Chapter 10: Psychosocial Interventions in Neuropsychiatry

INTRODUCTION

In this chapter, we discuss general aspects of the psychosocial dimension in the assessment and care of neuropsychiatric patients, and specific interventions including case management, various psychotherapies—with emphasis on cognitive-behavioral therapy (CBT) and mindfulness training, and cognitive rehabilitation.

Why are psychosocial interventions important in neuropsychiatry? Across disorders such as dementia, epilepsy, multiple sclerosis, Parkinson’s disease, and stroke, neuropsychiatric patients experience significant impact of illness on multiple domains of life¹ including:

• Emotional functioning

• Carrying out a daily routine

• Working and interpersonal relationships

• Reduced participation in the community

• Needing support from others, and limitations on independent living

Within the context of interdisciplinary care, psychosocial interventions can assist neuropsychiatric patients with all these difficulties. Research on psychosocial experiences and interventions in neuropsychiatry tends to focus on distinct neurological illnesses. There is the risk of losing specificity of experiences when generalizing across different illnesses, but there may also be some value in recognizing common experiences and needs.

THE IMPORTANCE OF CAREGIVERS

A unique aspect of psychosocial interventions in neuropsychiatry is the involvement of caregivers—they play a role in the different psychosocial interventions discussed in this chapter. Caregivers can be family members or friends, or professionals without a personal relationship with the designated patient. Caregivers facilitate and amplify the effect of psychosocial interventions. In addition, it is known that caregivers of patients with neuropsychiatric and behavioral symptoms may experience even a greater burden than caregivers of patients with motor symptoms and direct needs for physical care. Neuropsychiatric and behavioral symptoms are associated with increased burden for caregivers in all neurological illnesses. Some examples are: ALS²; multiple sclerosis³; Parkinson’s disease^4,5; post-stroke⁵; dementia.⁶ In dementia, neuropsychiatric and behavioral symptoms are associated with earlier placement in skilled nursing facilities.^7,8 Some of the most challenging symptoms for caregivers include agitation, aggression, accusatory delusions, and disrupted sleep-wake cycle. It is especially hard when these symptoms are combined with constant need for supervision, as caregivers just don’t get a break. All of this is magnified by the poignant fact that patients often do not seem like the persons they once were. Caregivers themselves are at significant risk for psychiatric morbidity, especially depression. The majority of people with dementia live with family caregivers who themselves are at risk for morbidity and mortality. Later in this chapter we discuss interventions that target caregiver coping style; this is a modifiable factor that mediates caregiver’s experience of burden.⁶

CASE MANAGEMENT IN NEUROPSYCHIATRY

Case management in neuropsychiatry can be essential in caring for the overall health of a patient and the patient’s caregivers. The National Association of Social Workers defines case management as “a process to plan, seek, advocate for and monitor services from different social services or healthcare organizations and staff on behalf of a client.” Case management is ...