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Current research is aimed at a better understanding of the cause and progression of the disease and at finding specific therapies that are both effective and practical to apply generic 400mg zovirax amex hiv infection prophylaxis guidelines. The structure of sensory organs optimizes their response to the preferred types of stimuli zovirax 200mg mastercard antiviral yify. A stimulus gives rise to a generator potential purchase zovirax 200mg with amex hiv infection oral, which order 800 mg zovirax visa antiviral meaning, in turn, causes action potentials to be produced in the associated sensory nerve. The speeds of adaptation of particular sensory receptors are related to their biologic roles. Specific sensory receptors for a variety of types of tactile stimulation are located in the skin. Somatic pain is associated with the body surface and the musculature; visceral pain is associated with the internal organs. The sensory function of the eyeball is determined by structures that form and adjust images and by structures that transform images into neural signals. The retina contains a number of layers and several cell types, each with a specific role in the process of visual transduction. The rod cells in the retina have a high sensitivity to light but produce less distinct images without color, whereas the cones provide sharp color vision with less sensitivity to light. The visual transduction process requires many steps, beginning with the absorption of light and ending with an electrical response. They are transmitted by the bones of the middle ear and passed to the inner ear, where the process of sound transduction takes place. The transmission of sound through the middle ear greatly increases the efficiency of its detection, whereas its protective mechanisms guard the inner ear from damage caused by extremely loud sounds. Sound vibrations enter the cochlea through the oval window and travel along the basilar membrane, where their energy is transformed into neural signals in the organ of Corti. Displacements of the basilar membrane cause deformation of the hair cells, the ultimate transducers of sound. Different sites along the basilar membrane are sensitive to different frequencies. The vestibular apparatus senses the position of the head and its movements by detecting small deflections of its sensory structures. There are five fundamental taste sensations: sweet, sour, salty, bitter, and umami. While recording the responses of a mechanoreceptor to stimulation of the skin, an investigator observes an increase in the number of action potentials. Receptors code an increase in stimulus intensity by an increase in action potential frequency. Cessation of a stimulus would produce a rapid decrease in action potential frequency, and adaptation of the receptor would also decrease action potential frequency. A constant and maintained stimulus would result in a steady response or a decrease due to adaptation. The action potential velocity is determined by the membrane properties of the nerve and would not be affected. Diffusion of sweet taste compounds into the mucus-filled taste pore is necessary for sweet taste transduction, but it does not produce significant osmotic changes inside the taste receptor cells. The T2R family of taste receptors are responsible for the transduction of bitter compounds and they are located on the microvilli. There are no sweet membrane channels in taste cells, but the entry of H+ ions through membrane proton channels is a mechanism for sour taste transduction. As a person enters middle age, reading text at distances less than arm’s length becomes more difficult. The person is suffering from presbyopia, the age-related inability to focus on close objects. Due to age-related changes in the elasticity of the lens the ability to accommodate decreases and the lens shape cannot be sufficiently curved so the near object is focused behind the retina. A loss of lens transparency (cataracts), corneal distortion (astigmatism) or receptor cells in the region of the fovea (age-related macular degeneration) would impair both near and far vision. Due to long-term exposure to a loud noise, the hair cells on the basilar membrane in the inner ear were damaged. The site of the damage was in the region of the basilar membrane nearest to the oval window. The basilar membrane contains a tonotopic map with high frequencies represented at the base of the basilar membrane near the oval window and low frequencies represented at its apex near the helicotrema. Long-term exposure to excessive noise at a particular frequency results in damage to the area of the basilar membrane responsible for coding that frequency. On a moonlit night, human vision is monochromatic and less acute than vision during daytime. The cone cells are responsible for color vision and are densely packed in the centrally located fovea, the region of the retina where the image is most focused. In such cases, the single-pigment rod cells that have greater sensitivity, but are located farther away from the fovea and show greater convergence, provide monochromatic but more diffuse vision. The color composition of light does not depend on its intensity, and dark adaptation does not change the spectral sensitivity of the receptors. While focusing mechanisms may be less effective with low light, they still function. After landing, the pain gradually disappeared, but sounds are muffled and he has a sensation of fullness in the ears. Otoscopic examination of his ears reveals tight and slightly distended eardrums with effusion, but no signs of infection, and the patient’s temperature is normal. The tight distended eardrum suggests that there is an increase in pressure within the middle ear, perhaps due in part to his inability to equalize the external and middle ear pressures (“the pop” during the plane’s descent). The effusion suggests an accumulation of fluid in the normally air- filled cavity is also contributing to the increased pressure. The patient decreased ability to hear a sound reflects a conductive hearing loss that is a result of increased pressure in the middle ear cavity. The increased pressure results in a less flexible tympanic membrane and consequently less energy is transmitted to the ossicles in response to an incoming sound. The increased pressure and fluid can also interfere with the movement of the ossicles further reducing energy transfer through the middle ear. The Rinne test is a relatively simple test that can quickly screen for the presence of conductive hearing loss. The inability to “pop,” or equalize the pressure between the outer and middle ear, indicates that the eustachian tube is blocked. The eustachian tube interconnects the middle ear cavity and the pharynx and is the route by which pressures in the outer and middle ear are equalized.

The space between the lungs and chest wall is the pleural space 200 mg zovirax amex hiv infection rates wiki, which contains a thin layer of fluid (~10 μm thick) purchase 800mg zovirax with visa antiviral resistance mechanisms, that functions discount zovirax 200 mg on-line anti viral cleaner, in part buy 800 mg zovirax with amex how hiv infection can be prevented, as a lubricant so the lungs can slide against the chest wall. Movements of the diaphragm and rib cage change thoracic volume, which allows the lungs to inflate during inspiration and deflate during expiration. With deep and heavy breathing, the accessory muscles (the external intercostals and sternocleidomastoids) also contract and pull the rib cage upward and outward. During forced expiration, however, the internal intercostal muscles contract and pull the rib cage downward and inward. The abdominal muscles also contract and help pull the rib cage downward, compressing thoracic volume. Breathing is largely driven by the muscular diaphragm at the bottom of the thorax. Contraction of the diaphragm enlarges the airtight chest cavity with a concomitant, increase in chest volume. When the volume increases in the airtight chest, the pressure decreases causing air to flow into the lungs (and alveoli) (see Fig. First, contraction of the diaphragm (which is attached to the lower ribs and sternum) pushes the abdominal contents downward, enlarging the thoracic cavity in the vertical plane. Second, the external intercostal muscles raise the rib cage up and outward, further enlarging the thoracic cavity. The effectiveness of bringing air into the lungs is related to the strength of the contraction of the diaphragm and the intercostal muscles. Obesity, pregnancy, and tight clothing around the abdominal wall can impede the effectiveness of the diaphragm in enlarging the thoracic cavity. Damage to the phrenic nerves (the diaphragm is innervated by two phrenic nerves, one to each lateral half) can lead to paralysis of the diaphragm. When a phrenic nerve is damaged, that portion of the diaphragm moves up rather than down during inspiration. During forced inspiration, in which a large volume of air is taken in, additional accessory muscles are also used. These include the scalene muscles and the sternocleidomastoids, and contraction of these muscles further elevates the upper rib cage and increases the thoracic volume. During expiration, the process is passive, and the respiratory muscles relax and the lung volume decreases causing pressure in the lungs (and alveoli) to increase. However, with exercise or forced expiration, the expiratory muscles do become active. These muscles include not only the diaphragm, but also those of the abdominal wall and the internal intercostal muscles (see Fig. Contraction of the abdominal wall pushes the diaphragm upward into the chest, and the internal intercostal muscles pull the rib cage down, reducing thoracic volume. These accessory respiratory muscles are also necessary for such functions as coughing, straining, vomiting, and defecating. The expiratory muscles are extremely important in endurance running and are one of the reasons competitive long-distance runners, as part of their training program, often do exercises to strengthen their abdominal and chest muscles. We have reviewed the components, some properties of lung and the chest wall, and the interaction between these structures during inspiration and expiration. A more complete understanding of how the lungs are inflated/deflated and air is inhaled/exhaled, however, requires knowledge of the pressure changes at the biophysical level. A brief review of the gas laws is in order before explaining how changes in pressures within the thoracic cavity and lungs cause changes in lung volumes and air movement. Partial pressure is2 the individual pressure exerted independently by a particular gas within an air mixture. The air we breathe is a mixture of gases: primarily nitrogen, oxygen, and carbon dioxide. For example, the air you blow into a balloon creates a pressure that causes the balloon to expand. This pressure that is generated is due to all of the molecules of nitrogen, oxygen, and carbon dioxide that collide with the walls of the balloon. However, the total pressure generated inside the balloon is the sum of the individual partial pressure of oxygen, nitrogen, and carbon dioxide. A gas’ partial pressure, therefore, is the pressure that the gas exerts if each gas were present alone. If all of the other gases in the2 balloon were removed, the remaining oxygen would still exert a pressure of 160 mm Hg. Partial pressure of a gas is often referred to as gas tension, and partial pressure and gas tension are used synonymously. The water vapor exerts a partial pressure that is a function of body temperature, not barometric pressure. W2 ater vapor pressure does not change the percentage of oxygen or nitrogen in a dry gas mixture; however, water vapor does lower the partial pressure of oxygen inside the lungs. The partial pressures of gases in the lungs are calculated on the basis of a dry gas pressure; therefore, water vapor pressure is subtracted when the partial pressure of a gas is determined. The dry gas pressure in the trachea is 760 − 47 = 713 mm Hg, and the individual partial pressures of O and N are:2 2 (2) and (3) Table 18. When calculating gas tensions in the lung, a good way to remember is as soon as the air hits the nose, always subtract water vapor pressure when converting gas fraction to partial pressure. Changes in2 2 2 lung pressures during breathing are often expressed as relative pressure, a pressure relative to atmospheric pressure. For example, if airway pressure is zero, the pressure inside the airway equals atmospheric pressure. Unless otherwise specified, the pressures of breathing are relative pressures and the unit is cm H O. A list of symbols and abbreviations used in respiratory physiology is shown in 2 Table 18. Because the thoracic cavity is airtight, an increase in thoracic volume causes the pleural pressure (Ppl), the pressure in the pleural fluid between the lung and chest wall, to fall. The Boyle law states that, at a constant temperature, the pressure (P) of the gas varies inversely with the volume (V) of gas, or P = 1/V. If either pressure or volume changes and if temperature remains constant, the product of pressure and volume remains constant: (4) The Charles law states that if pressure is constant, the volume of a gas and its temperature vary proportionately (V ≈ T). If either temperature or volume changes and pressure remains constant, then: (5) These two gas laws can be combined into the general gas law: (6) From the general gas law, at constant temperature, an increase in thoracic volume leads to a decrease in pleural pressure. In addition to pleural pressure, several other pressures are associated with breathing and airflow (Fig. In respiration, transmural pressure is the pressure across the airway or across the lung wall or the alveolar wall. It2 2 is important to remember that transpulmonary pressure is the pressure that keeps the lungs inflated and prevents the lungs from collapsing.

The older films still accurately reflect relative intensifying screen speeds cheap 200mg zovirax mastercard hiv infection rate jamaica, which is the purpose of this table discount 800 mg zovirax otc otc anti viral meds. Published values are accu­ within the accepted range for diagnostic rate for the conditions under which they radiology (usually considered to be density were determined buy 800 mg zovirax with mastercard antivirus software for mac, but such conditions vary buy zovirax 400mg without a prescription hiv infection rates louisiana. There are more than A will be limited to a log relative exposure 1000 flm-screen combinations on the mar­ ket today, so some "lumping" of an oth­ erwise enormous variety of expressions of speed seems necessary. Film B will remain in the designated emulsion is important only when the flm density values over a range of log relative is exposed with intensifying screens. Film B is said to cause any fltering action of the front have greater latitude than flm A in that it screen that might act to decrease the in­ will accept a wider range of exposures. Generally speaking, the Consider the case of a single-emulsion latitude of a flm varies inversely with film flm in a cassette, which receives two ex­ contrast. There are two practical aspects to posures, log E1 and E2, and responds with this concept of flm latitude. For the tech­ densities D1 and D2• Film contrast for this nologist exposing a film, the flm with more exposure difference may be expressed as latitude makes the exposure less critical; if he has picked the proper kVp for adequate log E2- log E, penetration, he has more room for error in his choice of exposure (mAs). Generally, If this same exposure is now used to expose the radiologist is interested in high con­ a double-emulsion flm with light from in­ trast, which means flms of less latitude. But tensifying screens, each emulsion will re­ there may be situations in which a wide spond with densities D1 and D2• When two range of subject contrast (such as in the films are superimposed, the resulting den­ chest) must be recorded, and in such cases sity is the sum of the densities of each flm. The con­ latitude as it pertains to kVp and subject trast that the eye now sees is contrast in Chapter 14). There is a phys­ without the log E2 - log E1 term: ical and photographic reason for this. The Single emulsion contrast = 02- D, emulsion is applied to the base in liquid form. When the emulsion dries, it shrinks Double emulsion contrast = 2(02 - D,) to about one tenth of its original volume. Most of the decrease in volume causes a The double-emulsion film has produced decrease in thickness of the emulsion, but twice the contrast of a single-emulsion flm. If emulsion were put on only one side ble-emulsion film is increased, resulting in of the base, shrinking of the emulsion increased flm speed. Be­ screens, such as Kodak Lanex screens, are cause light photons are easily absorbed by produced by the terbium ion with about the emulsion, however, only the outer layer 60% of its energy at about 544 nm (green of the emulsion is affected by light from light). This is one reason of flm to the green wavelengths by coating why x-ray film designed for exposure by the silver halide grains with a thin layer of light from two intensifying screens (in a dye that absorbs the green light and then cassette) has a thin emulsion on each side transfers this absorbed energy to the grain. This is illus­ screens, it is necessary for the silver halide trated in Figure 11-17. When rare earth grains in the flm to absorb the light emit­ screens are used, an appropriate flm ted by the screen phosphor. The ability of should be used if one is to take advantage the flm grains to absorb light depends on of all the light emitted by the screen. Remember that this phors emitted light that was absorbed by rare earth, activated by thulium, produces natural silver halide (Fig. Note that light to which natural silver halide film is natural silver halide flm does not absorb sensitive. Compare the twin peaks of 374 in the green and yellow portions of the vis­ nm and 463 nm in Figure 9-12 to the sen­ ible spectrum, where much of the light sitivity of silver halide as shown in Figure from some rare earth phosphors is emitted 11-17. You will recall that the trium tantalate intensifying screens also emit light in the ultraviolet and blue wave­ lengths to which natural silver halide flms exhibit maximum sensitivity. The main cause of this crossover is incomplete absorption of flm, some use blue-sensitive flm, and some light by the adjacent emulsion. The cross­ Darkroom Safelight over light is spread because of diffusion, The use of ortho films requires that the scattering, and refection caused by the film correct darkroom safelight be used. For base and interfaces between the emulsions many years an amber safelight (such as the and film base. Crossover exposure is a sig­ Kodak Type 6B filter) has been used with nifcant contributing factor to unsharpness blue-sensitive flms. With ortho films a sensitive films, up to 40% of the total ex­ safelight filter shifted more toward the red posure is attributed to print-through. Blue­ is required (this removes the green light to sensitive emulsions (natural silver halide) which ortho flm is sensitive). The ideal way to reduce print-through is to increase light absorption in the silver Crossover Exposur� halide grains of the film emulsion. This Crossover exposure, also called "print­ would improve image quality without re­ through exposure," occurs when a double­ ducing system speed. The original flm de­ emulsion x-ray flm is exposed in a cassette signed to reduce print-through had a light­ containing two intensifying screens. Ide­ absorbing dye coated on both sides of the ally, each film emulsion would receive light film base. This anticrossover dye absorbed only from the screen in contact with the light attempting to diffuse through the emulsion. System speed approximate indications of decrease in was decreased by about 40% with this flm. There are different ways of de­ At present, two technologies attempt to termining the fraction of crossover, and reduce crossover exposure by increasing signifcantly different answers result with light absorption in the flm emulsion. One must not use the These technologies involve: actual numbers to compare products. Matching screen light emission to sil­ illustrate the concept of reduction in print­ ver halide natural sensitivity through, not as a means of deciding which 2. The Why is a radiograph viewed as a trans­ ultravioletblue light emission of this phos­ parency rather than as a print, like an or­ phor is an excellent match for the natural dinary photograph? The density of in print-through from 33% using calcium the maximum black of most photographic tungstate screens to 19% using the same printing papers is between 1. Print­ few papers give density values as high as through can be decreased even more when 2. Using a tation on maximum density would be in­ flm that incorporates this dye technology tolerable in radiology, in which densities up reduces print-through to only 14% of total to 2. This limitation is over­ the emulsion is a higher speed flm, the come by viewing the radiograph as a trans­ result being no loss of system speed. This results in fat flm emulsion The amount of blackening of an x-ray grains that present a much larger surface flm is expressed by the term "photo­ area to incident light photons when com­ graphic density. Film Reduction in crossover is due to increased contrast amplifies subject contrast if the absorption in the tabular silver halide average gradient of the flm is greater than grains. Film contrast will vary with the amount posure fraction for conventional versus of exposure (density), the way the flm is tabular grain flm is in the range of 29 to exposed (intensifying screens or direct ac­ 30%, versus 15 to 19%. We must emphasize tion of x rays), and the way the flm is de­ that these percentages are only useful as veloped. American National Standards Institute: Ameri­ Physical characteristics of modern radiographic can National Standard Method for the Sensitom­ screen-flm systems. Screen fuorescence was so To test further the ability of lead to stop the faint that fluoroscopic examinations were rays, he selected a small lead piece, and in carried out in a dark room by a radiologist bringing it into position observed to his who had dark-adapted his eyes by wearing amazement, not only that the round dark red goggles for 20 to 30 minutes prior to shadow of the disc appeared on the screen, the examination.

They then present a mixed picture of neu- but may be resistant to the idea that they need help with rological and psychological denial purchase zovirax 200 mg fast delivery initial hiv infection symptoms rash. When social An important intervention is the establishment of a skills and anger management rehabilitation can be inte- therapeutic relationship zovirax 200mg otc hiv infection rates wiki. This is particularly important for grated into rehabilitation in domains people are willing to individuals who dispute the very premise that they need consider generic zovirax 800mg with amex anti smoking viral video, multiple goals can be met trusted zovirax 800 mg hiv infection gif. The therapist must tread a difficult line be- therapeutic foundation is present, interventions should be tween validating the individuals’ self and worldview and geared toward gently confronting the individual with the not fostering unrealistic expectations and hopes. Limited discrepancy between the patient’s own view of his or her studies have been conducted addressing the therapeutic strengths and abilities and the perceptions of others. Be- alliance within brain injury rehabilitation, but a positive cause of the usual associated memory and related cogni- relationship between the alliance and outcome is con- tive deficits, this must usually be done repetitively and in sistently reported (Bieman-Copland and Dywan 2000; small doses, taking cues from the individual with regard to Klonoff et al. Although individuals are typically poorly motivated 318 Textbook of Traumatic Brain Injury to pursue goals they see as irrelevant, rehabilitation be- 2007). Creating a realistic set of goals that by not confronting patients about their awareness deficits the patient is motivated to pursue represents a significant and instead focusing on increasing the therapeutic alli- but crucial challenge. Making decisions regarding appro- ance, therapists help patients to gravitate naturally toward priate goals involves obtaining history and input from the becoming more curious about their illness and deficits. Assistance may be required with generalization Treatment Advances of skills as well, because even when an individual is aware of his or her deficits, or at least acknowledges them, he or We believe that the next steps in the understanding of un- she can have great difficulty applying that knowledge to awareness may well come from the application of new real-life situations. Specifically, the development of tasks that will allow also play vital roles in the process of improving the pa- us to probe the different dimensions of unawareness will tient’s awareness (Ergh et al. They permit the family facilitate characterization of the circuitry underlying these to gain a better understanding of brain injury and the issues distinct dimensions. It would not surprise us to learn that related to awareness and lead to an appreciation of how the different clinical dimensions (unawareness of deficits, they apply to their loved one. Modeling the process of gentle overlapping but distinct neural circuits that can be clari- teaching about deficits is often necessary to prevent signif- fied with, for example, functional magnetic resonance icant others from provoking catastrophic reactions in the imaging. Awareness of Deficits 319 • The next steps in the understanding of unawareness may come from the application of new functional imaging techniques. Development of tasks that allow researchers to probe dimensions of unawareness will help to characterize the circuitry underlying these distinct dimensions. The different clinical dimensions (unawareness of deficits, reaction and response to deficits, generalizability and impact of deficits in daily func- tioning, attribution of deficits) may have overlapping but distinct neural circuits that can be clarified with, for example, functional magnetic resonance imaging. Anton G: Ueber Herderkrankungen des Gehirnes, welche von Pa- Recommended Readings tienten selbst nicht wahrgenommen werden. Can J Psychiatry/Revue Ca- individualized training package for increasing knowledge nadienne de Psychiatrie 48:338–341, 2003 and comprehension of personal deficits in persons with ac- Babinski J: Contribution a l’etude des troubles mentaux dans quired brain injury. Neuropsychol Rehabil 16:397–414, 2006 tive, and physical deficits in acute traumatic brain injury. Brain Cogn 44:1–5, 2000 Bisiach E, Geminiani G: Anosognosia related to hemiplegia and hemianopia, in Awareness of Deficit After Brain Injury. Int lowing lesions of the right hemisphere: anosognosia for Psychogeriatrics 18:3–17, 2006 hemiplegia and anosognosia for hemianopia. Ciba Foundation Symposium 34:141–155, 1975 mance of moderate versus severe head injured patients. Brain Inj Brain Inj 4:7–17, 1990 5:103–109, 1991 Amador X: I Am Not Sick, I Don’t Need Help! Outcome following a coping individualized training package for increasing knowledge skills group intervention for traumatically brain injured in- and comprehension of personal deficits in persons with ac- dividuals. J Nerv Ment Dis 127:381– Freeland J: Awareness of deficits: a complex interplay of neuro- 399, 1958 logical, personality, social and rehabilitation factors. Br J Psychiatry 156:798–808, Gianotti G: Emotional behavior and hemispheric side of lesion. Br J Psychiatry 161:599–602, 1992 disorder and emotional dysfunction following closed head David A, Van Os J, Jones P, et al: Insight and psychotic illness: injury: a controlled, cross-sectional follow-up study. J Head Trauma Re- Res 132:251–260, 2004 habil 17:155–174, 2002 Hanyu H, Sato T, Akai T, et al: Neuroanatomical correlates of un- Ezrachi O, Ben-Yishay Y, Kay T, et al: Predicting employment in awareness of memory deficits in early Alzheimer’s disease. Neuropsychiatry Neuropsychol Behav ness of deficit after moderate to severe traumatic brain in- Neurol 4:136–146, 1991 jury. Am J Psychiatry 157:1167–1169, 2000 nisms, in Awareness of Deficit After Brain Injury. New York, Oxford University lobe regions correlated with unawareness of illness in Press, 1991, pp 53–62 schizophrenia. J Clin Exp Neuropsychol 11:143–205, disability: implications for occupational therapy interven- 1989 tion. J Clin awareness of memory impairment in patients with mild Neuropsychol 6:97–99, 1984 Alzheimer’s disease. J Geriatr Psychiatry Neurol 19:3–12, Miller H, Stern G: The long-term prognosis of severe head injury. J Neurol 252:168– Laroi F, Fannemel M, Ronneberg U, et al: Unawareness of illness 175, 2005 in chronic schizophrenia and its relationship to structural Oddy M, Coughlan T, Tyerman A, et al: Social adjustment after brain measures and neuropsychological tests. Psychiatry Res closed head injury: a further follow-up seven years after in- 100:49–58, 2000 jury. J Nerv Ment Dis 182:656–660, new clinical assessment tool for acquired brain injury. Oxford, England, Ox- vation for change, insight into schizophrenia and adherence ford University Press, 1998, pp 307–316 to medication (abstract). Biol Psychiatry 36:559–561, 1994 Malec J, Smigielski J, DePompolo R, et al: Outcome evaluation Pia L, Tamietto M: Unawareness in schizophrenia: neuropsycho- and prediction in a comprehensive-integrated post-acute logical and neuroanatomical findings. Cortex 40: 367–377, 2004 loid plaque density correlates with anosognosia in Alzheimer’s Port A, Willmott C, Charlton J: Self-awareness following trau- disease. J Neurol Neurosurg Psychiatry 75:1396–1400, 2004 matic brain injury and implications for rehabilitation. J Head Trauma Rehabil 20:62–75, 2005 matic brain injury, in Awareness of Deficit After Brain Injury. J Neurol Neurosurg Psy- Shames J, Treger I, Ring H, et al: Return to work following trau- chiatry 47:505–513, 1984 matic brain injury: trends and challenges. J Head Sherer M, Bergloff P, Levin E, et al: Impaired awareness and em- Trauma Rehabil 9:91–102, 1994 ployment outcome after traumatic brain injury. J Clin Exp Neuropsychol 15:231–244, 1993 ness after traumatic brain injury: a comparison of the patient Reisberg B, Gordon B, McCarthy M, et al: Clinical symptoms ac- competency rating scale and the awareness questionnaire. Brain Inj of schizophrenia patients from symptomatology, multiple 21:663–672, 2007 neurocognitive functions, and personality related traits. Trauma Rehabil 20:301–314, 2005 Scand J Rehabil Med 6:180–183, 1974 Schonberger M, Humle F, Zeeman P, et al: Working alliance and Tournois J, Mesnil F, Kop J-L: Self-deception and other-deception: patient compliance in brain injury rehabilitation and their a social desirability questionnaire. J Head Trauma Rehabil 21:226– compliance during the process of brain injury rehabilitation. Sevy S, Nathanson K, Visweswaraiah H, et al: The relationship be- Ann N Y Acad Sci 907:114–131, 2000 tween insight and symptoms in schizophrenia.

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