Australia.,South Western Sydney Clinical School, UNSW Australia, Liverpool, Australia
| | - Grahame K Simpson
- Ingham Institute for Applied Medical Research, Sydney, Australia.,John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia
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4
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Marier-Deschênes P, Gagnon MP, Déry J, Lamontagne ME. Traumatic Brain Injury and Sexuality: User Experience Study of an Information Toolkit. J Particip Med 2020; 12:e14874. [PMID: 33064104 PMCID: PMC7434066 DOI: 10.2196/14874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/01/2019] [Accepted: 12/19/2019] [Indexed: 01/30/2023] Open
Abstract
Background After having sustained a traumatic brain injury (TBI), individuals are at risk of functional impairments in information processing, abstract reasoning, executive functioning, attention, and memory. This affects different aspects of communicative functioning. Specific strategies can be adopted to improve the provision of health information to individuals with TBI, including the development of written materials and nonwritten media. Objective A user-centered design was adopted to codevelop four audiovisual presentations, a double-sided information sheet, and a checklist aimed at informing individuals about post-TBI sexuality. The last phase of the project was the assessment of the user experience of the information toolkit, based on the User Experience Honeycomb model. Methods Overall, two small group discussions and one individual semistructured interview were conducted with individuals with moderate to severe TBI. Results The participants mentioned that the toolkit was easily usable and would have fulfilled a need for information on post-TBI sexuality during or after rehabilitation. They mostly agreed that the minimalist visual content was well-organized, attractive, and relevant. The information was easily located, the tools were accessible in terms of reading and visibility, and the content was also considered credible. Conclusions Aspects such as usability, usefulness, desirability, accessibility, credibility, and findability of information were viewed positively by the participants. Further piloting of the toolkit is recommended to explore its effects on the awareness of the potential sexual repercussions of TBI in individuals and partners.
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Affiliation(s)
- Pascale Marier-Deschênes
- Université Laval, Department of Rehabilitation, Québec, QC, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada.,Centre de recherche sur les soins et services de première ligne de l'Université Laval, Québec, QC, Canada
| | - Marie-Pierre Gagnon
- Centre de recherche sur les soins et services de première ligne de l'Université Laval, Québec, QC, Canada.,Université Laval, Faculty of Nursing, Québec, QC, Canada.,Centre de recherche du CHU de Québec, Québec, QC, Canada
| | - Julien Déry
- Université Laval, Department of Rehabilitation, Québec, QC, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada
| | - Marie-Eve Lamontagne
- Université Laval, Department of Rehabilitation, Québec, QC, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada
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5
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Scarpazza C, Ferracuti S, Miolla A, Sartori G. The charm of structural neuroimaging in insanity evaluations: guidelines to avoid misinterpretation of the findings. Transl Psychiatry 2018; 8:227. [PMID: 30367031 PMCID: PMC6203853 DOI: 10.1038/s41398-018-0274-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/24/2018] [Accepted: 09/10/2018] [Indexed: 01/03/2023] Open
Abstract
Despite the popularity of structural neuroimaging techniques in twenty-first-century research, its results have had limited translational impact in real-world settings, where inferences need to be made at the individual level. Structural neuroimaging methods are now introduced frequently to aid in assessing defendants for insanity in criminal forensic evaluations, with the aim of providing "convergence" of evidence on the mens rea of the defendant. This approach may provide pivotal support for judges' decisions. Although neuroimaging aims to reduce uncertainty and controversies in legal settings and to increase the objectivity of criminal rulings, the application of structural neuroimaging in forensic settings is hampered by cognitive biases in the evaluation of evidence that lead to misinterpretation of the imaging results. It is thus increasingly important to have clear guidelines on the correct ways to apply and interpret neuroimaging evidence. In the current paper, we review the literature concerning structural neuroimaging in court settings with the aim of identifying rules for its correct application and interpretation. These rules, which aim to decrease the risk of biases, focus on the importance of (i) descriptive diagnoses, (ii) anatomo-clinical correlation, (iii) brain plasticity and (iv) avoiding logical fallacies, such as reverse inference. In addition, through the analysis of real forensic cases, we describe errors frequently observed due to incorrect interpretations of imaging. Clear guidelines for both the correct circumstances for introducing neuroimaging and its eventual interpretation are defined.
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Affiliation(s)
- C Scarpazza
- Department of General Psychology, University of Padua, Via Venezia 8, 35131, Padova, Italy.
- Department of Psychosis Studies, Institute of Psychiatry, Psychosis and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - S Ferracuti
- Department of Human Neuroscience, Sapienza University of Rome, P.le A Moro 5, 00185, Roma, Italy
| | - A Miolla
- Department of General Psychology, University of Padua, Via Venezia 8, 35131, Padova, Italy
| | - G Sartori
- Department of General Psychology, University of Padua, Via Venezia 8, 35131, Padova, Italy
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6
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Latella D, Maggio MG, De Luca R, Maresca G, Piazzitta D, Sciarrone F, Carioti L, Manuli A, Bramanti P, Calabro RS. Changes in sexual functioning following traumatic brain injury: An overview on a neglected issue. J Clin Neurosci 2018; 58:1-6. [PMID: 30314923 DOI: 10.1016/j.jocn.2018.09.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/27/2018] [Indexed: 12/28/2022]
Abstract
Traumatic brain injury (TBI) is any damage to the skull and/or the brain and its frameworks due to an external force. Following TBI, patients may report cognitive, physiological and psychosocial changes with a devastating impact on important aspects of the patient's life, such as sexual functioning. Although sexual dysfunction (SD) occurs at a significantly greater frequency in individuals with TBI, it is not commonly assessed in the clinical setting and little information is available on this crucial aspect of patients' quality of life. As the number of people with TBI is on the rise, there is a need for better management of TBI problems, including SD, by providing information to patients and their caregivers to achieve sexual health, with a consequent increase in their quality of life. Discussing and treating sexual problems in TBI patients enters the framework of a holistic approach. The purpose of this narrative review is provide clinicians with information concerning changes in sexual functioning and relationships in individuals with TBI, for a better management of patient's functional outcomes and quality of life.
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Affiliation(s)
| | | | | | | | | | | | - Luigi Carioti
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
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7
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Mantell A, Simpson GK, Vungkhanching M, Jones KF, Strandberg T, Simonson P. Social work-generated evidence in traumatic brain injury from 1975 to 2014: A systematic scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:433-448. [PMID: 28795463 DOI: 10.1111/hsc.12476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Abstract
The International Network for Social Workers in Acquired Brain Injury (INSWABI) commissioned a systematic scoping review to ascertain the social work-generated evidence base on people with traumatic brain injury (TBI) of working age. The review aimed to identify the output, impact and quality of publications authored by social workers on this topic. Study quality was evaluated through assessment frameworks drawn from the United Kingdom National Service Framework for Long-Term Conditions. In the 40-year period from 1975 to 2014, 115 items were published that met the search criteria (intervention studies, n = 10; observational studies, n = 52; literature reviews, n = 6; expert opinion or policy analysis, n = 39; and others, n = 8). The publications could be grouped into five major fields of practice: families, social inclusion, military, inequalities and psychological adjustment. There was a significant increase in the number of publications over each decade. Impact was demonstrated in that the great majority of publications had been cited at least once (80.6%, 103/115). Articles published in rehabilitation journals were cited significantly more often than articles published in social work journals. A significant improvement in publication quality was observed across the four decades, with the majority of studies in the last decade rated as high quality.
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Affiliation(s)
- Andy Mantell
- School of Health and Social Care, London South Bank University, London, UK
| | - Grahame Kenneth Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Sydney, Australia
- Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, Australia
| | - Martha Vungkhanching
- Department of Social Work Education, California State University, Fresno, CA, USA
| | | | - Thomas Strandberg
- The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden
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8
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Gagnon J, Simpson GK, Kelly G, Godbout D, Ouellette M, Drolet J. A French adaptation of the Overt Behaviour Scale (OBS) measuring challenging behaviours following acquired brain injury: The Échelle des comportements observables (ÉCO). Brain Inj 2016; 30:1019-25. [DOI: 10.3109/02699052.2016.1148197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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9
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Joyal CC, Beaulieu-Plante J, de Chantérac A. The neuropsychology of sex offenders: a meta-analysis. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2014; 26:149-177. [PMID: 23567470 DOI: 10.1177/1079063213482842] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Typically, neuropsychological studies of sex offenders have grouped together different types of individuals and different types of measures. This is why results have tended to be nonspecific and divergent across studies. Against this background, the authors undertook a review of the literature regarding the neuropsychology of sex offenders, taking into account subgroups based on criminological theories. They also conducted a meta-analysis of the data to demonstrate the cognitive heterogeneity of sex offenders statistically. Their main objective was to test the hypothesis to the effect that the neuropsychological deficits of sex offenders are not broad and generalized compared with specific subgroups of participants based on specific measures. In all, 23 neuropsychological studies reporting data on 1,756 participants were taken into consideration. As expected, a highly significant, broad, and heterogeneous overall effect size was found. Taking subgroups of participants and specific cognitive measures into account significantly improved homogeneity. Sex offenders against children tended to obtain lower scores than did sex offenders against adults on higher order executive functions, whereas sex offenders against adults tended to obtain results similar to those of non-sex offenders, with lower scores in verbal fluency and inhibition. However, it is concluded that neuropsychological data on sex offenders are still too scarce to confirm these trends or to test more precise hypotheses. For greater clinical relevance, future neuropsychological studies should consider specific subgroups of participants and measures to verify the presence of different cognitive profiles.
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Affiliation(s)
- Christian C Joyal
- University of Quebec at Trois-Rivières, Trois-Rivières, Quebec, Canada
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10
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Prevalence, Comorbidities, and Correlates of Challenging Behavior Among Community-Dwelling Adults With Severe Traumatic Brain Injury. J Head Trauma Rehabil 2014; 29:E19-30. [DOI: 10.1097/htr.0b013e31828dc590] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Crotty G, Doody O, Lyons R. Aggressive behaviour and its prevalence within five typologies. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2014; 18:76-89. [PMID: 24189373 DOI: 10.1177/1744629513511356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Crucial to understanding an individual, presenting with intellectual disability and the management of their challenging behaviours, is the knowledge of the types of those specific behaviours. The term aggressive behaviour is a universal term that embraces many aspects of behaviour that vary in terms of severity, frequency and seriousness for the individual and those around them. Hence, greater consideration regarding intervention, management, person-centred strategies and prevalence and frequency rates are required in service provision for individuals with intellectual disability and aggressive behaviour. This review presents the context of aggressive behaviour and its prevalence within the five typologies of aggressive behaviour: verbal aggression, aggression against others, sexually inappropriate behaviour, self-injurious behaviour and aggression against property, as identified by Crocker et al. (2007). The focus of this review is to report on the prevalence of aggressive behaviour reported for individuals with intellectual disability and consider the ambiguity in defining aggressive behaviour.
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12
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James AI, Young AW. Clinical correlates of verbal aggression, physical aggression and inappropriate sexual behaviour after brain injury. Brain Inj 2013; 27:1162-72. [DOI: 10.3109/02699052.2013.804200] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Andrew I.W. James
- Department of Psychology, University of York
YorkUK
- Brain Injury Rehabilitation Trust
LeedsUK
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13
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Prevalence, Clinical Features, and Correlates of Inappropriate Sexual Behavior After Traumatic Brain Injury. J Head Trauma Rehabil 2013; 28:202-10. [DOI: 10.1097/htr.0b013e31828dc5ae] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Hassett LM, Tate RL, Moseley AM, Gillett LE. Injury severity, age and pre-injury exercise history predict adherence to a home-based exercise programme in adults with traumatic brain injury. Brain Inj 2011; 25:698-706. [DOI: 10.3109/02699052.2011.579934] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kelly G, Simpson G. Remediating Serious Inappropriate Sexual Behavior in a Male with Severe Acquired Brain Injury. SEXUALITY AND DISABILITY 2011. [DOI: 10.1007/s11195-011-9213-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kelly G, Brown S, Todd J, Kremer P. Challenging behaviour profiles of people with acquired brain injury living in community settings. Brain Inj 2009; 22:457-70. [DOI: 10.1080/02699050802060647] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Johnson C, Knight C, Alderman N. Challenges associated with the definition and assessment of inappropriate sexual behaviour amongst individuals with an acquired neurological impairment. Brain Inj 2009; 20:687-93. [PMID: 16809200 DOI: 10.1080/02699050600744137] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The subject of Inappropriate Sexual Behaviour (ISB) amongst clients with neurological impairment, specifically Acquired Brain Injury (ABI) and dementia, has received limited coverage to date within the literature. This paper discusses some of the problems encountered in the definition and quantification of ISB, in particular the absence of standardized measurement tools to record ISB within an inpatient setting. Whilst ISB is reported to be less prevalent than other behavioural sequelae of brain injury or dementia, it is suggested that its impact on patients and carers can be significant. Ill-defined terminology and the absence of relevant assessment tools add to the specific challenges of understanding and managing ISB within a care or rehabilitation setting. As a result, it is argued that the subjective attitudes of staff and the culture of an institution can dominate the approach taken to dealing with ISB for these client groups.
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Affiliation(s)
- C Johnson
- Townsend and Kemsley Division, St Andrew's Hospital, Northampton, UK
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Bezeau SC, Bogod NM, Mateer CA. Sexually intrusive behaviour following brain injury: approaches to assessment and rehabilitation. Brain Inj 2009; 18:299-313. [PMID: 14726288 DOI: 10.1080/02699050310001617398] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Sexually intrusive behaviour, which may range from inappropriate commentary to rape, is often observed following a traumatic brain injury. It may represent novel behaviour patterns or an exacerbation of pre-injury personality traits, attitudes, and tendencies. Sexually intrusive behaviour poses a risk to staff and residents of residential facilities and to the community at large, and the development of a sound assessment and treatment plan for sexually intrusive behaviour is therefore very important. A comprehensive evaluation is best served by drawing on the fields of neuropsychology, forensic psychology, and cognitive rehabilitation. The paper discusses the types of brain damage that commonly lead to sexually intrusive behaviour, provides guidance for its assessment, and presents a three-stage treatment model. The importance of a multidisciplinary approach to both assessment and treatment is emphasized. Finally, a case example is provided to illustrate the problem and the possibilities for successful management.
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Affiliation(s)
- Scott C Bezeau
- Department of Psychology, University of Victoria, Victoria, BC, Canada.
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Knight C, Alderman N, Johnson C, Green S, Birkett-Swan L, Yorstan G. The St Andrew's Sexual Behaviour Assessment (SASBA): Development of a standardised recording instrument for the measurement and assessment of challenging sexual behaviour in people with progressive and acquired neurological impairment. Neuropsychol Rehabil 2008; 18:129-59. [DOI: 10.1080/09602010701822381] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Gagnon J, Bouchard MA, Rainville C. Differential diagnosis between borderline personality disorder and organic personality disorder following traumatic brain injury. Bull Menninger Clin 2006; 70:1-28. [PMID: 16545030 DOI: 10.1521/bumc.2006.70.1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Organic personality disorder (OPD) is the traditional diagnostic category used to account for personality disturbances after traumatic brain injury (TBI). The recent use of Axis-II personality disorders, notably borderline personality disorder (BPD), has appeared in the TBI literature as an alternative to OPD. This would presumably offer a better description and understanding of the multiple clinical manifestations of these personality changes and disorders. This article offers a view that it is possible and fruitful to use both diagnoses in a complementary manner. An accurate recognition of the respective phenomenologies of both BPD and OPD is a key factor in achieving a differential diagnosis, including, if required, a dual diagnosis. The phenomenology of both conditions in reference to DSM-IV criteria is compared and illustrated through two clinical vignettes.
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Affiliation(s)
- Jean Gagnon
- Départment de psychologie, Université de Sherbrooke, Québec, Canada.
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