Klaus R.H. von Wild, MD, PhD, Prof. Hon. Caus., Dr. Hon Caus., Birgit Kemper, PhD
Jpn J Compr Rehabil Sci 2: 42-47, 2011
Objective: Post-stroke depression has been considered
the most common neuropsychiatric consequence of
stroke, even in the presence of successful neurological
recovery and good health-related quality of life. This
report describes a patientfs catastrophic reactions to
his unexpected illness, with a focus on the therapeutic
process, to provide an understanding of managing
denial and how to approach and engage brain-damaged
patients.
Methods: This is a case study of a 65-year-old
businessman with mental-cognitive and behavioral
impairments following hypertensive cerebellar massive
hemorrhage and secondary hydrocephalus, who made
a complete recovery following psychotherapeutic
intervention.
Results: Our supportive psychotherapeutic approach
combined with cognitive interventions enabled this
patient overcome moderate mental-cognitive and
behavioral deficits and extreme defensive coping
strategies, and facilitated his successful social re-entry.
Conclusions: Brain-damaged patients with preserved
self-awareness and a high level of independence in
activities of daily living (ADL), who do not have preexisting
psychiatric conditions, can benefit from
individualized psychotherapy over time. Attention
needs to be focused on a recovery beyond functional
outcomes, with an understanding of holistic
neurorehabilitation as a method of reconstructing lives
within a social context. Further research and education
is needed for the development of proper
psychotherapeutic approaches to address aspects such
as emotional coping and finding sense in life following
brain damage.
Key words: post-stroke depression, mood disorders, psychotherapy, neurorehabilitation