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This chapter provides an overview of psychiatric symptoms and syndromes that can be seen with neurologic diseases. Our goal is not to discuss every psychiatric disorder that might occur but to focus on those that are the most common. Important characteristics of this condition include: • Intermittently sad mood • Identifiable precipitant • Absence of major depression Just as grief is a normal response to loss, demoralization is a normal response to adversity. When bad things happen, our spirits fall. Because adversity is common with neurologic diseases, so is demoralization. Thus, patients may become demoralized when they learn they have a neurologic disease (eg, amyotrophic lateral sclerosis, Alzheimer’s disease, Huntington’s disease), when they experience the symptoms of such a disease (eg, blindness, aphasia, pain), or when they develop the side effects of treatment for the disease (eg, weight gain from prednisone, dyskinesias from levodopa). Demoralization is not linked to any particular group of neurologic diseases, but it tends to be more common in those that are chronic, progressive, painful, debilitating, or disfiguring. Demoralized patients are almost always sad, but they may also be frustrated, irritable, pessimistic, or anxious. These unpleasant emotions are directly related to the patient’s situation and diminish as that situation improves. Someone who is demoralized by pain cheers up when the pain is relieved. Even when patients are demoralized by circumstances that cannot be reversed, their mood often improves when they discover that they are not powerless in the face of adversity. In this way, patients who become demoralized when they are told that they have a terminal illness may feel better as they start to focus on what they can do with the time left to them, and patients who become demoralized by the onset of a paraplegia may brighten as they begin to make progress in rehabilitation. This direct relationship between the patient’s mood and his or her situation helps distinguish the sadness of demoralization from that of major depression, because in the latter condition the patient’s mood remains low despite improving circumstances. Other features of a demoralized state also help differentiate demoralization from major depression. |
