Encephalitis is a serious condition which can affect emotional, behavioral, cognitive, and intellectual functioning. Psychologists’ role in encephalitis rehabilitation is not standardized, but cognitive-behavioral therapy is well explored in other neurological conditions for the treatment of its comorbidities. For that reason, the aim of this article is to explore usefulness of behavioral interventions in encephalitis rehabilitation. In combined sample, only 32 patients were reportedly treated with behavioral interventions, out of which 17 (53.1%) were female. Majority of them were rehabilitated in post-encephalitis phase. Most popular treatment setting was rehabilitation institution, followed by combination of institutionalized and community rehabilitation. Researchers usually treated with behavioral interventions aggression, agitation, and deficits in functional living skills. Post-assessment measures showed that improvement is maintained from 1–12 months. Popular interventions included in vivo exposure, reinforcement, shaping, and aversion therapy. The author presents and discusses in detail practical guidelines for behavioral management techniques in encephalitis patients.
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Andrasik, F. (2003). Behavioral treatment approaches to chronic headache. Neurological Sciences, 24, 80–85. https://doi.org/10.1007/s100720300048.
Andrewes, D. (1999). The work rehabilitation of a herpes simplex encephalitis patient with anterograde amnesia. Neuropsychological Rehabilitation, 9(1), 77–99. https://doi.org/10.1080/713755591.
Bechter, K. (2019). Encephalitis, mild encephalitis, neuroprogression, or encephalopathy-not merely a question of terminology. Frontiers in Psychiatry, 9, 782. https://doi.org/10.3389/fpsyt.2018.00782.
Brett, M., Greenwood, R., Powell, J., & Morris, P. (1995). Late functional recovery with a novel community rehabilitation programme after herpes simplex encephalitis. Clinical Rehabilitation, 9(3), 267–270. https://doi.org/10.1177/026921559500900315.
Campbell, J. M. (2003). Efficacy of behavioral interventions for reducing problem behavior in persons with autism: A quantitative synthesis of single-subject research. Research in Developmental Disabilities, 24(2), 120–138. https://doi.org/10.1016/s0891-4222(03)00014-3.
Carey, R. N., Connell, L. E., Johnston, M., Rothman, A. J., de Bruin, M., Kelly, M. P., & Michie, S. (2019). Behavior change techniques and their mechanisms of action: A synthesis of links described in published intervention literature. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 53(8), 693–707. https://doi.org/10.1093/abm/kay078.
Carrion, C., Folkvord, F., Anastasiadou, D., & Aymerich, M. (2018). Cognitive therapy for dementia patients: A systematic review. Dementia and Geriatric Cognitive Disorders, 46(1–2), 1–26. https://doi.org/10.1159/000490851.
Christie, S., Chan, V., Mollayeva, T., & Colantonio, A. (2018). Systematic review of rehabilitation intervention outcomes of adult and paediatric patients with infectious encephalitis. British Medical Journal Open, 8(5), e015928. https://doi.org/10.1136/bmjopen-2017-015928.
Cohen, R. E. (1986). Behavioral treatment of incontinence in a profoundly neurologically impaired adult. Archives of Physical Medicine and Rehabilitation, 67(12), 883–884.
Connell, L. E., Carey, R. N., de Bruin, M., Rothman, A. J., Johnston, M., Kelly, M. P., & Michie, S. (2019). Links between behavior change techniques and mechanisms of action: An expert consensus study. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 53(8), 708–720. https://doi.org/10.1093/abm/kay082.
Cooper, J., Kierans, C., Defres, S., Easton, A., Kneen, A., Solomon, T., & on behalf of ENCEPH-UK study group. (2017). Care beyond the hospital ward: Understanding the socio-medical trajectory of herpes simplex virus encephalitis. BMC Health Service Research. https://doi.org/10.1186/s12913-017-2608-2.
Dewar, B.-K., & Gracey, F. (2007). “Am not was”: Cognitive-behavioural therapy for adjustment and identity change following herpes simplex encephalitis. Neuropsychological Rehabilitation, 17(4–5), 602620. https://doi.org/10.1080/09602010601051610.
Ellul, M., & Solomon, T. (2018). Acute encephalitis-diagnosis and management. Clinical Medicine (London, England), 18(2), 155–159. https://doi.org/10.7861/clinmedicine.18-2-155.
Emslie, H., Wilson, B. A., Quirk, K., Evans, J. J., & Watson, P. (2007). Using a paging system in the rehabilitation of encephalitic patients. Neuropsychological Rehabilitation, 17(4–5), 567–581. https://doi.org/10.1080/09602010701381933.
Falligant, J. M., Ojo, M. O., & Huete, J. M. (2020). Behavioral assessment and treatment of aerophagia in an adolescent with lennox-gastaut syndrome and herpes simplex encephalitis. Journal of Developmental and Physical Disabilities. https://doi.org/10.1007/s10882-019-09725-w.
Gagnier, J. J., Kienle, G., Altman, D. G., Moher, D., Sox, H., Riley, D., & CARE Group. (2013). The CARE guidelines: Consensus-based clinical case report guideline development. Journalof dietary supplements, 10(4), 381–390. https://doi.org/10.3109/19390211.2013.830679.
Giles, G. M., & Morgan, J. H. (1989). Training functional skills following herpes simplex encephalitis: A single case study. Journal of Clinical and Experimental Neuropsychology, 11(2), 311–318. https://doi.org/10.1080/01688638908400891.
Harder, J. A., & Mariano, T. Y. (2018). The importance of comprehensive neuropsychiatric care in the postencephalitic patient. Future Medicine. https://doi.org/10.2217/fnl-2018-0019.
Harris, L., Griem, J., Gummery, A., Marsh, L., Defres, S., Bhojak, M., & Kopelman, M. (2020). Neuropsychological and psychiatric outcomes in encephalitis: A multi-centre case-control study. PLoS One. https://doi.org/10.1371/journal.pone.0230436.
Hokkanen, L., & Launes, J. (2007). Neuropsychological sequelae of acute-onset sporadic viral encephalitis. Neuropsychological Rehabilitation, 17(4–5), 450–477. https://doi.org/10.1080/09602010601137039.
Hokkanen, L., Poutiainen, E., Valanne, L., Salonen, O., Iivanainen, M., & Launes, J. (1996). Cognitive impairment after acute encephalitis: Comparison of herpes simplex and other aetiologies. Journal of Neurology, Neurosurgery, and Psychiatry, 61(5), 478–484. https://doi.org/10.1136/jnnp.61.5.478.
Katzmann, S., & Mix, C. (1994). Improving functional independence in a patient with encephalitis through behavior modification shaping techniques. The American Journal of Occupational Therapy, 46(3), 259–262.
Kumar, R. (2020). Understanding and managing acute encephalitis. F1000Research, 9, F1000 FacultyRev-60. https://doi.org/10.12688/f1000research.20634.1.
Matson, J. L., Neal, D., & Kozlowski, A. M. (2012). Treatments for challenging behaviours of adults with intellectual disabilities. The Canadian Journal of Psychiatry, 57(10), 587–592.
McMillan, T. M., Papadopoulos, H., Cornall, C., & Greenwood, R. J. (1990). Modification of severe behaviour problems following herpes simplex encephalitis. Brain Injury, 4(4), 399–406. https://doi.org/10.3109/02699059009026193.
Michaelis, R., Tang, V., Goldstein, L. H., Reuber, M., LaFrance, W. C., Jr., Lundgren, T., Modi, A. C., & Wagner, J. L. (2018). Psychological treatments for adults and children with epilepsy: Evidence-based recommendations by the international league against epilepsy psychology task force. Epilepsia, 59(7), 1282–1302. https://doi.org/10.1111/epi.14444.
Minian, N., Corrin, T., Lingam, M., deRuiter, W. K., Rodak, T., Taylor, V. H., & Selby, P. (2020). Identifying contexts and mechanisms in multiple behavior change interventions affecting smoking cessation success: A rapid realist review. BMC Public Health, 20, 918. https://doi.org/10.1186/s12889-020-08973-2.
Monteiro, V. L., Barreto, F. J. N., Rocha, P. M. B., do Prado, P. H. T., Garcia, F. D., Correa, H., & das Neves, M. C. L. (2015). Managing severe behavioral symptoms of a patient with anti-NMDAR encephalitis: Case report and findings in current literature. Trends in Psychiatry and Psychotherapy, 37(1), 47–50. https://doi.org/10.1590/2237-6089-2014-0036.
Oates, L. L., Moghaddam, N., Evangelou, N., & das Nair, R. (2020). Behavioural activation treatment for depression in individuals with neurological conditions: A systematic review. Clinical Rehabilitation, 34(3), 310–319. https://doi.org/10.1177/0269215519896404.
Opie, J., Rosewarne, R., & O’Connor, D. W. (1999). The Efficacy of psychosocial approaches to behaviour disorders in dementia: A systematic literature review. Australian & New Zealand Journal of Psychiatry, 33(6), 789–799. https://doi.org/10.1046/j.1440-1614.1999.00652.x.
Pal, P. K. (2011). Guidelines for management of essential tremor. Annals of Indian Academy of Neurology, 14(1), 25–28. https://doi.org/10.4103/0972-2327.83097.
Priday, L. J., Byrne, C., & Totsika, V. (2017). Behavioural interventions for sleep problems in people with an intellectual disability: A systematic review and meta-analysis of single case and group studies. Journal of Intellectual Disability Research, 61(1), 1–15. https://doi.org/10.1111/jir.12265.
Rao, N., & Costa, J. L. (1991). Rehabilitation of three patients after treatment for herpes encephalitis. American Journal of Physical Medicine & Rehabilitation, 70(2), 73–75. https://doi.org/10.1097/00002060-199104000-00004.
Rapport, M. D., Sonis, W. A., Fialkov, M. J., Matson, J. L., & Kazdin, A. E. (1983). Carbamazepine and behavior therapy for aggressive behaviour. Treatment of a mentally retarded, postencephalitic adolescent with seizure disorder. Behavior Modification, 7(2), 255–265. https://doi.org/10.1177/01454455830072009.
Schinke, S. P., & Olson, D. G. (1982). Home remediation of subacutesclerosingpanencephalitis. Education and Treatment of Children, 5, 261–269.
Schmidt, J. G., Dombovy, M. L., & Watkins, K. (1995). Treatment of viral encephalitis organic personality disorder and autistic features with propranolol: A case report. Journal of Neurological Rehabilitation, 9, 41–45. https://doi.org/10.1177/154596839500900106.
Singh, A., Satheesan, S., Nagpal, A., Nitturkar, A., Shetty, P. H., Nanjundaswamy, M. H., Viswanath, B., & Math, S. B. (2013). Behavioural therapy in persons with intellectual disability and OCD: An effective augmentation strategy. The Australian and New Zealand Journal of Psychiatry, 47(9), 883–884. https://doi.org/10.1177/0004867413479067.
Steiner, J., Prüss, H., Köhler, S., Frodl, T., Hasan, A., & Falkai, P. (2020). Autoimmune encephalitis with psychosis: Warning signs, step-by-step diagnostics and treatment. The World Journal of Biological Psychiatry, 21(4), 241–254. https://doi.org/10.1080/15622975.2018.1555376.
Tailor, Y. I., Suskauer, S. J., Sepeta, L. N., Ewen, J. B., DeMatt, E. J., Trovato, M. K., & Slomine, B. S. (2013). Functional status of children with encephalitis in an inpatient rehabilitation setting: A case series. Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approaches, 6(3), 163–173. https://doi.org/10.3233/PRM-130248.
Tay, M. R. J., & Chua, K. S. G. (2020). A combined behavioral and pharmacological approach in nonparaneoplastic-related anti-N-methyl-Dasparate receptor encephalitis: A case report with positive outcome in a male patient. The Journal of the International Society of Physical and Rehabilitation Medicine. https://doi.org/10.4103/jisprm.jisprm_3_20.
Thakkar, R. C., & Navale, A. (2015). Acute encephalitis: A brief review of its types and clinical management. Pharmagene, 2(3), 1–7.
Tunkel, A. R., Glaser, C. A., Bloch, K. C., Sejvar, J. J., Marra, C. M., Roos, K. L., & Whitley, R. J. (2008). The management of encephalitis: Clinical practice guidelines by the infectious diseases society of America. Clinical Infectious Diseases, 47(3), 303–327. https://doi.org/10.1086/589747.
Warren, N., O’Gorman, C., McKeon, G., Swayne, A., Blum, S., & Siskind, D. (2019). Psychiatric management of anti-NMDAR encephalitis: A cohort analysis. Psychological Medicine. https://doi.org/10.1017/S0033291719003283.
Williams, J., Roth, A., Vatthauer, K., & McCrae, C. S. (2013). Cognitive behavioral treatment of insomnia. Chest, 143(2), 554–565. https://doi.org/10.1378/chest.12-0731.
Zareifopoulos, N., Lagadinou, M., Karela, A., Kyriakopoulou, O., & Velissaris, D. (2020). Neuropsychiatric effects of antiviral drugs. Cureus, 12(8), e9536. https://doi.org/10.7759/cureus.9536.
Zečević, I. (2020). Clinical practice guidelines based on evidence for cognitive-behavioral therapy in Parkinson’s disease comorbidities: A literature review. Clinical Psychology & Psychotherapy, 27(4), 504–514. https://doi.org/10.1002/cpp.2448.
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Zečević, I. Behavioral Management in Encephalitis Rehabilitation: Review of Clinical Research with Clinical Recommendations. J Rat-Emo Cognitive-Behav Ther 39, 620–637 (2021). https://doi.org/10.1007/s10942-021-00390-7
- Behavior management
- Behavioral therapy
- Intellectual disability
- Cognitive dysfunction