A-127 The Interplay of Social Perception and Psychiatric Symptoms in a Case of Traumatic Brain Injury

Abstract

Abstract Objective Acquired impairment in social perception (SP) is relatively common following moderate to severe traumatic brain injury (TBI), with up to 39% of these individuals experiencing deficient facial affect recognition. Formal assessment of SP is not common practice, despite evidence of this as a predictor of social functioning. We present the case of a 35-year-old, Caucasian male with new onset paranoid/delusional (P/D) thought processes in the context of prior TBI. Method The patient’s TBI (unknown severity) occurred 17 years prior and resulted in prolonged (>1 year) hospitalization, followed by intensive rehabilitation services. He reported residual, stable difficulties with attention, processing speed, executive functioning, and memory. Post-TBI, he was living independently with few external supports. Following a traumatic encounter with a family member (nine months prior), the patient developed P/D thought processes and a marked decline in functioning, resulting in three psychiatric hospitalizations. Brain MRI (Figure 1) revealed encephalomalacia and gliosis in the bilateral inferior frontal lobes anteriorly, high frontoparietal lobes, and bilateral (L > R) temporal lobes. Neuropsychology was consulted to clarify diagnosis/etiology and assess functional status. Results (Table 1). Evaluation results revealed non-amnestic memory impairment and variable language and processing speed. Performances on measures of SP revealed a notable weakness in the context of current intellectual performances. Conclusions This case highlights the importance of formally assessing SP in cases of TBI. Underlying SP difficulties in the context of a traumatic event may have increased vulnerability to psychiatric decompensation. Evaluation of SP allowed for enhanced understanding of the interplay between cognitive and psychiatric symptoms.