108 Chapter 5
Then the clinician asks the physiatrist if she would consider prescribing an antidepressant.
Ruth is extremely depressed, and the condition is not resolving. The clinician explains that the
antidepressant will help increase Ruth’s motivation and her ability to benefit from therapy. The
clinician knows that depression and anxiety are common in patients with this type of aphasia,
possibly caused by changes in brain chemistry resulting from the stroke. The stress and loss asso-
ciated with the disabilities also contribute to the depression. The fact that Ruth lacks consistent
emotional and social support from family and friends is also persuasive. The neuropsychologist
concurs and says, “It’s hard to learn to navigate in a storm. Antidepressants calm the seas long
enough for the patient to mobilize adaptive defenses and workable coping mechanisms.” The
physiatrist agrees and notes that if the depression is primarily organic, that is, caused by the brain
damage, the antidepressant regimen may be of long duration, perhaps permanent. It depends on
whether the brain’s chemistry can be readjusted. She also notes that antidepressants should never
be a quick and easy fix for the complex disturbances caused by stroke and aphasia, but they have a
place in rehabilitation and are remarkably free of serious side effects.
Aphasia is the loss of previously acquired language abilities due to a neurological insult; to
varying degrees, it affects all modalities of communication. Two forms of aphasia can occur:
predominantly expressive and predominantly receptive. Mild aphasia may only be a nuisance,
producing occasional word- finding prob lems and difficulty understanding long, complex state-
ments. Global aphasia can render a patient mute and unable to read, write, gesture, and understand
the speech of others. Some patients with aphasia may experience organic depression, anxiety,
perseveration, emotional lability, and the grief response. Most patients with aphasia benefit from
therapy, relearn speech and language, or learn alternative ways to communicate.
- List and describe the symptoms of expressive and receptive aphasia. Discuss how each modality
of communication can be impaired. - Compare and contrast aphasia resulting from stroke and traumatic brain injury.
- Compare and contrast aphasia and agnosia.
- What is a catastrophic reaction, and how might a clinician accidentally cause it?
- Describe the symptoms of aphasia. How does awareness of the disability affect the prognosis?
- How do organic and grieving depression differ in aphasia?
- Provide five examples of telegraphic speech and the longer sentences from which they are
derived.